Army - Stimulating Simulation

Mitch Mirkin
VA psychologist Alexander Libin
Sometimes, improvements are also seen in areas such as depression
or PTSD, even for study participants who are not in
treatment per se.
Dr. Joel Scholten, who directs the polytrauma clinic at the
Washington, D.C., VA Medical Center and serves as a coprincipal
investigator for COMPASS, called this “the beauty
of COMPASS. It focuses on a symptom or issue the participant
is interested in improving and is not dependent on the
underlying diagnosis.” (Manon Schladen, an implementation
scientist, is the study’s other lead investigator, along with Libin
and Scholten.)
For research purposes, the study excludes those who, at
baseline, are taking medication to treat severe mental health
conditions. The philosophy of COMPASS, though, is to not
wait for participants’ clinical challenges to be solved before
they get on with their goals and thereby re-engage with everyday
life. That also goes for TBI symptoms such as poor memory
or attention.
Flipping the Paradigm
“Some clinicians think, how can these veterans do goal-setting?
That’s a high-level cognitive process,” Libin said. “They
Mitch Mirkin, based in Baltimore, is the senior writer and editor
for the VA’s Office of Research and Development.
say we need to first fix their brains, fix their memory. We say
that isn’t necessarily so. You find a goal, the person gets engaged.
All the other things will fall into place. In the process
of working toward their goals, they will work on those areas of
function. We’re turning around the community reintegration
paradigm.”
Though participants like Hart report progress, COMPASS
is still being studied. Libin’s team will analyze the outcomes of
COMPASS participants against those of a control group. The
team will also compare the outcomes with those obtained
from other rehab approaches, such as one emphasizing physical
activity as a path to social engagement.
COMPASS aims to enroll a total of 110 volunteers. All
must be veterans of Iraq or Afghanistan who have a history of
mild TBI and deficits in their day-to-day function.
According to an August report from the Congressional Research
Service, approximately 327,000 deployed and non-deployed
troops have suffered a TBI since 2000, with 82 percent
of those injuries classified as mild. Most mild TBIs resolve after
a few months with no lingering symptoms, but some veterans
will continue to experience problems long after—even 10
or 20 years down the road.
“Memory, that’s the No. 1 complaint,” said Hart, who
started his Army career as a military policeman and then
switched to logistics after a couple of years. “When I think
back to the [military] schools I’ve been to and the training I
had, there’s no way I could have done that [with a TBI]. In logistics,
and in the MP corps, one thing you’ve got to have is a
good memory.”
He said since his TBI, he has a hard time recalling names
and faces. “If I look back to when I first came in, some people
that I deployed with or that I was an MP with, or the ones I
went downrange with and did certain missions, I can’t place
them at that point. I place them at Fort Knox [Ky.] instead,”
he said.
Job Struggles
Post-military, Hart has struggled with jobs and relationships.
Amid the TBI and several surgeries, most of which
were related to his blast injury, Hart strained to keep up. His
most recent job was as a civilian logistics analyst at a defense
agency in Northern Virginia. He lasted a few years but resigned
when he felt he could no longer keep up. He felt himself
becoming socially isolated and floundering in the office.
“I wasn’t doing well. I was sinking. I would get in early and
leave late and was still falling behind,” he said. “I was getting
aggravated and letting little things bother me. And then anxiety
started building up. I just crashed one day.”
Like a lot of other veterans with mild TBI, Hart has also
struggled with headaches, insomnia and balance problems. He
started to make some progress working with VA clinicians.
The study moved him further along.
“I got some good tools from VA in general,” he said. “The
COMPASS program sharpened it.”
The veterans in the program meet with a coach, also known
as a participant adviser, once a week for eight weeks. The
coach follows a loosely scripted manual based on motivational
interviewing. The aim is to get at what the client is interested
44 ARMY ■ March 2016