A new paper in Music Therapy Perspectives examines the importance of music therapy in military healthcare. There has been an increase in music therapy to treat combat-related injuries in recent years. With this growth in the use of the therapy, the authors of this article believe it's important for practitioners to publish information about effective music therapy treatment models for use in military settings.
The Military Healthcare System is presented with significant challenges following recent conflicts. With advances in military medicine and technology, survival rates are higher and more service members leave combat with psychological injuries, including traumatic brain injury and posttraumatic stress disorder. Such injuries present complex difficulties for treatment because of overlapping symptoms due to multiple health conditions, stigma of receiving care in military culture, and treatment options available within the Military Health System.
Integrating creative arts therapies in military treatment can present challenges. To overcome such issues and ensure consistent, high quality treatment the authors believe it's important for music therapists and military treatment facilities to share program models and intervention protocols. In addition, they argue that publications of program evaluation and patient outcome data are needed in order to further validate program models, expand implementation, and provide research evidence. The paper outlines the current program models at two facilities, the National Intrepid Center of Excellence at Walter Reed National Military Medical Center and the Intrepid Spirit Center at Fort Belvoir.
Research has shown that creative arts therapies improve patient outcomes for military patients. Blast injury often results in damage to white matter and connective tissue, and psychological trauma resulting in PTSD disrupts processes in multiple brain regions, heightening some systems and deactivating others. Studies suggest that music can impact multiple neural networks simultaneously and can assist with rebuilding connections between various regions of the brain. Studies also show that the brain releases dopamine while people listen to music. This promotes motivation, learning, and reward-seeking behavior. Thus, listening to music can create an enhanced learning environment and rebuild damaged neural connections.
"Music therapy is a dynamic treatment method for service members recovering from the invisible wounds of war," said Hannah Bronson, one of the paper's authors. "Building awareness of its benefits with this population can extend the power of music and its healing properties to many more men and women in uniform and their families."
The paper "Music Therapy Treatment of Active Duty Military: An Overview of Intensive Outpatient and Longitudinal Care Programs" is available here: https://academic.oup.com/mtp/article-lookup/doi/10.1093/mtp/miy006
The Original article can be found here
The National Intrepid Center of Excellence at Walter Reed Bethesda kicked off Brain Injury Awareness Month with a resource fair March 1 in the America Building at the medical center. In addition to NICoE, the fair included other agencies and organizations focused on traumatic brain injury care and research, including the Defense and Veterans Brain Injury Center and the Center for Neuroscience and Regenerative Medicine.
NICoE, as well as the Centers for Disease Control and Prevention, define TBI as a disruption in the normal function of the brain that can be caused by a bump, blow, or jolt to the head, or penetrating head injury. Everyone is at risk for a TBI, and information at the resource fair included advice people can use to help prevent injury including wearing seat belts when driving, as well as using proper head protection when performing certain jobs, motorcycling, and participating in various recreational and sports activities.
According to the CDC, approximately 2 million people sustain a TBI annually, and of that number, more than 50,000 die, nearly 300,000 are hospitalized, and about 1.3 million are treated in emergency rooms and released.
Other NICoE events planned at WRB for the month in observance of brain injury awareness include: a program March 19 from noon to 1:30 p.m. in Building 10’s Clark Auditorium focused on “The Roles of the Metacognitive and Emotional Regulation In Cognitive Rehabilitation after TBI,” and the DVBIC’s Annual Deborah Ward Lectureship on March 27 from noon to 1 p.m. in the NICoE Auditorium in Building 51.
For more information, contact U.S. Public Health Service Lt. Sherray Holland at email@example.com.
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Today, just like every time we get to visit a National Intrepid Center of Excellence (NICoE), we were amazed at the success stories we got to hear. NICoE does such an amazing job treating the whole service member and their family. The doctors, social workers, physical therapists, art therapists, and music therapists all work together on every case.
Today, we had the privilege of visiting Fort Belvoir in Virginia, one of several NICoE centers around the country.
These centers truly understand the hidden wounds of war. They treat our soldiers who are experiencing inner trauma, including post-traumatic stress disorder. Today we participated in an art therapy session with an entire family. The art therapist knows them well and has a working relationship with the entire family. We talked color choices and what colors mean to each of us.
I look forward to working with NICoE in the future.
Learn more about their unique program here.
Their dedication to military families is admirable. Thank you!
Original article can be found here
The opening of the Intrepid Spirit brain injury treatment center at Camp Pendleton is among the topics to be discussed at the veteran-focused meeting Monday at the Veterans Association of North County center in Oceanside.
The 25,000-square-foot brain injury treatment facility is slated to open this year next to the Pacific Views Event Center, near the base’s main gate.
The center will offer the latest medical technology and will be staffed by personnel from the nearby Naval Hospital Camp Pendleton. Clint Pearman, a brain injury specialist at Camp Pendleton, will give an update on the estimated $12.5 million center, which is the seventh of nine such facilities at military bases across the country funded by the New York-based nonprofit Intrepid Fallen Heroes Fund.
The center’s design is based on the original National Intrepid Center of Excellence, which opened in 2010 at the Walter Reed National Military Medical Center in Bethesda, Md., which is operated by the Department of Defense.
Other speakers at Monday’s meeting of the Interfaith Community Services/Veterans Association of North County Veterans Advisory Committee will include Matt Foster, North County Stand Down executive director. Foster will give an updated report on the nonprofit's second Stand Down in January in Vista. Hundreds of volunteers rallied to help more than 100 veterans.
Michael Walsh, Veterans Association of North County vice president, will provide more details about the planned Vietnam War Commemoration event to honor Vietnam veterans set for March 30.
The meeting is from noon to 1 p.m. at the VANC center in the conference room, 1617 Mission Ave.
Pizza lunch will be provided; pizza contributions are encouraged. If you want to give a 10-minute update regarding support of veterans, military service members and their families, contact John Stryker Meyer at firstname.lastname@example.org.
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ANCHORAGE, Alaska -- A program connecting troops and patients at the local Department of Veterans Affairs hospital with music therapy has been so successful that it is the subject of a summit Thursday between local military and veteran officials, state arts experts and the head of the National Endowment for the Arts (NEA).
The summit, held on Joint Base Elmendorf-Richardson (JBER), will focus on ways the program can be expanded to support more patients and families in Alaska, officials said at a reception here Wednesday.
Run as a partnership between an NEA program known as Creative Forces and the Defense Department, JBER's program has grown to 50 traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) patients since starting last summer, with about five new referrals each week, said Danielle Vetro-Kalseth, a music therapist who runs the program.
Patients enter the program through a group information session, she said. If they don't think it's the right fit for them, they don't have to continue.
Though music therapy, which can include playing instruments, drumming as a group and singing or examining and writing lyrics, might not seem macho enough for many troops or veterans, she's never had someone leave the program after the information session, she said.
"We always ask them to just come to the intake, see how you like it," Vetro-Kalseth said. "I have not had one person who doesn't continue."
Therapy sessions are offered both in groups and one-on-one, she said. She also works with speech and occupational therapists to use music therapy to help treat memory loss, fine motor skills and word recall, among other issues.
The Creative Forces program, which started almost a decade ago as a therapy program at the National Intrepid Center of Excellence in Washington, D.C., is offered at 12 bases nationwide, and NEA officials hope to expand it even further.
They also want the program here to evolve from an on-base-only offering to serving the community, with local art experts and therapists working together to help troops and veterans.
"It's not just an arts project -- it's the connection between clinical and healing arts therapy and the community piece where our service members and veterans can be in their community, be engaged and also in this arts program," said Jane Chu, who directs the NEA and is here for the summit. "We just think it's a win-win-win."
Alaska presents a unique challenge for connecting community arts programs and on-base resources because the state is so large and rural.
But connecting state-run arts initiatives, community programs and the federal program can help address that challenge, said Benjamin Brown, who heads the Alaska State Council on the Arts.
"The need is infinite, basically, compared to the resources we have," he said. "We are going to link what is currently happening at JBER with communities all across Alaska who can help."
Original article can be found here
Speaking with Second Lady Karen Pence during her Jan. 29 visit to the Intrepid Spirit Center here, it's apparent that championing art therapy is not just an initiative, but a passion.
Pence's passion is driven by the human and scientific evidence of art therapy's healing properties.
"People think its arts and crafts, but that's not what art therapy is," she said. "It is a mental health profession where a trained therapist uses art as their medium to help guide someone through the healing process."
Power of Art Therapy
Pence first learned of the power of art therapy to help people heal a decade ago when she observed an art therapy program for kids with cancer. Since then, the second lady's number one goal is to raise awareness of the unique form of therapy and how it benefits everyone from those battling cancer to those dealing with the invisible wounds of war.
Pence has partnered with the Creative Forces Military Healing Arts Network, a joint pro-arts initiative amongst the National Endowment for the Arts, the Defense Department and Veterans Affairs, which put creative arts therapies at the core of patient-centered care at Fort Hood and 10 other military medical facilities across the country.
As she travels across the nation advocating for art therapy, Pence said she is excited to meet active-duty soldiers and veterans who have embraced the therapy method and are thriving.
Her trip to Fort Hood included a tour of the Intrepid Spirit Center, an orientation to its Healing Arts program and a roundtable discussion with community leaders about the integration of art therapy in caring for service members.
"I hear a lot of stories about soldiers who initially don't want to go into art therapy sessions because it doesn't seem like the strong or tough thing to do," Pence said. "But then I hear them talk about the tremendous relief and success they experience after art therapy. One soldier confided in me that he doesn't go to that dark place anymore. Hearing success stories like that is powerful. It shows that art therapy saves lives."
The idea of patients being apprehensive, but quickly becoming appreciative is all too familiar to the team at the Intrepid Spirit Center.
"Art and music therapy are effective treatment modalities that enhance the total treatment regimen to help the recovery process," said Dr. Scot Engel, a clinical psychologist and director of the Intrepid Spirit. "When interweaving creative art therapies into our patient care plans we are improving clinical outcome for our warriors."
Peter Buotte, healing arts and therapy coordinator, believes art therapy benefits the patient as it fosters a safe, supportive environment for therapeutic self-expression.
"At its deepest, the art therapy process can go beyond the verbal -- and even beyond the recognizable image -- in order to emotionally engage with the patient/client," Buotte said.
Art and music therapy have been integral components of the Intrepid Spirit Center's multi-disciplinary approach to restoring service member's medical readiness for more than a year. The center is one component of the comprehensive system of behavioral health care offered for service members and their families at the Carl R. Darnall Army Medical Center here.
Before visiting Fort Hood, Mrs. Pence shared her message of art therapy significance with more than 140 local community arts professionals and military behavioral health care specialists at the Texas Creative Forces Arts and Military Conference held in Killeen, Texas. The conference aimed to support and grow collaborative relationships between local artists, arts organizations and military populations to help service members reintegrate after deployment.
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EDITOR’S NOTE: This commentary does not contain medical advice. If you have been injured seek assistance from a healthcare professional.
FORT BRAGG, N.C. - - I felt the back of my head connect with wood as my brain rocked inside of my skull.
My perpetually graceless body went limp as my backside fell to meet the sand below.
“I hit my head,” said a voice coming from my sweaty face.
On July 28, 2017, I had woken up a normal version of myself, but I was soon headed down a lengthier path, filled with more obstacles than the one I began at physical training that stifling morning.
Two days prior I felt confident as a public affairs print journalist and noncommissioned officer in the Army. I gave the performance of my life at the last face-to-face promotion board of my career, successfully jumping one more hurdle on the way to staff sergeant.
I was the Headquarters and Headquarters Battalion, 82nd Airborne Division, NCO of the Quarter. Two days later I was having trouble forming thoughts and getting words out.
“I hit my head on the obstacle course during PT,” I told the medics later that morning. “My headache is getting worse.”
Sgt. James Hartsell, my friend and the battalion aid station senior medic, said I wasn’t acting like my normal, bubbly self. I didn’t know it at that moment, but it would be a few months until I would begin to feel like myself again.
“It’s a concussion,” 1st Lt. Lamar Adams, the HHBN physician assistant, told me.
Adams said my case was on the mild end of the wide head injury spectrum. He explained concussions can affect each individual differently, and prescribed a weekend of “brain rest” before returning for an evaluation on Monday.
My orders were to sleep and do nothing except maybe light reading. Playing video games, watching TV and exercising were off limits. Caffeine and alcohol were also off the menu.
My husband took me home. Driving was no longer in my realm of capabilities, and my symptoms were steadily emerging.
I spent the weekend on my couch, existing in a disordered fog broken by periods of deep sleep. Thinking and verbal communication, things I normally do well as an Army public affairs Soldier, completely escaped me.
Pain swept through my head constantly as I became more sensitive to the lights and sounds of daily life. My husband’s music was too loud, and I combatted any sunlight peeking through the curtains by wearing sunglasses inside.
I was sad for no reason and thinking made me tired. I screamed at my husband for buying whole instead of two percent milk, which was completely out of character for me.
Within a week my mind, eyes, ears, head and emotions felt like a wrecked rollercoaster on the verge of an electrical fire. If this was supposed to be mild, I couldn’t imagine what a severe combat head injury would be like.
At my follow up, Adams prescribed a TBI standard 30 day physical profile of severely limited activity, which increased my mental chaos.
Even while fighting a headache demon, the physical restrictions were a crushing new blow for me - a person who routinely requires dedicated effort to meet the Army’s standards, and my own personal expectations.
In the face of an injury, I still worried a month of inactivity could have serious consequences on my body and performance as a Soldier.
I begrudgingly complied, and when I wasn’t sleeping, staring into space in my yard or struggling to think at work, I was on the couch. I spent August 2017 as a couch person.
In the Army we learn how to be resilient under certain extremes, but I think we maybe never quite master how to take a knee.
At the next appointment with Adams, he referred me to a clinic specializing in head injuries to help control the vice grip on my temples and get me feeling like me again.
My hypersensitive pupils objected to the blinding August sun as I passed the big “Intrepid Spirit” sign on Longstreet Road twice before finally making the correct turn.
The concussion care clinic at Fort Bragg had existed in some form, under various names for a number of years inside Womack Army Medical Center.
It wasn’t until 2016 that Fort Bragg’s Intrepid Spirit center came to life, operating in a dedicated facility based on the model of care offered by the National Intrepid Center of Excellence at Walter Reed National Military Medical Center. The Intrepid Fallen Heroes Fund helped make it possible for the Department of Defense to establish the NICoE and 12 new Intrepid Spirit clinics across the total force, all specializing in TBI associated conditions.
I was a basket case when I first walked into the clinic, but by the time I walked out I felt much more at ease.
“Education is a big piece of what we do,” explained U.S. Public Health Service Cmdr. Scott Klimp, director of Fort Bragg Intrepid Spirit. “Whether it’s from that initial evaluation and helping to let those patients know that what they’re experiencing is common and that they can get better … really just helping to normalize those things is a huge relief for patients.”
I learned why this clinic was so unique at my intake appointment with Christina Horvath, a physician assistant at Intrepid Spirit.
“Almost everything that we need to do for a patient is right here in the building,” Horvath told me.
She wasn’t kidding. The facility was brimming with providers, specialists and therapists focused only on TBI and associated conditions.
“Here, the patient I see is the patient I then follow up on, so there’s continuity,” Horvath said. “You get to see the specialists who are part of this clinic and you get to follow up with the same provider who saw you.”
On the way out, I made my first round of appointments from the laundry list Horvath gave me, before heading to pick up a new prescription for the invisible knife in my head.
My new appointment schedule had me almost living at Intrepid Spirit, starting with cognitive rehabilitation, yoga therapy, physical therapy, a neuro-optometry assessment and occupational therapy.
“It’s a journey ... but as long as (patients are) compliant with who they see, their medications (and follow) the restrictions of their profile, every time they come in something is better,” Horvath said. “If not, we figure out the next step.”
I wholeheartedly devoted myself to recovering, starting with my mind.
“I do what’s called cognitive rehabilitation,” said Evelyn Galvis, a speech-language pathologist at Intrepid Spirit. “Which is what I usually describe to patients as brain aerobics.”
At my first session, Galvis told me naptime was over and we got to work. She kept me on my toes with puzzles, brain games and homework.
“What we’re looking at is how to challenge yourself to potentially improve your neuroplasticity,” Galvis explained. “For all of us neuroplasticity is key. If you don’t use it, you lose it. All brain functions work this way. It’s true for the muscles in our body, if you don’t use them they atrophy.”
I dug deep into my homework. Galvis gave me a list of free brain training apps to download on my phone, and I paid for the full version. I invested in myself.
The daily frustration I felt when I couldn’t recall a simple word or remember someone’s name slowly began to ease. I could think more clearly.
All the while, I was spending time each week working with other providers on pieces of myself that ultimately fit into my TBI puzzle.
I got a prescription for glasses, one pair was blue but my sensitive eyes were already improving enough that I didn’t need the tint.
Horvath decided yoga therapy would be beneficial to my recovery, but I didn’t grasp her intent right away.
My heart has always been close to yoga. When I first got hurt I even tried to slowly navigate a yoga routine I used to practice daily, but I just could not will my body to move properly.
The greatest force in my healing path was Alyson Rhodes, a yoga therapist at Intrepid Spirit. Rhodes was previously a physician’s assistant in the Army, and started yoga as a patient herself following a lower body jump injury.
“It wasn’t just about my injury, it was all the ways that I felt about that, and kind of just feeling like I was less of a person, and I was annoyed, (angry, scared and) all those things that go with it,” Rhodes told me.
Her words were all too familiar. I was internally conflicted by my need to rest and desire to be whole again.
Rhodes said she was drawn to yoga as a low impact exercise, but later realized it was more than physical. The relaxation helped her address and manage some feelings she had about her injury.
I very awkwardly and noticeably cried through my whole first session. Rhodes asked if I needed to come in for individual appointments, but I think my mind caught up to my body realizing it was allowed to slow down and heal.
I knew wherever I wanted to be, I needed to listen to my body to get there, so I took more handouts from Rhodes, and put in what effort my body would allow.
I recorded audio of my last yoga session so I could have something to take with me, and by that time the seasons were beginning to change.
I used each small victory as fuel, driving me toward the finish line.
Time and the right prescription were steadily improving my headaches, and each visit to the clinic made me think of the poem "Invictus" by William Ernest Henley as I turned at the big “Intrepid Spirit” sign.
The Army threw a few curveballs into my healing timeline when I began physical therapy with Shaun Carlson, a physical therapist at Intrepid Spirit.
Carlson told me I could ease back into activity, but I wasn’t allowed to run yet. The same week my branch manager informed me that my husband and I would be moving to a new duty station.
My original worries about taking a knee returned when I learned that on the way to my new duty station I would also be attending the Advanced Leader’s Course.
My mind spiraled. I needed to take and pass an Army Physical Fitness Test to do these things, and in order to do that, I needed to run.
I couldn’t run until my brain stopped throbbing every time I exerted myself. Time was ticking and I was scared.
“If you don’t give yourself that time to relax, the symptoms just stay stagnant,” Carlson told me. “The body needs to recover. It’s just like any other injury. Say I break my foot. I don’t want to get out there and just keep walking and running on it, because it’s never going to heal - same thing with the head.”
I followed Carlson’s plan and tried not to panic. I didn’t have time to be injured anymore because I officially had things to do.
Carlson explained the cause of post-concussion exertional headaches is still unknown, but one theory involves heartrates and blood pressure.
“People tend to get to (the) cardiovascular portion of their heartrate really quick,” Carlson added. “So with that spike in their heartrate with activity comes increase in headache.”
I started with circuit training and heartrate monitored bike workouts. When I could tolerate that, I advanced to the Alter-G Anti-Gravity Treadmill for controlled interval training.
“We’re looking to see where (patients) get those symptoms and … start there, keep them there until they can tolerate that much exercise and then push them a little further as they become more tolerant,” Carlson said. “So we’re not over doing it, we’re just progressively getting the exertion back up.”
I negotiated with Carlson based on my progress and upcoming career deadlines, and he wrote me a return to run plan, with the caution to back off if any symptoms started.
In my flurry of recovery, I was at the clinic sometimes twice a day for vision rehab appointments with occupational therapy for my eyes and putting in work on the Alter-G machine.
When Christmas decorations began to appear, I was ready to be an even better me.
A Hopeful Recovery
Rest, time, tears and calculated effort carried me through this journey.
I graduated physical therapy in early December, crying tears of relief the whole way home. I did it; I recovered.
After a nearly five-month trial, my work was not entirely complete - the verdict was still out on one more hurdle. I still needed to pass an APFT and finish vision rehab to finalize my glasses prescription.
On Dec. 19, a culmination of efforts occurred when I took the APFT. I felt my own hard work and the Intrepid Spirit team’s dedication propel me across the finish line of the two-mile run.
I didn’t just pass – I crushed the APFT with a 270 score. Every worry and insecurity about my condition vanished.
I could only think about continuing to improve my run time ahead of ALC and my impending move.
My last eye appointment revealed unbelievable progress from vision rehab. The thick, coke-bottle prescription in my right eye was cut in half, and my astigmatism was gone entirely.
I walked out of the clinic better than I walked in, and then some.
At the end of this experience I felt fortunate that my TBI was not more serious, because other patients at Intrepid Spirit still have a longer, tougher journey ahead.
My involvement with the clinic’s scope of practice barely scratched the surface given my mild condition, but I know those who share my struggle will be taken care of by the best.
The range of care at Intrepid Spirit seemed almost limitless from my experience.
I am grateful for the team who helped me on this path, and that this resource was within reach to put me back together.
Namaste, Intrepid Spirit.
The original article can be found here
WASHINGTON, Nov. 22, 2017 —The Naval Medical Center San Diego’s Comprehensive Combat and Complex Casualty Care center, or C5, celebrated its 10th anniversary in October.
NMCSD is one of three hospitals in the Defense Department providing rehabilitation care to service members who are severely injured or ill, especially in overseas operations. The other two are Walter Reed National Military Medical Center in Bethesda, Maryland, which also works with the National Intrepid Center of Excellence, and San Antonio Military Medical Center, which used to be called Brooke Army Medical Center.
C5 is a program of care that manages severely or ill patients from medical evacuation through inpatient care, outpatient rehabilitation and eventual return to active duty or transition from the military. Program components include: trauma service, which coordinates the overall inpatient clinical management of the injured service member; orthopedic, reconstructive plastic surgery and wound care; amputee care, prosthetics and rehabilitation; physical, occupational and recreational therapy; mental health assessments and care; traumatic brain injury care; pastoral care and counseling; and family support and career transition services.
“We are a multidisciplinary, one-stop shop and if it’s not within C5, we simply just get on the phone and call the specialist we need,” said Navy Lt. Cmdr. (Dr.) Carter Sigmon, acting department head and medical director of the C5 department.
Since 2007, C5 has taken care of about 8,600 patients, “approximately … 20 percent of all the active duty [Operation Iraqi Freedom, Operation Enduring Freedom and Operation New Dawn] service members with war-related limb amputations,” he said. Sigmon said that the mission evolved over the years, and now the team sees service members with injuries from vehicular and training accidents.
Jackie Moore, a former Army major, helped stand up the C5 program. She had served as a physical therapist at Walter Reed and brought what she knew over to NMC-SD. “I was sent out here special to get C5 started,” she said.
“Nothing existed out here so we were instrumental in developing the program and setting it up how we wanted to, based on our experience that we had from Walter Reed,” Moore said. “When we first stood it up, there were a lot of service members coming back with combat injuries, primarily amputations, so when it began, that was our focus. Over time, it morphed into more poly trauma. We are the rehabilitation experts here at Naval Medical Center San Diego in poly trauma rehab.”
Navy Capt. (Dr.) Craig Salt, founder and director of Project Care, plastic surgeon, said Project Care, under C5, is the only one of its kind in the DoD. “Project Care is a multidisciplinary medical and surgical program designed to facilitate the restorative care of patients who have been traumatically disfigured,” he said. “We take people who have varying degrees of trauma and then we work to revise, repair and replace what has been damaged or lost versus the traditional rehab model. We look at the patient, top to bottom, figure out what they’ve lost, what their disfigurement is, what their cosmetic deformity is, and then in conjunction with all the other rehab that’s happening, we work to repair, replace and correct deformities.”
He said this can be anything from using lasers on scars to a hand transplant and the disciplines include plastic surgery, dermatology, orthopedic hand surgery, oculoplastic, ophthalmology, ENT fascial plastics, and reconstructive urology.
“The rehab center and all the different disciplines at this hospital are working to get the patient the best possible recovery we can get them so we’re committed to providing the medical and surgical care and psychological support. So whatever’s wrong with them and whatever they’ve lost, we’re going to see to it they get the best possible functional recovery, the best psychological recovery and the best aesthetic result they can get,” he said. “Everybody in the hospital that can help the patient look better, feel better, recover, function, whatever, is involved in their care, and we coordinate all of that. All of us in the program are really passionate about that goal.”
Dr. Chad Rodarmer, the traumatic brain injury program manager for C5, served 24 years in the Army as an enlisted field artilleryman, a physical therapist and health care administer, retiring as a major. He said because patients with TBI may require specialists ranging from speech language pathology to vestibular therapy to audiology, he works to coordinate the patient’s care within C5.
“On a weekly basis, we have our interdisciplinary team conference, and we bring up the patients currently enrolled and talk about when someone’s due for their follow up, what the plan is, how good they are at meeting the goals we and the patients have set. We can see their progress. We get together regularly to make sure we’re all on the same sheet of music and moving toward the same goals,” he said.
Rodarmer said they’ll also have support groups and bring in subject matter experts to talk to the patients to help alleviate anxieties such as going back to school while having a TBI.
Navy Petty Officer 1st Class Jordan True, a master at arms stationed at Naval Weapons Station Seal Beach, California, was injured Aug. 12, 2016, in a motorcycle accident.
“They told me I had a traumatic brain injury, a lot of internal organ injuries, broken ribs, a spinal injury and that my foot was crushed. I knew I might have to amputate it,” he said. “They flew my parents out here from Iowa because I had a less than 40 percent chance that I was going to live. They helped me make some long-term decisions.”
He’s working with the C5 prosthetics department to get a brace for his leg and with physical therapy so that he can begin running again. He said each of the doctors and staff he has worked with has taken the time to help him, especially since he has to drive down to make his appointments.
“Here, they have a day dedicated to primary care or Project Care. Me coming down from Long Beach, they would help me out,” he said. “I would ask one of the doctors if they would be willing to do one of these appointments on one of these days, and they were really flexible with me and helped me reduce a lot of stress, especially since southern California traffic is harder for me than it used to be. Any time I need a referral for anything closer to Long Beach, they would get it in. It didn’t matter who was doing it. It would get done really quickly. I was excited about that.”
True said what he liked most if that even though he was being stubborn about trying some of the services C5 offered, the doctors kept encouraging him to try them until he did. “They didn’t give up on me,” he said. “Especially the speech therapy, they just kept pushing me and that helped me go back to school and now I have a 4.0 GPA. They actually listen to what your issues are. I was taking a neuropsych exam one day and this person stayed like an hour and a half late just so I could finish my test so I wouldn’t have to reschedule and drive back down. It really made my life easier. My neuropsychologist, he was looking things up for me, like how I can get take the LSAT and get a private room.”
Navy Seaman Chris Krobath, an aviation electronics mate, is also a patient assigned to NMC-SD. He has a below the knee amputation on his left side from a motorcycle accident. He said his leg was amputated in May 2016 and after going into rehabilitation in June, he had his first leg. He’s been working with physical therapist Moore.
“They are all really helpful,” he said. “If I ever have a problem with anything, I can just come here to physical therapy or to prosthetics, and they’re always willing to help me. It’s pretty cool. It’s convenient to have everything together.”
Brian Zalewski, head of the prosthetics department at NMC-SD, said the artificial limb is a “unique and customized process” and that he and his team make every effort to cast the patients and turn around with a socket in the same day or the next day.
Zalewski said they’ve had unique challenges along the way. “We had the first bilateral above the knee amputee come out of here and go back and do a deployment which was incredible,” he said. “Our approach here is that everything’s custom.
“We work closely with the manufacturer,” he continued. “We had a Navy diver who wanted to stay on active duty. His list of requirements, he had to be able to walk to the water, get in the water and put on fins. Well that’s pretty hard to do with one type of leg so we worked with a manufacturer to make a foot with a button you push so that it goes flat and then you put the fin on it so you can dive. We did some testing, and it worked great.”
Zalewski said the diver went out and performed some missions and then called and asked about pressurization with deep dive.
“I told him, ‘You’re the only one who’s doing this so you tell us, and we’ll write the text book later. You’re the one pushing the limits,’” Zalewski said. He said he’s had a lot of patients he and his team have worked with who’ve received customized prosthetics from his team and who continue pushing the limits from climbing Mount Everest to competing in the Paralympics.
“We’re providing a multidisciplinary approach because our ability to work with other providers to take care of the whole patient, from the mental side to the physical side and constantly addressing those needs so that they’re not sitting there wondering what they could be doing or if they could be getting something better,” Zalewski said. “We never just give them a device and say, ‘Here you go, enjoy that.’ It doesn’t work that way. We’ll give you so much more to make you that much better. It’s a whole approach and practice from a team of medical professionals.”
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Approximately 2.6 million United States service members were deployed to serve in the military from 2001 to 2011, during the period of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). And research suggests that 10–18% of veterans from those operations return home with Post-Traumatic Stress Disorder (PTSD). Intense and debilitating fear, depression, negative moods, and nightmares interrupt their daily lives.
Among the various clinical techniques and tools used to treat service members with PTSD, art therapy is a strong option. A 2012–14 survey at the National Intrepid Center of Excellence (NICoE, the outpatient clinic dedicated to treatment of Traumatic Brain Injuries at Walter Reed Military Medical Center in Bethesda, Maryland) ranked art therapy among the top five most helpful techniques used to treat veterans.
NICoE is one of 11 sites across the U.S. that hosts Creative Forces, the creative arts therapy initiative launched by the National Endowment for the Arts and Department of Defense, which employs art therapy, music therapy, and dance therapy to treat psychological disorders related to post-traumatic stress and traumatic brain injuries (TBIs). In addition to these clinical sites across the country, and one telehealth program to help service members living outside of those communities, the initiative also funds research in the field.
A new article published in the International Journal of Art Therapy by researchers and art therapists of Creative Forces reports fresh evidence pointing to the positive effects of art therapy on U.S. military service members with TBIs and PTSD.
“The art therapy journey serves as an agent of change,” the authors write, “during which [service members] establish a new sense of self as creator rather than destroyer, as productive and efficacious instead of broken, as connected to others as opposed to isolated, and in control of their future, not controlled by their past.”
The program officially launched in 2011, but its efforts can be traced back to 2004, when the NEA partnered with the Department of Defense to create an expressive writing program called Operation Homecoming: Writing the Wartime Experience. That successful initiative became part of formal medical protocol, among other therapeutic activities for troops returning from active duty, and it paved the way for the Creative Forces pilot program at NICoE.
The second outpost of Creative Forces followed soon after at the Intrepid Spirit Center at Fort Belvoir Community Hospital in Virginia. The success of those programs led to a significant funding and expansion in 2016; the NEA received $1.92 million from congress for Creative Forces that year, in addition to the initiative’s existing annual appropriation. The total budget for the fiscal year that recently finished was $2.6 million. That funding covers the salaries of creative arts therapists as well as equipment and supplies at the clinical sites, the telehealth program, research, and the creation of a digital toolkit for community sites. The NEA projects that beginning in 2018 creative art therapists of Creative Forces will deliver an estimated 1,000 treatment sessions per year, and will enroll around 200 new patients per year.
Service members living near or being treated at Fort Belvoir work with art therapist Jacqueline Jones, who has been working with Creative Forces since 2013. There, Jones runs a fully-stocked art studio where she conducts three levels of programs, ranging from a three-week-long introductory course of “instinctive, spontaneous, process-oriented artmaking” to an open studio setting, where patients work side by side on their own long-term, self-directed projects.
Artmaking in the introductory course includes decorating a blank mask and other activities meant to surface underlying stressors. “You go with the flow and let the art lead you,” Jones explains, “then when you finish, you take a step back and we process it together. We delve into the symbolism of the colors and images used, and look at the orientation of everything on the canvas or page, and see what it reveals.”
She points to these artworks as particularly important when treating “invisible injuries,” a way to access “something concrete and tangible to explain and express their experience with a traumatic brain injury and post-traumatic stress—things that other people can’t see or understand.”
Most patients continue on to the second level: a six-week program of group and individual sessions, where patients work on a series of drawing and expressive writing tasks, and the creation of a box meant to celebrate or commemorate something. “We use art in different ways to process specific traumatic events, to grieve specific losses, or to work through moral injury or identity issues,” Jones says.
The third tier of therapy is an open studio program that allows vets to “continue to bond and develop camaraderie and community, while also allowing them to develop their own personal artistic identities,” Jones notes. One patient who has progressed through this level, Mike Goodrich, will have his first solo show this month at the National Museum of Health and Medicine in Maryland.
Different patients have different needs. “It really matters how long they’re seen in our clinic and what their goals for treatment and recovery are,” Jones says.
For example, a service member who is having angry outbursts in public might enter the clinic looking to gain emotional regulation. “He knows that that’s a behavior he wants to stop but he doesn’t know how,” Jones explains. “Through art therapy we can do things to work towards that goal, such as figuring out what someone’s particular triggers are or really uncovering what is underlying the anger.” Once the patient is able to identify those triggers, they’re better prepared to process whatever is inciting the anger and to recognize in the moment that they’re experiencing that trigger. “They can emotionally regulate and calm themselves down before having a reaction that they don’t want to have,” she explains.
Other patients with symptoms of post-traumatic stress might be looking to lessen nightmares and improve their quality of sleep. “In that case we may be using art to process specific traumatic events to a place where they come to resolution,” Jones says, “so that they may move to a place where they might dream about those things, but it becomes more like they’re watching a movie instead of actively being in the middle of the event occurring over and over.”
Communication is a common treatment goal, especially in regard to communicating with family members. “A lot of the art they create is a really good externalization of what they’re going through and it helps them gain insight into what’s really underlying their issues, symptoms, and behaviors and so it first and foremost gives them great insight into self.”
Jones recalls helping a specific patient at Fort Belvoir work through a traumatic event and the associated negative emotions. “At a certain point he just looked up at me and he said, ‘I like myself now,” Jones recalls.
While many patients who meet their treatment goals stop engaging in art therapy, some continue on an ongoing basis. “Artmaking is their primary method of processing things that happened in the past but also processing the present,” Jones explains. “It’s their way of maintaining well-being.”
Jones also collects data from her patients in order to determine how valuable art therapy is to them. “What has come back so far is that the majority of patients attribute or credit art therapy with increasing their ability to experience positive emotions and their self-concept,” she attests.
Recently, Creative Forces has begun to organize summits that bring together creative arts therapists, researchers, and military personnel to discuss and assess this research, and to determine what future studies should address.
Dr. Girija Kaimal, an art therapy researcher at Drexel University (one of the few schools with art therapy Ph.D. programs) has been working with Creative Forces since 2013. Her scholarship, undertaken in partnership with Jones and fellow art therapists Melissa S. Walker and Jessica Masino Drass, has been based upon the artwork and clinical notes coming out of Fort Belvoir and NICoE. One major project set out to analyze 370 artist-made masks created at the two sites. The clinicians had noticed certain recurrences over time, Kaimal explains, so they devised a way to analyze the masks systematically, looking for patterns among the ways that service members with TBIs and PTSD had represented themselves.
In the mask’s imagery, researchers found representations of people who had died, as well as allusions to damaged relationships, a sense of belonging and community, pop culture figures, an overall injured sense of self, and broad existential concerns. They were able to take this visual data and compare it with clinical data. “This is where we’re being very innovative,” Kaimal explains. “There’s very little done on how visual representations might relate to people’s psychological health and wellbeing.”
"What we are finding is that when people represent a whole image or an image that is integrated, that’s usually indicative of better psychological health,” she continues, “whereas images that are very fragmented tend to be associated with worse outcomes.”
Kaimal notes that future research based on artworks will look at a patient’s artistic output over time, through the course of the clinical program; and they will also collect, analyze, and compare data collected from the various Creative Forces sites.
Creative Forces is playing an important role not just for service members, Kaimal emphasizes, but for the art therapy profession at large. “One of the challenges in our field is that because it’s been mainly clinical and there are only a handful of Ph.D.s, so we haven’t had enough capacity for research,” Kaimal explains. “What Creative Forces offers is funding for research, which is quite scarce for creative art therapy. And we are able to do larger-scale studies—things at a scale that we’ve never been able to do before.”
Original article can be found here
On Wednesday morning, Second Lady Karen Pence held a press conference at Florida State University to outline how and why she will promote art therapy in the United States during her time in the White House. Her platform, officially known as Art Therapy: Healing with the HeART, aims to help Americans understand and access the benefits of art therapy and to stimulate interest among young people to pursue careers in the field.
“From children with cancer to struggling teens to grieving families to people with autism, to military service members experiencing Post Traumatic Stress Disorder to those with eating disorders…art therapy is changing lives and it is saving lives,” Pence said. A longtime art educator and painter, the Second Lady has been involved in art therapy initiatives for over a decade, working first with Tracy’s Kids, a D.C.-based nonprofit that administers art therapy to children with cancer, and later, steering fundraising efforts to bring art therapists to an Indiana children’s hospital.
Over the next three years, Pence aims to increase awareness and advocate for more research in art therapy by traveling to programs across the U.S. and abroad and meeting with stakeholders. (However, not every member of the profession is comfortable working in tandem with the current administration.)
“This attention is absolutely unprecedented,” says Dr. Donna Betts, president of the board of the American Art Therapy Association (AATA), who is a practicing art therapist and an associate professor in the art therapy program at George Washington University. “In this country, there has never been any national figurehead that has drawn this much attention to art therapy.”
In light of the announcement, and the potential impact the initiative could have on the field, we spoke with Betts to learn what art therapy is, exactly, and how it exists in the United States.
AATA defines art therapy as “a regulated, integrative mental health and human services profession,” which “uniquely promotes the ability to unlock emotional expression by facilitating non-verbal as well as verbal communication.”
The first of Pence’s three goals in her initiative is “to elevate the profession so that people understand that art therapy is a mental health profession, and not arts and crafts.” Confusion surrounding what art therapy is, and what it is not, is a frequent hurdle, Betts affirms.
“A lot of mental health professionals—social workers, counselors, psychologists—will have art materials in their offices; sometimes a psychologist will have a patient make a drawing. That's fine, but that's not art therapy,” Betts explains. “What’s important to distinguish is that in our profession, our students and professionals have had the requisite, in-depth training in understanding the implications and the power of different art materials and the artmaking process.”
And while sitting at home and dabbling with watercolors may feel therapeutic, that’s not art therapy either. Art therapy requires a client, a trained therapist, and the art itself.
Betts notes that qualified practitioners have expertise in both psychological theory and artmaking. They are prepared for scenarios where a patient may express that they’d prefer not to make art that day, in which case “the session becomes more of a psychotherapeutic experience,” Betts explains, “where we may just talk about whatever is bothering the client.”
An inclusive and expansive field, art therapy has been used in diverse settings to help individuals and groups work towards greater emotional, physical, and mental wellness. In the U.S., according to AATA, art therapists work at hospitals, schools, veterans’ clinics, psychiatric and rehabilitation facilities, community clinics, crisis centers, forensic institutions, senior communities, museums, and in private practices. It’s proven useful for communities in the aftermath of devastating natural disasters or terrorism, as well as prison inmates and those suffering from dementia and Alzheimer’s, to name a few. Research has illustrated art therapy’s efficacy in various scenarios: from improving mood among healthy adults, to helping troubled youth stay in school, to contributing to better physical well-being among HIV and AIDS patients.
Individuals looking to find and access an art therapist near them can do so through AATA’s website and those of its state chapters (not every state has a chapter due to the small number of art therapists in some states). Additionally, the website of the Art Therapy Credentials Board can be used to seek out art therapists and check their credentials.
What happens during an art therapy session?
Betts warns that due to the wide range of people that art therapists work with, and thus the variety of treatment goals, there is no formulaic approach to art therapy. She notes that there are, however, shared techniques that individual art therapists employ.
One example she gives is working in a small group setting with three children with autism, where the main treatment goal was to improve socialization. Betts employed a mural exercise with them, which required them to work together on a large sheet of paper. “They had to learn how to be cooperative, how to communicate, all through the process of creating a mural.” A secondary benefit of the exercise was that it helped the children learn how to use new materials, addressing “social-emotional goals, fine motor control, and sensory motor goals.”
Certain populations call for an entirely different approach. Betts gives the example of working with a group of people with eating disorders, primarily young women, which requires a more in-depth art psychotherapy approach. “They are very intelligent and intellectualize their problems,” she explains. “To be able to work with that population effectively you really do need to have a skillset that enables you to not only encourage patients to engage in artmaking as a vehicle for communication, but also to really be able to deal with some very serious issues related to trauma, anxiety, suicide, and depression.”
One exercise Betts employs with this latter group is the bridge drawing exercise. “Think of a bridge as a powerful metaphor for change or transition—after all, we are constantly in a state of change and flux,” she explains. “I invite them to create a bridge going from one place to another place.” Often, her clients will draw their life with an eating disorder, which tends to be dark and bleak, on one side of the bridge. On the other is a depiction of their life in recovery, which is decidedly optimistic. Betts uses these drawings to check in with her patients in sessions thereafter, to help them locate where they are on that path to healing.
“We do a lot of work, as art therapists, on a very symbolic and metaphorical level,” she explains. But she emphasizes that they do not analyze or diagnose the artwork, in a Freudian sense. “We are facilitators, we are there to witness the art process, we are there to help guide the patients in uncovering what they are communicating through the art.”
What is the state of art therapy in the U.S.?
“Throughout the world right now, art therapy is definitely the most well-developed in the United States and the United Kingdom,” Betts explains. The field has hit a new level of maturity in recent years, she says, adding that she often has meetings, facilitated through the State Department, to discuss art therapy with foreign officials.
Betts notes that, as with any mental health practice, the main difference between art therapy in the U.K. and the U.S. is that in the U.K., art therapy and other mental health professions are overseen by the federal government, through the Health & Care Professions Council (the HCPC), whereas in the U.S., it’s governed on the state level. In this sense, she continues, art therapy is more nationally stable in the U.K.
“I would say given the fact that art therapy began as a formal profession around 50 to 60 years ago in the U.S. (and also simultaneously in the United Kingdom), if you look at it from a developmental perspective, now we’re kind of in our late adolescence. Mrs. Pence is lifting up our field right at a time when we really are in a stage of rapid growth.”
How do you become an art therapist in the U.S.?
At present, to become a Registered Art Therapist (ATR) in the U.S., one must complete a master’s degree in the field—AATA recognizes 35 graduate masters programs across the country—and earn credentials from the Art Therapy Credentials Board (ATCB). At time of writing, the ATCB reports that there are 5,968 active, credentialed art therapists in the U.S.
To be accepted into a graduate program in art therapy, students must have completed undergraduate coursework in both psychology and studio art. Graduate coursework includes a range of studio-related classes as well as psychological theory and technique, and students must also complete 700 clinical supervised hours in internships during the program. After graduation, students go on to attain their credentials through the ATCB, which requires them to seek supervision for another 1,000 hours of clinical work. Once they’re working, art therapists must earn continuing education credits—through activities like attending conferences—in order to retain their status.
On top of ATCB credentials, 12 states currently offer formal licensing for art therapists. Betts says that it’s among AATA’s top priorities to increase this number, noting that licensing efforts are crucial in order to have a regulatory body protect the field. “Ten to twenty years ago, when the profession was younger, art therapists had to rely on a number of different creative ways to be able to practice and that often entailed having to get a license in another profession, which is complicated,” she explains. “The importance of having a license is to protect the public from harm.”
One of the few prominent, national art therapy programs in the U.S. is the National Endowment of the Arts initiative Creative Forces, which is a collaboration with the Departments of Defense and Veterans Affairs, and various state arts agencies. The program, established in 2011, pays for the salaries of art therapists, music therapists, and dance therapists who are hired to work in facilities for veterans across the country. The program has been implemented at 12 sites thus far, after originating at the National Intrepid Center of Excellence (NICoE) at Walter Reed Military Medical Center in Bethesda, Maryland.
Art therapy is also felt nationwide through emergency relief and natural disaster recovery. In the wake of devastating and traumatic events, volunteer art therapists partner with organizations like the Red Cross and Save the Children to work with affected communities, following first-responder efforts.
What does the field of art therapy need?
Betts and AATA have been involved in Pence’s initiative over the past few months, including a brainstorm session in May where the Second Lady gathered leaders of the field. “She wanted expert input on how to best promote art therapy,” Betts explains. “We informed her of our critical priorities as the leading association for art therapy in this country, regarding the need for more resources for research, the need for increased public awareness, and absolutely to bring more people into the profession.” Betts affirms that the approach Pence rolled out to the public on Wednesday “definitely dovetails with our critical priorities at AATA.”
“The public awareness piece is really huge, just to get it in front of people,” Betts says. “We’ve already seen it help in small ways and now that it’s been officially launched, with the rollout, I do think it will continue.”
More research, Betts says, is crucial in order to learn more about the efficacy of art therapy. “There is some evidence-based research, but we need more of it to demonstrate with certainty that art therapy works and how it works and why it works,” she says. She nods to neuroscience research being conducted at NICoE. “We’re trying to bring in the neuroscience aspect to help further understand what happens in the brain when someone’s engaged with art therapy, which will then help explain exactly how and why it is beneficial.”
There are other considerations for AATA in the near future. “One of our priorities is to increase the number of practitioners—which would mean more opportunity for people to see art therapists,” Betts says, “but also a critical priority is to increase diversity within the profession.” She notes that the field is, at the moment, predominantly white and female. “We’d like to see more men in the profession, but we would also like to see more ethnic and age diversity.”
AATA will continue to work with Pence in enacting the art therapy platform. “We are bound by our mission to advance the profession,” Betts says, “we will continue to help to make sure that it’s done the right way.”
Original article can be found here