>>I decided to jump out of perfectly safe airplanes for a living and pack parachutes.

>>I'm part of the intelligence community for the US Army.

>>I was in the US Navy.

I fixed the broken pieces of a ship to get the ship rolling again.

>>I incurred some injuries from time on the boat, time underway, serving in different areas.

>>I was in a, like a severe car accident.

Every, everything else is pretty, pretty foggy.

>>I had broken ribs, dislocated jaw, >>Fractured my neck, broke my back, blew out both my knees.

The therapy he's received here has really brought him to where he is today.

Now he can get up and and be mobilized.

Months ago it would've been a problem.

The polytrauma unit is very good.

>>I believe that there was no better place in the world for Ryan to be the caringness.

The amount of people that we're all focused in on helping Ryan get better we're, we're very grateful.

>>They understand the veteran's perspective.

They understand what we go through from the traumatic perspective of like being in a military environment, being in combat.

>>There you go.

>>My therapist, they awesome people.

Like I say, you know, if you commit yourself, they're gonna commit to theirself and we want to get better.

That's the purpose.

So they're there for you.

>>They honestly love what they're doing and they wanna help just to have the compassion for each and every one of them.

>>Good morning.

Good morning.

There's about four or five doctors every morning.

They all come in, ask about the night, ask about the day before, feel great.

Back feels good.

Doesn't hurt.

>>Good.

You like your clamshell.

>>I hate it.

>>We were just talking about that this morning.

>>Having four or five doctors come in it, it's pretty awesome.

They all just kind of talk right there of kind of how I'm feeling, how, how my legs are doing or how my back was doing.

So it, it is more of personal, I guess you can call it.

>>Good morning.

>>Good morning.

>>Hello.

>>Hello.

How are you?

I'm well.

How are you sir?

Okay, so how was your weekend?

>>It was great.

>>Yeah.

My >>Son came up and sat with me for a while.

>>Okay.

How's your wrist?

>>Yeah, well we just got through working on getting therapy on it.

I get a lot more movement than I had in the, >>I'm evaluating the patient, seeing what issues they had since the last time I saw them or since we, the last time we made any changes.

Doing a physical exam on them.

Yeah.

And then answering any questions they may have if the recovery stalls out at all.

It could be because of scar tissue and that's where your orthopedic surgeons may want to take a look at it again.

Everything else.

Okay.

Otherwise, oh >>Yeah, I, I want to thank his legs hit up pretty good I think.

>>Cool.

Lemme know if you need anything.

>>No doubt.

>>Have a good day.

Sometimes rounds for a patient may take only five minutes and sometimes round for a patient might take half an hour.

Morning, sir.

And then part of that rounds is coming out of there and discussing with the nursing staff for what the plan is for the day.

Making sure that everybody's on the same page.

>>Oh gosh.

I dunno where it is I call her and ask her.

>>Okay.

I think if you don't know what's going on with the patient or what their greatest concerns are, their fears, their hopes, if you don't know that, then you're just touching tissue.

I mean, we've gotta grab hold of the person that's inside the person that's struggling with whatever their issues are.

I mean, whether it be a new amputation, whether it's that their face is disfigured, I mean whatever it is, we've got to know them and let 'em know that we're listening to 'em.

We hear them, we care, and the one thing we do is take time with our patients.

>>Morning.

>>Good morning.

How are you?

Pretty good.

Do you mind if I interrupt for a second?

Yeah, >>Go >>Ahead.

>>How was your night?

Weekend went well.

>>Yes sir.

>>How's the memory >>It's off today?

>>It's off today.

Seem a little off today.

>>Seems like, He's a little off, but I can't really describe, can >>I see your wrist here?

You're having some palpitations or you some like your heart was like racing a little bit earlier this morning.

Mr.

Graham now had a hemorrhagic stroke from this pretty rare medical condition.

And how do you feel off like more body fatigue off or more kind of mind?

Hard to concentrate off concentrate because it was that rare medical condition.

We will look for any kind of signs of that medical condition coming back.

That's much improved >>Right.

Okay.

Scotty, switch to galloping.

>>We're all a team, but the patient's, the top and all of us are here to help hold them up.

They're always number one, they're the team leader even though they don't realize it sometimes.

All right, >>Good deal.

Dig in like that.

I'm good.

My man.

My man.

>>The best thing I like is there's no idle time.

Eight o'clock they doing therapy.

11 o'clock maybe he goes to the psychiatrist or whatever at two o'clock.

He went to recreational where I played that little game with them was really very interested.

By then you so tired it's time to rest, you know?

So I like that.

>>I love the dance at the end.

>>I'm not allowed to bend my legs on my own right now, so therefore I have to have therapists bend 'em for me.

Having them there to bend just a little bit further to get the little bit deeper of a stretch or the deeper of the bend to really stretch it out and then help you recover it in the end is, is great.

That little bit more range of motion for that day and then cover the next day and come back for another day to do same thing.

I'm still at the mercy of the army, so it's whatever they say.

If I could stay here longer, I definitely would.

>>For our active duty service members, when they come here, their orders are to recover and so the military makes it very clear to them.

They have one job that is to participate in rehabilitation.

>>My last few years in the news business, I essentially spent writing about murder and I was trying to find something good.

There's good in people out there.

The Associated Press distributed story worldwide.

It was a piece by a photographer with the AP named Anja Niedringhaus.

She had been with a medevac unit in Afghanistan in the summer of 2011.

The unit was sent out to a wheat field where a small unit of Marines had run into an IED and one of the Marines had been severely injured.

He had shrapnel injuries, I believe right around his jugular.

He was in a very agitated state.

He was losing a lot of blood and he was reaching around for someone, something and she reached out her hand to, you know, hold him and to try and comfort him.

She held his hand while he was being flown out of the wheat field.

Well, several months had passed and she wanted to find out what had happened to this Marine and she began a long, arduous effort to track him down and she eventually found him at the polytrauma Unit at the Richmond VA Hospital.

And she went there in the fall of 2011 and had a reunion with them for Christmas Eve.

She wrote a story and released a, a wonderful photo package that the Associated Press distributed worldwide.

I was reading the story and I was like, wow, Richmond has a polytrauma unit.

I need to learn more about this.

And within a couple weeks I was over there working on a book.

It was a wonderful place.

You know, after you're there a couple weeks and a couple months and you see the results and you see the difference it makes, then you start to really appreciate what patient-based healthcare is all about.

>>Polytrauma is physical as well as mental health injuries that occur due to one event at one time.

And this can be a brain injury, they can be amputations, they can be a post-traumatic stress disorder.

Everything that can happen due to a catastrophic event.

Initially it was related to combat operations and blast injuries.

>>Conflicts began around 2001.

By 2003 to five were realizing these are not gonna be short term wars, they're not gonna be ones that have no casualties, they're, there's gonna be difficulties specifically in the area of brain injury or polytrauma.

These conflicts were gonna generate folks who needed complex and integrated care that could be delivered through a Polytrauma center, Richmond, San Antonio, Palo Alto, Minneapolis and Tampa are the five centers.

Then we developed the next layer with the second tier sites and third tier, then fourth tier.

So there is a nationwide map of integrated care that was run through the VA's office of Physical Medicine, rehabilitation, department of Defense, department of Veterans of Affairs.

And you know, people across the system work together.

>>This is a huge system.

You are going to see some of the basic services being the same at all five Polytrauma rehabilitation centers, but they also have developed their individuality based on the geographical location, the population they serve, the kind of supports that they have around them.

But overall, the basic services are the same.

>>Working in and with the trauma program, we could track the patients from point of injury in the theater of war or if they had non battle injuries, we could track them along the path from their injury to stateside.

The trauma services team would request our rehabilitation lens, if you will, on these patients to help determine what their options are.

>>The population's changed over the years.

We saw this large influx of active duty service members and that was probably about 75 to 80% of our population.

However, we've seen an increase in stateside injuries for motor vehicle accidents, drinking and driving.

We have had a fair number of injuries from suicide attempts.

We still utilize the same resources that we did for our combat injured population, but it's slightly different.

We really focus on a wellness aspect for them.

Perhaps they had severe PTSD or perhaps they just were having a really hard time reintegrating into their home life and so there's a, all these other issues that were occurring prior to their injury that we wanna make sure we don't ignore.

>>Yeah, it looked pretty, it seemed good.

It went bad, so >>Yeah.

Yeah, and that's what we was kind, probably both of us was pretty scared of, oh, another surgery.

But you know, God is good.

He is still here and >>My goal is to get them here and make it feel seamless and to let them know that we're not only gonna take care of you, but we're gonna take care of your family as well.

Once you figured out what the diagnosis is that will sort of direct which program you're going into, you're looking at their physical ability to tolerate what we're doing because it's rigorous >>In 18 years.

>>Being able to allow our therapists time to treat our patients, an hour of therapy, a day for each of the therapies, more than just physical therapy, occupational therapy and speech therapy, but including kinesio therapy, vision therapy, recreational therapy, psychology sessions.

And so we have all of those and are able to provide 3, 5, 6 hours of therapy a day to our patients and it just gives them more opportunity to, to improve their function.

>>To breathe out when you pull down.

>>Yep, >>Good.

We assess what they can and can't do from a physical standpoint, from a cognitive standpoint, and come up with a treatment plan that suits them.

Six, >>You know, we get patients who roll in here on the PRC, who may not be talking, may have a trach they can't swallow, and I provide those tools and the strategies to, to improve those areas and get them eating and talking and remembering and functioning.

>>We always want to tailor the treatment program to something that's meaningful and purposeful to the patient.

We start here with the basics to make sure that the person feels comfortable eating, grooming, bathing, dressing, toileting, and then once they finish with those ADLs, then we move on to the higher level instrumental activities of daily living, which one does with their environment.

It really gets to where we have to break down so many things like vision, speech, swallowing, cognition.

So it's really nice to have the rest of the team because if you can't where your toothbrush is, it's gonna make it a little more difficult to brush your teeth.

>>If you're driving and you see a sign on our unit here, we have patients who have had a brain injury or maybe they've had a stroke and that affects vision because vision goes through between 70 and 90% of the brain.

So if a person has lost vision, then I can teach them skills of blindness, how to compensate for their field loss or for their inability to see the way they used to.

If they have vision but it's now dysfunctional or distorted, then I teach them skills of vision, how to get back the skills that they had before their accident or their injury.

Is it closer, farther away or closer?

>>Successful rehab is based on that patient's goals.

I mean, where do they want to go?

What are they trying to achieve?

And then, you know, in order to get there, you have to have everybody as a cohesive unit.

>>Alright, stand tall, you're leaning stand tall, there you go.

>>This has the physical and the cognitive and you know, the psychological and emotional things that just come with all of that.

So it's just, it's all systems and it's extremely challenging for somebody to go through >>All therapists, all staff, everyone is on the same unit.

Our patients don't need to go through any other unit to find any of us.

You're just a part of the team on a daily basis.

At any point in time >>You fail every time.

Before that, >>My job is to case manage the team.

So as they are telling me that someone can now start doing stairs, then that means, oh, he has stairs at his home and I can discharge him to this home.

So as each discipline is progressing in their therapies and rehab services, it lets me know what my next stage for my patient is regarding from a social work aspect and for the caregiver involvement.

>>Yeah, I can drive, once I sit down, >>It's patient centered, family centered, and every single patient's different and every single family's different.

I think >>I, I think you'll be fine.

Okay.

But >>The family member is maybe the primary unit that will be taking care of the patient.

So we have to keep 'em standing, we have to educate 'em, we have to give them as much respite as possible while we are here around the clock, taking care of their loved one so that they can begin to think about, you know, what's the right next step for us as a couple or as a family.

>>Morning >>Ryan, he loves to run bike swim.

He and his two brothers, plus his sister-in-law went on a trip to Colorado and they biked all over the place.

He was in a motorcycle accident in Dayton, Ohio.

Violent type of an accident.

>>First impression you get is that you see your son there in very serious conditions and he's not doing much on his own.

Machines are running his body and what's ever left of his life.

>>It, it was very scary.

He was at Walter Reed for about two and a half weeks, something like that.

>>They said, well you do have choices, you can go to different facilities, but why Richmond is good is because they have a polytrauma unit there and this seems like a perfect match.

We kind of felt like, well this is gonna be home for a little while, both for Ryan and for us because the other hospitals, we were there only a short time.

After a while you start to learn what the routine is, >>Bigger step with your left foot.

>>When the nurses told me that recovering from a traumatic brain injury is like running a marathon, it's running it through woods with rocks and trees and curves and all kinds, and sometimes there are setbacks too.

You're doing fantastic.

I am so proud of you, Ryan.

I had the goal, whatever the therapists were doing with Ryan that I would try to enhance it.

>>Hi, >>There's recreational therapy.

Paulette actually got a recumbent bicycle for Ryan to ride and actually one day she cleared off the floor and Ryan was able to ride his bike in a circle all around.

I thought that was really special because they knew Ryan, that he loves the bike.

They did that for him uniquely as a person.

Ryan's big goal is to be able to serve in Marines.

He's a wounded Warrior battalion and what's amazing is that he's playing his flute now.

He has a chance that he might be able to get back into the Marines and be able to serve again, only by faith could we have hoped for all these things before.

And to me it's amazing.

It is amazing.

>>Relax, relax.

So relax.

>>Have team is awesome.

Okay.

Awesome people.

It's definitely worth it.

You know, if you got any comeback in you, they gonna bring it option.

I spent 14 and a half years in the army.

I was E five when I got out.

I served from 79 to nine two.

I mean, you know, for what I've been through, most people don't make it to me.

Well I had a aorta dissection at work and so I had to get rushed to one of the hos outside hospitals.

During the process, one of my feet got infected, so I had to have an amputation.

What's something, I mean it's just every now and then you get it right and I just didn't know what it was.

And it keep you informed on what's going on with you medicine wise or you know, injury wise.

It's a good deal.

It is very appreciated by me.

I'll tell you, that >>Stays on for about 30 >>Minutes, so I'm looking forward to coming back to the booth camp and getting a prosthesis, keep it moving.

>>Theres the outer shell gel, >>We look at the whole person.

We, we have a holistic approach, so we make sure that their pain is okay, that their psychological wellbeing and, and the psychology team members are, are active in that.

We look at everything healing, just overall wellbeing and health and then we get them moving toward the direction of prosthetic use.

>>I was in an automobile accident and I got flipped and it crushed my heel.

We tried to save the foot, we tried to save the heel, but we were unable to and eventually the heel just had to be taken off.

Prosthesis was very beneficial to me.

They're getting you up and they're improving your life.

>>We have an intensive five day prosthetic bootcamp program.

We're fortunate that we can literally give them one stop shopping for probably no fewer than 10 disciplines.

You kind of want to look ahead about 10 to 15 feet.

>>Okay.

You look, >>I personally have always been a firm believer in, when you're wearing a prosthetic, it's about creating good habits to start.

By the time they go home on Friday, they personally feel that they've mastered the prosthetic use.

Is it more snuck on the bottom?

>>Yeah, another eighth inch in.

>>Yeah, and you know what's funny is that eighth inch makes all the difference in the world.

>>It's crazy.

>>So weird.

Yeah, >>Gotcha.

>>To see the difference between Monday and Friday is so exciting.

And then they come back for outpatient therapies with me and then they come back just for follow up visits, kind of like you would to your mechanic.

>>I was on the aircraft carrier, the USS kitty hawk.

That was pretty cool to be out in Japan.

I just, it wasn't enough for me.

So I started to cross train with the corpsmen on my ship.

I just wanted to go fight for my country and so I went to Afghanistan and that kind of screwed me up.

It's just like, you gotta go, go, go and adrenaline just pumping all the time and you're constantly, you know, one day you're at chow hall with your buddy and then the next day you KIA or you know, it was just a different mindset and then you come back and it's like, okay, good job.

So I had a problem with turning it off.

I I, >>There's nothing for them.

>>There's nothing for us to >>Do.

You're just supposed to go back to your job and be fine.

>>Go back everyday life and there's like disconnect with your family and disconnect with everything.

>>He was in a coma for two weeks and we thought we lost him.

We never thought he would come out.

When Robbie came here, had a traumatic brain injury and he was pretty bad off.

The miraculous recovery that he made over 18 months was just, it was shocking.

I mean it was just more than we ever could hope for.

>>He would go into therapies and just yell and scream and it was a slow process, but they never gave up here.

They just kept going and pushing him.

But knowing when to stop, you know that they care for you here.

Yeah.

You know that they honestly love what they're doing and they wanna help just to have the compassion for each and every one of them and understand what they went through.

>>This treatment that I put into the low back is a treatment to help infuse energy into a person.

So he was telling me on Tuesday, I believe it was, he just was feeling kind of run down overall.

When I checked his pulses from an acupuncture standpoint, he had lower chi and a couple of his meridians over here or over here.

>>Okay, >>Tell me when you feel it.

>>That's good.

>>That's good there.

Okay.

The other side >>Over here.

Over here.

Okay.

>>He has had chronic issues for years now.

Anybody with chronic problems, you usually have lower kidney chi and so this is giving him more energy and will hopefully replenish some of his chi.

When I have my patients relax, they're laying there or perhaps sitting there with needles in place and I give them 10, 15, 20 minutes, I explicitly tell them, I want you to relax and just kind of veg out.

Think about going to a place in your mind that you feel comfortable and it could be anything that allows them an opportunity to be spiritual within themselves.

For years in brain injury, we've really looked at the physical, the cognitive, and the psychological, and that's where you miss out.

>>All right, Rob, you ready?

>>So it's very easy to show that, you know, from a physical standpoint, we have our therapies from a cognitive standpoint, we have our speech therapies and neuropsychology from a mental health standpoint, our counselors and our psychologists and psychiatrists.

But from a spiritual aspect, we've always been lagging and so that's where our chaplaincy comes in play.

But it's spirituality is more than just religion and so that's where wellness comes in, that sense of self, that's the spirituality aspect of it.

We have to make sure that we hit all four of those aspects and that's where we structure our program.

So we can do that.

How do you feel?

>>Good.

>>Excellent.

All right, take your time.

>>Our heroes deserve everything that could possibly work, but also because they're, their difficulties tend to be a bit more challenging.

Folks who have polytrauma injury often have not one, not two, not not even three.

They sometimes have 17 symptoms that they're having.

Alright.

Often at the same time.

And you can't just treat them individually.

You're using some simple algorithm.

You need to figure out how to pull the layers apart, treat them in ways that are creative.

Let's always do things scientifically and appropriately, but let's make sure we're really trying everything.

So it's whatever it takes to help that person is what compassionate care is about.

>>Our program helps to evaluate active duty in veterans and we use technology to help them meet their goals.

We use the Amazon Echo, but also just your smart devices, your smartphone or your tablets to help with cognitive needs.

So remembering, take your medications, remembering to pick up your kids, remember your appointments.

So sometimes it's using what they already have before we add something else to your life.

>>When things don't exist, we make them, but it could be in the form of modifying existing products, maybe tweaking just something very small to make it work for that particular patient and their goals.

And that is a very unique capability that we have within the va.

>>Thank you very much.

This is our family.

And that's Bryce.

He joined the Air Force in 2010.

So his first year he served in Korea and then he made it over to Japan, living his dream.

Then on October 13th, 2012, we received a phone call that Bryce had been in an accident and told us we're not expecting Bryce to make it through the night in time because he laid there almost a month in Japan that they were just waiting and watching to see what was gonna happen.

I get handed a piece of paper and I find out that Dr.

Jit Pie has accepted him in Richmond, Virginia.

So Bryce has been accepted into a 90 day emerging consciousness program.

>>Look >>Over here.

Hi Bryce.

>>I like that they treated Bryce at the Polytrauma like he was awake.

Okay, Bryce, this is the first time you've been up in six and a half weeks.

I talk to him every day.

I would tell him, what's going on?

>>Here you are.

You're all the way up.

>>It snowed one day.

I remember just propping him up in his wheelchair and taking him out to see the snow.

Hey Bryce.

Hi.

Hi Bryce.

They're sustaining him every day.

They're dumping food in a feeding tube.

I think Bryce was on 27 different medications a day, just keeping him alive.

So I said I wish there were options.

And Dr.

Pie said, there are options.

It was my birthday.

Never forget that day.

And my husband was waiting for that phone call.

The option is that we could let him succumb to his injuries.

When they moved us downstairs to palliative care, Bryce died in slow motion.

It was so horrible.

I still have shame feelings that come from that.

Months later we received autopsy.

His brain had dissolved in itself.

It was full of black holes.

He had no chance.

As long as I live, all set aside a special time to honor and remember him and continue to love him.

Always knowing one day I'll see his beautiful smiling face again.

This more than anything else brings me joy.

This place is amazing.

We had absolute incredible treatment.

Everything, the medical, the friendships.

I just can't help but think we would have no peace.

Our family, I'm sure would've been destroyed if it wasn't for this place.

So it could have been a loss of four lives.

I don't say that lightly.

I'm saying literally it could have been the loss of four.

Just like >>They need this book.

They need to know, yes, >>That >>The, you know, family can heal.

>>Yes.

>>And I just so admire your courage, >>Actually going through all the tough stuff and coming out, okay, broken but not destroyed.

My marriage is stronger.

My relationship with my daughter is stronger.

Bryce I know is safe and I want the rest of the world to see that you can have that even when the ending is bad.

And I'm going to embrace offer hope and faith, whatever I can for anyone who has loss.

That's what I wanna do.

>>We - Hold interdisciplinary team meetings weekly to discuss our patients on the unit, His a ADL performance is great.

He has declined to participate in IADL retraining so far.

>>Persons with brain injury.

You really need a team to help that patient and family move forward.

We utilize the patient and family's goals along with other goals that we, we would like.

And we come up with team goals for the week and then we discuss that back with the patient and the family and everybody gets to be on the same page.

We also have admission meetings, midpoint meetings and discharge meetings with our patients and family members.

>>It's the Graham and Graham family.

This is your handoff meeting.

And what that really means is that some of your team members from Polytrauma are now doing a handoff to your new team in the transitional program that you're going to.

So >>If we don't communicate appropriately, then we're gonna struggle.

And it goes beyond clinical care.

It goes into everything that we do.

Army Sergeant Garcia Lafitte came in last week on Thursday.

So young gentleman, multiple spinal fractures, bilateral lower extremity, not fractures, but ligamentous injuries in his knees Here.

Myself, Dr.

Robbins from the P Trip Program, Dr.

Webster from the STAR program.

We give an update on our active duty service members to the director and the chief of staff.

And so we usually meet for about 10, 15 minutes.

Just give 'em a quick update.

We talk about any kind of medical issue that might be challenging to deal with.

And then we, we discuss any of those service members that may be transitioning out of the DOD into the VA system.

>>Okay, you guys need it.

>>We're good.

Great.

All these other services that are not within pm and r, not within mental health, not within social work that don't physically touch polytrauma every day, but they're part of who our team is.

The reality is our patients will graduate from needing rehabilitation, but they'll always need primary care.

>>It's cool it's cool.

It's going on.

>>What are you doing?

>>What am I doing?

Making a lot of good stuff, good meals.

>>So why aren't you bringing me any meals?

>>It was December 31st, 2011 and I get the call.

I was just devastated and not thinking, you know, what was he doing in an accident?

He's getting ready to go to Turkey.

You know, it was about January 29th or so that he came to Maguire.

More progress came once he, you know, finally got up here and he realized what was going on.

I think it was naturally a, a good feeling for this family.

Support >>It, it is not easy.

It is kind of like learning a new activity.

You, you gotta have a lot of determination.

Keep doing something over and over again till you get it over at the P Trip facility.

It was just like trying to get you back to normal life.

After P Trip, I transitioned to the STAR program, they were like, help you reach a job or some kind of occupation.

And, and now, now I'm currently going to, to culinary school.

>>Okay, welcome to house Feeding everybody.

>>Well I work in the polytrauma transitional program called P Trip, helping patients recover from particularly brain injuries.

Start off.

I'm trying to get them back to being in as independent as as they can.

>>Scotty, your job is going to be fridge number one.

>>They've survived the acuteness and now comes reality.

You know, there isn't a nurse running in every 24 hours.

They've gotta get up, they've gotta get themselves to the bathroom.

They've gotta learn how to make a sandwich again.

So their personalities, they're coming back.

Just helping them to realize that this is the time to breathe.

>>All right, thanks guys.

Get joined.

Thanks Dylan.

Free to go >>See that box over there.

If you wanna help by collecting, there's a box sitting between those two.

If you wanna put some things in there and collect some of the ones you see and then we can put 'em in the shed.

That would be great.

And Doran, you can even pull the ones outta here.

>>Well, I was in the US Navy, but I got, I got medically separated.

I I was, I was a machinist.

I fixed the, I fixed the broken pieces of a ship to get the ship rolling again.

What time is it.

>>It's almost 10 o'clock.

>>The only thing that I remember is are the faces, the faces of the people that came and took care of me.

They're angels.

For example, there's, there's the speech therapist.

She helped me, her name's Monique.

She helped me get off my feeding tube and she's helping me with my speaking so I can speak fluently and clearly.

Hello my peers.

My name is Dorian Brooks.

I would like to welcome y welcome y'all to goals group Here we're gonna talk about our goals on what we plan to.

We have our goals on what we want to accomplish while we're here at P trip, which is the Raum Rehab facility or whatever it is.

>>polytrauma is show rehabilitation program.

>>Yeah, that that place.

>>Yes.

>>Yes.

>>I, I remember when I came in I was using a walker.

Now I'm not using now I'm not using anything at all.

Trying to, trying to become independent.

I don't feel like growing up until I'm independent.

>>It is kind of like a residence.

They live there.

The setup is different than a hospital setting.

So they have their own room and their own bathroom, but they have responsibilities.

>>I have the same idea to be, >>Did you >>I could just put a, put a mid on my, my left hand and right in.

We have to do everything.

>>We're trying to transition you back.

So in our setting, you're required to clean your room every week you do your laundry, you change your sheets.

There are shared household duties that they rotate.

So it's really about getting them back into those everyday tasks and everyday living.

Okay, that's hard to do.

So you see what I'm saying?

We wanna work on improving that over a long period of time.

>>Honey vegetable oil >>Here is where the rubber meets the road.

It's like it is time to take it to that next level.

Once you're in P trip, all of your regular life is probably coming back to you as well.

So I get to be here to help you through all of that.

Is there anything else with brain injury?

If someone doesn't have a lot of clear physical injuries, you might just see a 25-year-old physically healthy guy who looks fine but sometimes says things that are inappropriate.

We know that that is a product of their injury, but we need the family to partner with us.

We need the patient to begin to understand what's going on so that out in the community they can learn strategies to manage that behavior and not be vulnerable when they go out there.

It's all about reintegrating in the community.

Of course they have their individual therapy sessions, but there's a heavy emphasis on the group here.

>>Easier welcome.

>>They plan where they want to go every Thursday.

So I'm trying to look at their balance, how they're setting themselves up.

It's just the, the actual process of the activities to try to make sure, 'cause they wanna be able to get back to doing this as well as they can.

Okay, you got the right, you was just above your ball that time.

There you go.

But I'm still trying to be back and not hovering because I want that to be as natural as possible and for them to actually have some freedom and not feel like they're in therapy.

Even though I'm still trying to help them as as much as needed.

There you go.

Nice and smooth.

Trying to do one smooth stroke.

From the RT standpoint, we try not to schedule all the waking hours of the day.

'cause that's just to me, setting them up for failure.

You know, when you're in military, you're so used to all the structure for, you know, eight to 12 hours a day you come to rehab, it's all structured.

And if when you leave rehab, if you're not going right back to active duty, then you're gonna have a lot of free time.

The molecular structure or something going back to the long term goal, you know, when they leave here, I want them to be able to do what they wanna do.

I can put them in that scenario or as close to that scenario as possible so that I can see how they're gonna interact with other folks.

So it's all about the real world.

>>Is it okay if we walk around?

>>Yes sir.

>>Perfect.

>>I wanted to make sure you had a good understanding how everything was going medically wise, things going well so far?

>>Yes sir.

>>I get an idea of what he expects from the visit.

I have ideas on how I may be able to help him through a discussion with my patient and myself.

Decide what's best for you.

This is a measure of your kidney function?

>>Yes sir.

>>Take a look at what your numbers were.

It's pretty high.

>>Yes sir.

>>I want you to take a look at this now.

>>It went from way up there to down here.

>>That's pretty cool, isn't it?

And I just feel like I can connect with these young guys in a way that I'm thankful for the changes that I see both in the computer and with my eyes.

Show that you're making a pretty tremendous recovery.

>>My job was operations specialist.

It was aircraft carrier, the CVN 75.

The ultimate goal was to go back to my ship, be able to deploy again and you know, work the same job I used to.

I had broken ribs, dislocated, jaw blunt trauma on the left side of my ear, cut open my spleen, kind of naive on the problems I was going through.

And then they told me I was coming to P trip and that's when the actual challenge started.

I knew I was injured, but I felt cognitively fine until I started seeing some extensive tests on paper.

You know, percentages against other kids my age that didn't have a traumatic brain injury.

I started seeing how poorly I was compared to them.

How are you?

How you doing Steve?

>>Good, good.

How you doing?

Doing great.

>>When I get outta here, I'll use a lot of the strategies that my OT and speech have have given me to be successful.

And every day things, even in my job, every thing I do in life working out or me at work every day I'm working even harder 'cause it's like, it allows me not to take things for granted.

Now looking back and seeing the progress I made, I never felt so good in my life.

>>I came to the Polytrauma Center here where I was in the STAR program am I think I had like 25 years at that time.

So I knew that I'd be retiring.

So I had to figure out what I wanted to do, which Polytrauma was a real benefit for me because I got treatment and it helped me kind of figure out what I could do, what I couldn't do and what I shouldn't do.

They prepared me for what was about to come in my near future with retirement and getting somewhere in life.

When I was active duty, I was on my feet, I was on drop zones, I was jumping out of planes.

Now I'm a desk jockey.

I didn't know if I was gonna like it, but then I learned, hey, here's my alternative.

At least I'm doing something that I consider constructive.

One of the big issues is I have a pretty bad case of PTSD.

My biggest thing is I have to occupy my time because I start thinking too much.

And when I think too much, I go into some dark places.

I was going to do Tai Chi with Renee and Mark.

I had my opinion about it at first, but then I found that it can help you relax.

I kind of do about five to 10 minutes before I leave for work every day to calm down a little bit, reduce the anxiety and try to relax.

So I found that very beneficial.

>>My job is to help you exactly where you are and to find out what direction you want to go.

You know, when people are deployed, they don't sleep much.

And when you do sleep, you know you're constantly on edge.

So therefore, you know, we have to try to change that mindset to say, okay, sleep can be something that is good for you.

We might do a whole series of different things like having them do Qigong or Tai Chi or any of the stretches, meditation.

So there's multiple that we work on, but it's mostly changing the mindset, changing the behavior.

>>So the real primary purpose of our program is to help individuals who have sustained some kind of severe injury or illness to be able to reintegrate back in the community and hopefully back into the workforce.

>>They have a place where you can create resumes within USA jobs as well.

I think using their template is a good idea.

>>What we recognized was the fact that you returning to gainful employment or returning to some kind of meaningful work was extremely important.

>>Formal job title >>Would be what your actual, like you wouldn't necessarily use your MOS number, but definitely use the name of your MOS.

They may have just come from occupational therapy and now they're gonna come tovo therapy and then after they leave me, they might go to physical therapy or speech therapy.

So we are enveloped within their rehabilitation process point.

You can view this, edit it, or even delete any entries that you've put in.

So let's just put edit.

>>We work on whatever that patient's goal is.

So if the patient's goal is to return to duty, then the the first thing we're gonna do is assess their ability to do that.

You know, I've had people who have interest in some really unique things, you know, from somebody who wanted to be a worm farmer or a deer farmer to somebody who wanted to be, you know, working in the intelligence field or >>Changing out the handlebar stem.

>>Just to see those lights turn on and let that person understand that just because they have a disability doesn't mean they are not able, you know, they, they have abilities and it's figuring out how do we use those abilities to help them to go out in the community and support themselves in life.

>>Yes, it goes in between here, which has gotta be on top of here.

Okay.

You see what I'm saying?

That's gonna be the, yeah, you wanna come over here and give it a >>Shout?

>>I think if someone leaves here and feels better in, in just one aspect of their life than they felt when they got here, that success, we really do work very hard to be accommodating and to, to help them be successful in every way possible.

>>I was involved in a car accident in 2014.

I had what is called compartment syndrome.

Doctors conducted a, what is called a fasciotomy.

So I was caught in different, like my stomach arms in different parts of my legs so that pressure could be released.

I was discharged from Polytrauma because I was like making progress.

I was already, you know, moving forward.

I came on board to the Star program.

So I wasn't thinking about vocational rehab at all.

I want to like go to physical therapy, go to occupational therapy and okay, I'll probably do some recreational therapy because I'm, I feel burned.

I don't want anything to do with vocational rehab.

Please don't talk to me.

All right, Sharon Barton, she was like super patient.

We work of course on building resumes, building like 30 second elevator speech and all these things that, you know, you never think it's gonna happen, but eventually we will.

During the whole Star process, we visited a whole bunch of different, like agencies.

They were looking at my resume and they were like, you're the guy man, we need you, you, you need to come with us.

And they, I'm like, wow, I still have hope.

I'm glad that that vocational rehab advisor was like telling me those things before we went over there.

When you have professionals that are willing to work with you, they're patient, they're caring and they actually motivate you and encourage you and tell you, hey, you can do it.

You can go through the worst day of your life.

But if they're like right there to say, Hey, you can do this, alright, you can go through this.

Things are a lot easier to accomplish.

I was officially returned to duty in February of 2015.

Long journey, but it was worth it.

>>The Marines are >>There.

You go >>From 07 to now.

It was a rocky road in the beginning, but the end result is what we have right now.

I know >>The goal, like to get to to, to here.

I'll be, I'll be there eventually, but not, not just, not just here.

I, I I'm going pass here.

I figured I'm gonna go higher there.

>>At first we were a little skeptical, just knew that I wanted my brother to be close to me after getting him here and the staff, the case managers, the, the, the therapists, it's like they clinging to us like family.

You know, we had lost our mom and not only helped him, they assisted with me.

They have different type of caregiver programs that you can sit in and, you know, just somewhere you can go and kind of like let your hair down.

And that really was good for me because I didn't know how to deal with life because I felt as though my whole world was like, sucked in like a Hoover vacuum cleaner.

So overall, how do you think when things went today, >>alright.

Hm, I did, all right.

>>Oh yeah.

The the therapy that he's received here has really brought him to where he is today.

And I think when he became outpatient, that's when they really kicked him.

He needs tough love.

You can't sit there and baby him.

He's a marine.

Kick him, let's go.

So by them doing that, the whole team, the staff, everybody just put him on board and I'm impressed if I stand him up, he can move around by himself like a bobblehead and not even fall, you know, you know, months ago it would've been a problem, but now he can get up and, and be mobilized himself.

And that's one of the goals that he planned that he wanted to do for himself.

>>And I be anybody.

>>I became a watercraft operator, watercraft, army boats, landing crafts, tug boats.

Just got licensed on everything that they had at the time.

Before, you know, Iraq and Afghanistan kicked off.

The boats were always on the way.

And you did missions, we called them missions.

You come back to Fort Eustis, which is your home base, and then you get a mission and you, off you go.

I have hardware in my neck.

My lower back shoulder has been rebuilt, had multiple concussions, Hemi facials, seizures.

My vision in the lower left quadrant is impaired hearing loss in both ears.

Because of my breathing problems.

I was non-deployable, which was awful for me.

When I got out of the army altogether January, 2011, by this time my head was so messed up, I wasn't talking as well.

I had ocular migraines I couldn't see.

I tore tendons in both hands.

I couldn't find my way outta my own neighborhood.

Half the time, lot of my rehab was cycling.

So once they put me on that bicycle, it was heaven.

How's it going brother?

All right.

Hello.

Hello.

I'm right.

Discovered Ride to Recovery.

Just be really challenged on a 350, 450 mile, five day, six day ride.

You have places to be, commitments to make and a mission plan, and you follow it and you execute it.

Maybe you help somebody else.

And that's the good part.

You were able to be a leader again.

And sometimes the harder part was letting somebody else help you.

And here, everybody wants to help and they're so willing and they're very, very good.

Very, very good.

>>Thank you.

>>Our team members don't just think about their own discipline.

They really look at that veteran or that service member as a whole.

>>I do believe that patient centered should always be first, no matter what department you work in.

Because if you don't include your patient, then who's working toward the goal?

Because your goal is supposed to be set for your patient.

So your patient should always be the center of everything that you do.

And that should be in the civilian sector as well.

>>This is a model that absolutely works.

It's part of the entire process and it makes primary care better.

We need primary care.

It's how healthcare should be delivered.

But when folks need more, the rehabilitation process, the Polytrauma program, integrative Medicine, the Emerging Consciousness program, Star P trip, all of that is there for them.

>>I, I have sacrificed so many nights, so much family time to serve our country.

Now receiving all this care, give me the sense of my country is taking care of me.

Our country is not leaving me behind.