The history and evolution of traumatic brain injury rehabilitation in military service members and veterans.

The field of traumatic brain injury has evolved since the time of the Civil War in response to the needs of patients with injuries and disabilities resulting from war. The Department of Veterans Affairs and the Defense and Veterans Brain Injury Center have been in the forefront of the development of the interdisciplinary approach to the rehabilitation of soldiers with traumatic brain injury, particularly those injured from the recent conflicts in Iraq and Afghanistan. The objectives of this literature review are to examine how the casualties resulting from major wars in the past led to the establishment of the current model of evaluation and treatment of traumatic brain injury and to review how the field has expanded in response to the growing cohort of military service members and veterans with TBI.

Veterans with history of mild traumatic brain injury and posttraumatic stress disorder: challenges from provider perspective.

The Department of Veterans Affairs (VA) has separate clinical structures and care processes for traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). However, because veterans are returning from the wars in Iraq and Afghanistan with TBI (most frequently mild TBI [mTBI]) and PTSD, the VA needs to evaluate current service delivery systems. We conducted key informant interviews with 40 providers from across the United States who represented separate clinical teams providing specialized TBI or PTSD services.

Practice changes associated with the Department of Veterans Affairs' Family Care Collaborative.

Background: The Department of Veterans Affairs (VA) provides rehabilitation for veterans with moderate to severe war injuries through four regional Polytrauma Rehabilitation Centers (PRCs). To standardize and improve care provided to these veterans' family members, health services researchers partnered with program leaders and rehabilitation specialists to implement a family care quality improvement collaborative.

Objective: To describe practice changes associated with the Family Care Collaborative's intervention.

Rehabilitation needs of combat-injured service members admitted to the VA Polytrauma Rehabilitation Centers: the role of PM&R in the care of wounded warriors.

Objective: To describe the rehabilitation course of combat-injured service members who sustained polytraumatic injuries during the current wars in and around Iraq and Afghanistan.

Design: Retrospective descriptive analysis.

Setting: Department of Veterans Administration Polytrauma Rehabilitation Centers (PRCs).

Rehabilitation of traumatic brain injury in active duty military personnel and veterans: Defense and Veterans Brain Injury Center randomized controlled trial of two rehabilitation approaches.

Objectives: To determine the relative efficacy of 2 different acute traumatic brain injury (TBI) rehabilitation approaches: cognitive didactic versus functional-experiential, and secondarily to determine relative efficacy for different patient subpopulations.

Design: Randomized, controlled, intent-to-treat trial comparing 2 alternative TBI treatment approaches.

Setting: Four Veterans Administration acute inpatient TBI rehabilitation programs.

Developing a polytrauma rehabilitation center: a pioneer experience in building, staffing, and training.

The military operations in Iraq and Afghanistan have resulted in patterns of injury not commonly seen in previous conflicts. Improvised explosive devices are the primary weapon, and exposure to blast is the most common mechanism of injury. Blasts can result in polytrauma injury, in which multiple body systems, including the head and brain, are injured.

Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror.

Objective: To describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.

Design: Observational study based on chart review and Department of Veterans Affairs (VA) administrative data.

Setting: The 4 VA polytrauma rehabilitation centers (PRCs).

"To care for him who shall have borne the battle and for his widow and his orphan" (Abraham Lincoln): the Department of Veterans Affairs polytrauma system of care.

The initiation of combat in Iraq and Afghanistan has resulted in a new cohort of active-duty service members and veterans seeking rehabilitation care through the U.S. Department of Veterans Affairs (VA).

Program development and defining characteristics of returning military in a VA Polytrauma Network Site.

The conflicts in Iraq and Afghanistan have resulted in a new generation of combat survivors with complex physical injuries and emotional trauma. This article reports the initial implementation of the Polytrauma Network Site (PNS) clinic, which is a key component of the Department of Veterans Affairs (VA) Polytrauma System of Care and serves military personnel returning from combat. The PNS clinic in Palo Alto, California, is described to demonstrate the VA healthcare system's evolving effort to meet the clinical needs of this population.

Practical and theoretical considerations in designing rehabilitation trials: the DVBIC cognitive-didactic versus functional-experiential treatment study experience.

This is a descriptive article outlining issues in the development and implementation of a multisite randomized rehabilitation trial for brain injury treatment. The goal of this article is to present practical and theoretical considerations in designing and conducting multicenter rehabilitation trials. Practical issues discussed include (a) treatment setting, (b) patient accessibility in determining the research question of interest, as well as inclusion and exclusion criteria, (c) research protocol development in the context of rehabilitation standard of care, and (d) protocol treatments in the context of realistic cost-benefits analysis.