Presented by Stephen Heck MRes MA Session Description Working with veterans is not always equivalent to providing care to the general population This session provides information for professionals on understanding and overcoming barriers to providing care to veterans with traumatic brai ID: 780228
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Slide1
Serving Veterans with TBI
Presented by
Stephen Heck
M.Res
., M.A.
Slide2Session DescriptionWorking with veterans is not always equivalent to providing care to the general population. This session provides information for professionals on understanding and overcoming barriers to providing care to veterans with traumatic brain injury.
Slide3Agenda
My background
Objectives
Seminar topics:
Military TBI
Blast TBI
Veterans experience with TBI
TBI and substance abuse with veterans
Resources
References
Questions
Slide4Background
Slide5Objectives
Slide6Military TBI
Slide7Traumatic brain injury (TBI) - described as the “signature injury” of the wars in Iraq and Afghanistan (Operation Enduring Freedom [OEF], Operation Iraqi Freedom [OIF], and Operation New Dawn [OND])
(Okie, 2005)
Slide8Military TBI
(DVBIC, 2010)
Slide9Concerns with servicemembers reporting TBIs
Stigma
Concerns about being forced out of their unit or the Army
Do not want to let their ‘battle buddies’ down
Do not recognize symptoms
Slide10How Common is TBI in the military?
(DVBIC, 2010)
Slide11Department of Defense Numbers for TBIs
Slide12Blast TBI
Slide13Mechanisms
(
Cernak
, 2015; Chen, 2013)
Slide14Blast TBI
(
Cernak
, 2015; Chen, 2013)
Slide15Primary Blast Injuries
(
Cernak
, 2015; Chen, 2013)
Slide16Secondary Blast Injuries
(
Cernak
, 2015; Chen, 2013)
Slide17Tertiary Blast Injuries
(
Cernak
, 2015; Chen, 2013)
Slide18Quaternary blast injuries
(
Cernak
, 2015; Chen, 2013)
Slide19From Combat to Care
Bailey et al., 2012
Slide20What we know
Belanger et al., 2009; Greer et al., 2018)
Slide21Veterans experience with TBI
Slide22Experience since injury
Experiencing reduced physical and mental function
Migraines, changes in memory, experiencing nerve damage, and sensitivity to light
Staying active, being physically active or going to school, as the most helpful
Lack of community support
Extensive amounts of time researching treatments for themselves
(
Koehmsted
et al., 2018)
Slide23Changes to health status
Concentration
Memory problems
Increased irritability
Changes in symptoms and new symptoms after many years pass
(
Koehmsted
et al., 2018)
Slide24Post-injury Factors
Slide25War-Zone Stressors
Preparedness (or lack thereof)
Combat exposure
Aftermath of battle
Perceived threat
Difficult living and work environment
Perceived radiological, biological, and chemical weapons exposureSexual or gender harassmentEthnocultural stressorConcerns about life and family disruptions
(Iraq war clinician guide, 2004)
Slide26Posttraumatic Stress Disorder
Hoge et al., 2008
Slide27TBI and substance abuse with veterans
Slide28Substances use after a TBI
(Weil et al., 2016; Corrigan & Cole, 2008; DVBIC, 2017)
Slide29Recommendations
(Weil et al., 2016; Corrigan & Cole, 2008; DVBIC, 2017)
Slide30Substance use and effect on TBI recovery
Make it harder for the brain to heal
Interfere with thinking processes that are already slowed down
Increase aggressive and socially inappropriate behaviors
Increase balance problems
Promote other risky behaviors
Cause problems with friends and family
Worsen feelings of depression and anxiety
(Weil et al., 2016; Corrigan & Cole, 2008; DVBIC, 2017)
Slide31How to help veteran TBI survivors with substance abuse
Slide32Resources
Slide33Important resourcesRealWarriors.net: 24/7 Live Chat: realwarriors.net/
livechat
Military Crisis Line for crisis intervention: 800-273-8255, press 1
Psychological Health Resource Center: 866-966-1020
National Suicide Prevention Lifeline: at 1-800-273-8255 (TALK)
Slide34For more information
WVU Center for Excellence in Disabilities
Brain Injury Association of America
Defense and Veterans Brain Injury Center
National Association of State Head Injury Administrators
North American Brain Injury Society
Traumatic Brain Injury Technical Assistance CenterDepartment of Veterans AffairsWounded Warrior Project
Slide35References
Slide36Bailey, J.,
Spott
, M. A., Costanzo, G. P., Dunne, J.R.,
Dorlac
, W., & Eastridge, B., (2012).
Joint Trauma System: Development, Conceptual Framework, and Optimal Elements
. U.S. Department of Defense, U.S. Army Institute for Surgical Research.Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., & Tupler, L. A. (2009). Cognitive Sequelae of Blast-related versus Other Mechanisms of Brain Trauma. Journal of the International Neuropsychological Society
, 15, 1–8 Chen, Y., Huang, W., & Constantini, S. (2013). Concepts and strategies for clinical management of blast-induced traumatic brain injury and posttraumatic stress disorder. The Journal of Neuropsychiatry and Clinical Neurosciences,25(2), 103-10. doi:10.1176/appi.neuropsych.12030058Corrigan, J., & Cole, T. (2008). Substance use disorders and clinical management of traumatic brain injury and posttraumatic stress disorder. Jama, 300
(6), 720-1. doi:10.1001/jama.300.6.720 Defense and Veterans Brain Injury Center (2016). Addressing family needs. Falls Church, VA: A Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Center
Defense and Veterans Brain Injury Center. (2010). Traumatic brain injury: A guide for caregivers of service members and veterans (Curriculum). Retrieved from https://dvbic.dcoe.mil/caregivers-companion.
Defense and Veterans Brain Injury Center. (2017). TBI, Substance use: This is your injured brain on alcohol (PDF slides). Retrieved from http://dvbic.dcoe.mil/training/webinars/2017/tbi-substance-use-your-injured-brain-alcohol.
Slide37Greer, N., Sayer, N.,
Koeller
, E., Velasquez, T., & Wilt, T. (2018). Outcomes associated with blast versus
nonblast
-related traumatic brain injury in us military service members and veterans: A systematic review.
The Journal of Head Trauma Rehabilitation, 33
(2), 29. doi:10.1097/HTR.0000000000000304Hoge, C. W., McGurk, D., Thomas, J. L., Cox, A. L., Engel, C. C., & Castro, C. A. (2008) Mild Traumatic Brain Injury in U.S. Soldiers Returning from Iraq. JAMA,
358(5), 453–463Iraq war clinician guide. (2004). White River Junction, VT: National Center for Post-Traumatic Stress Disorder.Koehmstedt, C., Lydick, S. E., Patel, D., Cai, X., Garfinkel, S., & Weinstein, A. A. (2018). Health status, difficulties, and desired health information and services for veterans with traumatic brain injuries and their caregivers: A qualitative investigation. PLoS ONE, 13
(9), 1-19. doi:10.1371/journal.pone.0203804Okie S. Traumatic Brain Injury in the War Zone. (2005). New England Journal of Medicine,
353
(6), 633-634. doi:10.1056/nejm200508113530621
Weil, Z., Corrigan, J., &
Karelina
, K. (2016). Alcohol abuse after traumatic brain injury: Experimental and clinical evidence.
Neuroscience and
Biobehavioral
Reviews,
62, 89-99. doi:10.1016/j.neubiorev.2016.01.005
Slide38Questions