Treating the 'Signature Wound' of War

VCU collaboration with VA Medical Center brings care to TBI soldiers and marines

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The traumatic brain injury has been labeled the “signature wound” of war, often caused by powerful blasts and Improvised Explosive Devices. And without appropriate care, soldiers returning from the war zone can experience continual issues and varying symptoms over an extended period.

But a partnership between the VCU Medical Center’s Department of Physical Medicine and Rehabilitation and the Veterans Affairs Hospital System has earned a national reputation as a comprehensive Polytrauma center in the country – treating seriously injured American soldiers and many with TBI while deployed. 

The term Polytrauma was coined by the VA to describe injuries to multiple parts of the body and organs occurring as a result of blast-related wounds.

Since the War on Terror commenced in October 2001 with Operation Enduring Freedom in Afghanistan followed by Operation Iraqi Freedom in May 2003, nearly two million military personnel have been deployed to Iraq or Afghanistan.

According to David Cifu, M.D., chair and Herman J. Flax M.D., Professor in the Department of Physical Medicine and Rehabilitation, the combat operations in Iraq and Afghanistan have resulted in a complex pattern of blast-related injuries from artillery, improvised explosive devices, mines and rocket-propelled grenades. To date, there have been 2,500 severe TBIs and more than 100,000 mild TBIs.

“What’s unique about the care that the patients receive through our program is that the Hunter Holmes McGuire VA Medical Center offers a service member-oriented treatment environment with active duty Marines and Soldiers embedded in the treatment team,” said Cifu. “There’s also a return to duty focus for all of our programs as opposed to just the focus on returning home and there are no specific limits on a patient’s length of stay.”

In 1992, the Departments of Defense and Veterans Affairs established seven lead Centers of Excellence for TBI research and clinical care to prepare for potential combat-related injuries in future military conflicts, including four sites in the VA system and one at the Hunter Holmes McGuire VA Medical Center in Richmond.

In response to the large number of returning service members with TBI complicated by multiple concurrent injuries, Congress allocated funding to provide state of the art care and rehabilitation in the VA in 2005 and this funding was utilized to develop the Polytrauma System of Care to provide state-of-the-art, integrated care for brain injury and polytrauma at more than 150 VA facilities. Five of these facilities – Polytrauma Rehabilitation Centers – provide comprehensive inpatient and outpatient care for all levels of injury and disability.

“The Richmond VAMC is nationally known for both the expertise and care associated with supporting the recovery of both the service member but also their loved ones,” said Shane McNamee, M.D., chief, PM&R services at McGuire VA.  “While many have sustained TBI and other common injuries, the injury characteristics are more complex than civilian-based injuries for a host of reasons.”

These sites were chosen because they had served as the TBI Centers of Excellence since 1991. VCU's Department of PM&R faculty have served in physician leadership and clinical positions in the Richmond VA for more than 30 years, including these TBI and polytrauma centers.

Active duty service members and veterans who have polytrauma injuries that would benefit from either inpatient or outpatient rehabilitation services are referred directly from their acute care facilities to the Richmond VA for admission to the programs.

The Richmond VA has been receiving service members and veterans from the Iraq and Afghan conflicts since the beginning of the wars in 2003 and has cared for more than 500 severely injured service members and veterans as inpatients and several thousand less severely injured as outpatients.

Other specialized services for family members also include a Fisher House for overnight stays, no limits on visiting hours, psychological counseling and direct telehealth/video linkages to all major military hospitals and treatment facilities.

In addition, the Polytrauma Transitional Rehabilitation Program at the Richmond VA offers a three-month stay for individuals who are unable to reintegrate into their home community and return to work. The program is not available in the private sector.

Cifu says that there is various ongoing research in the area of TBI such as care management of combat-related TBI, telehealth monitoring of sleep in TBI or post-traumatic stress disorder and studies on longitudinal outcomes for blast-related TBI.

The VCU Department of Physical Medicine and Rehabilitation has been ranked among the top 20 programs in the country by U.S. News and World Report. The department has grant-funded research investigating traumatic brain injury, spinal cord injury, return-to-work for people with disabilities and pain management. Other department programs focus on stroke, neural tumors, pediatric disability, pulmonary rehabilitation, limb deficiency and sports medicine.

The Hunter Holmes McGuire VA Medical Center is a 399-bed facility offering primary, secondary and tertiary health care in medicine, surgery, neurology, rehabilitation medicine, intermediate care, acute and sustaining spinal cord injury, skilled nursing home care and palliative care.