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.
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.
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