Odette A. Harris MD, MPH, FAANS
Department of Neurosurgery Stanford University Medical Center
Director, Defense Veterans Brain Injury Center
Stanford, CA
Advancement of medical knowledge has often occurred during and after wars. For neurosurgery, the Civil War brought an understanding of peripheral nerve injuries and infection prevention, while World War I enabled a clearer understanding of penetrating head injuries. Operations in the Middle East — Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) — resulted in significant knowledge of medical and rehabilitation care of the traumatic brain injury (TBI)/polytrauma injured patient. The U.S. Department of Veterans Affairs (VA) has also elevated its own medical readiness, accountability to service and responsibility toward its stakeholders.
The delivery of rehabilitation care to veterans with TBI and associated trauma has gone through a significant transformation since our country’s involvement in OEF and OIF. In 2005, the VA developed a memorandum of agreement with the U.S. Department of Defense (DoD) to care for and rehabilitate active duty service members injured in theater and non-combat accidents. A Polytrauma System of Care (PSC) within the VA was created, assigning five sites throughout the United States as centers of comprehensive care for these patients. This program incorporated a cadre of specialized clinicians and services (including neurosurgeons) in an integrated, interdisciplinary infrastructure that leveraged geographically established resources and networks to ensure a continuum of care for injured service members.
2016 marked the tenth anniversary of the initiation of this effort. Over this last decade, thousands of military service members with injuries ranging from mild to catastrophic have been treated. Included were women and men with, various levels and combinations of TBI, multi-limb amputation, visual impairment, post-traumatic psychological conditions and other associated disorders. The result of this national effort has been far reaching, with the progressive development of an integrated system of rehabilitation that affords improved coordinated care for patients as a whole. The resulting advancements in medical and rehabilitation delivery have been remarkable, and the potential for further landmark improvements and innovations in facilitating recovery in all rehabilitation patients is now deemed limitless. It is essential that the attention to, and resource allocation toward, this effort be sustained to continue this progress.
Notable breakthroughs in TBI/polytrauma care of the injured patient are highlighted below:
- TBI and Visual Disorders. There has been significant knowledge gained regarding TBI and concomitant visual disorders sustained by post blast injuries. The work of Cockerham and Goodrich revealed significant occult visual conditions that otherwise has gone undetected. This work resulted in the prestigious Olin Teague Award.
- Emerging Consciousness. Severely brain-injured patients who would previously die despite aggressive acute resuscitative efforts are now surviving and subsequently admitted into the PSC’s as emerging consciousness (coma) patients. The organized interdisciplinary efforts of the rehabilitation team allowed further research directed toward understanding and impacting the outcome of these patients. Codified management algorithms and nuances in approach to clinical and pharmacologic management of these patients developed, which increased the probability of patients emerging from a coma. More improvement in cognitive recovery than previously obtained in this population was also achieved. Additional sustained attention and care to these TBI patients afforded much better prognosis with improved chances of emerging from a coma.
- Women and Brain Injury. With the enlisting of more women during this conflict, a better understanding of the effects of brain injury and other associated trauma on women has also been gained and will hopefully enable more specifically target rehabilitation efforts.
- Reintegration. As part of the rehabilitation process, more efforts during these years have appropriately given high priority to facilitating the patient’s reintegration back into society and family. Progress has already been attained, and additional efforts continue.
These contributions are staggering and meaningful. Neurosurgeons have worked to advance and achieve these results. Ongoing success requires continued attention and designated resources toward providing this level of care. This will ensure the level of readiness and attention to duty that is expected of it from the citizens and governing bodies of the United States.
Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #ConcussionFacts.
