May 15, 2019 – For veterans and service members with brain injury in the VA's Polytrauma System of Care, rehabilitation follows a "person-centered, participation-oriented" (PCPO) approach – targeting participation goals identified by the person served and their significant others. A review and introduction to PCPO rehabilitation for brain injury in the VA appears in a special section of the May/June issue of the Journal of Head Trauma Rehabilitation (JHTR). The official journal of the Brain Injury Association of America, JHTR is published in the Lippincott portfolio by Wolters Kluwer.
James F. Malec, PhD, ABPP-Cn, Rp, an emeritus professor of Indiana University School of Medicine and Mayo Clinic, highlights the PCPO approach as an integral part of post-hospital rehabilitation for veterans and service members in the Polytrauma Transitional Rehabilitation Programs (PTRPs), part of the VA's Polytrauma/TBI System of Care. "The philosophy of PCPO is that we all have strengths and weaknesses and not all weaknesses need to be addressed to be a fully participating and contributing member of society," Dr. Malec writes.
"Effective rehabilitation focuses on weaknesses that will interfere with participation goal achievement as well as strengths and resources that may be capitalized on in the pursuit of participation goals," Dr. Malec comments. He notes, "In rehabilitation parlance, 'participation' is shorthand for participating in and contributing to family and community life to one's full capacity."
PCPO Rehabilitation for Brain Injury – Focusing on Veterans' Goals
The article introduces the special section of JHTR, which presents invited papers on the PTRPs' approach to post-hospital rehabilitation for veterans with brain injury. The VA has five PTRPs nationwide, providing residential care to assist veterans in making a successful transition into the least restrictive, most appropriate community setting. These specialized centers reflect the VA's commitment to effective rehabilitation care for veterans with brain injury and other forms of polytrauma.
Person-centered, participation-oriented rehabilitation focuses on therapeutic activities chosen to meet the participation goals identified as important by the person with brain injury and their family/significant others – not just targeting "impairments" identified by professionals. While research supports the effectiveness of PCPO rehabilitation, most such studies have been performed in civilian populations.
The PCPO approach begins with a comprehensive, holistic evaluation of the interacting factors that may affect rehabilitation after brain injuries: physical, cognitive, emotional, social, and spiritual. In collaboration with the person served and those close to them, treatment targets the "realistic participation goals of the person served." Dr. Malec notes that while many veterans and service members have milder brain injuries, the rehabilitation approach must address accompanying issues such as posttraumatic stress disorder or depression.
The individual's progress is closely monitored, and treatment modified accordingly. Family and significant others are an important part of PCPO rehabilitation, helping to make the social environment "more accessible and hospitable" to the individual's needs. The approach includes post-discharge planning to help sustain gains and self-management strategies. The PTRPs use state-of-the-science outcome measures and methods to evaluate the success of rehabilitation.
The PCPO approach has emerged as a key focus of the PTRP system – a central part of the VA's approach to individualized rehabilitation and community reintegration for veterans and service members with brain injury and polytrauma. Other topics in the special section of JHTR detail the development and effectiveness of PTRP care, including the principles and methods of vocational rehabilitation, support for community reintegration, concurrent treatments for mental health issues, and the overarching goals and outcomes of the PTRPs
Since their implementation in 2007, the PTRPs have experienced growth and enhancements of the environment of care. Service for veterans is often provided in collaboration with non-VA partners including service organizations, non-profit and for-profit organizations, and other community providers. As this series of articles describes, the PTRPs strive to maintain sufficient flexibility to address the individual needs of the veterans served.
About The Journal of Head Trauma Rehabilitation
The Journal of Head Trauma Rehabilitation is a leading, peer-reviewed resource that provides up-to-date information on the clinical management and rehabilitation of persons with traumatic brain injuries. Six issues each year aspire to the vision of “knowledge informing care” and include a wide range of articles, topical issues, commentaries and special features. It is the official journal of the Brain Injury Association of America.
About the Brain Injury Association of America
The Brain Injury Association of America is the country’s oldest and largest nationwide brain injury advocacy organization. Our mission is to advance awareness, research, treatment and education and to improve the quality of life for all individuals impacted by brain injury. Through advocacy, we bring help, hope and healing to millions of individuals living with brain injury, their families and the professionals who serve them.
About Wolters Kluwer
Wolters Kluwer (WKL) is a global leader in professional information, software solutions, and services for the clinicians, nurses, accountants, lawyers, and tax, finance, audit, risk, compliance, and regulatory sectors. We help our customers make critical decisions every day by providing expert solutions that combine deep domain knowledge with advanced technology and services.
Wolters Kluwer reported 2018 annual revenues of €4.3 billion. The group serves customers in over 180 countries, maintains operations in over 40 countries, and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.
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