A Traumatic Brain Injury (TBI) is defined as any damage to living brain tissue caused by an external, mechanical force. TBI’s have become so prevalent during Operation Iraqi Freedom (OIF), Operation Enduring Freedom (OEF) and Operation New Dawn (OND) the Department of Veterans Affairs (VA) and Department of Defense (DoD) have developed special treatment programs.

THE BASICS:

VA and DoD have numerous facilities, programs, and staff dedicated to treating the effects of Traumatic Brain Injuries (TBI). TBI programs and specialist’ can be found in most VA Medical Centers (VAMCs) and military hospitals. If the facility where you receive your healthcare is not equipped with the TBI resources needed to provide the appropriate level of care, you may be transferred to another facility or provider that is better suited to meet your medical needs.

Since a TBI is rarely the only injury or disability requiring care, VA and DoD have integrated several programs into their TBI treatment plans. These programs address the injuries and symptoms associated with a brain injury such as: pain management, mental health, and prosthetic services. An important term to understand when discussing programs and resources associated with Traumatic Brain Injuries (TBI) is polytrauma. The VA and DoD have started using the term Polytrauma to describe patients having experienced two or more severe physical or psychological injuries. This is due to the fact that most veterans or service members having sustained a TBI have also sustained another type of injury. Therefore, the term Polytrauma is often used when describing patients with TBI.

Challenges associated with experiencing a TBI or Polytrauma may include:

· Ongoing pain issues involving the body and/or head,

· Chronic problems with falling asleep or staying asleep or not getting enough sleep,

· Difficulties coping or emotionally adjusting to the experiences

· Problems such as combat-related stress or PTSD

· Depression

· Anxiety with duty station or home life demands and stresses

· Substance use

· Electrolyte or hormonal changes

· Nutritional problems (decreased or Increased appetite or changes in food taste)

· Medication side-effects

It is important to keep in mind however, that recovery from a TBI is possible when you utilize all of the resources available to you.

AM I ELIGIBLE?

VA services are provided to all Veterans who have the following:

· Completed active military service in the Army, Navy, Air Force, Marines, or Coast Guard (or Merchant Marines during WW II)

· Been discharged under other than dishonorable conditions

· National Guard members and Reservists who have completed a federal deployment to a combat zone

Please note that only emergency services can be received through the VA until your enrollment is processed. For more information, and to apply for VA healthcare services, go to the Online 10-10EZ Application or visit: http://www.va.gov/.

WHAT SERVICES & BENEFITS ARE AVAILABLE?

If you are a veteran entitled to benefits (discharge from military service under other than dishonorable conditions) and medically stable, you are eligible for admission into the Polytrauma System of Care.

The patient must:

· Have sustained multiple physical, cognitive, and/or emotional injuries secondary to trauma,

· Not require one-to-one staffing for medical or behavioral reasons,

· Not require a ventilator to breathe,

· Have potential to benefit from rehabilitation, or

· Need an initial, comprehensive rehabilitation evaluation and care plan

The most important things you should consider after suffering a TBI are to seek out help, if not already being treated, and utilize all the programs available to you and your family. While some patients treated in the polytrauma programs are able to return to active duty or work, others will continue to need more intense supportive services, programs and benefits. This is due to the fact that every TBI is unique and each person will respond differently to rehabilitation.

The following is a list of the various rehabilitation programs available to treat TBI:

· Brain Injury Rehabilitation, which is comprehensive, acute TBI rehabilitation with a focus on treatment for the medical, physical, cognitive, and emotional changes that can occur after TBI and Polytraumatic injuries. VA medical and rehabilitation specialists work with the patient to assess and treat a wide variety of symptoms and conditions that can affect functional independence, including:

o Communication skills

o Activities of daily living

o Thinking skills (memory, judgment, awareness)

o Strength and endurance

o Community reintegration

o Adjustment and coping

o Changes in behavior

o Dizziness and balance

o Pain

· Emerging Consciousness Program, which is a specialized program with a state-of-the-art protocol of care for patients in a minimally conscious state. An interdisciplinary program and services are used to:

o Improve responsiveness and return to consciousness

o Facilitate advancement to the next phase of rehabilitation care

· Blind and Low Vision Rehabilitation, which is a comprehensive evaluation by vision specialists for problems related to vision loss. Treatment services include:

o Use of adaptive equipment, including Guide Dogs

o Safe, independent mobility

o Return to community activities

· Amputation Rehabilitation, which is ongoing support and treatment for all prosthetic/orthotic needs, including:

o A full array of state-of the-art prostheses, including Service Dogs, designed to maximize function and return to independence

o Staff with specialized training in amputee care

o Referrals for Specialized or Adaptive Housing Program Services

· Mental Health and Social Support, which includes counseling services provided by rehabilitation mental health professionals to help families cope with the emotional issues and changes that arise after traumatic injury or illness including:

o Education about the TBI/Polytrauma rehabilitation process and recovery

o Assistance in identifying available resources and other avenues of support

o Focus on and training in self-care and wellness for family caregivers

· Driver Rehabilitation Program, which is a comprehensive assessment of driving skills and safety by Certified Driver Rehabilitation Specialist’ offering:

o State-of-the-art driver simulators

o Driver training vehicles

o Referrals for Automobile Adaption Grants and Services

· Vocational Rehabilitation, which offers individualized services matching your vocational or independent living needs and interests after sustaining a TBI to include:

o Vocational evaluations, career exploration, and job placement services for both civil service and private-sector employment

o Vocational education about VA benefits and community-based resources for independent living program services and education/training employment services

o Availability of functional assessments and functional capacity evaluations

For veterans and servicemembers requiring longer or more intense rehabilitation programs, VA has several special TBI treatment facilities:

· Polytrauma Rehabilitation Centers (PRC), which were established for veterans or servicemembers who need acute long-term care and rehabilitation. You will likely enter one of VA’s four Polytrauma Rehabilitation Centers (PRC). Following initial assessments, the members of an interdisciplinary medical team will have an admission conference, typically within the first week or two of admission, to discuss their findings and to design a rehabilitation treatment plan, including an estimated length of stay. You and your family/caregiver will be informed about the team’s findings and recommendations following the conference and be encouraged to provide input about goals and expectations for rehabilitation. The team also meets in weekly rounds to evaluate your progress and to adjust or redefine the treatment goals accordingly.

· Polytrauma Network Sites (PNS), which were established for the care and treatment of veterans with mild to moderate TBI. The PNS offers continued medical care and rehabilitation services for those who are transitioning closer to home following discharge from a Polytrauma Rehabilitation Centers (PRC). PNS programs will also be the entry point for those who have experienced a mild or moderate TBI. Depending on need, services may be provided on an inpatient or outpatient basis.

· Polytrauma Support Clinic Teams (PSCT), which are specialized programs located in 80 VA Medical Centers (VAMCs) across the country and may be the next step for a patient recovering from a TBI. PSCT programs offer continued medical and rehabilitation care closer to your home community.

Servicemembers injured while training and serving in the active duty military typically receive their first medical care in a Department of Defense (DoD) operated Military Treatment Facility (MTF). For those injured in battle, medical care usually involves evacuation from theater to a MTF abroad (e.g., Landstuhl Army Medical Center), followed by transport to a stateside MTF (e.g., Walter Reed Army Medical Center or National Naval Medical Center).

Depending on the severity of the injury, servicemembers may need Physical Medicine and Rehabilitation (PM&R) services after discharge from the MTF. When medically stable, the most severely injured are often transferred from the MTF to a VA Polytrauma Rehabilitation Center (PRC) for acute, inpatient rehabilitation. Prior to transfer to a PRC, the teams at the MTF and PRC work closely to share information and develop a patient transition plan.

It is critical that you take full advantage of the support services VA has in place for you and your family during your recovery and benefits application process. These support services include:

· Emotional Support, to assist with the emotional stress that family members face while dealing with the realities of their loved one's life after a polytrauma injury. VA facilities offer family support, education sessions, and family counseling services to help cope with adjustment issues following injury.

· Social Workers, who can be found in all program areas in VA Medical Centers (VAMC), and are ready to help with most any question or concern. A social worker can help a veteran or servicemember seek financial or housing assistance, apply for benefits from the VA, Social Security, and other government and community programs, arrange for respite care for his or her caregiver, and other critical aspects of life.

Logistical Support Systems, which are capable of assisting families as they struggle to cope with the financial sacrifices of remaining with a loved one during the rehabilitation process. Generous donations from VA Voluntary Services, Operation Helping Hand, Fisher House Foundation, local businesses, and other foundations and agencies frequently provide free housing and free or discounted meals. The polytrauma point of contact or your loved one's case manager will be able to help you identify and access these resources.

· Clinical Support/Polytrauma Teams, comprised of specialist’ who realize that every polytrauma injury is different. It is difficult to compare injuries and it is extremely difficult to compare different patients' responses to rehabilitation. Some patients have lengthy stays in an acute, inpatient rehabilitation program and other patients receive their care through outpatient services. While some patients treated in the polytrauma programs are able to return to active duty, pursue school, or return to work, others will continue to need more intense supportive services and care. All will continue to receive care and support from VA throughout their life.

Polytrauma injuries affect the injured individual, as well as his/her family. The polytrauma team works closely to help families keep abreast of their loved one's medical condition, as well as their progress through rehabilitation. VA staff members actively engage family members in treatment decisions, including discharge planning. If the patient is discharged home, family members are invited to join therapy sessions prior to discharge so that they can learn how to help the patient be as independent as possible at home.

Prior to discharge from a Polytrauma Rehabilitation Center, family members may be scheduled to stay with the patient in a family training apartment. This allows family members to experience what the return home may be like for their loved one while rehabilitation staff and nursing are available to answer questions, address unexpected problems, and provide the emotional support a family may need as they prepare for this next phase of rehabilitation.

Vet Centers, which are Community-Based Counseling Centers located across the country operated by the Department of Veterans Affairs (VA). Vet Centers provide individual, group, and family counseling to all veterans who served in any combat zone or have experienced Military Sexual Trauma (MST).

These service may be provided free of charge to you and/or your family members and include:

· Individual and group counseling

· Marital and family counseling

· Bereavement counseling

· Employment counseling

· Guidance and referral

· Alcohol and drug abuse assessments

· Information about and referral to community resources

· Outreach and community education

HOW DO I GET SERVICES & BENEFITS?

Any veteran already enrolled in the VA healthcare system is eligible for treatment and benefits relating to TBI. If you are not already enrolled in the VA healthcare system, yet are entitled to care and benefits, you need to enroll by using VA Form 10-10EZ. The 10-10EZ may be obtained by visiting, calling or writing any VA healthcare facility or veterans; benefits office.

You can also call toll-free 1-877-222-VETS (1-877-222-8387) or enroll online by visiting: https://www.1010ez.med.va.gov/sec/vha/1010ez/.

If you are currently still serving in the military and need assistance with your transition from DoD healthcare to VA healthcare, you may get assistance from a military liaison. Military liaisons are present at each Base Readiness Center and are instrumental in providing a connection to the servicemember’s military community. They assist with the transition from military healthcare to the VA healthcare system and interact with servicemember’s and their families on a regular basis. Liaisons are responsible for ensuring that military orders are in place and that all service-related needs are met in a timely manner.

COMMON Q & A’s

What is TBI?

A TBI happens when something outside the body hits the head with significant force. This could happen when a head hits a windshield during a car accident. It could happen when a piece of shrapnel enters the brain. Or it could happen during an explosion of an improvised explosive device (IED).

Does everyone with TBI experience the same symptoms?

No, individuals who sustain a TBI may experience a variety of effects, such as an inability to concentrate, an alteration of the senses (hearing, vision, smell, taste, and touch), difficulty speaking, and emotional and behavioral changes. Whether the TBI is mild, moderate, or severe, persistent symptoms can have a profound impact on the injured survivor and those who serve as caregivers. Since the symptoms can vary it is important to report any changes you experience to you healthcare provider.

Will I ever fully recover from my TBI?

Each patient responds differently to rehabilitation, because each TBI is unique. While some patients treated in the polytrauma programs are able to return to active duty or return to work, others will continue to need more intense supportive services and care. VA is continuing to advance medical treatments and develop programs to better the lives of any veteran who has sustained a TBI.

REMEMBER:

The programs and services offered by the Department of Veterans Affairs are not universal. Each region of the country is divided into Veterans Integrated Service Networks (VISN) with varying programs and services. Please consult with your primary care physician to learn more about the programs available in your community. To find the program nearest you please visit http://www2.va.gov/directory/guide/home.asp?isflash=1 .

Regardless of what type of medical facility you may be in or which programs you are using, it is a good idea for patients and caregivers to always ask questions and to keep a notebook on hand to write down questions, concerns or any other information that you would like to discuss with the doctors and other program team members. You will find that it is much easier to refer to a written list than to try to remember all of your questions on the spot.

It is important to provide a structured environment for TBI patients and to establish new routines to help them relearn old skills and develop new strategies. VA recommends that caregivers get involved as much as possible with nursing routines and the different therapies so that they can learn new critical care giving skills (i.e., positioning, transfers, feeding, bathing, toileting, and medication management). Throughout this process, the medical team will help and support you and your family member.

Caregivers should anticipate that your family member will participate in various intensive therapies each day. There may be times when a therapist feels that a one-on-one session with your family member will be more productive. Likewise, nursing may need to conduct an assessment or complete an element of nursing care without interruption. This is not an effort to exclude you, but rather, is an opportunity for the staff to work more effectively on promoting your family member’s return to maximum independence.

IMPORTANT TERMS:

Traumatic Brain Injury (TBI): Injuries to the brain caused by physical trauma to the head.

Polytrauma: A medical term describing the condition of a person who has sustained more than one traumatic injury , such as TBI in addition to the loss of a limb.

Post-Traumatic Stress Disorder (PTSD): Is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Military Sexual Trauma (MST): Is the term used by the Department of Veterans Affairs (VA) to refer to experiences of sexual assault or repeated, threatening acts of sexual harassment. The definition of MST used by the VA is given by U.S. Code (1720(D) of Title 38). MST includes any sexual activity where you are involved against your will or you may have been pressured into sexual activities.

Vocational Rehabilitation: Individualized services that match the vocational or independent living needs and interests of someone having sustained a TBI. VA provides employment vocational rehabilitation, independent living services and education and job counseling benefits for qualified veterans and dependents.

Vet Center: Vet Centers are community based and part of the Department of Veterans Affairs (VA). The goal of the Vet Center program is to provide a broad range of counseling, outreach, and referral services to eligible veterans in order to help them make a satisfying post-war readjustment to civilian life. Vet Centers also furnish bereavement counseling services to surviving parents, spouses, children and siblings of servicemembers who die of any cause while on active duty, to include federally activated Reserve and National Guard personnel, veterans of both sexes, and all eras. Vet Center services include individual readjustment counseling, referral for benefits assistance, group readjustment counseling, liaison with community agencies, marital and family counseling, substance abuse information and referral, job counseling and placement, sexual trauma counseling, and community education. All counseling received at Vet Centers is confidential and is not put in your VA files. Any veteran who was sexually traumatized while serving in the military is eligible to receive counseling regardless of gender, era of service or enrollment in the VA healthcare system.

Physical Medicine and Rehabilitation (PM&R): Services provided after discharge from the Military Treatment Facility (MTF). When medically stable, the most severely injured are often transferred from the MTF to one of VA’s Polytrauma Rehabilitation Centers (PRC).

Automobile Adaption Grants and Services: Automobile Adaptive Equipment (AAE) program permits physically challenged persons to enter, exit and/or operate a motor vehicle or other conveyance. Veterans are trained, through the VA Driver's Rehabilitation Program, how to safely operate their vehicle on our nation's roadways. VA also provides necessary equipment such as platform wheelchair lifts, UVLs (under vehicle lifts), power door openers, lowered floors/raised roofs, raised doors, hand controls, left foot gas pedals, reduced effort and zero effort steering and braking, and digital driving systems. Additionally, VA's program provides reimbursements for standard equipment including, but not limited to, power steering, power brakes, power windows, power seats and other special equipment necessary for the safe operation of an approved vehicle.

Service Dogs: A service dog is trained to help those with disabilities other than visual or hearing impairment. Service dogs typically perform tasks for the benefit of an individual with a physical or hearing disability. VHA Prosthetics and Sensory Aides consider a Service Dog a prosthetic device. Veterans using approved Service Dogs are entitled to financial benefits for the upkeep of the prosthetic device (i.e.- Service Dog).

Guide Dogs: Guide dogs are trained to lead the blind or vision impaired. The dog acts as a pilot to direct its owner in a straight line unless directed to turn, while avoiding obstacles in all directions. VHA Prosthetics and Sensory Aides consider a Guide Dog a prosthetic device. Veterans using approved Guide Dogs are entitled to financial benefits for the upkeep of the prosthetic device (i.e.- Guide Dog).

Specialized or Adaptive Housing Program Services: Under the Home Improvements and Structural Alterations (HISA) program, veterans with service-connected disabilities or veterans with non-service-connected disabilities may receive assistance for any home improvement necessary for the continuation of treatment or for disability access to the home and essential lavatory and sanitary facilities. A HISA grant is available to veterans who have received a medical determination indicating that improvements and structural alterations are necessary or appropriate for the effective and economical treatment of his/her disability. A veteran may receive both a HISA grant and either a Special Home Adaptation (SHA) grant or a Specially Adapted Housing (SAH) grant.

VA Polytrauma Rehabilitation Centers (PRC): VA facility that provides care for acute, inpatient rehabilitation. Prior to transfer to a PRC, the teams at the Military Treatment Facility (MTF) and PRC work closely together to share information and develop a patient transition plan.

Military Liaisons: Are present at each Base Readiness Center and are instrumental in providing a connection to the servicemember’s military community. They assist with the transition from military healthcare to the VA healthcare system and interact with servicemembers and their families on a regular basis. Liaisons are responsible for ensuring that military orders are in place and that all service-related needs are addressed in a timely manner.

Prosthetic Device: Anything that goes in a veteran, on a veteran or a veteran uses is a prosthetic device. These devices range from heart stents, prosthetic limbs, hearing aids, glasses, service or guide dogs, wigs, clothing and thousands of other items.