The Transition of Returning Disabled Veterans: Easy as apple pie

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The Transition of Returning Disabled Veterans
Easy as apple pie?
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Disclaimer

• The views expressed in this presentation are
  those of the authors and do not reflect the
  official policy of the Department of the Navy,
  Department of Defense, U.S. Government or the
  University of Massachusetts, unless otherwise
  stated.

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Workshop Overview

• Discuss Iraq/Afghanistan veteran profile.
• Review pathologies of combat
• Post Traumatic Stress Disorder (PTSD)
• Traumatic Brain Injury (TBI)
• Provide insight into dealing with academic
  challenges within the combat veteran population.
• Apply practical learning techniques and solutions
  to common learning difficulties.

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Iraq/Afghanistan Veteran Profile

• Gender 85 male 15female.
• Military service 40 of those deployed are
  National Guard/Reserve.
• Age older population.
• Since October 2001 gt1.5 million men and women
  deployed to Iraq and Afghanistan 280,000
  re-deployed.
• 89-95 reported being ambushed or attacked.
• 93-97 reported being shot at.
• 86-87 reported knowing someone who was
  seriously injured or killed.
• 
  (NCPTSD Nov 2006)

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Historical Notes Post Traumatic Stress Disorder

• Homers account of Trojan War tells of Achilles
  disintegration
• following the battlefield death of his best
  friend, Petroclus.
• 1800s Civil War soldiers suffered with
  Nostalgia, Soldiers Heart.
• WWI, WWII, Korean War Shell shock, Combat
  Fatigue.
• 1970s misdiagnosed Vietnam veterans maladies
  ranged from
• alcoholism to schizophrenia Post-Vietnam
  Syndrome.
• 1980 Post Traumatic Stress Disorder listed as
  sub-category to anxiety disorder with APA.
• 1987 Post Traumatic Stress Disorder recognized as
  a diagnosis, following National Vietnam Veterans
  Readjustment Study.

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Incidence of Post Traumatic Stress Disease

• One in six Iraq veterans have suffered from Post
  Traumatic Stress Disorder, (PTSD) major
  depression or generalized anxiety.
• One in nine Afghanistan veterans have suffered
  from PTSD, major depression or generalized
  anxiety.
• Many unreported cases due to stigma perceived.
• General population prevalence of PTSD is 4-6
  10 will have clinically diagnosable PTSD
  sometime in their lives.
• 
  (NCPTSD 2006)

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Its All in Their Head

• Post Traumatic Stress Disorder
• Acute Stress Disorder
• Traumatic Brain Injury
• Depression/Suicide
• Drug and alcohol abuse

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What is Post Traumatic Stress Disorder?

• Post Traumatic Stress Disorder (PTSD) is a
  debilitating condition that can occur after
  exposure to a terrifying event or ordeal in which
  grave physical harm occurred or was threatened.

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• PTSD is the inability to flip the switch
• from combat soldier to every day citizen to
• stop reliving the war at so high a frequency
  that it interferes with the ability to
• function.
• 
  Betsy Streisand
• 
  U.S. News World Report, Oct. 2006

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Signs and Symptoms of PTSD

• Spontaneous re-experiencing or reliving of event
  (flashbacks), intrusive memories
• Increased or hyper-vigilance
• Hyper-arousal
• Avoidance behavior (activities/situations/people/
  conversations avoided which are associated with
  the trauma)

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Signs and Symptoms of PTSD

• Social impairment, detachment, loss of interest
• Memory deficits
• Concentration difficulty
• Numbing, referred to as a freezing of the heart
• Anger outbursts
• Feelings of intense guilt
• Recurrent dreams/nightmares/frightening thoughts
• Sleep disorders

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Physical Changes Found In PTSD

• Elevated levels of stress hormones such as
  noradrenalin and adrenaline.
• Hyperactive sympathetic nervous systems.
• Exaggerated increases in heart rate and blood
  pressure.
• Reduction in the volume of the hippocampus
• and amygdale region of the brain (learning
  and memory).
• Alteration in brain processes.

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• MRI View of
• Post Traumatic Stress Disorder

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How prevalent is PTSD in Veteran population?

• About 30 of men and women who have been in a war
  zone experience Post Traumatic Stress Disorder.
• More than half of all male Vietnam veterans, and
  just under half of Vietnam female veterans have
  experienced clinically serious stress reaction
  symptoms.
• Gulf War estimates are as high as 8.
• 
  (NCPTSD 2006)
  
  
  

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Obstacles to Treatment

• Over forty percent of those experiencing
  mental health problems associated with combat
  refuse treatment due to fear that treatment will
• - hurt their image
• - ruin their military
  careers/promotions
• - cause negative perception from peers
  and
• leadership

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What is Traumatic Brain Injury (TBI)?

• A TBI is a blow or jolt to the head or a
  penetrating
• head injury that disrupts the function of the
  brain.
• Blasts are a leading cause of TBI for active duty
• military personnel in war zones. Closed head
  injury may
• be missed when more visible injuries require
  immediate
• attention. The severity of injury to the brain
  ranges from
• mild and undetected, to life threatening.
• 
  

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Blast Injury/TBI

• Primary Direct exposure
• Secondary Impact from blast energized debris
• Tertiary Displacement of the individual by the
  blast and impact

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Mild Traumatic Brain Injury(MTBI)

• Caused by external physical force to the head
• In war zone caused by sudden explosion from
  Improvised Explosive Device (IED),
  Rocket-Propelled Grenade (RPG), land mines, bombs
• Shaken Soldier Syndrome.
• The signature injury/disability from current
  war.
• Understanding the complexity of this injury is
  critical to helping our troops achieve optimal
  transition

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Signs and Symptoms of mTBI

• Mild Traumatic Brain Injury
• Insomnia/sleep problems
• Impaired memory
• Poor concentration/attention
• Depression
• Anxiety
• Irritability/mood changes
• Headache
• Dizziness/Imbalance
• Excessive Fatigue physical and mental
• Noise/light intolerance
• Ringing in the ears (tinnitus)
• Vision change blurred or vision

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mTBI vs. PTSDOverlapping Signs and Symptoms

• Mild Traumatic Brain Injury
• Insomnia/sleep problems
• Impaired memory
• Poor concentration/attention
• Depression
• Anxiety
• Irritability/mood changes
• Headache
• Dizziness/Imbalance
• Excessive Fatigue physical and mental
• Noise/light intolerance
• Ringing in the ears (tinnitus)
• Vision change blurred or double

• Post Traumatic Stress Disorder
• Insomnia
• Impaired Memory
• Poor concentration/attention
• Depression
• Anxiety
• Irritability/mood changes
• Stress symptoms
• Emotional numbing
• Avoidance

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mTBI

• Diagnosis and treatment made through soldiers
  verbal history and/or witnesses account.
• Technological advances in battlefield gear,
  reduces deaths, increases severity of injuries to
  head and limbs.
• Modern military medicine allows for life-saving
  trauma care in the war zone with immediate
  transport to definitive care and rehabilitation.
• Incidence of MTBI in Iraq 1 in 10 has sustained
  a concussion or more.

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Cognitive Consequences of mTBI

• Attention and concentration difficulty
• Information processing (speed and efficiency)
• Learning and memory difficulty
• Abstract reasoning sluggish
• Executive functions slowed
• - problem solving
• - planning
• - Insight/awareness
• - Set shifting
• - Sequencing

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Classroom Challenges

• Concentration Difficulties
• Memory/Learning/Info retrieval
• Time Management/Performing or Completing Tasks
• Stress
• Sleep Disturbance
• Panic Attacks
• Emotions