afghanistan & iraq

VA’s Research and Development program has a comprehensive

research agenda to address the deployment-related health issues

of the newest generation of Veterans—those returning from

Operation Enduring Freedom andOperation Iraqi Freedom (OEF/OIF).

A F G H A N I S T A N & I R A Q

Research to Improve the

Lives of Veterans Who Served

in Afghanistan & Iraq

D I S C O V E R Y I N N O V A T I O N A D V A N C E M E N T

For questions or additional copies contact:

R&D Communications (12)

103 South Gay Street, Ste. 517

Baltimore, MD 21202

(410) 962-1800 x223

[email protected]

D I S C O V E R Y I N N O V A T I O N A D V A N C E M E N T D I S C O V E R Y I N N O V A T I O N A D V A N C E M E N TD I S C O V E R Y I N N O V A T I O N A D V A N C E M E N T D I S C O V E R Y I N N O V A T I O N A D V A N C E M E N T

A Messageto Our

Veterans

As the largest integrated health caresystem in the country, the VeteransHealth Administration (VHA), partof the Department of Veterans AAairs(VA), provides health care to morethan five million Veterans each year.

VA is committed to providing thebest care possible to all Veterans,including our newest generationof Veterans—the men and womenreturning from combat inAfghanistan and Iraq.

Many of the brave men and womenwho served and were injured inOperation Enduring Freedom andOperation Iraqi Freedom (OEF/OIF)are returning home with complexmedical conditions such as traumaticbrain injury, limb amputations, andburns. Furthermore, due to improvedbody armor and exceptional medicalcare provided on the battlefield, manyservice members are surviving majorblast-related injuries and will requirelong-term, specialized care here athome. For some of the new Veterans,readjustment to civilian life andmental health challenges such asposttraumatic stress disorder anddepression may be critical issues.

While VA’s Office of Research andDevelopment is dedicated to conduct-ing research that will advance the carefor all Veterans, the urgent health careneeds of military members returningfrom conflicts in Afghanistan and Iraqare a top research priority.This booklet provides an overviewof deployment-related health issuesand highlights research advances thatwe hope will improve the health careof returning OEF/OIF Veterans.

Joel Kupersmith, M.D.Chief Research and Development OfficerDepartment of Veterans Affairs

Research AgendaVA’s Office of Research and Development has a comprehensive research agenda toaddress the deployment-related health issues of the newest generation of Veterans—those returning fromOperation Enduring Freedom and Operation Iraqi Freedom(OEF/OIF). VA researchers are working to develop new treatments and tools for

clinicians to ease the physical and psychological pain of returning service members,improve access to health care services, and accelerate discoveries of new and innovativeways to evaluate and treat OEF/OIF Veterans’ needs.

This research will also benefit Veterans of other military conflicts and improve the livesof civilians suffering from disability due to injury or disease. In addition, the VAOfficeof Research and Development works collaboratively with other organizations, such as theDepartment of Defense (DoD) and the National Institutes of Health (NIH), to advanceresearch aimed at improving the health and care of all generations of Veterans.

CollaborationsIn an effort to provide the highest quality and most cost-effective specialized care forreturning OEF/OIF service members, VA Research and Development collaborateswith other programs within the Veterans Health Administration and with other federalagencies, including DoD and NIH.

Below are just a few examples of collaborative work.

• VA researchers are collaborating with clinical staff at the four regionalVA Polytrauma Rehabilitation Centers, which provide specialized rehabilitationtreatment, to expand clinical expertise in polytrauma and blast-related injuriesthroughout VA and between VA andDoD. Research projects include evaluationof a pain assessment tool and a study aimed at improving family support andprovider-family communication during an injured service member’s stay in thePolytrauma Rehabilitation Center.

• DoD, NIH, and VA researchers are collaborating to develop a family interventionprogram with spouses of service members being treated for limb loss or traumaticbrain injury. This project was designed to teach spouses techniques in alternativeand complementary medicine that have been shown to lessen anxiety and painlevels and allow for reduced use of pain medication.

• VA, in collaboration with the National Institute of Mental Health and DoD,issued a call for collaborative research focusing on combat-related mental disordersand stress reactions involving active-duty or recently separated National Guardand Reserve troops fromOEF/OIF. Funding has begun for projects to screen,assess, and provide direct care (that is, early intervention, prevention, treatment,rehabilitation, and maintenance) to groups and individuals who are at risk becauseof their combat exposures or who have been diagnosed with posttraumatic stressdisorder.

VA’s Research and Development program will continue to discover new knowledgeand create innovations to help advance the health and care of Veterans and the nation.

Baltimore, MD 21202

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A Messageto Our

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• Collaborating with BrownUniversity and theMassachusetts Institute of Technology to develop a“biohybrid” limb that will combine regenerated tissue,lengthened bone, and implanted sensors to allow the limbto be controlled by the user’s brain signals, and newanchoring techniques to reduce the discomfort associatedwith current prostheses.• Partnering with the Department of Defense (DoD) toimprove prosthetic designs, define standards of function,and conduct outcome studies.

BurnsMany burn injuries result in the loss of fingers. VA researchersare developing a state-of-the-art prosthesis for people whostill have a wrist but have lost their fingers due to burns orother injuries.

US Medicine. June 2006. www.usmedicine.com

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

VA researchers are:

• Exploring new approachesto pain treatment thatwill help Veterans continuerehabilitation and achievemaximum restoredfunction.• Collaborating withDoD colleagues to assesslong-term outcomes ofOEF/OIF Veterans with burn injuries.• Working on the jointly outlined VA andDoD researchagenda on burns to address priority areas such asmanaging burn scar contractures (tightening of muscle,tendons, ligaments, or skin that prevents normal move-ment), fostering successful psychological adjustment,and establishing reliable outcome measures to guideclinical care.

Important areas that VA researchers are investigating include:

• Developing and testing comprehensive rehabilitationstrategies.• Searching for ways to improve memory and attentionand protect brain cells from injury.• Testing new drugs for treating TBI.• Helping Veterans with TBI to regain a measure ofindependence—for example, by using a driving simulatorto evaluate Veterans’ driving ability or provide driverretraining.

Spinal Cord InjuryA neuromotor prosthesis (NMP) is a brain-computer interfacethat helps replace or restore lost movement in paralyzedpatients. The technology uses a miniaturized array of electrodesthat picks up brain signals and sends them to a computer fordecoding. VA researchers and others recently demonstratedthat an NMP could enable paralyzed patients to operate anartificial hand, robotic arm, computer, or television by usingonly their thoughts.

Nature. 2006; 442(7099):164–71.

VA has the largest network of care for spinal cord injury (SCI)in the nation and provides primary and specialty care at 23regional SCI centers. VA leads the health care profession in

defining new methods of rehabilita-tion through SCI research andengineering. For example, VAresearchers identified a molecularbasis for “phantom pain,” aphenomenon in which patientsexperience the sensation of painin a limb that has lost all feeling,as in SCI, or in a limb that is nolonger there, as in amputation.This discovery has enabled a betterunderstanding of phantom pain andmay eventually lead to new methodsof pain relief.

Currently, VA researchers are conducting importantSCI studies that are:

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

Amputation and ProstheticsCurrently available prostheses for transtibial (below the knee)individuals with amputations do not help promote normalwalking; in fact, their “passive” design can result in balancedifficulties and slow walking. A team partly funded by VAhas addressed this problem by developing a poweredankle-foot prosthesis that promises to help restore the abilityto walk normally. A preliminary study involving three transtibialindividuals with amputations confirmed the benefits of the newprototype: the patients expended less energy during walking,had fewer balance problems, and walked 15 percent faster.

Approximately 6 percent of wounded service membersreturning from Iraq are individuals with amputations.The number of Veterans accessing VA health care forprosthetics, sensory aids, and related services has increased bymore than 70 percent since 2000. VA’s Research andDevelopment program currently supports a broad researchportfolio related to amputation and prosthetics.

VA researchers are:

• Implementing cutting-edge technology usingmicroelectronics and microchips (very small electroniccomponents), as well as robotics, to create lighter, morefunctional prostheses that look, feel, and respond morelike natural arms and legs.

Military personnel face many psychological challengesduring their tours of duty that can make it difficult to readjustto life back home. As many as one in three service membersmay seek or need mental health care after returning from dutyin Afghanistan or Iraq. Service members may experiencesymptoms of psychological distress, “readjustment disorders,”or more serious problems such as posttraumatic stressdisorder (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 theirpsychological distress. Use of alcohol or drugs can exacerbatethese mental and emotional disorders.

VA researchers are working to improve mental health care by:

• Developing methods to screen for mental health problemsbecause early recognition and treatment results in betterpatient outcomes.• Leading the way in conducting studies on both drug andpsychosocial/behavioral therapies.• Studying treatment for women Veterans, who mayexperience trauma differently than male Veterans.

Posttraumatic Stress DisorderVA researchers have found that prazosin, an inexpensivegeneric drug already used by millions of Americans for highblood pressure and prostate problems, improves sleep andreduces nightmares for Veterans with PTSD. A larger trialto confirm the drug’s effectiveness is underway.

Biological Psychiatry. 2007;1(8):928–34.

PTSD is an anxiety disorder that may occurafter 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 havea diagnosis of PTSD respond well to standard treatment,but others do not. Research is critically needed to betterunderstand this disorder so that effective preventive strategiesand treatments can be developed and made available.

Some key research questions include:

• What determines which individuals will develop PTSD?• How can we correctly identify those at risk for PTSD anddetermine the most effective interventions?• Can we identify biological markers that might help guidepsychological 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 ofprolonged exposure therapy.• Developing new ways to provide care to Veterans livingfar from VAmedical facilities, such as the deliveryof health information and services via telephone, theInternet, and videoconferencing.• Striving to ensure that evidence-based, state-of-the-artcare is available to all Veterans with PTSD by quicklymoving scientific breakthroughs from the laboratory intopatient care.

Traumatic Brain InjuryVA researchers demonstrated that the intravenous infusion ofbone marrow stem cells taken from adults can protect againstbrain trauma. This has major implications for an early interven-tion in Veterans with brain trauma and spinal cord injury.

Neuroscience. 2005;136(1):161-9.

Traumatic brain injury (TBI) is a general diagnosis coveringa wide range of injuries to the brain that can occur duringcombat. These injuries can result in physical symptoms suchas vision impairment, dizziness, and headache, as well ascognitive and emotional problems such as memory impair-ment, poor judgment, anxiety, and depression. VA investigatorsare conducting cutting-edge research to help return maximumfunction to Veterans with TBI.

PolytraumaMany of the wounded service members returningfrom the OEF/OIF conflicts are victims of carbombs 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 internalorgans, limb loss, vision loss, hearing loss, paralysis, chronicpain, burns, and psychological disorders.

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

• Improve coordination of care for Veterans with multipleinjuries.• Identify subtle indicators of potentially significantproblems caused by head trauma, such as disorderedperception and judgment.• Repair the injured brain, spinal cord, and other organs,and protect them from further damage.• Advance technologies such as hearing and vision implantsand computerized or robotic prostheses.• Develop strategies that will reduce the burden for familymembers of injured Veterans.

Mental HealthVA researchers developed a screening tool for depressionfor use in primary care settings. The tool has been adopted

in other health care systems in the U.S.and the United Kingdom.

JAMA. 2006;295(24):2874-81.

A New Generation of Veterans

Working to Further Improve the

Health and Care of Veterans Who

Served in Afghanistan & Iraq

VA researchers are:

Nature. 2006; 442(7099):164–71.

VA researchers are:

Neuroscience. 2005;136(1):161-9.

JAMA. 2006;295(24):2874-81.

VA researchers are:

Nature. 2006; 442(7099):164–71.

VA researchers are:

Neuroscience. 2005;136(1):161-9.

JAMA. 2006;295(24):2874-81.

Baltimore, MD 21202

(410) 962-1800 x223

[email protected]

A Messageto Our

Veterans

afghanistan & iraq

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