VA develops a new program for helping veterans recover from traumatic brain injury

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Recovery from head injuries can be among the most difficult for veterans. Medical practitioners at the Veterans Health Administration’s Center of Excellence in Palo Alto are acting on the idea that encouraging veterans to share their stories can help. They’ve teamed with the non-profit TeachAids to develop a project called the Crash Course Concussion Story Wall. For details, Federal Drive with Tom Temin‘s Eric White spoke to professor of neurosurgery at the Palo Alto VA Health Care System, Dr. Odette Harris, and clinical assistant professor of physical medicine and rehabilitation/orthopedic surgery, Dr. Molly Timmerman.

Interview transcript:

Dr. Odette Harris: The program is just a fantastic example of collaborative efforts and addressing the needs of our patients. So headaches are one of the primary diagnosis, the most common symptom after traumatic brain injury. And so our team here of TBI experts led by Dr. Timmerman, this is something that they encounter quite frequently. And so we’ve been sort of, over the years, trying to find innovative ways to address these clinical concerns, in addition to the clinical armamentarium that we have at hand. And so our relationship with TeachAids provided an opportunity to do just that, to provide something innovative with impact on the clinical realm. And so, our VA clinicians worked with TeachAids together to develop these educational materials, including the concussion story wall so that we could really sort of tailor and specialize the care available to our veterans.

Eric White: Dr. Timmerman, how will the wall actually work and how did you think of it?

Dr. Molly Timmerman: Well, it was a collaboration, like Dr. Harris mentioned. And so the wall consists of about 4,000 individual stories relating to how the veteran or patient’s injury occurred, their personal experiences, and as well as suggestions to others out there. So it’s intended as a resource for all folks out there who’ve been impacted by head injury. So including military veterans, their loved ones, athletes, and really anyone who’s been affected by head injury.

Eric White: How many veterans overall or people overall, you just mentioned, athletes, how many people will be involved with this project?

Dr. Molly Timmerman: Well, we have 4,000, stories, our goal within our clinic here was 50 videos, we were unable to complete all of those due to the COVID-19 pandemic, but we do hope it’ll reach many other veterans and providers.

Dr. Odette Harris: We should also state that our VA polytrauma system, our healthcare system is in a hub and spoke framework rather. Although we are one clinic here, we actually span a large geographic area when it comes to our expertise in traumatic brain injury. Our polytrauma site extends over ten different states and territories, and our non contiguous states of Alaska and Hawaii. Additionally, our network site of clinics has the whole expanse of our vision as well. So our expectation is that the reach of this will be quite large for that patient cohort. And the clinicians who are integrated into this network will also aid in the dissemination of this.

Eric White: And in your experience working with people with head injuries, how does this sort of thing help in their recovery, hearing people’s testimonials about their experiences and whatnot?

Dr. Odette Harris: So there’s a lot of evidence in our peer reviewed literature that the phenomenological component of one’s experience, the patient’s experience, of the storytelling component is significantly contributory to their recovery. That’s been well established. And this is sort of taking that to a next level.

Dr. Molly Timmerman: Yeah, I was just going to add on to that. There can be a stigma associated with these sort of invisible injuries. And I think it’s therapeutic for patients to share their story, as well as others, who are living with this to hear sort of the success stories and the struggles that others have encountered and kind of the solutions that they’ve found through the experience of living with a head injury.

Eric White: And I imagine you’re getting something out of this as well. Are you going to be using this in any sort of research capacity, hearing these stories and are you going to maybe have them apply to the way that you treat other patients in the future?

Dr. Molly Timmerman: Oh sure, I can answer that. We are conducting a qualitative study to look at the contents of the stories and examine the impact of concussions, especially post traumatic headaches, which is one of the most common persistence, the quality of mild head injury, mild TBI. And also looking at other symptoms as well as memory loss. And then, just as a provider, it’s always good to kind of listen to patients stories, both the content and the emotions that it brings up and the effect it has on their personal lives. So yes, it’s gonna be very helpful, I think, both from a scientific perspective, and also as a clinician.

Eric White: Dr. Harris, any other experiences that you can recall from hearing these stories?

Dr. Odette Harris: I think this storytelling component of recovery, as I said, is just so vital and integral, and I think it’s one that’s been under utilized in the past. I’m really glad that we’re bringing this to the forefront of our teaching, and our clinical armamentarium, for sure. As clinicians and scientists and academics, we take every opportunity with every patient to use what we’ve learned to move the field forward. And this will be no different. But I think that most importantly, as Molly said, the clinical impact on our patient is what is central to this work. And so we’re very excited, because it’s definitely shown peer to peer stories, peer to peer interactions and learning from each other in that format is just incredibly valued.

Eric White: Are there any other sort of injuries, whether it be Post Traumatic Stress Disorder, or not pertaining even specifically to neurological disorders, that you think that this kind of experience could help understanding what is going on with them? Dr. Timmerman we can start with you.

Dr. Molly Timmerman: Sure, yeah. I mean, concussion and post traumatic stress often go along closely, many of these injuries occurred in combat, life threatening situations. Additionally, a lot of times there are orthopedic or pain issues related to these head injuries, because they can affect more than, than just the the brain, you can suffer orthopedic or burns or other things. So there’s a lot there, that people have experienced, and I think the diversity of stories will have sort of something for many of our veterans, and I do think a psychological component. We do know that depression, post traumatic stress, commonly co-occur with head injuries. So I do think it will benefit a broad scope of issues with veterans coming back from deployment.

Dr. Odette Harris: I think one of the key things is that this represents thousands of individual stories, thousands of experiences. And I think it’s important to highlight just the cost of our freedom that these individuals or people who have put their health on the line, in some cases, their lives on the line to make sure that we benefit and I think partnerships like this with organizations like TeachAids and the veterans wanting to help other veterans — it’s just so remarkable. And I’m so grateful that you guys are highlighting this contribution. We are grateful to the veterans who participated, and we’re grateful to our partnership with the community partners of TeachAids, without either of them, this would not be possible. And so we consider ourselves sort of the middlemen in making sure that the technology and the stories get to impact the patient. So just thank you for highlighting this.

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