Veterans’ Health Matters
Volume 2, 2008
Technology: Playing aKey Role in Rehab Programs
It made its worldwidedebut in September 2006,five years after Nintendodesigners and engineers beganwork on the Japanese company’s fifth home video game console.Given the unusual name of Wii(pronounced “we”), it was aninstant success, being sweptoff store shelves as soon as itbecame available.
Aimed primarily at video gamefans, the Wii gaming system hastaken on a different and evolvingtherapeutic role. Today, the Wiihas become a fun part of the rehabilitation process and a formof “therapy” for veterans andreturning service members at theVA Palo Alto Health Care System(VAPAHCS) Polytrauma program.
VA’s Mission
The Polytrauma Unit, whichcares for severely injured servicemembers with Traumatic BrainInjury (TBI) and other seriousand often life-threateninginjuries, has introduced theWii system during RecreationTherapy treatment sessions.
Polytrauma refers to the complexpatterns of injury commonly seenin personnel injured during Iraqand Afghanistan deployments.Polytrauma typically resultsfrom blast injury caused byimprovised explosive devices orrocket-propelled grenades. Thecombination of high-pressurewaves, explosive fragments, and falling debris producemultiple injuries, including braininjury, amputations, burns,wounds, fractures, blindness andhearing loss.
The magnitude of these injuries,and the circumstances in whichthey occur, can cause additionalpsychological stress to patientsand their families. Consequently,reports Richard K. Smith,Certified Therapeutic RecreationSpecialist and Recreation TherapySupervisor, their care requiresa full complement of medical,surgical, rehabilitation andmental health personnel andservices.
From a recreation therapistperspective, Smith reports, theemphasis and treatment goalof using the Wii may includeincreasing the patient’s hand-eyecoordination, improvingbalance, strength and movement,and overall safety in theirenvironment. The activities aresomething patients enjoy andbenefit from and continue usingwhen they go home. From thepatient perspective, it’s all about“having fun.” While bowling, apatient mentioned that he neverknew “therapy” could be such fun.
“The beauty of the Wii andadaptive technology,” Smith adds,“involves other applications,such as social networking siteson the Internet. It helps patientsget back into communicatingand socializing with theirfamilies, friends and comradesin other locations. The virtualtogetherness is a great way tohelp them in their recovery andrehabilitation process.”
The inpatient Polytraumaprogram currently has threerecreational therapists, who meetwith patients during individualand groups sessions. “Usingthe Wii system and gaming canenhance part of the treatmentsession,” Smith says, “Armmovements during boxing andrecreation therapy sessions canalso address issues brought upin other areas, such as physicaltherapy.”
Bed-bound patients are alsoinvolved in recreation therapyduring bedside treatmentssessions; a computer or gamingsystem can be rolled directly topatients’ rooms.
Outpatient and TransitionalPrograms
Much of the responsibilityfor the transitional outpatientRecreation Therapy programs isin the hands of Susan Feighery,Lead Recreational Therapist.“Much of our work,” she says,“involves applying currenttechnology to meet the clinicalneeds of our recently woundedcombat service personnel.”
For example, the program usesthe WiiBrainAcademy gameto increase cognition, memory,mathematical and visualscanning skills with head-injuredpatients. In addition, the WiiSports program allows patients,families and friends to competeathletically, while the recreationtherapist measures and monitorsthe physical recovery process.
The recently released Wii Fitnessprogram teaches other mind/bodyfitness skills through innovativeactivities, such as yoga and hulahoop contests.
Additionally, all Wii programs,when clinically utilized, canaddress specific patient deficitsvia interventions involvingbehavioral, social, physical andcognitive applications, which canthen be directly transferred tothe patients’ home environmentwhen they return to their localcommunities.
“Keeping up with rapidlychanging technology can be quitea challenge,” says Feighery.“There’s a huge learning curve,but tools such as Wii and theXBox360 make treatmentsessions enjoyable for bothpatients and clinicians. In usinggaming technologies, we’rebreaking new clinical grounds,as we develop new treatmentstrategies.”
“With clinicians, patients andfamilies working as a team, wecertainly put the ‘WE’ in adaptiveWII technology,” stated Feigheryand Smith.
“We’re constantly learning fromour patients and their families,”Feighery says. “But there may beveterans out there with stronggaming skills who can assistus in the development of futureadaptive technology and gamingprograms.”
VA Says Goodbye to Dr. Wiebe
Robert Wiebe, M.D.,M.B.A., M.P.H., Directorof the VA Sierra PacificNetwork 21 since 1998, has leftVA to serve as Chief MedicalOfficer for Catholic HealthcareWest System.
Dr. Wiebe managed yournetwork that serves veteransin 36 locations in northern andcentral California, northernNevada, Hawaii, Philippines,and other islands in the PacificBasin. He was also co-chairof the national VHA FinanceCommittee.
Throughout his dedicatedservice, Network 21 has beenone of the top performingVISNs throughout VA. Hiscontributions during his 22years of VA service are far toonumerous to list.
“I am extremely grateful forthe privilege of working withand learning so much from Dr.Wiebe,” wrote Lisa Freeman,Director of VA Palo Alto. “I ameven more fortunate to havebenefited from his mentoring and from witnessing hisexemplification of a true leader.I thank him for all he has donein service to our veterans.”
Dr. Wiebe said: “This decisionwas incredibly difficult for me.I have spentmy entireprofessionallife with VA,including the last11 years as yourNetwork Director. To be able toprovide health care is a specialgift; to be able to provide healthcare to veterans is truly a noblemission. I leave VISN 21 with anenormous sense of pride.”
The new VISN 21 directoris Sheila Cullen, the formerdirector at the VA San FranciscoMedical Center. The next issueof Veterans’ Health Matters willinclude a profile of Ms. Cullenand her VA career.
VA National News
VA Announces InsurancePremium Reductions
Veterans who served in combat since November 11, 1998, including those who servedin Iraq and Afghanistan, are now eligible for five years ofhealth care and medicationsexempt from co-pays (regardlessof income level), for treatmentof conditions a VA cliniciandetermines are possibly relatedto combat military service. Thisinitiative increases a two-yearlimit that had been in effectpreviously.
VGLI premium rate reductions,ranging from 4 to 12 percent, will apply for veterans aged 30 to 64.Premium rates for those underage 30 are already competitive.
The reductions will ensure thatVGLI remains highly competitivewith similar insurance offered bycommercial insurers.
More than 400,000 veteranscurrently participate in theVA-managed VGLI program. Toobtain more information, or toview a table with the new VGLIrates, visit the VA insurance website at
Five Years of Care forRecent Combat Vets
Military veterans who served incombat since November 11, 1998,including veterans of Iraq andAfghanistan, are now eligiblefor five years of free VA medicalcare for most conditions. Thismeasure increases a two-yearlimit that had been in effect.
Veterans may apply at any timeafter their discharge – evendecades later – for medical carefor service-connected healthproblems.
The new provision applies tocare in a VA hospital, outpatientclinic or nursing home. Combat veterans discharged betweenNovember 11, 1998 and January16, 2003, who never tookadvantage of VA’s health caresystem, have until January 27,2011 to qualify. The five-yearwindow is also open to activatedReservists and members of theNational Guard, if they servedin a theater of combat operationsafter November 11, 1998 andwere discharged under otherthan dishonorable conditions.
VA Awards Nearly $65Million for CaliforniaVeterans Homes
To continue construction of threemajor projects in California,while launching majorrenovations at a fourth facility,the Department of VeteransAffairs (VA) has awarded thestate nearly $65 million. Grantstotaling $55.3 million will helppay for ongoing construction inWest Los Angeles for a 396-bedstate veterans’ nursing home,and 60-bed state veterans’ homesand adult health care facilitiesin Ventura and Lancaster. A$9.4 million grant will pay forimprovements to the Californiaveterans’ home in Yountville.
In addition to Yountville,the California Departmentof Veterans Affairs operatesveterans’ homes in Barstow andChula Vista. The homes areopen to state residents who arehonorably discharged veteransof ages 62 and above. The agelimit can be lowered for disabledveterans.
This year, VA expects to spendmore than $7.6 billion inCalifornia on behalf of its 2.1million veterans. VA operates10 major medical centers inthe state, along with nearly 50outpatient clinics, 11 nursinghomes and 21 Vet Centers.
New Travel Nurse ProgramLaunched
To deal with a nationwideshortage of nurses and toimprove the quality of carefor veterans, the Departmentof Veterans Affairs (VA) hascreated a “Travel Nurse Corps”to enable VA nurses to traveland work throughout theDepartment’s medical system.
The Travel Nurse Corps isbeginning a three-year pilotprogram. Initially, it will place asmany as 75 nurses at VA medicalcenters across the country. Thegoals of the program are toimprove recruitment, decreaseturnover and maintain highstandards of patient care.
The program is also designedto establish a potential pool fornational emergencies and serveas a model for an expanded VAtravel corps with nurses whohave varying specialties.
VA Increases TravelReimbursement
Effective February 1, 2008, theDepartment of Veterans Affairshas increased the beneficiarytravel mileage reimbursementrate from 11 cents per mile to28.5 cents per mile for travel toVA medical facilities.
As mandated by law, VA alsoequally increased the deductibleamounts applied to certainmileage reimbursements. Thenew deductibles, which may bewaived if they cause financialhardship to the veteran, are$7.77 for a one-way trip,$15.54 for a round trip, with amaximum of $46.62 per calendarmonth.
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VA FacilityHighlights
PacificIslands
Exercise and Rehab Classes with a Difference
The VA Pacific IslandsHealth Care System’sSpark MatsunagaVeterans’ Clinic offers aunique collection of classesthat help veterans withexercise and rehabilitation.Voices of the Drums is adrum and dance exercisegroup that uses old rockand roll to set the beat.It is a fun alternative totraditional aerobics.
Drumming involves physical,psychological, emotional andsocial wellness. There is laughterwith every class. This exercisecan be adjusted for all disabilities.Voices of the Drumsleaves participantsfeeling energized, yetcentered and relaxed.
The clinic also offersStretching withSelina. The “GetFit for Life” DVDfrom HealthierUSVeterans is used.One veteran statedhe didn’t know where he would bewithout these classes. He couldn’tstand up from his chair and nowhe can push up.
Two classes atthe TriplerArmyMedicalCenter gymare also offered incombination withour mental healthteam: “WorkingTogether, MakingMusic Together,Moving TowardsHealth!”
Sierra Nevada
The New Rage in Rehabilitation
Wii is the newest ragegetting veterans activein the CommunityLiving Center (CLC)at the Reno VA MedicalCenter. It started withtwo donations. Thefirst came from StevenTometczak, age 20, theson of CLC’s ChargeNurse, Terry Wycoff.The second came fromAlex Baker, a 14-year-oldstudent at CoralAcademywho did a fundraiser asa school project. Bothdonations came as a result ofall the publicity in the mediarelated to the benefits of Wii inrehabilitation.
Since the invention of the Wii,many surprises with the veterans’capabilities have occurred. Oneresident who never engagesin activities and has a shortattention span started talkingand engaging with others.Another resident who hasdifficulty with arm movementssuddenly started swinging hisarm. Mark Amstrup, a veteran atthe CLC, commented, “This is thebest recreation activity around.It helps me move and keeps mymind working.”
Recreation Therapy hasincorporated Wii as anintergenerational activity knownas Wii Wednesday, which is runby youth volunteers. Accordingto Joanne Farris, the RecreationTherapist in the CLC, “The Wiiis a great way to get people usingtheir minds and bodies in a funand challenging way. It givesveterans an opportunity to playsports they never thought theycould play again.”
San Francisco
SFVAMC Opens New SimulationCenter
The San Francisco VAMedical recently opened anew high-tech SimulationCenter that createsrealistic medicalscenarios toallow cliniciansto improve andrefine theirmedical skillsand techniques. Staff participatein hands-on educationalprograms specificallydesigned for physicians, nurses,and other health professionalswith a focus on healthcare teamtraining. Theseexercises provide a simulatedenvironment to imitate a real-lifepatient care setting in a non-threateningenvironment.
The simulatorhas a full-sizeSimMan, whichis a computer controlledmannequinwhose major bodysystems have been programmedto respond realistically to theenvironment, medicines, andother interventions. SimMancan be changed to appear tohave incisions, broken bones,injuries, or certain diseases.The mannequin may be used topractice a number of physicalexamination techniques ormedical procedures. Othersimulator devices train staffin airway management, chesttube placement, and central lineplacement.
“We’re very excited about theopening of the Simulation
Center,” said Center DirectorRichard Fidler. “We’ve createda confidential, non-judgmentalenvironment where our clinicianscan learn better clinicalmanagement skills and improvethe way we all function as amember of a team.”
Palo Alto
Cancer Survivors Day Set for August
The VA Palo Alto HealthCare System (VAPAHCS) Cancer Care Committeeis dedicated to providingquality care to our cancerpatients by providing themwith a supportive caresystem. The committee,in conjunction with theAmerican Cancer Society(ACS), will host the secondCancer Survivors DayCelebration, to honor andrecognize the courageand strength of our veterancancer survivors.Our veterans with cancers areamong nearly 10 million cancersurvivors in the United States.
To honor our survivors and theirfamilies locally, the committeewill host a celebration onFriday, August 22, 2008 at thePalo Alto Canteen Courtyard,including educational activitiesand resources, luncheon servedby cancer healthcare providers,and entertainment. Registrationbegins at 10 a.m. and the eventwill conclude at 2 p.m. Pleasecontact the Cancer ProgramOffice, 650-493-5000, ext. 67912,for information.
To promote cancer prevention andawareness, the VAPAHCS offersprograms such as the CancerSupport Group for survivors andfamilies that meet at the hospitalto discuss cancer, treatmentoptions, and survivorshipissues. To help you get startedto a healthier you, VAPAHCSHealthier US Vets Committeeis hosting an outdoor Farmer’sMarket from 10 a.m. – 3 p.m. onWednesdays. Call 650-493-5000ext. 69933 for more information.
Central California
VA Staff Support Local Programs with Relay
VA Central CaliforniaHealthcare Systemheld up its longstandingtradition ofparticipating in theAmerican CancerSociety Relay for Life.“Strike Back” was theinspirational theme forthe 2008 Relay, whichwas filled with musicand camaraderie during theweekend of April 26-27 at FresnoStateUniversity.
The 2008 VA Team fieldedthe largest contingent in thecompetition by presenting threeseparate teams composed ofseventy VA employees, familiesand friends. VA teams took a hardfoughtsecond place in both therunning and competitive walkingevents. In all, TeamVA raisedmore than $5,000 in donations tosupport cancer research.
Merna Fletcher andAnnmarie Wyderko, the 2008Team Co-Captains, said,“It’s a physicallydemanding24 hours and now highlycompetitive, but it’s reallyworth the efforts we put intodoing well. While we didn’tbring home the Most MilesRun Trophy (VA has wonit four times from 2001 to 2005),we delight in the opportunity togive back to our community, andalso help support our own VAEmployee Wellness Program.”
Northern California
TBI Screening at VANCHCS
The Traumatic BrainInjury program at NorthernCalifornia Health CareSystem (VANCHCS) is anevolving, comprehensiveevaluation and treatmentprogram serving ourveterans. Our systemevaluates and treatsveterans from any of thefour Polytrauma NetworkCenters nationwide, butpredominately from theVA Palo Alto, as well asveterans who live in ourcatchment area.VANCHCS has instituted abrief screening for all returningveterans from the Operation Enduring Freedom and Operation Iraqi Freedom theaters in order toscreen for veterans with possibleTBI that was not previouslyidentified. More than 90 percentof the registered OEF/OIFpatients in our system have beenscreened for TBI and, of these, atotal of 584 consults for an initialcomplete evaluation has beenaccomplished. Approximately
70 percent of these patients areexpected to need further treatmentby a neuropsychologist. Currentlythe Martinez campus is seeingsome consults via admission tothe Center for Rehabilitation andExtended Care.
Our workload statistics currentlyproject that in four years we willhave approximately 946 unique patients, which is a 30 percentpositive TBI screening rate. Ourplan is to extend the programfrom the 12 to 15 patients inSacramento currently having onevisit a week to ideally having threevisits a week, which will allow fora more intense therapy program.
New Benefits HandbookUpdates for Veterans andDependents
The Department ofVeterans Affairs (VA) hasannounced the release ofthe 2008 edition of the popularhandbook Federal Benefits forVeterans and Dependents. Thisnew edition updates the ratesfor certain federal payments andoutlines a variety of programsand benefits for Americanveterans.
Most of the nation’s 24million veterans qualifyfor some VA benefits,which range from healthcare to burial in anational cemetery. Inaddition to describingbenefits provided byVA, the 2008 edition ofthe 153-page booklet providesan overview of programs andservices for veterans provided byother federal agencies.Federal Benefits for Veterans andDependents includes resourcesto help you access your benefits,with a listing of toll-free phonenumbers, Internet addressesand a directory of VA facilitiesthroughout the country. Youmay download the handbook atno cost from VA’s Web site at
The handbook is one of the topselling consumer publications ofthe U.S. Government PrintingOffice (GPO). GPO accepts creditcard orders for the publication at866-512-1800 (toll-free) for a costof $5 each to U.S. addresses, or$67 for bulk orders of 25 copies.It can be ordered by mail fromthe GPO at Superintendent of
Documents, P.O. Box 979050,St. Louis, MO63197-9000 (stock#051-000-00233-4),or online at
In addition to healthcareand burial benefits,you may be eligible forprograms providinghome loan guaranties,educational assistance,training and vocationalrehabilitation, income assistancepensions, life insurance andcompensation for service-connectedillnesses or disabilities.
In some cases, survivors ofveterans may also be entitledto benefits.The handbook describes programsfor veterans with specific serviceexperiences, such as prisonersof war or those concerned aboutenvironmental exposures inVietnam or the Gulf War, as wellas special benefits for veteranswith severe disabilities.
Health Tip for Travelers with Disabilities
The U.S. TransportationSecurity Administration (TSA)has established a program forscreening of air travelers withdisabilities and their associatedequipment, mobility aids anddevices. Additionally, TSApermits prescriptionliquid medications and otherliquids needed by personswith disabilities and medicalconditions.
For more information, visit the TSA web site at and click on the linkto “Travelers with Disabilities &Medical Conditions.”
Exercise Video on YouTube
As part of its ongoingHealthierUS Veteranscampaign to get veteransto become more physically fit, theDepartment of Veterans Affairs(VA) has posted a video clip fromits “Get Fit for Life” exercise DVDon the YouTube web site. It can beseen by individuals who conductsearches using the key words:veterans, health, fitness, obesityor diabetes.