A New Generation of Veterans

Polytrauma

Many of the wounded service members returning from the OEF/OIF conflicts are victims of car bombs or improvised explosive devices (IEDs) that cause severe injuries to several parts of the body. These multiple complex injuries are called polytrauma. Polytrauma can include a combination of injuries to internal organs, limb loss, vision loss, hearing loss, paralysis, chronic pain, burns, and psychological disorders.

To help address these critical needs, VA researchers are working to:

• Improve coordination of care for Veterans with multiple injuries.
• Identify subtle indicators of potentially significant problems caused by head trauma, such as disordered perception and judgment.
• Repair the injured brain, spinal cord, and other organs, and protect them from further damage.
• Advance technologies such as hearing and vision implants and computerized or robotic prostheses.
• Develop strategies that will reduce the burden for family members of injured Veterans.

Mental Health

Military personnel face many psychological challenges during their tours of duty that can make it difficult to readjust to life back home. As many as one in three service members may seek or need mental health care after returning from duty in Afghanistan or Iraq. Service members may experience symptoms of psychological distress, "readjustment disorders," or more serious problems such as posttraumatic stress disorder (PTSD). Depression and anxiety are fairly common and returning service members, especially younger Veterans, may turn to alcohol or drugs in an attempt to deal with their psychological distress. Use of alcohol or drugs can exacerbate these mental and emotional disorders.

VA researchers are working to improve mental health care by:

• Developing methods to screen for mental health problems because early recognition and treatment results in better patient outcomes.
• Leading the way in conducting studies on both drug and psychosocial/behavioral therapies.
• Studying treatment for women Veterans, who may experience trauma differently than male Veterans.

Posttraumatic Stress Disorder

PTSD is an anxiety disorder that may occur after a person experiences or witnesses a traumatic event, such as military combat, natural disasters, serious accidents, or physical or sexual assault. Many service members who have a diagnosis of PTSD respond well to standard treatment, but others do not. Research is critically needed to better understand this disorder so that effective preventive strategies and treatments can be developed and made available.

Important areas that VA researchers are investigating include:

• Developing and testing comprehensive rehabilitation strategies.
• Searching for ways to improve memory and attention and protect brain cells from injury.
• Testing new drugs for treating TBI.
• Helping Veterans with TBI to regain a measure of independence—for example, by using a driving simulator to evaluate Veterans' driving ability or provide driver retraining.

Spinal Cord Injury

VA has the largest network of care for spinal cord injury (SCI) in the nation and provides primary and specialty care at 23 regional SCI centers. VA leads the health care profession in defining new methods of rehabilitation through SCI research and engineering. For example, VA researchers identified a molecular basis for "phantom pain," a phenomenon in which patients experience the sensation of pain in a limb that has lost all feeling, as in SCI, or in a limb that is no longer there, as in amputation. This discovery has enabled a better understanding of phantom pain and may eventually lead to new methods of pain relief.

Some key research questions include:

• What determines which individuals will develop PTSD?
• How can we correctly identify those at risk for PTSD and determine the most effective interventions?
• Can we identify biological markers that might help guide psychological evaluation, treatment selection, and outcomes?

To help answer these critical questions, VA researchers are:

• Testing whether computer-simulated, "virtual reality" combat environments can enhance the effectiveness of prolonged exposure therapy.
• Developing new ways to provide care to Veterans living far from VA medical facilities, such as the delivery of health information and services via telephone, the Internet, and videoconferencing.
• Striving to ensure that evidence-based, state-of-the-art care is available to all Veterans with PTSD by quickly moving scientific breakthroughs from the laboratory into patient care.

Traumatic Brain Injury

Traumatic brain injury (TBI) is a general diagnosis covering a wide range of injuries to the brain that can occur during combat. These injuries can result in physical symptoms such as vision impairment, dizziness, and headache, as well as cognitive and emotional problems such as memory impairment, poor judgment, anxiety, and depression. VA investigators are conducting cutting-edge research to help return maximum function to Veterans with TBI.

Currently, VA researchers are conducting important SCI studies that are:

• Testing tiny stimulators implanted into breathing muscles of Veterans with SCI that will help avoid respiratory complications, the leading cause of death in SCI patients.
• Developing systems that deliver low-level, computer controlled electric current to the muscles, which may allow individuals with incomplete SCI to walk and maneuver in their environments.
• Developing new pain treatments.

Amputation and Prosthetics

Approximately 6 percent of wounded service members returning from Iraq are individuals with amputations. The number of Veterans accessing VA health care for prosthetics, sensory aids, and related services has increased by more than 70 percent since 2000. VA's Research and Development program currently supports a broad research portfolio related to amputation and prosthetics.

VA researchers are:

• Implementing cutting-edge technology using microelectronics and microchips (very small electronic components), as well as robotics, to create lighter, more functional prostheses that look, feel, and respond more like natural arms and legs.
• Collaborating with Brown University and the Massachusetts Institute of Technology to develop a "biohybrid" limb that will combine regenerated tissue, lengthened bone, and implanted sensors to allow the limb to be controlled by the user's brain signals, and new anchoring techniques to reduce the discomfort associated with current prostheses.
• Partnering with the Department of Defense (DoD) to improve prosthetic designs, define standards of function, and conduct outcome studies

Burns

Severe burns cause excruciating pain and debilitation. VA is further expanding its research focus on burn injury to advance knowledge in this area of growing importance.

VA researchers are:

• Exploring new approaches to pain treatment that will help Veterans continue rehabilitation and achieve maximum restored function.
• Collaborating with DoD colleagues to assess long-term outcomes of OEF/OIF Veterans with burn injuries.
• Working on the jointly outlined VA and DoD research agenda on burns to address priority areas such as managing burn scar contractures (tightening of muscle, tendons, ligaments, or skin that prevents normal movement), fostering successful psychological adjustment, and establishing reliable outcome measures to guide clinical care.