matrix by liuqingyan

VIEWS: 33 PAGES: 18

									                                 Year
Authors, Title, & Journal:       Pub: Purpose:




                                      This study was done to see if EMRD (eye movement
                                      desensitation and reprocessing) is a efficient and
                                      effective form of therapy. The final consensus was
                                      established as EMRD is not a credible form of
                                      treatment among combat injuries in our current war,
Albright, D., & Thyer, B. Does        due to lack of research in current war and contexts.
EMDR reduce posttraumatic             They found that EMRD is not much different from
stress disorder symptomatology        exposure therapy. Furthermore, EMRD is not a real
in combat veterans? Behavioral        life therapy that acknowledges exposures in relation
Interventions                    2010 to context.




                                        The main idea of this article was to analyze the
Brenner, L.,& Vanderploeg, R.           current situation of PTSD and TBI affecting the
Assessment and diagnosis of mild        military personnel. This paper discusses assessment
traumatic brain injury,                 and intervention strategies and proposes we focus on
posttraumatic stress disorder,          understanding cumulative disadvantages along with
and other polytrauma conditions:        implementation of early screening and treatment,
burden of adversity hypothesis.  2009   combined with decreasing adversities and burdens.
                                            This study was done to look at the effects of goal
                                            directed therapy. The research explores goal directed
                                            therapy in clients with TBI. Not only did they explore
                                            the planning/process of the program for the client
Doig, E., Fleming, J., Cornwell, P.,        they also explored the process involvement when
& Kuipers, P. Qualitative                   their families or friends are involved in the decision
exploration of a client-centered,           making with the therapist. Results showed the
goal-directed approach to                   positive enhancements that are made with goal
community-based occupational                directed therapy involved within a community base.
therapy for adults with traumatic           Goal directed therapy provides meaning,
brain injury. American Journal of           encouragement, purpose, power, and enhanced
Occupational Therapy                   2009 perception to all of those involved.


                                         The main purpose was to took into test results of
                                         patients with mTBI. They hypothesized that patients
                                         would experience deficits in awareness, participation,
                                         and executive functioning. What they found was that
Erez, A., Rothschild, E., Katz, N.,      there was an increase in executive functioning such as
Tuchner, M., & Hartman-Maeir,            planning and shifting, yet they were aware of their
A. Executive functioning,                own deficits. They also found that the major issues
awareness, and participation in          faced among people with mTBI is problems with
daily life after mild traumatic          IADL's and difficulty finding employment. Future OT's
brain injury: A preliminary study.       should focus on these areas by using a top down
American Journal of Occupational         assessment approach that better measures real life
Therapy                             2009 situations.




                                            Investigated "explicit problem solving skills training
Fong, K., Dorothy, H. Effects of            program." They wanted to test and see what
an explicit problem -solving skills         therapies worked best among those with brain
training program using a                    injuries. What they found is that the tests were not
metacomponential approach for               able to analyze real life situations with limited them in
outpatients with acquired brain             validity. Despite this, they found that
injury. American Journal of                 metacomponential therapy with focus on executive
Occupational Therapy                   2009 functioning seem to be the best fit or intervention.
                                           Goal was to synthesize data from military populations
                                           on assessments and treatments for OIF/OEF veterans
                                           returning back from war who are recovering
                                           polytraumas. There are many challenges to over
                                           come that include a combination of dysfunction and
                                           integration back into society. These commorbid
                                           dysfunctions include any of the following: cognitive,
Gironda, R., Clark, M., Chait, S.,         medical, emotional, and integration back into society.
Walker, R., Ruff, R., Craine, M., &        These dysfunctions are partly due to the increasing
Scholten, J. Traumatic brain               among of TBI and posttraumatic stress experienced as
injury, polytrauma, and pain:              a result of combat. They found there is a need to
challenges and treatment                   provide early prevention care and pain management
strategies for the polytrauma              strategies. We need to integrate clinical care with
rehabilitation. Rehabilitation             other specialties to incorporate a holistic model of
Psychology                            2009 reference.




                                          TBI's are increasing and affecting thousands of people
                                          every year. Previous researched focused on
Giuffrida, C., Demery, J., Reyes, L.      "repetitive practice." This research paper promotes
Lebowitz, B., Hanlon, R.                  diversity in practice schedules and show how change
Functional skill learning in men          and dynamic environments increases performance
with traumatic brain injury.              skills in TBI's. Therapists should integrate more
American Journal of Occupational          randomized therapy techniques to enhance
Therapy                              2009 treatment.




Humphrey, K. Responding to the             This research paper explores the psychological
psychological impact of war on             damage that has affected both the U.S. and Iraq. This
the Iraqi people and U.S.                  looks at the necessities to improve services to the
veterans: mixing icing, praying for        military personnel and the limitations that need to be
cake. American Psychologist         2009   addressed in the health care services provided.
                                            Brain injuries within the department of defense are
                                            increasing. Rates of concussions are increasing and
Jaffee, M., Helmick, K., Girard, P.,        the causes are unknown. An increasing amount of
Meyer, K., Dinegar, k., & George,           these concussions are going undiagnosed or treated.
K. Acute clinical care and care             This is a major concern. This article looks at the
coordination for traumatic brain            assessment, treatment, and care that hospitals offer
injury within department of                 for TBI and also provides new ideas on how increase
defense. Journal of Rehabilitation          awareness and procedures for providing the care that
Research & Development                 2008 is needed.




                                            This editorials purpose is to challenge our OT's to
                                            getting more involved in the rehabilitation research.
                                            This article explains why it was so hard for me to find
                                            AJOT articles on combat treatment and related topics.
                                            "A search of the occupational therapy literature using
                                            key words such as disaster, terrorism, and PTSD
Josman, N., & Josman Z. Is                  reveals an alarming scarcity of articles." OT's really
Occupational Therapy in step                need to become involved because psychological and
with the extreme events of our              psychiatric literature fails to recognize the need for
time? OTJR: Occupation,                     occupation and participation as key components in
Participation, and Health              2007 recovery. This is huge!



                                            This paper analyzes the care that is administered to
                                            the military's Department of Defense and Veterans
                                            Affairs Polytrauma System of Care. TBI treatment is
Meyer, K., Helmick K., Doncevic,            of main focus. Polytrauma centers focus on holistic
S., Park, R. Severe and                     care through a team approach to therapy. Also noted
penetrating traumatic brain                 is that family/friends support contributes to higher
injury in the context of war.               recovery rates. Also provided is a continuum of care
Journal of Trauma Nursing              2008 which helps to ensure stability in recovery.
                                       This research journal acknowledgement the stresses
                                       that couples face in their relationships when one or
                                       both come back from war with conditions such as
                                       PTSD; before now there was lack of evidence or
                                       treatment strategies to monitor or combat these
                                       issues. This journal presents cognitive-behavioral
Monson, C., Fredman, S., & Adair,      conjoint therapy to acknowledge the effects of war in
K. Cognitive behavioral conjoint       relation to integration of the military personnel back
therapy for posttraumatic stress       into their home environment. CBCT seems to show
disorder application to operation      significant improvement but further tests and
enduring and Iraqi freedom             research needs to be done in order to validate such
veterans. Journal of Clinical          claims. "...We are called to innovate and provide the
Psychology                        2008 best possible services..."




                                       Objective: to explain and explore current issues
                                       pertaining to combat injuries (physical and
Uomoto, Jay M., & Williams,            psychological symptoms) that have affected soldiers
Rhonda M. Post acute                   in the past and are relative to present day OEF and
polytrauma rehabilitation and          OIF (Operation Enduring Freedom & Operation Iraqi
integrated care of returning           Freedom). Discussion is on historical concepts that
veterans: Toward a holistic            can provide a holistic view on developing
approach. Rehabilitation               rehabilitation strategies we can integrate into current
Psychology.                       2009 day soldiers coming home from war.
                                           This paper looks at the minority veterans (of different
                                           race and ethnic background) with ABI (Acquired Brain
                                           Injury). The paper brings to light they variety of
                                           impairments in cognition and vocation that lead to
Wehman, P., Gentry, T., West,              physical, social, and economic hardships that these
M., & Arango-Lasprilla, J.                 individuals face. Further suggested are ways to help
Community integration: current             such individuals. They found that cognitive therapy
issues in cognitive and vocational         needs to focus on real life application, in a
rehabilitation for individuals with        multidisciplinary approach, using compensation and
ABI. Journal of Rehabilitation             technology as assists. Community therapy also
Research & Development                2009 proved to be an effective form of treatment.
Subject Characteristics:   Key Words:         Comments:


                                             EMRD is a cognitive behavioral
                                             therapy that has been used for the
                                             last twenty years. Combat injuries in
                                             our current war include: mental
                                             disorders, PTSD, anxiety disorders,
                                             sexual assault, natural disasters, and
Research was collected                       accidents. Therefore, current studies
from databases, websites,                    and further research should
and manual services.                         acknowledge factors such as: multiple
Specifically six          Wiley Inter        deployment, longer rotation theatre,
experiments and three     Science: Operation more women experiencing combat,
quasi studies were        Iraqi Freedom and and more involvement of The
analyzed.                 combat injuries. National Guard and Reserve Units.




                                            1.64 million troops in OEF/OIF.
                                            Combat injuries include: one wounds,
                                            traumatic brain, spinal cord, eye, ear,
                          Operation         and musculoskeletal injuries,
                          Enduring          amputations, and mental health
                          Freedom;          problems. These diverse factors
                          Operation Iraqi   introduces us to the term polytrauma
                          Freedom,          to describe the war injuries of our
                          Traumatic Brain   time. Mindsets and biases keep
Subjects were exposed to injury;            military personnel from reporting all
emotional trauma,         posttraumatic     their symptoms. Treatment of sleep
military personnel,       stress disorder;  problems could reduce other areas of
posttraumatic stress      war; poly trauma; concern. We need to educate, assess
disorder, traumatic brain and military      early, look at past history, decrease
injury and war.           personnel.        stigmas,
twelve people with TBI
were put on a twelve
week program. The goals
were designed by the
client their significant
others, and collaboration    brain injuries
with the therapist.          community health
Afterwards interviews        services
were given to gather         goals
information from the 12      patient
clients, 10 significant      participation    group goal directing is better than
others, and 3 therapists.    rehabilitation   individual in the case of TBI.




                                                The most common issues in mTBI
13 participants with mTBI.                      include: reduced processing speed,
Time of injury had been                         attention, memory verbal fluency,
on average 4.7 months                           and executive functioning. BADS
previous. The mean age                          (Behavioral assessment of
was 43.4. Study was          awareness          dysexecutive syndrome) seemed to
conducted at an out          brain injuries     attain the most accurate results. Also
patient rehabilitation       cognition          there is suggestion of using the
hospital in Israel.          self-concept       Executive Function Performance Test.


                                              Solving problems in real life is an
                                              essential component to a persons
                                              executive functioning skills. Such
                                              training should focus on solving
                          brain injuries;     problems in real life scenarios.
33 outpatient with        cognitive training; Dysexecutive questionnaire seems
moderate acquired brain decision making; best in pin pointing ideal common day
injury. Study was done in metacognition;      problems. More tests need to be
Hong Kong at a cognitive and problem          done to assess the social component
rehabilitation hospital.  solving.            affecting mTBI's.
                                                Subtopics of research paper include:
                                                polytrauma non headache pain
                                                treatment, pharmacologic
                                                management of nonheadache pain,
                                                rehabilitation modalities for non
                                                headache pain, cognitive behavioral
                                                interventions for non headache pain,
                                                posttraumatic headache,
                                                posttraumatic headache diagnosis,
                                                pathophysiology of posttraumatic
                                                headaches, posttraumatic headache
                                                treatment, barriers to effective pain
                             pain; headache;    management in polytrauma
                             polytrauma;        populations, pain assessment in the
                             traumatic brain    communication impaired, pain
Empirical data from          injury;            management among those with
civilian and veteran         postconcussive     multiple somatic and cognitive
populations. OEF/OIF         syndrome;          symptoms of mixed or
personnel with               posttraumatic      undifferentiated etiology, and
polytrauma.                  stress disorder.   conclusions.

                                                "randomly ordered practice schedule
                                                results in depressed performance in
                                                acquisition but enhanced
                                                performance in retention and transfer
                             brain injuries;    in contrast to a blocked ordered
                             cognitive          practice schedule." Could this be due
                             disorders,         to plasticity? Possible implications for
six men with TBI. Men        learning, motor    rebuilding neurons through new
had problems with            skills, task       environmental regimes. This article
processing and motor         performance and    has further implications in
functions.                   analysis.          neuroscience.

subjects included military                    Psychological issues need to be
veterans with addictions                      addressed in our countries military.
who utilized mental                           The sad part is that IRAQ only dreams
health services due to       posttraumatic    about being able to address such
PTSD in relation to war.     stress disorder; issues. Future Occupational therapist
Common themes and            addiction;       can help the reintegration and be
personal experiences of      veterans; Iraq;  apart of the team to holistically
the author were also         mental health    approach these issues. Suggestions
discussed.                   systems; and war further presented in research.
                          cognitive
                          assessment;
                          community
                          reentry; loss of
                          consciousness;
                          medical
                          evaluation;            according to the concussion
                          polytrauma;            management grid Occupational
                          posttraumatic          Therapy should be implemented with
                          amnesia;               focus in cognition to combat memory,
                          rehabilitation; TBI;   concentration, and decreased
                          TBI screening; and     executive functioning. Treatment
                          traumatic brain        option should be to normalize sleep,
military personnel        injury.                nutrition, and pain control.




                                                 OT's need to become more apart of
                                                 the holistic treatment that can be
                                                 provided not just to the military but
                                                 to all disaster reliefs (hurricanes,
Guest editorial                                  floods, ect.) IT is important to
commenting on the lack                           individuals to maintain a "sense of
of information, research,                        coherence" their perceptions of what
and therapeutic designs                          actually has happened to them. If we
to help cater to the                             do not engage ourselves in this issues
changing that is                                 we will cause more problems to our
happening in the world    PTSD; disaster;        visibility and essence to the society at
today.                    recovery               large.


                                                 Occupational therapists need to focus
                                                 on assisting recovery in
                                                 musculoskeletal function,
                                                 coordination, and lifestyle
                          military,              (restoration and reintegration into
                          penetrating TBI,       society/community). Acute rehab is
                          severe TBI,            essential. Time in-between or before
                          traumatic brain        treatment begins highly affects the
military personnel        injury                 recovery rate of the individual.
                                                 In relation to a part of chaos theory
                                                 and the idea of having a butter fly
                                                 effect (where one butterfly flapping
                                                 his wings in china creates a tornado in
                                                 Texas) reminds me of this article and
                                                 how everyone affects everyone else
synthesis of knowledge       couples;            no matter how insignificant you think
gathered from veterans       posttraumatic       it is. Therefore it only makes sense to
and their partners;          stress disorder;    cater or make therapies not just for
present a case study using   couple therapy;     the patient but also for the people
cognitive behavior           cognitive-          that are important actors in the
conjoint therapy (CBCT)      behavioral          patients life. This is true holistic care
for PTSD.                    conjoint therapy.   and room for OT involvement.




                             Key Words:
                             Operation
                             Enduring
                             Freedom;
                             Operation Iraqi
                             Freedom; war;       Focus: hysteria, shell shock, and
Military veterans who        rehabilitation;     polytrauma. Challenges are in the
experienced                  brain injuries;     neurorehabilitaiton services. The
rehabilitation, stress,      stress disorders;   symptoms are complex and
trauma, traumatic brain      veterans;           interdisciplinary treatment
injuries, combat             polytrauma;         approaches need to accommodate to
experience, and war.         combat injury.      the multiple issues or polytraumas.
                      acquired brain
                      injury; alternative
                      work
                      arrangements;
                      cognitive
                      rehabilitation;
                      community
                      integration;
                      employer              With job coaching looking at skill level
                      supports,             of individual and specific jobs they
                      posttraumatic         could do is important. Try to find the
                      stress disorder;      right job position by looking at
                      race/ethnicity;       different types, supports, intensities,
                      return to work;       challenges, and interests that could
                      veterans; and         make a perfect fit for the individual.
minority soldiers     vocational            Make their "limitations
returning from war.   rehabilitation.       accommodated."
Quotes or Further Research:




"Placebo responses to believable but inert
psychosocial treatment can be
exceedingly powerful." " Given the
incidence of combat related PRSD the
costs it exacts upon the disorder their
families, and the military, we believe that
such well designed intervention research
is urgently needed."


"Accumulation of disadvantaged genetic
and/or environmental factors can result in
a cascade of physical and psychiatric risk."
"Increasing coping strategies was also
suggested as being potentially useful,
thereby supporting the idea that
addressing specific symptoms or problems
early may decrease long term negative
outcomes." "Early assessment and
treatment is indicated in order to alter
negative life course trajectories." Future
Research: Look at evidence based
treatment with "co-occurring disorders,"
expectations of recovery, cumulative
disadvantage and how this affects OEF/OIF
military and their integration back into
society
" Goals provide structure, which facilitates
participation in rehabilitation despite the
presence of barriers, including reduced
motivation and impaired self-awareness."
"Goals facilitate a client centered
approach to rehabilitation because they
can be uniquely adapted to each person
according to his or her profile of strengths
and limitations."




"A need exists to examine the impact of
the mTBI
cognitive profile on participation in
meaningful life roles." A wider
perspective beyond impairment and
disability need to be examined.




"Innovative cognitive rehabilitation
program involving training in problem
solving and emotional self regulation
could lead to greater improvement in self
reports and role play problem solving
measures for experimental compared with
control participants." "The explicit
problem solving training approach
emphasizing metacognitive principles and
showed greater effectiveness."
"An integrated, intensive out patient
treatment program may be the most
efficient and effective approach for those
with PMD…. Specific components of an
integrated treatment program would be
individual and group based
psychoeducation, coping skills training,
and cognitive behavioral therapy with an
emphasis on instilling proactive self
management techniques. Specific
psychoeducation topics would include
sleep hygiene, anger management,
physical conditioning, relaxation training,
substance use/abuse moderation or
prevention, vocational rehabilitation,
analgesic overuse, and cognitive
restructuring."

"An unexpected finding from the study
was that 4 to 5 participants reported that
their experience in the study positively
changed their view about their abilities
after their TBI. One participant reported,
"it made me care about myself a lot
more." Another stated, "it gave me a
better out look on myself and helped my
self esteem also." This has great
implications for further research and
treatment!


"on March 20, 2003, the United States and
its allies began a devastating "shock and
awe" bombing campaign in Baghdad as
300,000 soldiers invaded Iraq in ensuing
years, of whom several hundred thousand
would return home with psychological
problems ranging from depression to drug
addiction."
" While TBI may result in physical
impairment, often the more problematic
consequences involve an individual's
cognition, emotional functioning, and
behavior, These consequences can affect
all aspects of life, including development
and maintenance of interpersonal
relationships and the ability to function in
social settings. Community reintegration
efforts are therefore aimed at maximizing
individual strengths and creating
supportive environments that will allow
individuals with TBI to return to work and
family."




"Although we can develop methods for
intervening with disaster and trauma
victims, we posit that to make a
substantial contribution our profession
needs to develop a frame of reference for
addressing these challenges, in terms of
both scope and scale. Moreover, we need
to incorporate our unique concept of
participating and occupation as key factors
in providing services to victimized
populations. In addition, we must reassess
who our target clients are."




"Recognizing that TBI has been labeled a
signature injury of the wars in Iraq and
Afghanistan much research needs to be
done to improve diagnostic tests and
treatment of TBI as well as elucidate the
pathophysiologic changes that occur with
blast injury."
A list of stages and sessions included in
the 15 wk program: introduction to Tx,
safety building, listening and approaching,
sharing thoughts and feelings, getting
unstuck, problem solving, acceptance,
blame, trust issues, power and control
issues, emotional closeness, physical
intimacy, posttraumatic growth, and
review and reinforcement of treatment
gains. "Although the robust association
btw PTSD and intimate relationship
problems are unfortunate, this connection
also presents an opportunity to capitalize
on the healing power of intimate
relationships to improve the health of the
individuals and their relationship."




"Holistic post acute brain injury
rehabilitation has been shown to improve
community functioning and quality of
life." Conclusion discuss resilience.
"Frequent reports from veterans state
that much of their suffering is not related
to combat or to disability perse, but rather
to leaving the military and integrating in a
civilian culture. Veterans also often
indicate they perceive honor in their
experience and their injuries and that
some degree of suffering shows respect
for the fallen and the sacrifices they have
made."
"As more service members are returning
from conflict, interventions are needed to
help them return to productivity, including
compensatory strategies job
accommodations, and job coaching.
Individuals from racial/ethnic minority
backgrounds often face even more
difficulties in returning to productivity and
normalcy."

								
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