Health services and rehabilitation for active duty service members and veterans with mild TBI

ABSTRACT

Objective: We review health services and reintegration practices that contribute to the rehabilitation of US active duty service members (ADSMs) and Veterans who experienced traumatic brain injury (TBI), especially mild TBI (mTBI), as discussed at the 2015 Department of Veterans Affairs (VA) TBI State-of-the-Art (SOTA) Conference.

Methodology: We reviewed the state-of-the-art at the time of the previous 2008 TBI SOTA Conference, advances in the field since then, and future directions to address gaps in knowledge.

Main results: We reviewed: (1) mTBI and its comorbid conditions documented in ADSMs and Veterans, and recognized the need for additional healthcare utilization, health cost and quality of care studies; (2) VA vocational rehabilitation programmes and the effectiveness of supported employment for helping those with workplace difficulties; (3) the application of technology to assist in TBI rehabilitation, including mobile device applications for self-management, videoconferencing with providers, and virtual reality to help with behavioural and cognitive challenges, and (4) Department of Defense (DoD)-VA partnerships on identification, evaluation and dissemination of TBI best practices.

Conclusions: There have been significant advances in TBI rehabilitation, but multiple areas across the DoD and VA care continuum need further exploration and development to meet the needs of ADSMs and Veterans.

KEYWORDS:

• Assistive technology
• cognition
• rehabilitation
• supported employment
• system of care
• traumatic brain injury

Acknowledgments

The authors wish to thank Dr. Shana Bakken, Mr. Joseph Carlomagno, Dr. Kathleen Carlson, Dr. Micaela Cornis-Pop, Dr. Sandra Resnick, and Dr. Joel Scholten for their contributions to and support of this research.

Statement of interest

Portions of this article were presented at the TBI State-of-the Art Conference, sponsored by the VA Office of Research and Development, in Washington, D.C., USA, August 24–25, 2015. Drs Levy, Pogoda and Pugh are employed at the Department of Veterans Affairs, and Ms Helmick is employed at the Defense and Veterans Brain Injury Center. The authors declare no conflicts of interest. The views expressed in this article are those of the authors and should not be construed as official views of the US Department of Defense, US Department of Veterans Affairs (VA) or of the US Government. This material is based upon work supported in part by the VA, Veterans Health Administration, Office of Research and Development, VA Health Services Research and Development (HSR&D) Service Grant PPO 13-123, VA HSR&D IIR 11-078, VA HSR&D IIR 11-358, VA HSR&D PPO 13-123, VA Research and Development (RR&D) Merit Awards 1I21RX002060 and 1I01RX000339-01A3,and Department of Defense Chronic Effects Neurotrauma Consortium Award # W81XWH-13-2-0095-04.