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One of the most powerful aspects of the Home Base Program is the way it helps veterans and service members come together again with those who may have had similar experiences in combat and now back at home with issues around TBI and PTSD. Along with the comprehensive individualized treatment plans for each person, the program includes group therapies and events, which play a large role in the healing process.
The Home Base program, which includes comprehensive assessments and a two-week immersion into therapies and treatments for TBI, PTSD, and other conditions, is created anew for each veteran or service member who joins. Whether engaging in physical or cognitive therapeutic interventions, learning how better to communicate with family and friends, or delving into art therapies, each individual becomes part of a strong and supportive community of people who understand their experiences, though everyone’s experiences and issues are unique and treated as such.
Home Base, a free Red Sox Foundation and Mass General Hospital program, started small, but then and now—as it has grown to help 1,000s of veterans and service members nationwide—it remains a passion for many. The program focuses on treating the invisible wounds of war like TBI and PTSD. With evidence-based treatments in all domains like behavioral therapy, physical therapy, health and wellness, and medications, providers help these warriors with issues that run the gamut from sleep apnea and cognitive function to depression and physical pain.
The jury is still out on the exact ways that repeated blast injuries affect the brain. Some believe that the blast waves travel through the organs, producing a change in the gray-white matter of the brain. Others believe that blast-related injuries produce a unique pathology while others still think that the pathological signals from these injuries result in behavioral disturbance. But all researchers seem to agree that repeated blast-related injuries affect a person’s brain in the short-term as well as in the long-term with the risk of neurodegenerative disease.
For many service members and veterans, traumatic brain injury and PTSD often go hand in hand, with some of the symptoms of these conditions being co-morbid. By using evidence-based treatments, providers work with their patients with the goal of getting them as symptomless as possible.
A family member or support person at home plays a key role as part of the treatment plan for a service member or veteran. An adjunct in their loved one’s care, the family member collaborates with the team of providers to help their loved one follow through with appointments, medications, and health regimens. They often serve as the more impartial eyes and ears to their loved one’s challenges and improvements.
Changes don’t happen 0-60 mph, rather they occur incrementally. Providers know that barriers can impede improvement to healing, but by setting a series of step-by-step goals—whether treatments for better sleep, pain relief, or relationship strategies— service members and veterans can see improvements to their physical, behavioral, and emotional issues and build on them from there.
Two-week intensive outpatient programs that implement a comprehensive, holistic approach to treatment, The Road Home Program includes two treatment arms for veterans and their families—one for veterans who experience battlefield PTSD, the other for survivors of military sexual trauma. Their data reveal high success rates during the program and in the long-term, post-program.
After intensive treatment programs like Home Base, often veterans and service members need to rely on their local providers who have not been specifically trained to work with people who have military-related TBI and/or PTSD. But there are lots of resources out there, like Home Base, that can help civilian providers learn more to successfully understand and help this large, unique population in their cities and towns.
Originally, the Home Base program focused primarily on the brain injury, itself, of service members and veterans. With time, experience, and research, the program now approaches treating brain injury from a holistic method as other issues affect brain health—neurological, cognitive, and psychological functions—like sleep deprivation, chronic pain, or co-occurring substance abuse. Treating the whole person with an individually tailored plan has provided far better outcome.
Often feelings of lost connection with family members—whether with a spouse, children, parents, or siblings—is what finally catalyzes a veteran or service member to seek treatment for TBI and/or PTSD. For example, a Special Ops veteran who had deployed 10 times during a 35-year military career finally sought treatment through the Home Base program because his child told his wife that he was afraid of him. He did not want the effects of TBI and/or PTSD to create irreparable damage to his whole, multigenerational family.
There are several misconceptions around brain injury and it is important to dispel them. One is that someone with a TBI cannot get better. Not true; in fact, many, many people with TBI who are engaged in treatment get better and return to full lives. The second issue is the wishful thinking that there is one pill or technology that can cure a TBI. Not true; rather engaging in a series of evidence-based treatments and sticking to one’s treatment regimen is what helps people heal.
Home Base has been offering outpatient programs for 10 years and intensive programs for the last five, during which time they have learned two main lessons. The first is the importance of designing individual treatment plans for each person based on their biomarkers of injury, symptoms, and needs. Secondly, they learned the importance of follow through post-program—whether helping a service member or veteran learn the tools for self-management when ready or educating local practitioners to better help the military population with TBI and/or PTSD.
Researchers and doctors are learning more about how blast injuries, especially if repetitive and sustained close together, can affect the brain far more significantly than a singular blow to the head as from football, boxing, or a car crash. When treating veterans and service members, clinicians in the Home Base program start by taking an in-depth TBI history starting from childhood to the present. The more they understand the mechanism, frequency, and interval between any sustained injuries, the more pointed their treatment can be.
Oftentimes, a family member is the first to recognize symptoms of TBI and/or PTSD in their loved one who has returned from military service. At the Home Base program, veterans and service members are accompanied by a family member for part of the two-week intensive so upon returning home, the family knows better how to help their loved one understand their symptoms and aid with and ongoing treatments, interventions, medications, and general support.
TBI is a multi-faceted injury that can present physically through headaches, balance, hearing, or vision problems; psychologically through depression or post-traumatic stress; cognitively through memory and attention issues; or all or a combination of these “buckets.” Home Base is a two-week intensive program for veterans and service members that serves as part of their journey to recovery. After the two weeks, case managers help their clients set up the necessary care and services they need in their community and follow their progress.
Once upon a time, researchers and doctors treated all traumatic brain injuries the same, but they now know that the mechanism of injury plays a key role in diagnosis and treatment. There are many parallels for civilians and service members who sustain a traumatic brain injury, but the people are very different. Athletes who sustain a TBI most likely will not have the overlapping emotional challenges that service members may who sustained their injury in combat or in a more threatening setting. Helping service members and veterans often includes treating them for both TBI and PTSD simultaneously.
Dr. Iaccarino shares how suffering a spine injury as a teenager sparked her passion for helping others with brain injury using neurological rehabilitation and recovery, especially veterans and military service members.
Because Wounded Warrior Project works with many vets who have TBI and/or PTSD, staff hear many misconceptions. One misconception is that there are no treatments for TBI and PTSD. Not true. There are gold-standard treatments to heal people with PTSD and there are very effective rehab programs for people with TBI. Also, people need to remember that both of these conditions are often invisible wounds and can affect anyone—male, female, young, old, and so on.
A traumatic brain injury or repeated brain traumas can sometimes lead to chronic traumatic encephalopathy, Parkinson’s, multiple sclerosis, astrogliosis, or other neurogenerative conditions. Since researchers are still learning about the progression of these diseases, which can stem from repeated TBIs, providers are currently trying to plan and address how to change their model of care to best help veterans and their families in the long term.
Service members and veterans feel a deep connection with each other and their families. Through Wounded Warrior Project’s various programs—in-person and/or online—veterans can come together, empower each other, and once home, support the greater good of their communities.
Wounded Warrior Project’s Independence Program does not have a protocol to work with service members and their families when they transition home from a clinical facility, but they do have a highly successful formula for independent programing that caters to the individual needs of their clients whether those needs arise from the vet’s neurological trauma or from emotional or psychological challenges that result from that trauma.
Emory Healthcare Veterans Program’s two-week PTDS Treatment intensive for post-9.11 vets is a convenient and effective means for people to get needed treatment for PTSD, TBI, depression, chronic pain, and substance abuse from home. The results are the same whether accessing care via telehealth or on site.
Connor Martin and his family donated his brother Kevin Ash's and evidence of CTE was discovered, a condition that can only be diagnosed after death. Kevin's family encourages others to donate as well so we can learn more about brain injuries and CTE.