Michael E. DeBakey VA Medical Center - Houston, Texas

Houston VA Teams Up with Memorial Hermann TIRR to Treat Veterans with Traumatic Brain Injuries
June 21, 2007

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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About MEDVAMC:
MEDVAMC’s goal is to ensure every seriously injured or ill serviceman and woman returning from combat receives easy access to benefits and world-class service.  Combat veterans have special health care eligibility.  For two years after discharge, these veterans have special access to VA health care, even those who have no service-connected illness.  Veterans can become "grandfathered" for future access by enrolling with VA during this period.  This covers not only regular active-duty personnel who served in Iraq or Afghanistan, but also Reserve or National Guard members serving in the combat theaters.  Veterans with service-related injuries or illnesses always have access to VA care for the treatment of their disabilities without any time limit, as do lower-income veterans.  Additional information about VA medical eligibility is available at http://www.va.gov/healtheligibility. To contact the MEDVAMC OEF/OIF Coordinator Fern Taylor, call (713) 794-7034.

About TIRR Foundation:
TIRR Foundation is a nonprofit organization dedicated to a mission of improving the quality of life for people who have sustained neurological damage by supporting pioneering research programs and advancements in rehabilitative medicine and educational programs.   TIRR Foundation is classified as a public charity under 170(b)(1)(A)(vi) and 509(a)(1) of the IRS Code.   

About Memorial Hermann │TIRR:
Founded in 1959 in the Texas Medical Center, Memorial Hermann | TIRR is a not-for-profit rehabilitation provider serving the needs of individuals who have sustained catastrophic injury or illness.  In addition to a 116-bed hospital, Memorial Hermann│TIRR includes Memorial Hermann│TIRR Challenge Program, a community re-entry program for brain injury survivors, Memorial Hermann│TIRR Outpatient Therapy Services, and TIRR Rehabilitation Centers, a network of outpatient therapy facilities. TIRR (The Institute for Rehabilitation and Research) merged within the Memorial Hermann Healthcare System in July 2006. 

About Memorial Hermann
An integrated healthcare system, Memorial Hermann is known for world-class clinical expertise, patient-centered care, leading edge technology, and innovation. The system, with its exceptional medical staff and 19,000 employees, serves southeast Texas and the greater Houston community. Memorial Hermann’s 16 hospitals include three hospitals in the Texas Medical Center, two long-term care facilities, three heart & vascular institute locations and nine suburban hospitals. The system also operates numerous imaging, sports medicine and rehabilitation, and surgery centers, a Wellness Center, a chemical dependency treatment center, a home health agency, a retirement community and a nursing home. To learn more, visit www.memorialhermann.org or call 713-222-CARE.

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