Date Presented 4/1/2017
The purpose of this study is to describe the occupational challenges in daily life faced by active duty military service members who experience persistent symptoms following mild traumatic brain injury. The findings establish needs that fall within each aspect of the occupational therapy domain of practice.
Primary Author and Speaker: Alison Cogan
Contributing Authors: Maria Devore, Christine Haines, Karla Lepore, Margaret Ryan
PURPOSE: Occupational therapists do not currently have a well-established role in the treatment of chronic symptoms after mild traumatic brain injury (mTBI). Although acute symptoms of mTBI typically resolve within 3 mo, 15%–20% of individuals experience chronic symptoms after injury (Carroll et al., 2014). Military service members are at particularly high risk for mTBI, yet their needs that fall within the scope of occupational therapy practice are not ascertained. They may also present with different patterns of symptoms than do civilians with mTBI (Bailie et al., 2016). The purpose of this study is to describe the challenges in daily life faced by active-duty military service members who experience persistent symptoms following mTBI.
DESIGN: A qualitative research design was used. Participants were recruited from a concussion care clinic at a military medical facility and had received occupational therapy services as part of their care. Individuals who were currently in substance abuse treatment or who had a diagnosis of a DSM–V personality disorder were excluded.
METHOD: Participants completed a semistructured interview about their military experience, injury history, recovery process, and current daily life. Data analysis was primarily descriptive and focused on experiences related to occupation. The Occupational Therapy Practice Framework (OTPF; American Occupational Therapy Association, 2014) was used to organize the findings.
RESULTS: All participants (N = 12) were male enlisted personnel and had experienced at least one mTBI (range = 1–10). Of the 12 participants, 11 reported at least one combat-related mTBI event. Eleven were Marines and one was a Navy corpsman. Age range was 22–49 yr. Length of military service ranged from 3 to 24 yr. Nearly all reported concurrent diagnoses of anxiety or depressive disorders. Deficits were reported in all areas of occupation described in the OTPF. Disordered sleep was a major problem, as it negatively impacts many other areas of occupation. As one person described, “I try to wear myself out completely to hope that I am just so dog tired I got to sleep, but it still doesn’t happen.” Service members reported loss of leisure and, in many cases, work due to their symptoms. Chronic pain was an important client factor that disrupted participation in daily life. Many reported challenges with meaningful roles, such as father, husband, and Marine. All described the cultural context of the military as a reason for delaying care immediately after an injury event and seeking help only when they reached a point at which they could no longer perform essential elements of a valued role. A service member explained, “I played it real tough Marine, didn’t want to tell nobody nothing, and slowly my body just started breaking down.”
CONCLUSION: Service members who have experienced mTBI often have co-occurring mental health concerns and physical limitations that prevent their full engagement in the occupations they value. Occupational therapy services that address the full domain of practice, in concert with an interdisciplinary care team, have the potential to improve participation of service members who are experiencing chronic symptoms after mTBI.
IMPACT STATEMENT: The findings from this study begin to establish the need for occupational therapy services among service members with chronic symptoms after mTBI. As these individuals separate from military service, it will be critical for providers in civilian settings to recognize their range of concerns.
Disclaimer: The views expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. government.
References
American Occupational Therapy Association. (2014). Occupational therapy practice framework: Domain and process (3rd ed.). American Journal of Occupational Therapy, 68(Suppl. 1), S1–S48. http://dx.doi.org/10.5014/ajot.2014.682006
Bailie, J., Kennedy, J., French, L., Marshall, K., Prokhorenko, O., Asmussen, S., . . . Lange, R. (2016). Profile analysis of the neurobehavioral and psychiatric symptoms following combat-related mild traumatic brain injury: Identification of subtypes. Journal of Head Trauma Rehabilitation, 31, 2–12. https://doi.org/10.1097/HTR.0000000000000142
Carroll, L. J., Cassidy, J. D., Cancelliere, C., Cote, P., Hincapié, C. A., Kristman, V., . . . Hartvigsen, J. (2014). Systematic review of the prognosis after mild traumatic brain injury in adults: Cognitive, psychiatric, and mortality outcomes: Results of the International Collaboration on Mild Traumatic Brain Injury Prognosis. Archives of Physical Medicine and Rehabilitation, 95(3, Suppl.), S152–S173. http://dx.doi.org/10.1016/j.apmr.2013.08.300
