- Email: [email protected]
Community Reintegration, Participation, and Employment Issues in Veterans and Service Members With Traumatic Brain Injury
Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2018;99(2 Suppl 1):S1-3
SPECIAL COMMUNICATION
Community Reintegration, Participation, and Employment Issues in Veterans and Service Members With Traumatic Brain Injury Christina Dillahunt-Aspillaga, PhD,a,b Gail Powell-Cope, PhD, ARNP, FAANa From the aHealth Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL; and bRehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL.
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). Archives of Physical Medicine and Rehabilitation 2018;99(2 Suppl 1):S1-3 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
Recent combat operations in Iraq, Afghanistan, and neighboring countries comprise the longest period of wars fought by the Unites States since the Vietnam War.1 As a result of these conflicts, some veterans and service members experience deployment-related difficulties and readjustment issues on returning home.1 Characteristics of these conflicts (eg, multiple deployments of veterans and service members, use of improvised explosive devices) have increased the rate of survival, but with physical, cognitive, and The Polytrauma Rehabilitation Center Traumatic Brain Injury (TBI) Model System collaboration is funded through an Interagency Agreement between the Department of Veterans Affairs and the Department of Education and the National Institute on Disability, Independent Living, and Rehabilitation Research. This research is sponsored by the Veterans Health Administrative Central Office, Veterans Affairs TBI Model System Program of Research and a subcontract from General Dynamics Health Solutions (no. W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center, U.S. Army Medical Research and Material Command, U.S. Department of Veterans Affairs (grant nos. 1 I50 HX001233-01 and W81XWH-13-2-0095), and U.S. Department of Defense Congressionally Directed Medical Research Programs. The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official position of the Department of Defense or any other federal agency, policy, or decision unless so designated by other official documentation. Publication of this article was supported by the American Congress of Rehabilitation Medicine. Disclosures: none.
emotional problems.1-5 Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common deployment-related health concerns.6 Veterans and service members with TBI often experience symptoms (eg, headaches, other pain), sleep disorders, and co-occurring mental health conditions (eg, adjustment disorder, anxiety disorder, depression, alcohol abuse/dependence, PTSD).7-9 Psychological problems and physical injuries can interfere with the veterans and service members experience of returning home and reintegrating into the community.7,10 Research priorities for the Department of Veterans Affairs center on ensuring continued care for veterans throughout their life span, with an emphasis on providing leading-edge care for conditions related to military service.6 Facilitating adjustment to life at home and in the community and to participation in social life roles is a Department of Veterans Affairs priority.10 Return to participation in life roles has been labeled broadly as community reintegration (CR).10 CR is an ultimate rehabilitation outcome for all disability groups, including those with disabilities that are combat-related and those that are none deployment-related.3,10-13 Participation in the community can
0003-9993/17/$36 - see front matter Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine http://dx.doi.org/10.1016/j.apmr.2017.04.013
S2 be challenging for veterans and service members because of the co-occurrence of TBI, PTSD, depression, severe mental illness, chronic pain, substance abuse, physical injuries, and sleep disorders.1,2 These conditions pose unique challenges to the current generation of veterans returning to prior relations, social roles, and living situations and seeking education or employment.1,14 Employment (engaging in paid or unpaid work), social life (engaging with friends and family members), and education are key dimensions of CR for veterans and service members.10 Considerable resources have been allocated to diagnose and treat disabilities in veterans and service members; however, despite these efforts, many veterans and service members continue to experience CR challenges.1 A comprehensive approach to CR that involves multiple participants and systems (veterans and service members, families, federal health care systems, private sector providers, and public providers) has been proposed to help veterans and service members set and achieve CR goals.1 This Archives of Physical Medicine and Rehabilitation supplement highlights chronic rehabilitation needs in the unique and important veterans and service members cohort and provides new information on the effects of postdeployment disorders and comorbidities on return-to-duty or CR and employment. This supplement on CR and veterans and service members with TBI includes studies addressing the critical needs in furthering our clinical and rehabilitation research agenda in this area. Findings from these studies will provide clinicians and researchers with: Current information on the effect of deployment disorders, conditions related to military service, and comorbidities on veterans and service members CR. Treatment implications and comparisons between military and civilian findings, which may be beneficial in service provision and rehabilitation planning. Shared knowledge of rehabilitation needs and treatment interventions that may facilitate implementation of more effective care for veterans and service members in the context of a chronic disease model and that may influence rehabilitation outcomes. Evidence for addressing deployment- and military servicerelated conditions, which require a comprehensive approach to reintegration. In total, the 12 articles in this issue address both veterans and military service members, and 2 articles include providers, vocational rehabilitation specialists, families, or stakeholders. The studies use a range of designs (eg, prospective cohort, crosssectional descriptive, case-control) and methods (eg, surveys, questionnaires, observations, performance-based testing), but no clinical trials of interventions are included. Five studies examined specific dimensions of CR (eg, employment, school, return to duty); the remainder examine CR globally. The first series of articles by Pogoda,15 Carlson,16 and colleagues focuses on supported employment for veterans and service members with TBI and provides patient and provider perspectives. Findings suggest there is a gap between vocational rehabilitation interest and vocational rehabilitation needs. Veterans and service
List of abbreviations: CR community reintegration PTSD posttraumatic stress disorder TBI traumatic brain injury
C. Dillahunt-Aspillaga, G. Powell-Cope members experience challenges accessing and using supported employment resources. Veterans Health Administration’s expansion of services that focus on career-building in a competitive environment for those with intense support needs has the potential to help veterans with TBI history become more successful in the workplace. Ensuring that veterans and service members with a history of TBI can access supported employment may help prevent downstream health and functional problems. Systematically identifying and referring those with employment and financial/ housing difficulties may help close this gap. The next series of articles examines functional outcomes, including employment stability17 and long-term functional outcomes.18 Improved understanding of functional outcomes in veterans and service members with TBI is important in both clinical and research settings. Additional articles in this supplement focus on veterans and service members with TBI and persistent TBI symptoms and the effect of comorbidities19,20; facilitators, barriers, and CR needs21,22; return to duty decision-making23; and participation measures.24 One final article assess associations between traumatic injuries and self-reported use of university services and describe student veteran perceptions of the impact of such services on academic success.25 In conclusion, much of the current research available on CR and veterans and service members with conditions related to military service is sparse and descriptive, does not provide comparisons with civilian populations, and does not include clinical trials of interventions to improve CR outcomes. Articles in this supplement, however, do compare and contrast findings with current civilian literature, which may be of great value to those providing services in civilian and military settings. Also, treatment implications are highlighted in studies predicting poor CR outcomes. Study findings on identifying veterans and service members who may be at risk for poor outcomes may be of interest to clinicians for directing at-risk veterans and service members to services which may facilitate CR. Results of these studies could be used to inform implementation trials of best practices and evidence from the civilian sector, efficacy trials of interventions to improve CR outcomes, and pragmatic trials that include veterans, service members, men and women, and a range of TBI severity and multiple comorbidities.
Keywords Brain injuries, traumatic; Employment; Rehabilitation; Veterans
Corresponding author Gail Powell-Cope, PhD, ARNP, FAAN, Center of Innovation on Disability and Rehabilitation Research, 8900 Grand Oak Circle (673/151R), Tampa, FL 33637. E-mail address: Gail. [email protected].
Acknowledgments We thank the contributions of the internal reviewers: Alison Cogan, PhD, Diane Cowper-Ripley, PhD, Charles DeGeneffe, PhD, Stephanie Kolakowsky-Hayner, PhD, James Malec, PhD, William Mann, PhD, OTR/L, Jill Massengale, DNP, ARNP-C, Risa Nakase-Richardson, PhD, Angelle Sander, PhD, Nina A. Sayer, PhD, and Joel D. Scholten, MD.
www.archives-pmr.org
Community reintegration in veterans
References 1. Sayer NA, Carlson KF, Frazier PA. Reintegration challenges in U.S. service members and veterans following combat deployment. Soc Issues Policy Rev 2014;8:33-73. 2. Cernich A, Chandler L, Scherdell T, Kurtz S. Assessment of cooccurring disorders in veterans diagnosed with traumatic brain injury. J Head Trauma Rehabil 2012;27:253-60. 3. Tanielian T, Jaycox LH. Invisible wounds of war. Santa Monica, CA: Rand Corporation; 2008. 4. Okie S. Traumatic brain injury in the war zone. N Engl J Med 2005; 352:2043. 5. Lew HL, Cifu DX, Sigford B, Scott S, Sayer N, Jaffee MS. Team approach to diagnosis and management of traumatic brain injury and its comorbidities. J Rehabil Res Dev 2007;44:vii-xi. 6. Department of Veteran Affairs. Blueprint for excellence. Washington (DC): Veterans Health Administration; 2014. Available at: http://www. va.gov/HEALTH/docs/VHA_Blueprint_for_Excellence.pdf. Accessed January 13, 2017. 7. Phillips KM, Clark ME, Gironda RJ, et al. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era veterans. J Rehabil Res Dev 2016;53:413-32. 8. Pugh MJ, Finley EP, Wang CP, et al. A retrospective cohort stury of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars. Brain Inj 2016;30:1481-90. 9. Farmer CM, Krull H, Concannon TW, et al. Characteristics and treatment patterns of service members with mild traumatic brain injury. Available at: http://www.rand.org/pubs/research_briefs/ RB9889.html. Accessed January 17, 2017. 10. Resnik L, Bradford DW, Glynn SM, Jette AM, Johnson Hernandez C, Wills S. Issues in defining and measuring veteran community reintegration: Proceedings of the Working Group on Community Reintegration, VA Rehabilitation Outcomes Conference, Miami, Florida. J Rehabil Res Dev 2012;49:87-100. 11. Trudel TM, Nidiffer FD, Barth JT. Community-integrated brain injury rehabilitation: treatment models and challenges for civilian, military, and veteran populations. J Rehabil Res Dev 2007;44: 1007-16. 12. Manderscheid RW. Helping veterans return: community, family, and job. Arch Psychiatr Nurs 2007;21:122-4. 13. Sander AM, Clark A, Pappadis MR. What is community integration anyway?: defining meaning following traumatic brain injury. J Head Trauma Rehabil 2010;25:121-7.
www.archives-pmr.org
S3 14. Sayer NA, Cifu DX, McNamee S, et al. Rehabilitation needs of combat-injured service members admitted to the VA polytrauma rehabilitation centers: the role of PM&R in the care of wounded warriors. PM R 2009;1:23-8. 15. Pogoda TK, Carlson KF, Gormley KE, Resnick SG. Supported employment for veterans with traumatic brain injury: provider perspectives. Arch Phys Med Rehabil 2018;99:S14-22. 16. Carlson KF, Pogoda TK, Gilbert TA, et al. Supported employment for veterans with traumatic brain injury: patient perspectives. Arch Phys Med Rehabil 2018;99:S4-13. 17. Dillahunt-Aspillaga C, Pugh MJ, Cotner BA, et al. Employment stability in veterans and service memebers with traumatic brain injury: a veterans administration traumatic brain injury model systems study. Arch Phys Med Rehabil 2018;99:S23-32. 18. Gray M, Chung J, Aguila F, Williams TG, Teraoka JK, Harris OA. Long-term functional outcomes in military service members and veterans after traumatic brain injury/polytrauma inpatient rehabilitation. Arch Phys Med Rehabil 2018;99:S33-9. 19. Pugh MJ, Swan AA, Carlson KF, et al. Traumatic brain injury severity, comorbidity, social support, family functioning, communicty reintegration among veterans of the Afghanistan and Iraq wars. Arch Phys Med Rehabil 2018;99:S40-9. 20. Mortera MH, Kinirons SA, Simantov J, Klingbeil H. Long-term neruobehavioral symptoms and return to productivity and operation enduring freedom/operations Iraqi freedom veterans with and without traumatic brain injury. Arch Phys Med Rehabil 2018;99: S50-7. 21. Hawkins BL, Crowe BM. Contextual facilitators and barriers of community reintegration among injured female military veterans: a qualitative study. Arch Phys Med Rehabil 2018;99:S65-71. 22. BestermaneDahan K, Chavez M, Njoh E. Rooted in the community: assessing the reintegration effects of agriculture on rural veterans. Arch Phys Med Rehabil 2018;99:S72-8. 23. Scherer, MAJ MR, Weightman MM, Radomski MV, et al. Measuring soldier performance during the patrol-exertion multitask: preliminary validation of a postconcussive functional return-to-duty metric. Arch Phys Med Rehabil 2018;99:S79-85. 24. Wen P-S, Waid-Ebbs JK, Graham DP, Helmer DA. Psychometric properties of 2 participation measures in veterans with mild traumatic brain injury. Arch Phys Med Rehabil 2018;99:S86-93. 25. Elnitsky CA, Blevins C, Findlow JW, Alverio T, Wiese D. Student veterans reintegrating from the military to the university with traumatic injuries: how does service use relate to health status? Arch Phys Med Rehabil 2018;99:S58-64.
SPECIAL COMMUNICATION
Community Reintegration, Participation, and Employment Issues in Veterans and Service Members With Traumatic Brain Injury Christina Dillahunt-Aspillaga, PhD,a,b Gail Powell-Cope, PhD, ARNP, FAANa From the aHealth Services Research and Development Service Center of Innovation on Disability and Rehabilitation Research, James A. Haley Veterans Hospital, Tampa, FL; and bRehabilitation and Mental Health Counseling Program, Department of Child and Family Studies, College of Behavioral and Community Sciences, University of South Florida, Tampa, FL.
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). Archives of Physical Medicine and Rehabilitation 2018;99(2 Suppl 1):S1-3 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
Recent combat operations in Iraq, Afghanistan, and neighboring countries comprise the longest period of wars fought by the Unites States since the Vietnam War.1 As a result of these conflicts, some veterans and service members experience deployment-related difficulties and readjustment issues on returning home.1 Characteristics of these conflicts (eg, multiple deployments of veterans and service members, use of improvised explosive devices) have increased the rate of survival, but with physical, cognitive, and The Polytrauma Rehabilitation Center Traumatic Brain Injury (TBI) Model System collaboration is funded through an Interagency Agreement between the Department of Veterans Affairs and the Department of Education and the National Institute on Disability, Independent Living, and Rehabilitation Research. This research is sponsored by the Veterans Health Administrative Central Office, Veterans Affairs TBI Model System Program of Research and a subcontract from General Dynamics Health Solutions (no. W91YTZ-13-C-0015) from the Defense and Veterans Brain Injury Center, U.S. Army Medical Research and Material Command, U.S. Department of Veterans Affairs (grant nos. 1 I50 HX001233-01 and W81XWH-13-2-0095), and U.S. Department of Defense Congressionally Directed Medical Research Programs. The views, opinions, and/or findings contained in this article are those of the authors and should not be construed as an official position of the Department of Defense or any other federal agency, policy, or decision unless so designated by other official documentation. Publication of this article was supported by the American Congress of Rehabilitation Medicine. Disclosures: none.
emotional problems.1-5 Traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD) are common deployment-related health concerns.6 Veterans and service members with TBI often experience symptoms (eg, headaches, other pain), sleep disorders, and co-occurring mental health conditions (eg, adjustment disorder, anxiety disorder, depression, alcohol abuse/dependence, PTSD).7-9 Psychological problems and physical injuries can interfere with the veterans and service members experience of returning home and reintegrating into the community.7,10 Research priorities for the Department of Veterans Affairs center on ensuring continued care for veterans throughout their life span, with an emphasis on providing leading-edge care for conditions related to military service.6 Facilitating adjustment to life at home and in the community and to participation in social life roles is a Department of Veterans Affairs priority.10 Return to participation in life roles has been labeled broadly as community reintegration (CR).10 CR is an ultimate rehabilitation outcome for all disability groups, including those with disabilities that are combat-related and those that are none deployment-related.3,10-13 Participation in the community can
0003-9993/17/$36 - see front matter Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine http://dx.doi.org/10.1016/j.apmr.2017.04.013
S2 be challenging for veterans and service members because of the co-occurrence of TBI, PTSD, depression, severe mental illness, chronic pain, substance abuse, physical injuries, and sleep disorders.1,2 These conditions pose unique challenges to the current generation of veterans returning to prior relations, social roles, and living situations and seeking education or employment.1,14 Employment (engaging in paid or unpaid work), social life (engaging with friends and family members), and education are key dimensions of CR for veterans and service members.10 Considerable resources have been allocated to diagnose and treat disabilities in veterans and service members; however, despite these efforts, many veterans and service members continue to experience CR challenges.1 A comprehensive approach to CR that involves multiple participants and systems (veterans and service members, families, federal health care systems, private sector providers, and public providers) has been proposed to help veterans and service members set and achieve CR goals.1 This Archives of Physical Medicine and Rehabilitation supplement highlights chronic rehabilitation needs in the unique and important veterans and service members cohort and provides new information on the effects of postdeployment disorders and comorbidities on return-to-duty or CR and employment. This supplement on CR and veterans and service members with TBI includes studies addressing the critical needs in furthering our clinical and rehabilitation research agenda in this area. Findings from these studies will provide clinicians and researchers with: Current information on the effect of deployment disorders, conditions related to military service, and comorbidities on veterans and service members CR. Treatment implications and comparisons between military and civilian findings, which may be beneficial in service provision and rehabilitation planning. Shared knowledge of rehabilitation needs and treatment interventions that may facilitate implementation of more effective care for veterans and service members in the context of a chronic disease model and that may influence rehabilitation outcomes. Evidence for addressing deployment- and military servicerelated conditions, which require a comprehensive approach to reintegration. In total, the 12 articles in this issue address both veterans and military service members, and 2 articles include providers, vocational rehabilitation specialists, families, or stakeholders. The studies use a range of designs (eg, prospective cohort, crosssectional descriptive, case-control) and methods (eg, surveys, questionnaires, observations, performance-based testing), but no clinical trials of interventions are included. Five studies examined specific dimensions of CR (eg, employment, school, return to duty); the remainder examine CR globally. The first series of articles by Pogoda,15 Carlson,16 and colleagues focuses on supported employment for veterans and service members with TBI and provides patient and provider perspectives. Findings suggest there is a gap between vocational rehabilitation interest and vocational rehabilitation needs. Veterans and service
List of abbreviations: CR community reintegration PTSD posttraumatic stress disorder TBI traumatic brain injury
C. Dillahunt-Aspillaga, G. Powell-Cope members experience challenges accessing and using supported employment resources. Veterans Health Administration’s expansion of services that focus on career-building in a competitive environment for those with intense support needs has the potential to help veterans with TBI history become more successful in the workplace. Ensuring that veterans and service members with a history of TBI can access supported employment may help prevent downstream health and functional problems. Systematically identifying and referring those with employment and financial/ housing difficulties may help close this gap. The next series of articles examines functional outcomes, including employment stability17 and long-term functional outcomes.18 Improved understanding of functional outcomes in veterans and service members with TBI is important in both clinical and research settings. Additional articles in this supplement focus on veterans and service members with TBI and persistent TBI symptoms and the effect of comorbidities19,20; facilitators, barriers, and CR needs21,22; return to duty decision-making23; and participation measures.24 One final article assess associations between traumatic injuries and self-reported use of university services and describe student veteran perceptions of the impact of such services on academic success.25 In conclusion, much of the current research available on CR and veterans and service members with conditions related to military service is sparse and descriptive, does not provide comparisons with civilian populations, and does not include clinical trials of interventions to improve CR outcomes. Articles in this supplement, however, do compare and contrast findings with current civilian literature, which may be of great value to those providing services in civilian and military settings. Also, treatment implications are highlighted in studies predicting poor CR outcomes. Study findings on identifying veterans and service members who may be at risk for poor outcomes may be of interest to clinicians for directing at-risk veterans and service members to services which may facilitate CR. Results of these studies could be used to inform implementation trials of best practices and evidence from the civilian sector, efficacy trials of interventions to improve CR outcomes, and pragmatic trials that include veterans, service members, men and women, and a range of TBI severity and multiple comorbidities.
Keywords Brain injuries, traumatic; Employment; Rehabilitation; Veterans
Corresponding author Gail Powell-Cope, PhD, ARNP, FAAN, Center of Innovation on Disability and Rehabilitation Research, 8900 Grand Oak Circle (673/151R), Tampa, FL 33637. E-mail address: Gail. [email protected].
Acknowledgments We thank the contributions of the internal reviewers: Alison Cogan, PhD, Diane Cowper-Ripley, PhD, Charles DeGeneffe, PhD, Stephanie Kolakowsky-Hayner, PhD, James Malec, PhD, William Mann, PhD, OTR/L, Jill Massengale, DNP, ARNP-C, Risa Nakase-Richardson, PhD, Angelle Sander, PhD, Nina A. Sayer, PhD, and Joel D. Scholten, MD.
www.archives-pmr.org
Community reintegration in veterans
References 1. Sayer NA, Carlson KF, Frazier PA. Reintegration challenges in U.S. service members and veterans following combat deployment. Soc Issues Policy Rev 2014;8:33-73. 2. Cernich A, Chandler L, Scherdell T, Kurtz S. Assessment of cooccurring disorders in veterans diagnosed with traumatic brain injury. J Head Trauma Rehabil 2012;27:253-60. 3. Tanielian T, Jaycox LH. Invisible wounds of war. Santa Monica, CA: Rand Corporation; 2008. 4. Okie S. Traumatic brain injury in the war zone. N Engl J Med 2005; 352:2043. 5. Lew HL, Cifu DX, Sigford B, Scott S, Sayer N, Jaffee MS. Team approach to diagnosis and management of traumatic brain injury and its comorbidities. J Rehabil Res Dev 2007;44:vii-xi. 6. Department of Veteran Affairs. Blueprint for excellence. Washington (DC): Veterans Health Administration; 2014. Available at: http://www. va.gov/HEALTH/docs/VHA_Blueprint_for_Excellence.pdf. Accessed January 13, 2017. 7. Phillips KM, Clark ME, Gironda RJ, et al. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era veterans. J Rehabil Res Dev 2016;53:413-32. 8. Pugh MJ, Finley EP, Wang CP, et al. A retrospective cohort stury of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars. Brain Inj 2016;30:1481-90. 9. Farmer CM, Krull H, Concannon TW, et al. Characteristics and treatment patterns of service members with mild traumatic brain injury. Available at: http://www.rand.org/pubs/research_briefs/ RB9889.html. Accessed January 17, 2017. 10. Resnik L, Bradford DW, Glynn SM, Jette AM, Johnson Hernandez C, Wills S. Issues in defining and measuring veteran community reintegration: Proceedings of the Working Group on Community Reintegration, VA Rehabilitation Outcomes Conference, Miami, Florida. J Rehabil Res Dev 2012;49:87-100. 11. Trudel TM, Nidiffer FD, Barth JT. Community-integrated brain injury rehabilitation: treatment models and challenges for civilian, military, and veteran populations. J Rehabil Res Dev 2007;44: 1007-16. 12. Manderscheid RW. Helping veterans return: community, family, and job. Arch Psychiatr Nurs 2007;21:122-4. 13. Sander AM, Clark A, Pappadis MR. What is community integration anyway?: defining meaning following traumatic brain injury. J Head Trauma Rehabil 2010;25:121-7.
www.archives-pmr.org
S3 14. Sayer NA, Cifu DX, McNamee S, et al. Rehabilitation needs of combat-injured service members admitted to the VA polytrauma rehabilitation centers: the role of PM&R in the care of wounded warriors. PM R 2009;1:23-8. 15. Pogoda TK, Carlson KF, Gormley KE, Resnick SG. Supported employment for veterans with traumatic brain injury: provider perspectives. Arch Phys Med Rehabil 2018;99:S14-22. 16. Carlson KF, Pogoda TK, Gilbert TA, et al. Supported employment for veterans with traumatic brain injury: patient perspectives. Arch Phys Med Rehabil 2018;99:S4-13. 17. Dillahunt-Aspillaga C, Pugh MJ, Cotner BA, et al. Employment stability in veterans and service memebers with traumatic brain injury: a veterans administration traumatic brain injury model systems study. Arch Phys Med Rehabil 2018;99:S23-32. 18. Gray M, Chung J, Aguila F, Williams TG, Teraoka JK, Harris OA. Long-term functional outcomes in military service members and veterans after traumatic brain injury/polytrauma inpatient rehabilitation. Arch Phys Med Rehabil 2018;99:S33-9. 19. Pugh MJ, Swan AA, Carlson KF, et al. Traumatic brain injury severity, comorbidity, social support, family functioning, communicty reintegration among veterans of the Afghanistan and Iraq wars. Arch Phys Med Rehabil 2018;99:S40-9. 20. Mortera MH, Kinirons SA, Simantov J, Klingbeil H. Long-term neruobehavioral symptoms and return to productivity and operation enduring freedom/operations Iraqi freedom veterans with and without traumatic brain injury. Arch Phys Med Rehabil 2018;99: S50-7. 21. Hawkins BL, Crowe BM. Contextual facilitators and barriers of community reintegration among injured female military veterans: a qualitative study. Arch Phys Med Rehabil 2018;99:S65-71. 22. BestermaneDahan K, Chavez M, Njoh E. Rooted in the community: assessing the reintegration effects of agriculture on rural veterans. Arch Phys Med Rehabil 2018;99:S72-8. 23. Scherer, MAJ MR, Weightman MM, Radomski MV, et al. Measuring soldier performance during the patrol-exertion multitask: preliminary validation of a postconcussive functional return-to-duty metric. Arch Phys Med Rehabil 2018;99:S79-85. 24. Wen P-S, Waid-Ebbs JK, Graham DP, Helmer DA. Psychometric properties of 2 participation measures in veterans with mild traumatic brain injury. Arch Phys Med Rehabil 2018;99:S86-93. 25. Elnitsky CA, Blevins C, Findlow JW, Alverio T, Wiese D. Student veterans reintegrating from the military to the university with traumatic injuries: how does service use relate to health status? Arch Phys Med Rehabil 2018;99:S58-64.