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Chung JS, Jouk A, Licona NP, Terry JH, Harris OA. In her own words: a phenomenological analysis of stories told by female service members and veterans after traumatic brain injury. Disabil Rehabil 2023; 45:4086-4093. [PMID: 36398683 DOI: 10.1080/09638288.2022.2146766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Given the majority of Service Members and Veterans (SMV) who have sustained a traumatic brain injury (TBI) are male, the female experience with TBI has not been captured in the general understanding of TBI. To improve understanding of the experience of female SMV after TBI utilizing a qualitative phenomenological approach on stories as told by female SMV. MATERIALS AND METHODS Ten female SMV participated in storytelling workshops and created video stories documenting their personal experience with TBI. Workshops were hosted by the VA Palo Alto Health Care System Polytrauma System of Care (VAPAHCS PSC). A grounded thematic analysis was conducted on the video stories. RESULTS Three common content themes emerged from all the stories: (1) negative psychological and emotional impacts of TBI, (2) acceptance and healing process associated with recovery, and (3) military contexts. Negative psychological and emotional impacts included intrapersonal impacts such as negative emotions, suicidal ideation, and dealing with cognitive and physical challenges, and interpersonal impacts in relationships and loss of independence. Notably, all the stories acknowledged an acceptance and healing process, characterized by several subthemes including motivational factors, TBI education, spirituality, and advocacy work. Lastly, each story mentioned military context, highlighting the unique experience within this population. CONCLUSIONS This phenomenological examination adds evidence-based understanding to the experience after TBI among female SMV. Each story uncovered nuanced and multifaceted issues that women experience in their TBI recovery. Our findings provide context to guide future intervention on the care, support, and TBI recovery for the female SMV population.
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Affiliation(s)
- Joyce S Chung
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Alexandra Jouk
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Nytzia P Licona
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- University of Illinois Chicago, Palo Alto, CA, USA
| | - Jennifer H Terry
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Odette A Harris
- Polytrauma System of Care, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Stanford University, Stanford, CA, USA
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Lee S, Mansoor S, Amatya B, Sayed T, Galea M, Khan F. Functional outcome and community reintegration of survivors following disasters: A community-based survey in pakistan. THE JOURNAL OF THE INTERNATIONAL SOCIETY OF PHYSICAL AND REHABILITATION MEDICINE 2021. [DOI: 10.4103/jisprm-000115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Devendra A, Nishith P G, Dilip Chand Raja S, Dheenadhayalan J, Rajasekaran S. Current updates in management of extremity injuries in polytrauma. J Clin Orthop Trauma 2021; 12:113-122. [PMID: 33716436 PMCID: PMC7920200 DOI: 10.1016/j.jcot.2020.09.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Injury-related morbidity and mortality have been one of the most common causes of loss in productivity across all geographic distributions. It remains to be a global concern despite a continual improvement in regional and national safety policies. The establishment of trauma care systems and advancements in diagnostics and management have improved the overall survival of severely injured. A better understanding of the physiopathological and immunological responses to injury led to a significant shift in trauma care from "Early Total Care" to "Damage Control Orthopedics." While most of these algorithms were tailored to the philosophy of "life before limb," the impact of improper fracture management on disability and societal loss is increasingly being recognized. Recently, "Early Appropriate Care" of extremities has gained importance; however, its implementation is influenced by regional health care policies, available resources, and expertise and varies between low and high-income countries. A review of the literature was performed using PubMed, Embase, Web of Science, and Scopus databases on articles published from 1990 to 2020 using the Mesh terms "Polytrauma," "Multiple Trauma," and "Fractures." This review aims to consolidate on guidelines and available evidence in the management of extremity injuries in a polytraumatized patient to achieve better clinical outcomes of these severely injured.
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Affiliation(s)
- A. Devendra
- Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India
| | - Gupta Nishith P
- Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India
| | - S. Dilip Chand Raja
- Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India
| | - J. Dheenadhayalan
- Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India
| | - S. Rajasekaran
- Dept of Orthopaedics, Trauma and Spine Surgery, Ganga Medical Centre & Hospitals Pvt Ltd, 313, Mettupalayam Road, Coimbatore, 641 043, Tamil Nadu, India
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Lee JM, Herrera-Escobar J, Apoj M, Al Rafai SS, Han K, Nehra D, Salim A, Brasel K, Kasotakis G, Velmahos G, Haider A, Kaafarani HM. The impact of in-hospital complications on the long-term functional outcome of trauma patients: A multicenter study. Surgery 2019; 166:398-402. [DOI: 10.1016/j.surg.2019.04.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/11/2019] [Accepted: 04/24/2019] [Indexed: 11/28/2022]
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Polytrauma Transitional Rehabilitation in the Veterans Administration: Implementing the Principles of Person-Centered, Participation-Oriented Rehabilitation. J Head Trauma Rehabil 2019; 34:135-140. [PMID: 31058755 DOI: 10.1097/htr.0000000000000456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To review principles of person-centered, participation-oriented (PCPO) rehabilitation and introduce their implementation in Veterans Administration (VA) Polytrauma Transitional Rehabilitation Programs (PTRPs). BACKGROUND Post-hospital rehabilitation for individuals with acquired brain injury (ABI) has evolved toward PCPO rehabilitation, an approach that makes participation goals identified by the person served and his or her significant others the primary focus of rehabilitation. Goals to reduce impairments and increase activities contribute to the achievement of primary participation goals. Research, primarily in the nonveteran population, confirms the effectiveness of PCPO rehabilitation. OVERVIEW In the civilian sector, PCPO programs are generally provided locally or regionally in outpatient or community settings to individuals with moderate-severe ABI associated with other traumatic injuries and comorbidities. Because of the geographical dispersion of veterans, the VA provides these services in residential centers serving larger geographical areas. The group of veterans served more often has sustained milder traumatic ABI associated with neuropsychiatric comorbidities, particularly posttraumatic stress disorder and depression. Measuring progress and outcome is important to establish a feedback loop for process improvement. VA PTRPs use state-of-the-science standardized outcome measures and methods for identifying successful cases, that is, the minimal clinically important difference. Vocational reintegration is an important element of PCPO rehabilitation. Articles in this special section detail the development and effectiveness of PTRPs.
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Dillahunt-Aspillaga C, Powell-Cope G. Community Reintegration, Participation, and Employment Issues in Veterans and Service Members With Traumatic Brain Injury. Arch Phys Med Rehabil 2019; 99:S1-S3. [PMID: 29406019 DOI: 10.1016/j.apmr.2017.04.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/10/2017] [Accepted: 04/15/2017] [Indexed: 10/18/2022]
Abstract
Traumatic brain injury (TBI) has been called the signature injury of the post-9/11 wars in Iraq, Afghanistan, and neighboring countries. Although similarities exist between veterans and service members with TBI, levels of severity and different constellations of coexisting comorbid conditions affect them differently. These conditions affect physical, cognitive, and emotional function, which in turn can complicate community reintegration (CR), or the ability to return to family, vocational, and community life. This special supplement of the Archives of Physical Medicine and Rehabilitation consists of articles written by accomplished teams from multiple disciplines, including anthropology, neuropsychology, nursing, occupational therapy, psychology, and rehabilitation sciences. Each article brings a different perspective to bear on what CR means for veterans and service members from examination of predictors and perceptions of veterans and service members and others to measurement studies. Collectively, this group of articles represents current thinking about CR and lays the groundwork for testing interventions to improve CR outcomes for veterans and service members (eg, employment, living situation, family life).
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Affiliation(s)
- Christina Dillahunt-Aspillaga
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL; Rehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL
| | - Gail Powell-Cope
- Health Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL.
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Koehmstedt C, Lydick SE, Patel D, Cai X, Garfinkel S, Weinstein AA. Health status, difficulties, and desired health information and services for veterans with traumatic brain injuries and their caregivers: A qualitative investigation. PLoS One 2018; 13:e0203804. [PMID: 30208083 PMCID: PMC6135487 DOI: 10.1371/journal.pone.0203804] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 08/25/2018] [Indexed: 01/22/2023] Open
Abstract
Traumatic brain injury (TBI) is considered the signature injury among military service member and Veterans who served in Operation Iraqi Freedom and Operation Enduring Freedom with over 360,000 individuals sustaining a first-time TBI in the military. These service members and Veterans, and their caregiver(s), must navigate multiple health systems and find experts across many fields of expertise to recover and optimize functionality. Twenty-two individuals, 10 caregivers of Veterans with TBI, 12 Veterans with TBI, participated in semi-structured interviews. Responses were coded using NVivo. Participants from both groups reported difficulties finding community supportive services (support groups) in local communities. Most participants identified the need for an advocate or point-person to help guide them to needed services and provide ongoing support in the post-acute health care recovery phase. Caregivers and Veterans desired a more personalized recovery plan from their medical professionals. When describing their ideal health information and services model most identified interactivity and twenty-four-hour availability as essential components. To provide Veterans and caregivers with optimal support and resources to navigate a complicated health services system, advocates and personalized care plans are needed. Future research should examine the feasibility and cost-effectiveness of these services.
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Affiliation(s)
- Christine Koehmstedt
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Susan E. Lydick
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Drasti Patel
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
| | - Xinsheng Cai
- American Institutes for Research, Washington, DC, United States of America
| | - Steven Garfinkel
- American Institutes for Research, Washington, DC, United States of America
| | - Ali A. Weinstein
- Center for the Study of Chronic Illness and Disability, College of Health and Human Services, George Mason University, Fairfax, Virginia, United States of America
- * E-mail:
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Andelic N, Howe EI, Hellstrøm T, Sanchez MF, Lu J, Løvstad M, Røe C. Disability and quality of life 20 years after traumatic brain injury. Brain Behav 2018; 8:e01018. [PMID: 29888869 PMCID: PMC6043714 DOI: 10.1002/brb3.1018] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/19/2018] [Accepted: 05/06/2018] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The study describes functional outcomes and health-related quality of life (HRQL) in patients with traumatic brain injury (TBI) 20 years postinjury. MATERIALS AND METHODS Forty-four survivors who acquired moderate and severe TBI during 1995-1996 were followed 10 and 20 years postinjury. Outcomes were Glasgow Outcome Scale Extended (GOSE), Community Integration Questionnaire (CIQ), and SF-36 questionnaire (SF-36). Multiple regressions were performed to examine the relationship between follow-up measurements, controlling for baseline demographics and injury severity. RESULTS There were no significant differences in baseline age and civil status between moderate and severe TBI, but patients with severe injury had significantly lower employment rates (p = 0.05). Mean age at 20-years follow-up was 50.8 (SD 11.4) years, and 73% were males. Most patients showed good recovery (52%) or moderate disability (43%). Disability levels remained stable between and within severity groups from 10 to 20 years. Community integration including social integration improved from 10 to 20 years (p = 0.01 and p = 0.005, respectively). HRQL remained stable, except for subscales Bodily Pain and Role Emotional (p = 0.02 and p = 0.06). Depression at 10 years and females were associated with poorer mental health, while productive activity at 10 years indicated better physical and mental health at 20 years postinjury, respectively. CONCLUSIONS Functional limitations persist even decades after moderate and severe TBI, with poorer prognosis for females and persons who were depressed at the 10-year follow-up. Development and evaluation of targeted long-term follow-up programs and access to rehabilitation services for these groups should be highlighted. Improved community integration despite stable functional limitations draws attention to long-term adaptation to adversity and illness.
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Affiliation(s)
- Nada Andelic
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Emilie I Howe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Torgeir Hellstrøm
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway
| | - Maria Fernandez Sanchez
- Institute on Community Integration (INICO), Faculty of Psychology, University of Salamanca, Salamanca, Spain
| | - Juan Lu
- Institute of Health and Society, Research Centre for Habilitation and Rehabilitation Models and Services (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway.,Division of Epidemiology, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Marianne Løvstad
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
| | - Cecilie Røe
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Ulleval, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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