Treating TBI at the VA

Trigger warning: discussion of blast injury and TBI

Patients are an integral part of the interdisciplinary polytrauma team at the Washington, D.C., VA Medical Center. The team works collaboratively with veterans to help them meet their personal goals and reintegrate back into the community, academics, and the workforce. "I've got a long way to go," says Vincent Short, Specialist (RET), U.S. Army, "but I feel very empowered."

[♪ music ♪] [male narrator] In 2003, Army Specialist Vincent Short was serving as a heavy duty vehicle operator in Iraq. [Vincent Short] We were just on a routine security escort mission. The vehicle that I was operating in the rear of the convoy was hit by an IED. There was no sound. It was just this rush of heat, and I had suffered a massive brain injury. [narrator] It took Vincent months to recover from his physical injuries but over five years to realize his brain wasn't getting better. [Vincent Short] I first knew I had a brain injury when I didn't know I had a brain injury. I was in complete and utter denial. I felt my life slipping away. I mean, yeah, I'm breathing, my heart is beating, and my brain is working. I can talk, I can move my hands, I can walk. But nothing was going right. [narrator] Vincent finally decided to return to the Polytrauma Program at the Washington DC VA Medical Center. With cognitive and speech therapy, Vincent's brain slowly began to rebuild the connections it made before he was injured. Dr. Pamela Harman helped design Vincent's therapy program. [Dr. Pamela Harman] Patients who have had a TBI often have what we call pragmatic deficits. So that may be they're hyperverbose, they talk too much, they can't keep track of a topic, they have tangentiality. [Vincent Short] Pre-injury I could figure it out. I could find the dots and connect them and, boom, move on. Here [chuckling] there would be a dot here, a dot there, and then I see a dot way over there. [therapist] Good so far? [Vincent Short] Yeah. [therapist] Okay. [Dr. Harman] Vincent wants to go back to school, and he's willing to come in every week, and he's willing to come to therapies. We will have him take one class at a time maybe and then two, and little by little he will make his way through that college degree. But we see this over and over again. [narrator] Dr. Joel Scholten helped design the VA's polytrauma approach to treatment in response to the injuries from Iraq and Afghanistan. [Dr. Joel Scholten] When the war started back in 2001 and 2002, the injuries were much more complex. Prior to that when we saw a veteran with a traumatic brain injury, it tended to be just a traumatic brain injury and maybe one other fracture. We're seeing individuals with multiple body systems that were impaired or injured— severe head injuries. One of the things we didn't know back at the beginning of the war was the effect of multiple repeated concussions. [Dr. Harman] When the soldiers come back, they've been exposed to between 10 and 20 blasts over their year or 18 months in service. [blast - soldier exclaiming] The brain rocks. It is specifically at that midbrain subcortical area where the attention, the memory are encompassed. And then it's all of the relay functions, because one part of the brain may not be able to talk to the rest of the brain. So you may be able to recognize an object, but you can't name it. [therapist] Press all of the red lights and don't hit any green. [Dr. Harman] Or you may be able to recognize somebody's face but not put a name to it. [narrator] Adam Anicich is both a congressional liaison and advisor to the VA and a former patient. When a mortar exploded near Adam in Iraq in 2006, he fell about 20 feet and sustained a brain injury. After struggling to get back to civilian life, he came to the VA for help. [Adam Anicich] I was involved in the physical therapy, the occupational therapy, and speech/language therapy. I was having difficulty concentrating, memorizing faces. Using strategies to keep myself on track was really helpful for me because it kind of compensated for a lot of those areas where I was weak. [Dr. Harman] Anybody who works here would be the first to admit that it is a big, clunky system. But we see great progress in our patients, and it's the result of the interdisciplinary team approach. It's also the fact that the patient is part of the interdisciplinary team, and it's the patient who directs the care. Adam says, "I want to work with Congress. I want to get down there, I want to make a difference for other vets." And it's up to us to help him get there. [narrator] Adam knows firsthand the VA's programs for veterans with TBI. [Adam Anicich] One of those ways that VA helps individuals with cognitive impairments is through what we call Independence Way. Veterans and individuals with TBI can come and experience an artificial reality, if you will. There's a mock convenience store to practice pricing out your food, staying within a budget, and incorporating tax and other costs. There's also a fully functioning ATM that allows individuals to practice their banking transactions. Veterans and individuals with TBI can really get the real experience of interacting with an ATM, but at the same time they're in a safe, secure environment within VA. [Dr. Harman] We are very focused on getting our service members back into the community, back into academics, back into the workforce. [Dr. Scholten] We've seen great recoveries in a variety of different individuals. Our goal is not to rehab someone to live successfully in the hospital; we want to rehabilitate them so they can be as independent as possible in the community. [narrator] The VA's interdisciplinary TBI program has provided Vincent links to recreational therapy, including horseback riding, kayaking, and even golf. [Vincent Short] Recreational therapy has been like a lifesaver to me. [golf club swooshing, hitting ball] Lots of problem solving going on. It just really forces one to think on their feet quickly [club swooshing, hitting ball] without the pressure of failure ever being an option. That's not what you're worried about. You're not worried about failing. [Dr. Harman] Recreation therapy is an integral part of the polytrauma team. It gets people out of the hospital, make plans. It really is essential to getting service members out into the community and reintegrated into socialization again. [♪ music ♪] [Vincent Short] There's no shame anymore. There was shame. Once you know you've taken all the responsibility that you can for yourself, recognizing you're not in this alone, whatever team you're a part of, whoever your doctors are, you need to go and share this with them. I feel very empowered while at the same time I still recognize I've got a long way to go. [to doctor] Okay. I'm able. That's it. I'm able. I feel able again. [♪ music ♪]
Posted on BrainLine August 1, 2013.

Produced by Drescher Films for, a WETA website.