Psychosocial Impact of National Veterans Wheelchair Games and Winter Sports

Psychosocial impact of participation in the National Veterans Wheelchair Games and Winter Sports Clinic. 06/13/09. Recommending veterans participate in events such as the NVWG and WSC can provide psychosocial benefits to veterans with disabilities. Disability and Rehabilitation via PubMed

Home Telehealth for Vets Following Strokes

Testing a home-telehealth programme for US veterans recovering from stroke and their family caregivers. 06/13/09. Home telehealth offers innovative ways to target post-stroke rehabilitation programmes to the needs and concerns of patients and their caregivers, and should include regular real-time contact between stroke patients and their healthcare providers. Disability and Rehabilitation via PubMed

VA's Polytrauma Units for Mild TBI

The Veterans Health Administration's (VHA's) Polytrauma System of Care for mild traumatic brain injury: costs, benefits, and controversies. 06/13/09. The Veterans Health Administration's (VHA's) Polytrauma System of Care, developed in response to a new cohort of patients back from Iraq and Afghanistan, is described with particular focus on the assessment and treatment of mild traumatic brain injury (mild TBI). The development of systemwide TBI screening within the VHA has been an ambitious and historic undertaking. As with any population-wide screening tool, there are benefits and costs associated with it. The purpose of this article is to identify and discuss the strengths and weaknesses of the VHA's TBI clinical reminder and subsequent evaluation and treatment processes. Complicating factors such as increased media attention and other contextual factors are discussed. The Journal of Head Trauma Rehabilitation via PubMed

Neuropsychological Assessment Screening Tests for Mild TBI

Performance on the Automated Neuropsychological Assessment Metrics in a nonclinical sample of soldiers screened for mild TBI after returning from Iraq and Afghanistan: a descriptive analysis. 06/13/09. A history of self-reported MTBI or current postconcussive symptoms does not increase the risk of cognitive impairment in service members returning from Iraq and Afghanistan. The Journal of Head Trauma Rehabilitation via PubMed

Some Factors for Postdeployment Rehab

Relationship between processing speed and executive functioning performance among OEF/OIF veterans: implications for postdeployment rehabilitation. 06/13/09. BACKGROUND: Comorbid mild traumatic brain injury (mTBI) with posttraumatic stress disorder (PTSD) is a common clinical presentation among troops returning from Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). This study examined processing speed and executive functioning in a sample of OEF/OIF veterans who had sustained mTBI, a subset of whom also had comorbid PTSD. METHODS: Fifty-three OEF/OIF veterans with a history of mTBI completed Wechsler Adult Intelligence Scale-III Symbol Search and Digit Symbol-Coding subscales, Stroop Word, color and color-word trials, and Trail Making Test, Parts A and B as part of a comprehensive neuropsychological test battery. RESULTS: Excluding from analysis those who scored poorly on effort testing, multiple regression showed that measures of processing speed accounted for 43% of the variance in performance on the Trail Making Test, Part B and 50% of the variance in performance on the Stroop task. Significant differences in processing speed and executive functioning were found on the basis of presence of comorbid PTSD. Stroop Color (F = 9.27, df = 52, P < .004) and Stroop Color Word (F = 7.19, df = 52, P < .01) scores differed significantly between the groups. Those having comorbid PTSD (+TBI/+PTSD) scored significantly poorer than the mTBI-only group (+TBI/-PTSD). Implications for treatment of the comorbid conditions are discussed. The Journal of Head Trauma Rehabilitation via PubMed

Use of Driving Simulators in Cognitive Rehab Following TBI

The potential utility of driving simulators in the cognitive rehabilitation of combat-returnees with traumatic brain injury. 06/13/09. A large number of Operation Enduring Freedom/Operation Iraqi Freedom returnees are seeking DOD and VA rehabilitative care for war-related traumatic brain injury (TBI). This article reviews evidence on the utility of driving simulators as tools for assessment and training in TBI rehabilitation. Traditionally, cognitive rehabilitation has been shown to improve specific cognitive skills. However, there are few studies and only weak evidence to show that these gains transfer to everyday activities. Theoretically, modern driving simulators may be useful in cognitive rehabilitation because they can systematically present realistic and interesting tasks that approximate driving activities, while automatically monitoring performance. The use of simulation technology for patients with TBI provides cognitive stimulation in an ecologically compatible setting, without the risks associated with a corresponding real-world experience. The utility, limitations, and future directions for the use of driving simulator in the rehabilitation of patients with war-related TBI are discussed. The Journal of Head Trauma Rehabilitation via PubMed

Change of Job Status Following TBI in a Military Population

Clinical, cognitive, and genetic predictors of change in job status following traumatic brain injury in a military population. 06/13/09. Factors associated with a change in job status are different when APOE genotype is considered. We conclude that APOE genotype may be an important genetic factor in recovery from mild to moderate head injury. The Journal of Head Trauma Rehabilitation via PubMed

Coping With the Transition From Military to Civilian Life

Shaken world: coping with transition to civilian life. (Free full text) 06/13/09. Military service is very different from civilian life. Veterans speak of the camaraderie of the “military family,” in which needs are addressed in a highly structured culture. Canadian Forces members have ready access to health care and know their rank in the organization. They often bond closely with unit members. Family relationships can be strained by moving to new postings every few years and long family separations during training and deployment. Park recently described the demographics of the modern CF. Canadian Family Physician Médecin de Famille Canadien via PubMed

Blast-related Mild TBI: Mechanisms and Care

Blast-related mild traumatic brain injury: mechanisms of injury and impact on clinical care. 06/13/09. Mild traumatic brain injury has been called the signature injury of the wars in Iraq and Afghanistan. In both theaters of operation, traumatic brain injury has been a significant cause of mortality and morbidity, with blast-related injury the most common cause. Improvised explosive devices have been the major cause of blast injuries. It is estimated that 10% to 20% of veterans returning from these operations have suffered a traumatic brain injury, and there is concern that blast-related injury may produce adverse long-term health affects and affect the resilience and in-theater performance of troops. Blast-related injury occurs through several mechanisms related to the nature of the blast overpressure wave itself as well as secondary and tertiary injuries. Animal studies clearly show that blast overpressure waves are transmitted to the brain and can cause changes that neuropathologically are most similar to diffuse axonal injury. One striking feature of the mild traumatic brain injury cases being seen in veterans of the wars in Iraq and Afghanistan is the high association of mild traumatic brain injury with posttraumatic stress disorder. The overlap in symptoms between the disorders has made distinguishing them clinically challenging. The high rates of mild traumatic brain injury and posttraumatic stress disorder in the current operations are of significant concern for the long-term health of US veterans with associated economic implications. The Mount Sinai Journal of Medicine via PubMed

Epidemilogy of TBI

Traumatic brain injury in the United States: an epidemiologic overview. 06/13/09. A basic description of severity and frequency is needed for planning healthcare delivery for any disease process. In the case of traumatic brain injury, severity is typically categorized into mild, moderate, and severe with information from a combination of clinical observation and self-report methodologies. Recent US civilian epidemiological findings measuring the frequency of mortality and morbidity of traumatic brain injury are presented, including demographic and etiological breakdowns of the data. Falls, motor vehicle accidents, and being struck by objects are the major etiologies of traumatic brain injury. US civilian and Army hospitalization trends are discussed and compared. Features of traumatic brain injuries from Operation Iraqi Freedom and Operation Enduring Freedom are discussed. The Mount Sinai Journal of Medicine via PubMed

PTSD in Combat Related vs Non-combat Related Burns

A comparison of posttraumatic stress disorder between combat casualties and civilians treated at a military burn center. 06/13/09. The incidence of PTSD is not significantly different in burned combat casualties and civilians treated at the same burn unit. These findings suggest that PTSD is related to the burn trauma and not to the circumstances surrounding the injury. Journal of Trauma via PubMed

Some Aspects of Impact of Sexual Assault on Women Veterans

Sexual assault in the military and its impact on sexual satisfaction in women veterans: a proposed model. 06/13/09. SAIM's negative impact on sexual satisfaction in women veterans operates both directly and through its physical and mental health sequelae. Of the proposed mediators in this association, the most prominent is mental health-related quality of life; the other proposed mediators were minimally related. Journal of Women's Health via PubMed

Predictors of Attrition From VA Substance Abuse Programs

Individual and program predictors of attrition from VA substance use treatment. 06/11/09. The study investigated patient- and program-level variables associated with attrition from intensive outpatient (IOP) substance use treatment in a national VA sample. National databases were used to identify a recent cohort of veterans receiving intensive IOP substance use treatment. Attrition was defined as receiving less than five visits of IOP treatment. Patient-level variables examined included age, gender, race, and psychiatric and medical comorbidities. Program-level variables examined included the number of hours of treatment offered, the percentage of patients living on-campus, and extent of staff cuts in the past year. Twenty-seven percent of veterans left treatment early. Being older, female, and having a psychotic disorder was associated with attrition. Program-level factors associated with attrition were the number of hours the program offered treatment, in that more treatment offered was associated with higher attrition. Focus on individual and program level factors associated with attrition is crucial to retaining individuals in treatment. J Behav Health Serv Res

Voucher Help Vets With Substance Use Disorders

Using vouchers to increase continuing care participation in veterans: does magnitude matter? 06/11/09. The present study examined the comparative effects of adding contingency management (CM) schedules to an existing substance abuse continuing care program, with the goal of increasing attendance. We retrospectively examined the attendance of 135 veterans enrolled in one of three CM programs and a quasi-control condition of 55 veterans. Results indicated that participants enrolled in the two higher magnitude CM voucher programs increased both continuing care attendance and length of participation. Findings support the use of CM to increase continuing care attendance among veterans with substance use disorders, and suggest that voucher magnitude and bonuses both had a positive impact. AM J Addict

Higher Post-surgical Mortality in Native American Vets

Surgical outcomes in American Indian veterans: a closer look. 06/11/09. American Indian/Alaska Native (AI/ANs) male veterans have considerably higher postoperative mortality rates than their Caucasian counterparts, but similar postoperative morbidity rates even after adjusting for major preoperative risk factors. This study seeks to explain the discrepancy in morbidity and mortality. STUDY DESIGN: We obtained data from the Veterans Affairs National Surgical Quality Improvement Program on major, noncardiac, surgical procedures performed from 1991 to 2002 for all AI/AN men (n = 2,155), and a random sample of Caucasian men (n = 2,264), matched by site. We compared the number and types of postoperative complications and mortality rates for those patients in whom complications developed. We also examined complication and mortality rates by whether they occurred after hospital discharge, or by specific type of surgical procedure. Preoperative risk factors were assessed in patients who died. Chi-square or Fisher's exact tests were used for all comparisons. RESULTS: AI/ANs and Caucasians did not differ by number of complications but Caucasian patients had considerably higher rates for three specific complications. There was no difference in deaths after discharge or in mortality rates after specific surgical procedures. The groups differed considerably in the types of procedures performed. Among patients who died, three preoperative risk factors, ie, hemiplegia, diabetes, and wound infection, occurred more frequently among AI/AN than Caucasian veterans. CONCLUSIONS: We cannot fully explain higher postoperative mortality rates experienced by AI/AN relative to Caucasian veterans after examining complications, types of procedures, and other relevant factors. AI/ANs with certain preoperative risk factors can be vulnerable to 30-day postoperative mortality and benefit from closer postoperative surveillance. J Am Coll Surg