DOI: 10.1097/HTR.0b013e31825ee26a

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PMID: 22767071

Issn Print: 0885-9701

Publication Date: 2012/07/01


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Best Practices in Veteran Traumatic Brain Injury Care

Jay M. Uomoto

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AT THE TIME of the writing of this preface, the United States has been engaged in Operation Enduring Freedom (OEF) in Afghanistan and associated regions for more than 11 years. In September 2010, military operations in Iraq known as Operation Iraqi Freedom (OIF) came to a close and renamed Operation New Dawn (OND) to reflect the change of mission by US forces to provide assistance and play an advisory and training role. As of May 4, 2012, the Department of Defense reported a total of 4422 deaths in OIF, 66 in OND, and 1949 in OEF,1 all of whom we deeply honor for their service and sacrifice. Although the vast majority of those who have served in these combat environments have returned without significant injury, many service members return with a wide array of injuries, not unlike that which has occurred in combat from every past conflict known to humankind. Traumatic brain injury (TBI) has been often referred to as the “signature wound” of these most recent wars, yet in reality a multitude of injuries are common among the wounded including musculoskeletal injuries with associated chronic pain, mental health conditions such as posttraumatic stress disorder (PTSD) and depression, ill-defined signs and symptoms, sensory input impairments (eg, vision and hearing deficits), and those who sustained traumatic amputations secondary to a blast exposure.2,3 The return of injured service members from the theater of war has required both the Department of Defense and the Department of Veterans Affairs (VA) to organize systems of care, develop effective and evidence-based treatments, disseminate these approaches at an enterprise level, and coordinate such efforts between the 2 departments. In those service members who separate from military service because of retirement and those whose injuries result in being medically boarded, enrollment in VA healthcare is now on the rise.
The Veterans Health Administration (VHA) organized a nationwide healthcare system to address the healthcare needs of returning service members and Veterans with complex injuries known as the Polytrauma System of Care (PSC). This system was expanded and built upon an existing network of specialty TBI programs that existed in the VA since the time of the first Gulf War. The PSC now exists as the largest single system of healthcare in the United States for those with polytrauma (ie, those with multiple and simultaneous system injuries) and TBI. Currently, the PSC is distributed across VA medical centers in the continental United States, Alaska, Hawaii, and Puerto Rico. It consists of 3 levels of care: 5 polytrauma rehabilitation centers, 23 polytrauma network sites, and 86 polytrauma support clinic teams. In addition, the PSC has 40 polytrauma points of contact in VA medical centers that do not have specialized polytrauma rehabilitation teams.4
As a sampling of the types of approaches that characterize the care of service members and Veterans, this topical section of the Journal of Head Trauma Rehabilitation focuses upon 3 best practices in the rehabilitation of those who have suffered combat injuries. Collaborative efforts between the VA and the Department of Defense (DoD) through the evidence-based practice guideline workgroup was established to advise the joint VA/DoD Health Executive Council on the application and development of clinical practice guidelines that translate empirical research to practice implementation. Several clinical practice guidelines (CPGs) have been developed to address an array of conditions seen in primary care, mental health problems, military-related disorders, pain, rehabilitation practices, and women's health issues.5 These CPGs are disseminated to the field across the VA healthcare enterprise, and themselves define best clinical practices.

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