Project 1: Promoting Adherence among Outpatients in Physical Rehabilitation Programs
Rehabilitation for warfighters with orthopaedic trauma (including limb salvage / limb loss) has been structured at the military treatment facilities to allow for independence and progressive reintroduction in the civilian community or active duty. However, no studies to date have specifically targeted the issue of control and timing in the designed rehabilitation programs to determine if these tools are used several years outside of the clinic. Therefore, this study addresses the issues of control and of time in rehabilitation programs. To improve the current rehabilitation regimen, we will be performing ethnographic interviewing with patients about their temporal experiences as well as their sense of autonomy while they are in the rehabilitation sites and contrast them to patients who have left rehabilitation within the last 36 months.
Project 2: Neuropsychiatric Co-morbidities and Reintegration
Mild traumatic brain injuries have remained a challenging rehabilitation barrier in the military community, as the number of returning service members with mTBI has been estimated to be 300,000. Therefore, improved understanding of the current standard of care for injuried service members and veterans with mTBI is neccesary for determining the effects of combat-related deployment on the cognitive states and well-being of warfighters.
This research addresses the role the brain plays in the development of ideas about health and well being in the U.S. particularly in exploring the changing way that people understand trauma – its infliction and its effects. This research investigates the nexus of psychiatry and biomedicine particularly as they interact in clinical programs that address the needs of members of the U.S. Armed Forces returning from deployments in Iraq and Afghanistan as well as how information about these programs, and the population they serve, percolates into broader public consciousness and shapes how veterans who are currently in treatment or seeking care understand the effects of their deployment on their minds and their wellbeing.
Three post-deployment military populations will be ethnographic interviewed to address the effect of mTBI: (1) those recovering from orthopedic trauma who are also diagnosed with mTBI (2) patients at veteran centers who are in counseling for social integration challenges, and (3) non-injured and non-treatment seeking post deployment veterans. The goal is to better understand how these sub groups of military personel are affected by exposure to a combat sitation in an effort to improve the quality of care post-deployment.
Project 3: Social Reintegration of Service-Members with Orthopedic Injuries
The proposed research project builds upon the knowledge in Projects 1 and 2 to better determine the various challenges service members experience in terms of their reintegrating into the household following combat-related trauma. These issues remain important as veterans with limb-loss have a higher report of violence, suicide, substance abuse and family dissolution following orthopedic injuries. This study must be performed to ensure the psychosocial need of warfighters’, especially since this has not been investigated previously.
The proposed research projects seeks to explore, using qualitative research methods associated with medical anthropology, the ways that individuals and practitioners understand the various challenges service member patients experience in terms of their reintegrating into their home communities. Research will be conducted with practitioners and with patients and with discharged patients in the National Capital region as well as adjacent areas in Delaware, Maryland and Virginia to understand how patients and practitioners understand the challenges of social reintegration and what the practical and subjective barriers are to patients re-entering mainstream American life.