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Much of the research on post-combat mental health of ..

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Consider the three major arguments  putting women into combat — none of them hold up.
In her 2006 "" primer in The ASHA Leader, Gloriajean Wallace challenged medical SLPs to explore the emerging landscape of blast injuries and define their role in "facilitating restoration and wholeness" to returning military service members with communication and swallowing impairments. SLPs are playing a critical role in the recovery and rehabilitation of wounded soldiers and using technological advancements to enhance access to the specialty care we provide. In fact, just as technological advances have changed the nature of warfare and injuries sustained in combat, the armamentarium of telehealth and advanced technologies are being used to improve access to and the quality of rehabilitative care for military service members and veterans in environments that lack the presence of SLPs.

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So why do men and women perform so differently in combat-related tasks? First, physiologically and psychologically, women and men are significantly different. Men are not simply bigger women with different plumbing. Men’s blood carries 10 to 12 percent more oxygen per liter than does a women’s; and men’s VO2 max, a measure of the top rate of oxygen consumption, is 40 to 60 percent greater than that of women. An average fit man will weigh about 23 percent more, have 50 percent more muscle mass, and carry 10 percent less body fat than an average fit woman. Pound for pound, men have thicker skulls, , hearts that are 17 percent larger, and bones that are both . Despite being much heavier, men’s vertical leap is nearly 50 percent greater than that of women.

 

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Research in mTBI has been unparalleled over the past five years because of the nation's need to care for fighters returning from OEF and OIF. The telehealth service delivery model should be included in research initiatives for cognitive-communication interventions for this patient population. The service delivery model is being used and tested in the civilian population as well. Lyn Turkstra, professor in the Department of Communicative Disorders at the University of Wisconsin just completed a study with Maura Quinn-Padron, speech-language pathologist at the Marshfield Clinic, in which they compared telehealth to in-person assessment of cognitive-communication functions in 20 adults with chronic TBI (personal communication, Sept. 10, 2010). Results support the use of telehealth for the assessment of cognitive-communication functions in adults with TBI who have sufficient cognitive skills to follow telehealth procedures. They concluded that telehealth has particular appeal for management of post-TBI cognitive-communication disorders because communication problems often become more apparent in the chronic stage post-injury after acute rehabilitation has ended, when the individual returns home and attempts to re-enter community life. A comparable study with veterans would have high relevance, as access to speech-language services in their local communities after discharge from acute care or rehabilitation facilities would be a significant advantage.

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Speech-language pathology clinicians and researchers are committed to advancing the science of cognitive-communication interventions to fulfill our critical role in rehabilitating service members and veterans with TBI, and are partnering with colleagues across disciplines as well as across DoD, VA, civilian, and academic sectors to develop innovative technological solutions. For example, Sohlberg and Steve Fickas (professor in computer sciences) at the University of Oregon are beginning a five-year project funded by the National Science Foundation that focuses on compensatory reading comprehension strategies for students in post-secondary courses. In the first four years of their , they will work closely with active-duty service members and veterans with mTBI who intend to enroll in specialized training programs or return to university or community college campuses. They also are incorporating technology-assisted prompting (TAP) in administering the evidence-based Attention Process Training (APT)-II (Sohlberg et al., 2001) program to address attentional deficits for patients with mild cognitive dysfunction (personal communication, Sept. 12, 2010).


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The U.S. Army Medical Information Technology Center is supporting tele-TBI and tele-psychological health initiatives by providing the infrastructure to connect soldiers and health care providers via VTC to medical facilities and specialists. The network also is being used for professional education with monthly multidisciplinary TBI grand rounds broadcasts from Brooke Army Medical Center (BAMC). These broadcasts have included outstanding presentations by SLPs on psychogenic versus neurogenic stuttering (Joseph Duffy, professor of speech pathology at the Mayo Clinic) and assessing and treating attentional processes (McKay Sohlberg, professor in communication disorders and sciences at the University of Oregon). Kevin Manning (Traumatic Brain Injury Service at Brooke Army Medical Center in Fort Sam Houston, Texas) and his colleagues are using the network to provide speech-language services remotely via VTC.

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Tripler Army Medical Center (TAMC) in Hawaii is the only federal tertiary care hospital in the Pacific Basin. Over the past 10 years, telehealth has been an important initiative for otolaryngology, audiology, and speech-language pathology because of the vast geographic span of our catchment area (Burgess et al., 1999; Mashima et al., 2003; Mashima & Holtel, 2005). Organizational support has been vital to the success of our cognitive-communication rehabilitation program, including the telehealth component. Telehealth was incorporated in TAMC’s multidisciplinary TBI team's strategic plan; resources allocated for telehealth include upgrading VTC equipment and providing administrative and technical personnel support for implementation and maintenance onsite and at the remote site.

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In speech-language pathology, we have used interactive VTC for consultations with patients, group and individual treatment, patient and family education, and clinician mentoring. In addition, multiuse of the VTC system supports care coordination and professional education. The multidisciplinary TBI team at Tripler collaborates with the TBI team at the Schofield Barracks Health Clinic (SBHC), which is part of the Pacific Regional Medical Command, for weekly case discussions and program planning; for example, the SLP at the SBHC participates in program development meetings and TBI journal groups at Tripler.