Outcome Success for Special Forces: Intensive Outpatient Chronic Pain Management Program for Rehabilitation of Neuro-musculoskeletal Injuries and mTBI


Samantha Parker MS, C-IAYT, E-RYT 500, CPT,(1), Jeff Frankart (2), PT, MAJ, USAR, SP

US Army Health Clinic, Landstuhl Regional Medical Center; Defense Veterans Brain Injury Center, Landstuhl Regional Medical Center

Keywords: Yoga, Chronic Pain, Multidisciplinary, Alternative Medicine, Interdisciplinary care, TBI

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Objective: The purpose of this comparative analysis was to explore two separate cohorts of Special Operators, an experimental group and a control arm, both with musculoskeletal pain & TBI receiving standard TBI treatment only to patients receiving traditional TBI rehabilitation in conjunction with the Intensive Movement Recovery Program (MRP); yoga being a CAM modality as well as N-GPS physical therapy addressing Kinesiophobia to facilitate quicker functional recovery times and outcomes, return to duty status, reduction of opioid medication use as well as controlling and diminishing pain with more holistic treatments and approaches.

Methods: The experimental group consists of (n= 14) service members with comorbid diagnoses of musculoskeletal pain and TBI who received six weeks of intensive outpatient TBI rehabilitation. The intensive outpatient Movement Recovery Program consists of experimental treatment enriched in Neuroplastic-Graded Proprioceptive Stimulation (N-GPS) rehabilitation, vestibulocochlear nerve stimulation, cognitive restructuring, motor function training and task overloading. The control arm consisted of (n=15) SOF participants who received standard of care TBI treatment. Metrics used to evaluate their improvement included the NSI, WHO-QOL, TMT, PGIC, WAIS, Epworth, NeuroCom SOT, HIT-6, PCL-5, AUDIT, Headaches, Sit/Reach and functional performance metrics. The physical function of the Service member was tested using a FUNCTIONAL MILITARY EXERCISE (FME):  (7-1 PYRAMID TEST 7-1 PYRAMID TEST=The improvement in number of repetitions of push-ups, prone rows, supine rows, squats, dips, burpees complete in a 20 minute test cycle.) PT sessions consisted of 40 minutes total treatment 20 minutes of dynamic warm-ups (YoMo; Yoga in Motion) and 20 minutes of Physical Function Pyramid Test once a day, twice a week for 6 weeks for a total of 12 treatments. Yoga treatments consisted of 5 sessions a week for 6 weeks, for a total of 30 treatments. Yin yoga treatment was implemented immediately after PT sessions for 40 minutes for active recovery and reinforcing cognitive restructuring that was implemented throughout the duration of the activation of the neuroendocrine response. Hatha yoga was taught for 60 minutes the remaining 3 days of the week for the duration of 60 minutes. Practice included a yoga protocol of sequenced asanas, diaphragmatic breathing, guided imaginary and mediation.

Results: A series of paired-samples t-tests were used to examine pre-post differences in report of headache, dizziness, sleep, cognitive functioning, sensory organization and motor coordination, neurobehavioral symptoms, balance, functional performance as well as report of pain, pain intensity, quality of life, PTSD symptoms and overall behavioral health concerns. A standardized measure of effect size, Cohen’s d, is reported to index the magnitude of the observed differences between pre- and post-treatment scores. The statistical significance level was set at P < 0.05 for all. Preliminary results indicate statistically significant (p<.05) differences on simple paired t-test for all pre-post measures between the two groups. The treatment group evidenced as high as a 188% symptom and functional improvement rate with over 80% of the cohort returning to full active duty. Significant improvement in patient symptom sequelae was observed, however more comprehensive regression analysis of the data is in process.

Conclusion: Interdisciplinary care involving CAM modalities such as yoga that incorporate a more dynamic, interactive delivery model for patients throughout TBI rehabilitation, achieve greater improvements in TBI symptoms, functional improvement and return success to functional duty. Functional Outcomes indicate that Overcoming Fear avoidance, Kinesiophobia, is key. Pain is not a limiting factor to function!


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