Houston VA Teams Up with Memorial Hermann TIRR to Treat Veterans with Traumatic Brain Injuries
HOUSTON – The Michael E. DeBakey Veterans Affairs Medical Center (MEDVAMC) is teaming up with rehabilitation specialists from Memorial Hermann│TIRR Challenge Program, a brain injury rehabilitation program of Memorial Hermann│TIRR, for Project Victory. This initiative, funded by a $3 million grant from a private foundation, is a comprehensive rehabilitation and community re-integration program to treat service members who have sustained a traumatic brain injury (TBI) while serving in Operation Enduring Freedom in Afghanistan (OEF) or Operation Iraqi Freedom in Iraq (OIF).
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, TBI, 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.
Of the injured military personnel, between 30 and 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.
The goal of Project Victory is to help combat service members with TBI achieve the maximum degree of return to their pre-injury level of functioning. This program will serve 65 service members annually who meet the criteria for care, and will be available without cost or regard to age, gender, or ethnicity.
“Our goals at the DeBakey VA 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.
An OEF/OIF combat veteran’s first contact with the MEDVAMC consists of two screenings: 1) a medical appointment with a general practitioner in a Primary Care Clinic; and 2) an appointment with a mental health professional to be checked for symptoms of a variety of mental health complaints including depression, post traumatic stress disorder (PTSD), anxiety disorder, substance abuse/dependence, and adjustment disorder.
The mental health 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.
Community re-integration will help combat veterans achieve the greatest degree of independence in their daily lives as medically possible. A designated family member or care giver of the injured service member will participate as an integral part of the rehabilitation team and an important element of their progress. Together, Project Victory staff and the service member’s caregiver will assess progress and revise goals based on the patient’s changing life situation. This will ensure a more successful transition from rehabilitation back into the home and community environment.
The VA’s first priority is to provide the highest quality health care possible for service-connected disabled veterans, veterans with no health care options, and those who need specialized services. Another major priority for the VA is to have the highest possible concern for the welfare of service members returning from Southwest Asia. Project Victory is being funded by the Iraq Afghanistan Deployment Impact Fund of the California Community Foundation, which was established in 2006 to address the unmet needs of men, women, and families affected by deployment to Iraq and Afghanistan.
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