Community Reintegration of Veterans Takes Center Stage
Two important pieces of legislation, one pending and one Executive Order, address the treatment of traumatic brain injury (TBI) and mental health issues in veterans and active military. The National Traumatic Brain Injury Research and Treatment Improvement Act of 2015 is a pending bill introduced by Representatives Bill Pascrell, Jr. (D-NY) and Thomas J. Rooney (R-FL) to establish a surveillance system to track the incidence and circumstances precipitating traumatic brain injury and establish a scientifically credible, publicly available and integrated National Traumatic Brain Injury Surveillance System. Experts from the Departments of Defense, and Veterans Affairs are drawing the roadmap for the National Research Action Plan, in response to an executive order signed by President Barack Obama to improve access to mental health services for veterans, service members, and military families.
The incidence of TBI in our military and veteran population is estimated at20% of Iraq veterans, or 150,000 to 300,000 service members, andthe incidence of PTSD, and suicidal behaviors in our active duty military personnel and veterans has also increased significantly. Co-occurring disorders, such as depression and substance abuse complicate the prevention and treatment of these behaviors, which can result in increasing homelessness as veterans struggle to reintegrate into their communities post-deployment and discharge, due to inadequate support networks and lack of employment.
Drs. William Kearns and Tina Dillahunt-Aspillaga are researchers in the Department of Rehabilitation and Mental Health Counseling at the College of Behavioral and Community Sciences at the University of South Florida, who are actively engaged in rehabilitation research and reconnecting veterans with their community and work life.
Dr. William Kearns is an original author of the James A. Haley Smart Home project, which uses a high tech indoor position tracking system to help patients reestablish skills and activities of daily living possibly lost due to injury. Wrist tags that function like an indoor GPS allow clinicians to follow patients’ progress closely during their months of treatment and enable them to remind patients about appointments, activities, and reinforce skill sets with text or video prompts.
Building upon earlier studies of persons with dementia, Dr. Kearns has discovered that persons with dementia and with TBI move about their environments more randomly, in a manner resembling that of an intoxicated person. Using fractal mathematics employed for quantifying the classic “drunkard’s walk,” Dr. Kearns can precisely measure each patient’s movement variability and has published findings showing that the measure (Fractal Dimension – aka Fractal D) declines over time in those with better clinical outcomes. A veteran with a TBI may enter the Smart Home with high Fractal D, indicating difficulty navigating the space. Literally, he or she relearns how to navigate interior and exterior spaces and thereby reducing spatial confusion. Over time, and through rehabilitation, Fractal D begins to decrease, as he or she is able to more readily navigate the building or an outside space, with less weaving and an increased ability to remember how to get from point A to point B. Dr. Kearns is working to extend “smart” technology to a smartphone to provide contextual support both inside and outside of the home environment.
Community reintegration is an issue that affects caregivers and families as veterans with TBI come back to a civilian community. Working with Drs. Gail Powell-Cope and Karen Besterman–Dahan (PIs), HSR&D Center of Innovation on Disability and Rehabilitation Research (CINDRR), James A. Haley Veterans Hospital (JAHVA) on an ethnographic study, Dr. Dillahunt-Aspillaga seeks to better understand of the experiences of veterans with moderate to severe TBI, families and community reintegration workers in the transition to and sustainability of living in local communities. While many community integration projects address issues of urban and suburban veterans, Dr. Dillahunt and Karen Besterman–Dahan (PI), are examining healthcare partnerships to increase outreach with and access to healthcare by veterans who are transitioning into rural communities.
One major indicator for successful community integration for veterans with TBI is return to work. Dr. Dillahunt-Aspillaga and Dr. Stephen L. Luther, CINDRR/JAHVA are exploring how employment concerns of veterans with deployment-related-PTSD are associated with health-related quality of life. She is also working with Dr. Risa Nakase-Richardson on the VA Polytrauma Rehabilitation Center (PRC) Traumatic Brain Injury Model System (TBIMS), a longitudinal multi-center study. They are examining predictors of employment outcomes in veterans with TBI.
For more information about these and other veteran-focused projects conducted at the College of Behavioral and Community Sciences at the University of South Florida, please see the RMHCand Collegewebsites.
For more about the National Traumatic Brain Injury Research and Treatment Improvement Act of 2015(introduced by Bill Pascell, Jr. (D-NY) and Thomas J. Rooney (R-FL), the National Research Action Plan, visit these links.
CITATIONS: Jasiewicz, J., Kearns, W., Craighead, J., James L. Fozard, J. L., Steven Scott, S., & Jay McCarthy J. M. (2011). Smart rehabilitation for the 21st century: The Tampa Smart Home for veterans with traumatic brain injury. JRRD: Journal of Rehabilitation Research & Development, 48(8), vii-xviii. Available http://www.rehab.research.va.gov/jour/11/488/pdf/jasiewicz488.pdf
Kearns, W. D., Fozard, J. L., Schonfeld, L., Scott, S., & Marshall, K. (2015). Elevated movement path tortuosity in voluntary outdoor ambulation in community-dwelling veterans with a history of traumatic brain injury. Journal of Head Trauma Rehabilitation, 30(1), E8-14. doi:10.1097/htr.0000000000000021 ABSTRACT
Dillahunt-Aspillaga, C., Finch, D., Massengale, J., Kretzmer, T., Luther, S. L., & McCart, J. A. (2014). Using information from the electronic health record to improve measurement of unemployment in service members and veterans with mTBI and post-deployment stress. PLoS One, 9(12), e115873. doi:10.1371/journal.pone.0115873 FULL-TEXT