USA — Defense, VA Expand Work on Traumatic Brain Injuries

WASHINGTON, May 5, 2010 — The depart­ments of Defense and Vet­er­ans Affairs have great­ly expand­ed care for ser­vice­mem­bers and vet­er­ans with trau­mat­ic brain injuries from the bat­tle­field after they’re dis­charged from reha­bil­i­ta­tion cen­ters, offi­cials said today.

Air Force Col. (Dr.) Michael Jaf­fee, direc­tor of the Defense and Vet­er­ans Brain Injury Cen­ter, and Dr. Lucille Beck, chief con­sul­tant with VA’s Office of Reha­bil­i­ta­tion Ser­vices, tes­ti­fied before the Sen­ate Vet­er­ans’ Affairs Com­mit­tee on progress in brain injury diag­no­sis and treat­ment since Con­gress passed a 2007 law for the depart­ments to work togeth­er to enhance treat­ment.

A “high­ly col­lab­o­ra­tive and fruit­ful rela­tion­ship” between the two depart­ments has spawned com­pre­hen­sive care for improve­ments in research, pre­ven­tion, ear­ly detec­tion, treat­ment and out­reach, Jaf­fee said.

The Defense Depart­ment has made impor­tant con­tri­bu­tions in the ongo­ing under­stand­ing of brain injuries, Jaf­fee said, and has received sev­er­al awards for its ran­dom­ized-con­trolled clin­i­cal tri­als and con­tri­bu­tions to med­ical lit­er­a­ture.

Also, the depart­ment has improved pre­ven­tion of TBI with its con­tin­ued devel­op­ment of pro­tec­tive equip­ment, includ­ing a next-gen­er­a­tion com­bat hel­met still in pro­duc­tion, he said.

To improve ear­ly detec­tion, the Defense Depart­ment has increased its manda­to­ry con­cus­sion screen­ings to four lev­els, which begin as close to the time of injury as pos­si­ble, and also include pro­posed guide­lines for manda­to­ry eval­u­a­tion of all ser­vice­mem­bers involved in inci­dents con­sid­ered at risk for con­cus­sions, Jaf­fee said.

The depart­ment has improved treat­ment by pub­lish­ing clin­i­cal prac­tice guide­lines for TBI that rec­og­nize the com­mon co-exist­ing con­di­tions of post-trau­mat­ic stress dis­or­der and sub­stance abuse, and cre­at­ed an elec­tron­ic con­sul­ta­tion ser­vice to help med­ical providers down­range, he said.

Brain Injury Cen­ter offi­cials have worked with their VA coun­ter­parts to con­tract civil­ian orga­ni­za­tions to serve patients through the Assist­ed Liv­ing for Vet­er­ans with TBI project at nine state-owned facil­i­ties, Jaf­fee said.

The VA Polytrauma/TBI Sys­tem of Care, Beck said, con­sists of four reha­bil­i­ta­tion cen­ters, 22 net­work sites, 82 sup­port clin­ic teams, and 48 points of con­tact devot­ed to mul­ti­ple blast-relat­ed injuries.

The sys­tem strong­ly advo­cates fam­i­ly involve­ment, Beck said, and offers mul­ti­ple lev­els of clin­i­cal, psy­choso­cial, and logis­ti­cal sup­port to ensure a smooth tran­si­tion and con­tin­u­ous care for patients and their fam­i­lies. VA case man­agers are assigned to every patient – with each case man­ag­er main­tain­ing six cas­es at a time – and case man­agers can be reached 24 hours per day, sev­en days per week, she said.

VA treat­ed 1,736 patients with severe brain injuries between March 2003 and Decem­ber 2009, Beck said. Of those, 879 were active duty ser­vice­mem­bers, and 736 were injured in Iraq or Afghanistan, she said.

The Defense Depart­ment has iden­ti­fied more than 134,000 ser­vice­mem­bers with TBI since Jan­u­ary 2003, most of which were mild, Jaf­fee said. Near­ly 90 per­cent have com­plete­ly recov­ered with­in days or weeks of the injury, he said.

Hawaii Sen. Daniel K. Aka­ka III, the com­mit­tee chair­man, said some 360,000 ser­vice­mem­bers are believed to have suf­fered brain injuries dur­ing ser­vice in Iraq and Afghanistan. Aka­ka said he has been impressed with the poly­trau­ma cen­ters and wants to cre­ate more to ease the bur­den on fam­i­lies who trav­el far from home to be with ser­vice­mem­bers need­ing care.

The hear­ing occurred just hours before Pres­i­dent Barack Oba­ma signed a bill, which Aka­ka wrote, that increas­es sup­port to fam­i­lies of injured ser­vice­mem­bers and vet­er­ans so that many who oth­er­wise would need insti­tu­tion­al care can remain at home.

U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs)