After being medically retired from the Army last year as a result of mental wounds he suffered in Iraq, Michael Bradley faced a daunting challenge that would later prove pivotal in his recovery: holding down a job in the civilian world.

But a new education campaign, America’s Heroes at Work, aims to make employment a less intimidating transition by teaching bosses and managers how to accommodate workers like Bradley — a pool of productive, capable employees who are afflicted with post-traumatic stress disorder or traumatic brain injury.

Bradley, who today joined officials from the departments of Labor and Defense and industry representatives at a news conference to kick off the new program, shared his story with American Forces Press Service.

With six years under his belt as an active-duty medic, Bradley’s move back to civilian life was precipitated by a roadside bomb in Baqouba, Iraq, that detonated under his vehicle.

“I was driving a high-profile individual,” recalled Bradley, a former staff sergeant with the Army’s 4th Infantry Division. “All I remember is that I saw the flash, and I pulled him to get him out of the way of the blast. That’s all I remember.”

Moments later, a 155 mm mortar struck the driver’s seat. “A piece of shrapnel had taken out my seat where I was sitting; it probably would have killed me,” he said. But the preceding blast that knocked him unconscious had caused him to slump over and out of the way.

Though he escaped the horrific scene without serious physical wounds, the scar tissue on the former staff sergeant’s mind is still fresh. His memories are so raw that the sound of a slammed door makes him edgy and on guard.

“I went to Disneyland, and the cannons starting firing off the ship,” Bradley recalled. “And here I am low-crawling across the ground, knowing full well that I’m in Disneyland, but my body’s reacting.

“My mind is saying, ‘Get up you fool.’ But my body’s saying, ‘No. I’m not going to do it,’” he said.

Intense physiological responses to harmless stimuli often are a hallmark of post-traumatic stress disorder and traumatic brain injury — known as PTSD and TBI — afflictions that affect Bradley and an estimated 20 percent of U.S. veterans of the wars in Iraq and Afghanistan, according to a report by the Rand Corporation.

But Bradley, who was hired as an analyst with Halfacre & Associates in February, has found that, in addition to dispelling his fears that the skills he learned in the Army wouldn’t translate into a civilian job, his employment also has helped on the road to recovery.

“To get back into the work force and be able to see that I can succeed [and that] what I wrote down on my resume is true, and that I can do it, and I have a lot to offer … has really decreased stress,” he said. “To overcome those obstacles, and being able to be out in the work force, has really helped emphasize that I can do it and I can succeed.”

Bradley, 27, credits his patient boss for exercising understanding when Bradley takes occasional brief breaks from work to mitigate problems stemming from his ailments. Common symptoms can include dizziness, headaches and anxiety, according to the Department of Labor.

But in most cases, employers need only make modest and inexpensive changes — most totaling under $500 — to adapt a workplace to fit the needs of an employee with similar mental afflictions, said Neil Romano, assistant secretary of labor for disability employment policy.

The mitigation of minor symptoms, which in some instances can take the form of basic accommodations like providing better-lit office space or a quieter work area, can pay huge dividends, Romano said. Eighty percent of the time, he added, effects of mild TBI cases disappear in about a year.

“We can’t lose their productivity; we can’t lose their skills; we can’t lose their value to society,” Romano said last week. “These are human beings that deserve the opportunity to continue doing what it is they want to do, which is to continue to be productive in society.”

Romano noted that while the America’s Heroes at Work initiative applies to a wide range of Americans suffering from PTSD and TBI, the nation has a special obligation to its returning veterans.

“An initiative like this is terribly important, because if you’re going to have one in five veterans coming home with this, they’re just not people we can afford to forget or lose,” he said. “They didn’t forget us, they did their job. And we can’t [forget them].”

The Labor Department spent almost a half-million dollars developing the program’s Web site, americasheroesatwork.gov, Romano said, adding that additional contributions have come from interagency and business partners.

David S. C. Chu, undersecretary of defense for personnel and readiness, said the Labor Department-led effort is to create the kind of environment that “promotes resiliency.”

“What Labor is trying is to do, in my judgment, is help employers understand [that] if you support [the employee], he’ll perk back up again,” Chu said. “It’s a bit like being on team with a good coach. You’ve got a good coach, that performer somehow finds an extra amount of energy, an extra effort.

“What we’re hoping to do is to give each one of these veterans a little bit of extra coaching, a little bit of extra help that will get them to the finish line,” he said.

DoD
By John J. Kruzel
American Forces Press Service

A revolutionary treatment program here is demonstrating “little miracles” as it gives new hope to soldiers afflicted with post-traumatic stress disorder who want to stay in the Army, its director reports. The new program is the brainchild of clinical psychologist John E. Fortunato, who uses a holistic approach to treating PTSD at the new Fort Bliss Restoration and Resilience Center.

Fortunato conceded that his proposal “wasn’t an easy sell” initially, particularly because it wove yoga, massage therapy and other nontraditional approaches into its treatment program. But driven by the frustration of seeing soldiers with PTSD forced to leave the Army against their wishes, Fortunato pressed forward and won approval for his prototype program.

With $2.2 million in initial funding and a 1940s barracks building to rehab, he set out to launch the Restoration and Resilience Center in June 2006. The center opened last summer.

Fortunato was convinced traditional PTSD treatments weren’t long enough, intense enough or comprehensive enough. “So we set out to create a program to address all aspects of PTSD and treat the whole soldier,” he said.

The participants, all volunteers, take about one-half the doses of medications they’d typically get through community mental-health programs. “That’s because we’re doing a bunch of other things,” Fortunato said.

Many PTSD-afflicted soldiers experience “hyper-arousal,” which the center staff treats with techniques like medical massage and “Reiki,” a Japanese stress-reduction technique. Acupuncture has proven to be “extremely effective” in treating the anxiety, panic, and tension-induced physical pain many experience, Fortunato said.

There’s a big physical component to the program, too. The soldiers must walk at least 10,000 steps a day, including a daily 45-minute “power walk.” They play water polo three times a week, forcing interaction that Fortunato said many would rather avoid.

“That’s another piece of PTSD. They want to socially isolate. They don’t like to interact with other people,” he said. “So we have them interact with the people they feel most comfortable with: other soldiers with PTSD.”

Field trips during the program take the soldiers to the local mall and Wal-mart, “two hells” to many of them because they’re too big, too crowded and too noisy, Fortunato said. “We teach them ways to regulate their stress level so they can handle those kinds of environments.”

Many afflicted soldiers have trouble with concentration and memory, Fortunato said. For them, the program’s mix of physical activity and calming techniques appears to help. They do yoga; tai chi, a Chinese martial art; “Quigong,” a centuries-old Chinese self-healing method; and biofeedback, which uses the mind to heal the body. “We have a meditation room that looks like it came out of a Zen monastery,” Fortunato said.

The program aims to repair the physical damage to the “learning center” in many PTSD sufferers’ brains. That’s caused, Fortunato explained, when the body’s stress hormone is elevated too high and for too long — as it commonly is among combat troops.

“The good news is, [the learning center] is one of only two parts of the brain that can grow new cells,” he said. So his program requires participants to sit at a computer several times a day, doing mental exercises to help them regain their cognitive functioning.

While confronting the physical aspects of PTSD, the program addresses the emotional and spiritual aspects, too.

“Few soldiers come back from war without terrible images and events in their head,” Fortunato said. Many “suck it up and soldier on” in the combat theater because they have no choice. But when they return home, these issues can percolate to the surface as nightmares, flashbacks and other problems.

Fortunato’s program uses “rehearsal therapy” to help participants confront their most painful memories and experiences. “The soldier tells the story, as painful as it is, over and over until you’ve emptied it of its emotional punch,” he said. “They are never going to forget the story, but it doesn’t have to have the grip on their guts that it did before.”

Meanwhile, many soldiers with PTSD find that their combat experience has shaken their core beliefs and values, Fortunato said. A chaplain helps them review “the big organizing things in their life” as they address the spiritual piece of their PTSD struggle. “We weren’t doing much to address this before,” but it’s critical to a soldier’s healing, he said.

Fortunato said there’s nothing monumental about the Recovery and Resilience Center’s approach to treating PTSD. “If you put all of that together, it isn’t magic,” he said. “None of it is magic. And do you know what? None of it is new. All we did is, we looked at the whole soldier and tried to treat all of him.”

The “whole soldier” approach appears to be paying off. Twelve of the 37 soldiers who volunteered for the program have graduated and returned to their units. Among the recent graduates is a soldier who was in a catatonic state in August, but now is free of all signs of PTSD.

“Little miracles are what we are watching happen,” Fortunato said.

So far, only two participants have washed out of the program, both taking medical discharges from the Army.

Fortunato is the first to say his program isn’t for everyone. “This is a hard program,” he said. “[Participants are] in treatment 35 hours a week [with] daily psychotherapy, daily group therapy [and] integrative medicine. They go from 8:30 in the morning until 4:30 every afternoon. You have to be highly motivated to put up with that much treatment.”

There’s no set timetable for completing the program, but Fortunato said he’s finding six months to be optimal for most soldiers. “As long as they are working hard, we are going to hang in with them,” he said.

The soldiers formed their own platoon, which they dubbed, “the Wolf Pack.” It’s a testament, Fortunato said, to the way they take care of each other and the strength they’ve shown in admitting they have PTSD and seeking treatment.

As the soldiers work to overcome their combat stress and return to their units, Fortunato said he’s convinced the program is in the Army’s best interest as well.

The cost alone of treating a soldier — somewhere between $14,000 and $20,000 — is a bargain to the force, he said. By comparison, he said it would cost about $400,000 to recruit and train a new soldier and provide lifetime disability payments and medical care to the discharged soldier.

“So why wouldn’t you do this?” Fortunato said. “I think the numbers are all in our favor.”

Defense Secretary Robert M. Gates appears to agree. He toured the Restoration and Resilience Center on May 1, calling the visit an “extraordinary experience.”

“They are doing some amazing things here in terms of helping soldiers who want to remain soldiers but who have been wounded with post-traumatic stress disorder,” he said. “It is a multi-month effort by a lot of caring people, and they are showing some real success in restoring these soldiers.”

Gates called the center an example of new approaches the military is taking to care for these troops. “This center here is illustrative of what can be done,” he said.

Gates said he’ll consider the idea of possibly replicating Fort Bliss’ prototype program to other posts.

Fortunato said he’s all for duplicating his effort, but emphasized that his program’s small size is a key to its success. The soldiers and staff all know each other, have nicknames for each other, and feel a personal commitment to each other. “We all love these guys,” he said.

DoD
By Donna Miles
American Forces Press Service

CJTF-82
Written by Army Pfc. Daniel M. Rangel 22nd Mobile Public Affairs Detachment

BAGRAM AIRFIELD, Afghanistan – Thousands of Servicemembers are returning home this spring. As they return to their regular lives, reintegration with their friends and loved ones can be a challenge; especially for those suffering from symptoms of Post Traumatic Stress Disorder.

“PTSD can occur after any kind of trauma,” said Air Force Dr. (Maj.) Kellie Griffith, Task Force MED psychiatrist at the Combat and Operational Stress Control Clinic here.
The three primary symptoms of PTSD are: re-experiencing, where one relives a traumatic event through nightmares, flashbacks or intrusive images; hyper-vigilance, which includes irritability and jumpiness; and avoidance, not wanting to think about the trauma again and doing anything to avoid it, Griffith said.

Another common symptom is what’s called sense of a foreshortened future. It’s the belief that the future is not going to work out, like somehow it’s going to be cut short.

(more…)

DoD
By Fred W. Baker III
American Forces Press Service

Army Col. (Dr.) Loree Sutton is a woman on a mission.

The military psychiatrist has, for the last month, ricocheted across the Capital Beltway landscape and beyond, setting up a Defense Department office that will, for the first time, bring together the best of the best relating to psychological health and brain injury treatment.

(more…)

DVIDS
By Sgt. Jasmine Chopra
302nd Mobile Public Affairs Detachment

The sound is thunderous as the earth explodes, emitting fragments of shrapnel at high velocity. A firestorm erupts. Black smoke fills the vehicle.

The improvised explosive device is the main killer and most common threat facing Soldiers in Iraq. Recent implementation of better protective equipment and the latest in explosives-mitigating vehicles results in troops surviving blasts they might have died from in past wars.

Yet IED blasts remain one of the most terrifying experiences for Soldiers. Even those emerging with seemingly minor injuries could be at risk for what is being called the war’s”signature injury”: Mild Traumatic Brain Injury, said Air Force Lt. Col. Barbara Severson-Olson, a licensed clinical social worker at the mental health clinic, and part of the 332nd Expeditionary Aerospace Medicine Squadron.

With the 316th Sustainment Command (Expeditionary) being the largest logistics command in theater, pushing the most supplies throughout Iraq usually by ground, mTBI will continue to be cause for concern.

Severson-Olson, Air Force Maj. Connie J. Johnmeyer, staff psychologist with the 332nd Expeditionary Medical Group, and Air Force Master Sgt. Gary Scott, a mental health service non-commissioned officer, also with the 332nd EAMDS, are on the frontline of assessing mTBI in service members. The more attacks on service members, the busier the clinic gets and it’s not hurting for business.

TBI Defined

According to the Defense and Veterans Brain Injury Center’s May 2007 TBI Consensus Conference, TBI is a traumatically induced structural injury and/or physiological disruption of brain function as a result of an external force. It is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event: any period of loss of or a decreased level of consciousness; any loss of memory for events immediately before or after the injury; any alteration in mental state at the time of the injury (e.g. confusion, disorientation, slowed thinking); neurological deficits (e.g. weakness, balance disturbance, praxis, paresis/plegia, change in vision, other sensory alterations that may or may not be transient); intracranial lesion mTBI is a less severe version of TBI.

“You know all those (public service announcements) that say “don’t shake your baby?” A soldier’s brain is experiencing something similar to that during a blast. Your brain is sitting in this gel, fluid situation and the blast causes your brain to do this back and forth motion,” said Johnmeyer, using her hands to gesture the motion the brain experiences. “Injury can result and it doesn’t require unconsciousness to be mTBI,” said Johnmeyer.

Diagnosing TBI

The team uses various assessment tools to determine if Soldiers are experiencing mTBI, including the Military Acute Concussion Evaluation and the Automated Neuro-psychological Assessment Metrics.

The goal of the team is to get service members suspected of having mTBI assessed and sent to the appropriate agency or facility. In some cases that means service members will be returned to their units with either no or some restrictions to duty, sent to specialists such as radiologists, ophthalmologists and audiologists here in theater, or if need be, sent to Landstuhl Regional Medical Center in Germany for further treatment. After evaluating the patient, the team compiles a report with recommendations for the referring physician.

When asked who is at risk, the team said Soldiers traveling in vehicles on IED- laden roads are at greatest risk, but anyone could be affected.

“If you’re in uniform in Iraq, you’re at risk,” said Scott.

“Some of our patients are folks who were on foot patrols, others were just standing in their base and got mortared, but by in large our clients are folks that were injured while on the road,” said Severson-Olson.

Prognosis

But the prognosis is not hopeless and a flurry of new research into TBI is presently being conducted. Some servicemembers experiencing mTBI can heal over time according to Johnmeyer.

“We have a young population. Most of our (patients) are in their early twenties. “Time can be the best treatment for some – Think of a sprained ankle. You need to give it time to heal, time for the swelling to reduce. After a week your ankle is better. This can happen to the brain too.”