Vocational and Community Integration for Military Servicemembers and Civilians with Traumatic Brain Injuries at Paintings & Prose: A Combined Art Gallery and Bookstore

Article excerpt

Key elements of successful independence in life are securing and maintaining a job and meaningfully engaging in satisfying activities--working and playing. The ability to be productive, however, requires a complex set of skills that are often lost when a brain injury occurs. Unfortunately, military personnel involved in the Iraq and Afghanistan wars often experience traumatic brain injuries (TBIs) from enemy explosives [1]. Brain injuries from explosive blasts from car bombs, improvised explosive devices, the more lethal explosively formed projectiles, and rocket-propelled grenades occur so frequently as to be considered the signature injury of these wars [2]. In addition, military personnel and civilians will also experience brain injuries from other mechanisms, such as motor vehicle accidents, falls from heights, training accidents, and violent encounters (e.g., fights, robberies) in unsafe situations in the United States as well as in foreign countries.

These difficulties, along with others, are addressed in a real-world environment at Virginia NeuroCare (VANC) and its innovative art gallery and used bookstore, Paintings & Prose. VANC, a civilian-operated, Department of Defense-funded brain injury services program for military servicemembers with brain injuries, is located in Charlottesville, Virginia. Founded in 1999, VANC is an active member of the Defense and Veterans Brain Injury Center (DVBIC) (www.dvbic.org), a national network of providers with several missions: (1) to evaluate and treat TBI in military servicemembers; (2) to provide brain injury education to family, friends, individuals with brain injuries, and the general public; (3) to track all returning military personnel from overseas deployments to Iraq and Afghanistan; (4) to develop clinical standards of care for providing brain injury services for the military; and (5) to implement research on TBI and posttraumatic stress disorder (PTSD).

Gainful employment is a major marker for a successful recovery following TBI [3]. However, basic skills required for even entry-level jobs can often be lost as a result of TBI [4]. Accordingly, TBI rehabilitation focuses not only on reducing typical problems with behavioral disinhibition or initiation but also on redeveloping social skills, basic problem-solving, safety awareness, and the abilities required for a specific job. Poor coping strategies such as substance abuse; social interaction styles that include passivity or anger; and basic problems with deficit awareness, disorganization, and lacking goal-directed behaviors often preempt the veteran's ability to get or sustain a job following a brain injury. While often not the primary focus of rehabilitation, the development of avocational, recreational, and leisure skills is also a critical component in enhancing quality of life after TBI.

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Active Duty military and veterans from all branches of service, as well as civilians, are treated at VANC. From the point of injury, the process of evaluation, treatment, and rehabilitation begins. As military servicemembers move through the beginning stages of acute medical care and stabilization (or in some mild TBI cases, are recognized some time afterward), the question of what percentage of recovery will likely occur is raised. Some servicemembers return to their units and do well. Often in the National Guard and Reserve Units, servicemembers return to their civilian jobs and can be effectively treated as outpatients. In other cases, while the need for hospitalization has passed, success in returning to jobs and community integration has not been fully achieved. This gap, which sometimes exists but is often not recognized in the traditional stages of rehabilitation recovery, results in less than optimal outcomes and diminished quality of life. VANC seeks to fill this gap.

VANC allows individuals in this category to live, temporarily, in the Grove House, an actual home setting in the community, while receiving intensive therapy from a comprehensive interdisciplinary clinical team, including a medical director (James R. …