How Do Other Professions Treat Combat-Related Issues?
Treatment of Traumatic Brain Injury
Physical Therapy (Weightman et al., 2010)
Literature is limited for specific interventions for TBI. However, specific problem areas/complaints associated with TBI is well supported. IE: benign paroxysmal positional vertigo, posttraumatic headache, and balance deficits caused by unilateral vestibular hypofunction.
Treatment of Post Traumatic Stress Disorder:
There is a proliferation of unsupported alternative methods: field therapy, tai chi, massage therapy, Reiki, meditation, etc. (Peterson et al., 2011)
Increased collaboration between primary care and mental health specialists is important because patients with PTSD are more likely to receive treatment in nonmental health clinics. (Calhoun et al., 2002)
Although there was no deterioration in effectiveness related to reduced length of inpatient stay, programs that converted to a residential model showed decreased effectiveness. (Rosenheck et al., 2001)
Psychotherapy:
Exposure-Based Therapy:
Recent review of literature concluded that the only approach with enough empirical support to be concluded as effective for treating PTSD are exposure-based therapies. (Peterson et al., 2011)
Nursing in the ICU: (Baxter, 2004)
Physical Therapy (Weightman et al., 2010)
Literature is limited for specific interventions for TBI. However, specific problem areas/complaints associated with TBI is well supported. IE: benign paroxysmal positional vertigo, posttraumatic headache, and balance deficits caused by unilateral vestibular hypofunction.
- Patient/client education: Handouts on exercise, injury, conversations,
- Activity Intolerance: a slow progression for return to duty. Lots of rest until symptom free. Intensity of activity should be decreased. NO exercise in the first 7 days after concussion.
- Vestibular dysfunction: individualized treatment and made specific to current understanding of etiological origins.
- High-level balance dysfunction: Balance retraining programs improve symptoms of dizziness associated with TBI. Programs include progressively more challenging tasks and environments including sports and martial arts activities to make them relevant for Service members. Also, posturography platforms used to provide practice in adjusting to altered platform stability and sensory conditions.
- Posttraumatic headache: pharmacologic treatment is not typically PT duty but may be for the military PT. Also, multimodal approach of specific training in exercise and postural retraining, stretching and ergonomic education, and manipulation and/or mobilization in combination with exercise is well supported in the literature.
- Temporomandibular disorders: No studies specifically address interventions for TMDs. Best managed by a multimodal approach. Symptom management techniques & education.
- Attention and dual-task performance deficits: Functional skills for balance, gait, and cognitive tasks trained in progressively more challenging dual-task conditions.
- Participation in exercise: PT’s encourage active lifestyles and provide recommendations that modify participation according to injury. Determine Service member’s ability to self-monitor exercise intensity so that they know how to modify to a healthy frequency and duration of exercise.
- Within the PT & OT domain: Benign paroxysmal positional vertigo of the posterior or lateral canal & unilateral vestibular hypo function
- Within the general practice therapist domain: Episodic dizziness associated with migraines.
- Within the domain of ear, nose, and throat physician or neurolis t& therapists with specialized vestibular training: More complex etiologies like perilymphatic fistula, bilateral vestibular hypofunction and Meniere’s disesase
Treatment of Post Traumatic Stress Disorder:
There is a proliferation of unsupported alternative methods: field therapy, tai chi, massage therapy, Reiki, meditation, etc. (Peterson et al., 2011)
Increased collaboration between primary care and mental health specialists is important because patients with PTSD are more likely to receive treatment in nonmental health clinics. (Calhoun et al., 2002)
Although there was no deterioration in effectiveness related to reduced length of inpatient stay, programs that converted to a residential model showed decreased effectiveness. (Rosenheck et al., 2001)
Psychotherapy:
- Cognitive behavioral therapy (cognitive therapy, exposure therapy, stress inoculation training, eye movement desensitization and reprocessing) (Peterson et al., 2011)
- Critical incident stress debriefing, stress inoculation therapy, trauma management therapy, psychodynamic psychotherapy, hypnotherapy. (Robertson et al., 2004)
- Imagery rehearsal, memory structure intervention, interpersonal psychotherapy, dialectical behavior therapy. (Robertson et al., 2004)
- Sertraline and paroxetine = popular & well accepted (Peterson et al., 2011)
- Citalopram: studies have shown effectiveness (English et al., 2006)
- PTSD-sleep issues: a1- adrencoceptor antagonists and 5-HTz receptor antagonists appear to be promising in treatment. (Liempt et al., 2006)
- Best used in combination with psychotherapy (Peterson et al., 2011)
Exposure-Based Therapy:
Recent review of literature concluded that the only approach with enough empirical support to be concluded as effective for treating PTSD are exposure-based therapies. (Peterson et al., 2011)
- Prolonged Exposure: 10-12 sessions of 90 min each, and the therapy has 4 main components: psychoeducation, breathing retraining, imaginal exposure, and in vivo exposure. Also effective for acute stress disorder. However, PE research on military personnel is lacking. (Peterson et al., 2011)
- Cognitive Processing Therapy: 12 one-hour sessions. Includes psychoeducation about PTSD, cognitive restructuring, and exposure. Limited research on military personnel. (Peterson et al., 2011)
Nursing in the ICU: (Baxter, 2004)
- In the ICU, need to be able to recognize and differential the symptomology of PTSD.
- Establish protocols to minimize triggers of PTSD symptomology and engage client in participation in therapeutic management of PTSD. IE: Calmly and slowly approach patient within field of vision, minimize loud unexpected noises, wake patients verbally rather than touch, appreciate chronicity of each patient’s condition.
- Discussing psychiatric referral options for those patients exhibiting signs and symptoms.