April / May 2009

Rehabilitation and Reintegration, Military Style

09aprmay_gall Lieutenant Colonel Kevin Galloway, AN, is chief of the Clinical Care Branch in the Proponency Office for Rehabilitation and Reintegration (PR&R) at the United States Army Office of The Surgeon General. PR&R is the Army’s lead organization for policy, direction, and oversight of rehabilitation and reintegration. PR&R’s vision is to optimize the quality of life of soldiers and their families by establishing the world-class model of military rehabilitation and reintegration services.
    He will present “Returning Heroes: U.S. Army Rehabilitation and Reintegration History and Current Initiatives” at ARN’s 35th Annual Educational Conference in Albuquerque, NM.

Q. How did you become involved in rehabilitation? Did your career in the military begin at the same time?
A. The Army Nurse Corps has no formal area of concentration for rehabilitation nursing. My nursing experience has been gained in a wide variety of inpatient and outpatient settings. Since I’ve been in the Army, I’ve worked in military community hospitals, larger medical centers, and many military field hospitals. I’ve worked in inpatient medical-surgical units, several emergency departments, and ambulatory care clinics.
    I guess you can say that I officially became involved in rehabilitation when I was assigned to the PR&R at the Office of The Surgeon General (OTSG) last summer. Unofficially, my eclectic clinical background has always been focused on returning soldiers and family members to optimal levels of function, and rehabilitation is a part of this mission.
    Since my arrival at PR&R, I’ve been reading a lot of rehabilitation literature and focusing on networking to gain a better understanding of rehabilitation issues. I met Donna Jernigan, president of ARN, while exhibiting at the ARN Annual Educational Conference last year.

Q. What have been the major advances or changes that have most affected the way rehabilitation is conducted in the U.S. Army?
A. The most obvious would be the advances in amputee care and rehabilitation of wounded service members returning from Iraq and Afghanistan. The work done at the Center for the Intrepid at Fort Sam Houston, TX, and the Military Advanced Training Center at Walter Reed Army Medical Center in Washington, DC, is remarkable. Our rehabilitation teams of doctors, nurses, physical therapists, and occupational therapists have been working with state-of-the-art equipment and techniques and have been able to assist many of the seriously injured amputees to quickly return to levels of function unheard of in the past. Many have even returned to duty in the military.
    The Army Medical Department (AMEDD) has recognized the importance of more immediate and available rehabilitation resources to address the less serious but more frequent musculoskeletal injuries occurring in our military units deployed around the world. Physical therapists are now being integrated into many military units and this allows for quicker initiation of rehabilitation proximal to the time and place of injury, which improves the chance that soldiers will be returned to duty.

Q. What is the protocol for initiating rehabilitation treatment for soldiers?
A. Traditional inpatient rehabilitation following significant injuries is certainly organic to the military’s medical mission. We have multidisciplinary teams that address the rehabilitation requirements within our facilities and partnerships with Veterans Administration and civilian hospitals to take care of patients who are referred elsewhere for care. The bottom line is that if our patients require increased levels of rehabilitation services not available in our facilities, we will look outside our facilities to ensure they get the care they need and deserve.
    As I mentioned earlier, the Army also recognizes the importance of starting rehabilitation as soon as possible following any injury and has moved rehabilitation resources as close to the soldiers as possible. Primary care providers who are taking care of our soldiers should have access to trained physical therapists and other rehabilitation resources, regardless of where they are located. In addition, PR&R has been working on providing educational toolkits to standardize and improve rehabilitation for common musculoskeletal injuries.

Q. Does rehabilitation for military personnel differ from rehabilitation treatment for civilians?
A. If you are asking me if there is a difference within the military healthcare system in rehabilitation for military personnel and nonmilitary persons, the answer would essentially be “no.” The same standard of care applies to military and nonmilitary patients in our hospitals and clinics.
    However, based on our need to maintain a ready force, we do recognize some unique differences with our military personnel. The majority of rehabilitation conducted in the military is for mild-to-moderately severe musculoskeletal injuries. Military personnel are akin to athletes, so we tend to use a sports medicine approach to their care. We focus on minimizing further injury, minimizing recovery time, and maximizing long-term function. This involves everyone from the medic taking care of a soldier in the field, to the primary care provider in his or her unit, to physical therapists supporting these units, and to specialty care provided in our military hospitals by our physicians, nurses, and other staff. It is most certainly a team approach.

Q. How do you coordinate care after a soldier has been discharged from military care but must continue rehabilitation?
A. We work with all members of the healthcare team to ensure a soldier is able to make a smooth transition from the military. Every soldier’s transition from the military includes a review of his or her medical condition. For those who will require ongoing rehabilitation services after discharge, a case manager and possibly an Army Wounded Warrior (AW2) Program advocate are assigned to help with the transition.
    AW2 is the official U.S. Army program that assists and advocates for severely wounded, injured, and ill soldiers and their families, wherever they are located, including after discharge. The AW2 advocate maintains a relationship with the soldier and family to ensure they are receiving the support they need for as long as it takes.

Q. Are there innovations in rehabilitation treatment that originated in the military that are now benefitting the general rehabilitation population?
A. Advanced amputee care techniques refined and invented during the last 8 years have started to carry over to civilian practice. For example, at last year’s ARN conference, I spoke with a nurse who was involved in the care of a civilian bilateral upper-extremity amputee. She had several questions about how to best help this patient with certain rehabilitation tasks and goals that were beyond the experience of the local providers. I was able to refer her to one of the occupational therapist at the Center for the Intrepid who was able to provide direction and insight based on experiences with the military population with similar challenges.

Q. What challenges still exist for providing rehabilitation care to soldiers?
A. The name of our office, Proponency for Rehabilitation and Reintegration, brings certain challenges. The rehabilitation side is difficult but supported by volumes of peer-reviewed literature and clinical experience. The reintegration side is another matter altogether. We are tasked with supporting the reintegration of our soldiers into their military units, alternate military specialties, or their optimal function as citizens. We take this duty very seriously and work toward ensuring the AMEDD policies are fully integrated and support this goal.

Q. What are you looking forward to when presenting at the ARN Educational Conference?
A. I always enjoy telling stories about our military heroes, their families, and those who are responsible for caring for them. Frequently, in venues such as this, there are clinicians who have been working with military or former military patients and are struggling to get information about how to best care for these patients. I enjoy nothing more than being a conduit for information and a bridge to the correct point of contact for these clinicians and their patients.

Q. What do you hope attendees of the ARN Educational Conference will gain from your session “Returning Heroes: U.S. Army Rehabilitation and Reintegration History and Current Initiatives?
A. I hope attendees will begin to see the similarities between civilian and military medicine. I’d like them to feel more comfortable if they ever have the opportunity to interact with any of our patients, their families, and our providers. In addition, I hope to highlight and explain some of the unique differences that exist for our patients and our mission.