Coming home from deployment – especially after a combat-related injury – is a win, but it’s not enough. The big win – what really matters – is successfully readjusting back to your family, your unit, your school and your community.

Facing the uncomfortable

“The doctor would tell me, ‘Go over to the mall and have lunch. It’s part of your treatment,’” said former Master Sergeant George Vera. “At first, this was not an easy order to follow.”

This seems like medical advice most people would be happy to follow.

Vera in Afghanistan.

But going to the mall and surrounding yourself with hundreds of people in an open space can be an exceptionally difficult task for a hypervigilant Special Operations Forces (SOF) soldier who has seen multiple deployments and was severely wounded in combat.

“Part of the treatment was to put us in uncomfortable situations. It helped us re-integrate into civilian life,” Vera continued. “I would be tasked with going to the mall and sit with my back to everyone as I ate lunch. Sometimes I’d be told to drive in Tampa rush hour when people are acting like clowns. Afterwards I’d come back to PREP to talk about how I coped with these situations.”

PREP is the Post-deployment Rehabilitation and Evaluation Program.

It provides a one of a kind treatment opportunity at the Tampa VA Medical Center for both Veterans and Active Duty service members with ongoing symptoms following a deployment related concussion or Traumatic Brain Injury (TBI).

“The staff at PREP learn what we liked and didn’t like and then they would design a unique treatment plan. As you would expect, SOFs are not big on sharing our feelings,” Vera said. “However, after putting us in uncomfortable situations, we’d go back to PREP and talk about how we coped with things that would normally piss us off. They gave us a good plan of action and good coping mechanisms.”

PREP for complex and persistent issues

While thousands of Veterans experience concussions in service, most issues related to head trauma resolve within a few days or weeks. For Veterans with more complex and persistent issues, PREP is there.

Common ongoing symptoms include chronic headaches, dizziness and balance issues. The mental health components from TBI-related combat are also addressed and treated.

Vera was referred to the PREP program as he experienced multiple head traumas during his deployments that resulted in cognitive, vestibular and emotional symptoms. Those symptoms persisted despite standard outpatient services for TBI.

PREP provided 11 weeks of specialized TBI treatment following a comprehensive interdisciplinary evaluation

Treating the whole patient

“There is no other program like it in VA or the civilian world,” said Larry Miller, physician assistant with PREP. “We work with active duty and combat Veterans who have experienced a mild to moderate TBI and focus on post-deployment readjustment issues. Our treatment involves an interdisciplinary team that can address both rehabilitation and mental health needs simultaneously.”

Vera "in the equipment"

Vera works out on a special machine with straps an employee put together for him.

While the emphasis is on TBI, readjustment issues and mental health functioning, PREP treats all the patient’s needs. Treatments for headaches, pain management, PTSD, relaxation and sleep, vision therapy and hearing or audiology therapy are integral to PREP.

As a wheelchair user, Vera’s time at PREP was more physically challenging than some of his fellow patients, but it also gave him more time with his occupational therapists (OT).

In the top photo, Vera is with his daughter, Angela, at the 2018 Invictus Games. She’s wearing her dad’s gold medal for wheelchair basketball.

“Normally, I’d have short visits with my OT and we’d go through mundane tasks, but with PREP I was able to do the advanced work I needed,” Vera added. “It was one of the unique things about PREP. We had access to all the help we needed to recover. It’s head-to-toe care in Tampa”

“We like to think that everyone who enters PREP comes out of it better,” said Miller. “That goes for the staff, too. By providing the wholistic care our active duty services members and Veterans need, we are also becoming better providers for all our patients.”

PREP and beyond

A service member or Veteran usually stays in PREP for 80 days. During that time, the service member or Veteran has limited (or no) contact with family and friends so he or she can focus on treatment and readjustment.

It’s a rigorous treatment program that allows for camaraderie, as patients are all housed on the same ward. Individual and group sessions focusing on areas ranging from combat deployments to marriage counseling are integral to the program. Art, yoga and recreation are part of the re-adjustment therapy as well.

“The program is three weeks for evaluation. If the team has rehabilitation goals, we can offer an additional eight weeks inpatient treatment,” Miller added. “I have never worked with a more dedicated group of medical providers. These are highly trained experts in their fields who put their heart and soul into the care of their service members every day. They truly are amazing.”

Once discharged, the journey continues.

“My wife and kids can tell a big difference,” said Vera, “Life is always going to have problems and challenges, but PREP made me a better man, a better husband and a better father.”

Learn more about PREP.

March is TBI Awareness Month.

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