Rehabilitation in the Department of Veterans Affairs Polytrauma System of Care: Historical Perspectives.

The purpose of this article is to inform the reader of the historical aspects of the Polytrauma System of Care, understand the solutions that were implemented in addressing the continuum of care needs for service members and veterans, and provide an understanding of ongoing research efforts that will inform future solutions to strategically identified future care needs.

Integrative Medicine and Health Coaching in Polytrauma Rehabilitation.

Veterans Health Administration (VHA) has embarked on a journey of cultural transformation focused on creating a personalized and patient-driven experience with health care service. In addition to training thousands of providers in the principles of whole health and expanding availability of complementary medicine, VHA also pursues developing the evidence for such care. The Polytrauma Integrative Medicine Pilot explored the feasibility of implementing health coaching in polytrauma care. The qualitative and quantitative data collected on 547 participants in the pilot shows high satisfaction with the health coaching services received and statistically significant positive changes in domains of life satisfaction and well-being.

Examination of validity in spoken language evaluations: Adult onset stuttering following mild traumatic brain injury.

BACKGROUND: Reports of increased incidence of adult onset stuttering in veterans and service members with mild traumatic brain injury (mTBI) from combat operations in Iraq and Afghanistan lead to a reexamination of the neurogenic vs. psychogenic etiology of stuttering. OBJECTIVE: This article proposes to examine the merit of the dichotomy between neurogenic and psychogenic bases of stuttering, including symptom exaggeration, for the evaluation and treatment of the disorder. METHODS: Two case studies of adult onset stuttering in service members with mTBI from improvised explosive device blasts are presented in detail. Speech fluency was disrupted by abnormal pauses and speech hesitations, brief blocks, rapid repetitions, and occasional prolongations. There was also wide variability in the frequency of stuttering across topics and conversational situations. Treatment focused on reducing the frequency and severity of dysfluencies and included educational, psychological, environmental, and behavioral interventions. RESULTS: Stuttering characteristics as well as the absence of objective neurological findings ruled out neurogenic basis of stuttering in these two cases and pointed to psychogenic causes. However, the differential diagnosis had only limited value for developing the plan of care. CONCLUSIONS: The successful outcomes of the treatment serve to illustrate the complex interaction of neurological, psychological, emotional, and environmental factors of post-concussive symptoms and to underscore the notion that there are many facets to symptom presentation in post-combat health.

VA integrated post-combat care: a systemic approach to caring for returning combat veterans.

The Department of Veterans Affairs (VA's) mission is to care for those who have borne the battle. As medical technology has advanced, more and more of our returning combat Veterans survive what would have been fatal wounds in previous conflicts ( Gawande, 2004 ). But survival is only the immediate goal-our job is to restore Veterans to the greatest level of health, independence, and quality of life that is medically possible. The VA is achieving this goal through close collaboration with the Department of Defense (DoD) to facilitate a smooth transition and continuum of care that ensures Veterans and Service Members receive the care they deserve. This article describes VA's system of Veteran-centered, post-combat care programs that rely on significant involvement of social workers to support Service Members, Veterans and their families through recovery, rehabilitation, and re-integration into their home communities.