The stressful and often dangerous situations faced by military personnel and first responders can place them at high risk for emotional, cognitive, and physical complaints. Police, firefighters, and emergency medical technicians (EMTs) often experience depression, anxiety, and post-traumatic stress in the aftermath of life-threatening events. The same is true for military staff and veterans, where nearly one of every three service people is affected by traumatic brain injuries (TBIs) and post-traumatic stress disorder (PTSD). These invisible wounds also affect their families and can be passed from one generation to the next.
Care provided by the Veterans Administration (VA) and through routine health care is often insufficient to address their specific needs. The MossRehab Institute for Brain Health (MRIBH) was established to bridge this gap. The new program will offer comprehensive and specialized care for veterans and first responders who experienced mild to moderate TBIs (primarily concussions) and PTSD.
Based on the national cognitive and mental wellness model launched by the Marcus Institute for Brain Health (MIBH), the MossRehab Institute for Brain Health (MRIBH) is a community-based clinical outreach program that addresses the brain health issues associated with mild to moderate head trauma and concussions that vets and first responders may face from service in demanding situations.
“MossRehab will offer specialized services to meet the needs of service members specific functional issues and improve their quality of life,” explains Alberto Esquenazi, MD, the John Otto Haas Chair of PM&R and Chief Medical Officer at MossRehab, who also serves as Senior Vice President for Rehabilitation and Post-Acute Care, Jefferson Health.
MRIBH is backed by the long-term experience and established practices of MossRehab traumatic brain injury (TBI) rehabilitation program and the transformative research of the Moss Rehabilitation Research Institute. MossRehab is one of only 16 federally funded Traumatic Brain Injury Model Systems of Care in the U.S., making it a center of excellence in the research and clinical care of TBI. In addition, the relationship with MIBH also provides access to clinical data from veterans and emergency responders from around the country.
“MossRehab is currently the only healthcare institute partnering with the MIBH that offers a legacy of serving patients with mild to severe traumatic brain injuries as well as providing an impressive set of research on persons with TBI,” says Dr. Esquenazi.
MRIBH will provide services in two phases: evaluation and intervention. During an evaluation, individuals interested in receiving care are assessed through tests and interviews for three to five days to determine if their main concern is within the scope of the MRIBH. A team of dedicated veteran coordinators, therapists, social worker, counselors, physician staff and program director, work to determine a candidate’s eligibility.
“The initial evaluation helps determine an individual’s issues,” says Dr. Esquenazi. “We might interview ten people during an initial assessment and bring three people into the program with similar profiles to work as a group.”
During the intervention phase, those accepted into the program are offered personalized treatment as part of a three-week program. Interventions might be cognitive, physical, emotional and/or psychosocial. Family members attend at the end of the program so that they can learn how to provide support at home.
Based on patient needs, team clinicians may include a physician who is a rehabilitation specialist in traumatic brain injury and experienced with the needs of service members and the consequences of concussion; a psychologist and a neuropsychiatrist who provide emotional and mental health support; and therapists of different disciplines (physical, occupational, recreational, art, etc.). Administrative staff will direct programs and coordinate travel for individuals while clinical staff monitors their health throughout the program.
“The level of intervention from our staff depends on the individual’s specific issues,” says Dr. Esquenazi. “Patients may complain of dizziness, double vision, recurrent headaches, and other symptoms. We might directly treat the complaint but most important address the root causes of it.”
For instance, double vision is a problem associated with balance disturbance and may result in the inability to run due to a lack of coordination for fast movements. Treating balance issues through therapy can help compensate for double vision so that person can walk or run again. In another scenario, someone with dizziness may be re-trained to allow driving so that they can return to work.
“Teams periodically meet during the intervention period to discuss best approaches to treatments, results and the need for therapy adjustments,” says Dr. Esquenazi. “We continuously make adjustments to provide more effective care to achieve best results.”
MRIBH will begin initial patient assessments at MossRehab Elkins Park in July 2022. In October, the program will move to a dedicated facility at The Station in Willow Grove, PA. In the first year, the program anticipates treating 60 veterans and first responders, ramping up to address the needs of 1,000 service members and their families over five years.
“Our veterans coordinator is gathering the names of individuals who already showed interest as well as coordinating with the region VAs,” says Dr. Esquenazi. “Services are free to individuals as the program will cover all insurance co-pays and the cost of logistics and meals.”
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