March 2, 2007
Wounded in Iraq by an improvised explosive device, Army CPL Robert Engelbrecht undergoes a kinesiotherapy session with Laura Lawhorn, RKT, MEDVAMC kinesiotherapist.
HOUSTON - Recent combat in Iraq and Afghanistan has demonstrated the nature of modern warfare has changed. There are new causes of injury, improvements in body armor, and surgical stabilization at the front-line of combat. More war-wounded are returning with complex, multiple injuries such as amputations, traumatic brain injuries, spinal cord injury, visual impairments, and psychological adjustment problems. Moreover, improvised explosive devices, blasts (high pressure waves), landmines, rocket-propelled grenades, and explosive fragments now account for the majority of combat injuries.
Blast-related injuries are often “polytraumatic,” meaning they result in injury and/or impairment to more than one body system or organ, and often require specialized intensive rehabilitation processes and coordination of care across the full continuum. Of these injured military personnel, about 60 percent have some degree of traumatic brain injury. The frequency and unique nature of these blast injuries create the need for a unique interdisciplinary polytrauma rehabilitation program to handle the ongoing rehabilitative, psychological, medical, and prosthetic needs of these individuals.
In August 2005, the Michael E. DeBakey VA Medical Center (MEDVAMC) added an extremely important and timely program to its array of available health care services, a Network Polytrauma Program.
As part of the VA’s Polytrauma System of Care, the program at the MEDVAMC provides both inpatient and outpatient services using an interdisciplinary team consisting of specialty physicians, rehabilitation therapists, audiologists, speech pathologists, neuropsychologists, blind rehabilitation specialists, prosthetists, psychologists, psychiatrists, social workers, and other disciplines, with access to the full range of medical and support services within the medical center to meet a patient’s needs. Specialized rehabilitation programs are provided for traumatic brain injury, spinal cord injury, blind rehabilitation, and treatment for post traumatic stress disorder.
“In the Spinal Cord Injury Care Line, we strive to restore and maintain maximal health, independence, productivity, and quality of life in persons with spinal cord injury or dysfunction. We provide this specialty care to veterans for the rest of their lives,” said Sally A. Holmes, M.D., Spinal Cord Injury Care Line executive and a supporting member of the Polytrauma Program.
The goals of the MEDVAMC Polytrauma Program are to provide post-acute medical assessment to patients injured by blasts or accidents; provide medical, rehabilitation, and psychological treatment services; coordinate care as patients move from acute hospitalization through rehabilitation and ultimately back to the home and community; provide case management and family support through all phases of treatment; monitor short and long-term outcomes for these individuals; and continue a program of research to better understand the effectiveness of treatments for traumatic brain injuries, spinal cord disabilities, and post traumatic stress disorders.
Key components of the Polytrauma Program are MEDVAMC’s Orthotics and Prosthetics Program accredited by the American Board for Certification and its Comprehensive Integrated Inpatient Rehabilitation Program, Vocational Rehabilitation Program, and Spinal Cord Injury Programs, all fully accredited by the Commission on Accreditation of Rehabilitation Facilities.
“Our goals here are to coordinate care as patients move from acute hospitalization through rehabilitation and ultimately back to their home and community, and to also monitor short and long-term outcomes for these individuals. It is extremely important for each patient to receive in-depth and consistent case management and family support through all phases of treatment,” said Helene K. Henson, M.D., Rehabilitation Care Line executive with clinical and administrative responsibility for implementing the Polytrauma Rehabilitation Program at the MEDVAMC.
Combat or post-deployment stress management or mental health services are provided as needed. Patients initially receive a comprehensive evaluation by a mental health practitioner. This evaluation includes self-reported medical history and current complaints, followed by a comprehensive physical examination from a physiatrist (a physician specializing in physical medicine and rehabilitation). Findings from these initial assessments trigger appropriate treatments and/or referrals to other specialists in the areas of brain injury evaluation and treatment, amputation management and prosthetics, visual and hearing impairment, and emotional adjustment/stress management.
A common finding from the polytrauma evaluations is the identification of previously unrecognized injuries or impairments that have ongoing adverse functional effects. What doctors call "closed-head injuries," from blows to the head or blasts, are more likely to have diffuse effects throughout the brain, particularly on the frontal lobes, which control the ability to pay attention, make plans, manage time, and solve problems.
“I believe the majority of veterans who return to our level of care will require treatment with an emphasis on cognitive assessments and interventions. Working with the Mental Health Care Line, we have produced educational materials for our prime care providers to help identify veterans with hidden brain injury. My biggest concern is those patients with mild to moderate head injuries that may not be visible. These individuals are able to walk and talk, but their memory is not good, they lose their temper, they have personality changes, and they get into trouble with the law. We want to be sure these patients receive appropriate medical attention,” said Henson.
VA’s Polytrauma System of Care consists of four VA Polytrauma Rehabilitation Centers (PRC) and 17 Polytrauma Network Sites. The PRCs, located in Minneapolis, Palo Alto, Ca., Richmond, Va., and Tampa, provide acute intensive inpatient rehabilitation. The VA Polytrauma System coordinates the transfer and provision of health care for polytrauma patients within the VA and between VA and the Department of Defense to ensure timely access to veteran health care benefits. In addition to medical rehabilitation services and psychosocial support for both patient and family, each location offers education and training to prepare patients and families for success after going home.
“This Polytrauma Program reflects VA’s commitment to care for the men and women who have served in uniform. A reality of combat is that some return with loss of limbs, traumatic brain injuries, and other severe injuries. The Michael E. DeBakey VA Medical Center recognized that it must provide specialized care for military service members and veterans who sustained multiple and severe injuries,” said Thomas A. Kent, M.D., Neurology Care Line executive and a supporting member of the Polytrauma Program.
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