Running Head: REFLECTIVE ANALYSIS PART II 1

Gretchen Kempf & Tara Wisbauer

OT 501: Reflective Analysis on the Rehabilitation of American Veterans
The University of Scranton











Reflective Analysis Part II 2
Past
By the late 1960s occupational therapy (OT) was establishing a new trend of thought as it
developed its new identity as a profession. At this time there was a shift from rehabilitation and
disability program expansion to advocating for disability rights. Sheltered workshops,
community-based rehabilitation, independent living, halfway houses, homebound programs,
outpatient clinics, follow up programs, and new mechanical interventions began a new
movement in the treatment of physical dysfunction (Moore, 1967; Zasler, Katz, Zafonte, &
Arciniegas, 2013). The passage of legislation for rehabilitation provided funding in order to aid
and expand OT in community-based rehabilitation. Whether it was in the schools, homes,
neighborhood, hospitals, or businesses, OT was helping the individual functionally exist in his
environment. However, soldiers returning home from fighting in the Vietnam War were grossly
overlooked (Finn, 1971; Moore).
By the 1970s as the war came to an end, soldiers homecoming was less than joyful because
of Americas disapproval of the war. They were antagonized, rioted against, or simply ignored
(Figley, 1978). Despite OT advances for people with physical disabilities, little progress was
made to meet the needs of Vietnam veterans (Padilla, 2005). Although the Vietnam War made its
mark on the history of disability rehabilitation through the use of more advanced technology,
many survivors with traumatic brain injury (TBI) went unrecognized and untreated (Zasler et al.,
2013). TBI was extremely prevalent in this population. Neurological treatment was given to
wounded soldiers within hours of the trauma, which increased chances of survival and the need
for rehabilitation services upon returning home (Carey, Sacco, & Merkler, 1982).
America was a divided nation. Internal conflict between military and civilian values took
precedence over the veterans basic human needs. According to Hitt (1990) American values
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include democracy, justice, human rights, equality, freedom, responsibility, reason, diversity of
opinion, quality of life, and world peace (pp. 18). Throughout history, America has engaged in
warfare in order to sustain these values for the American people, however many of these values
were not upheld during the Vietnam War. In previous wars, American soldiers were welcomed
back as heroes due to their voluntary service defending freedom, equality, and justice for the
people. Although the act of fighting for ones country remains honorable, soldiers who were
forced into fighting the war due to a large and involuntary draft, lacked courage and enthusiasm.
Those who wanted to be part of the war believed more in the goals of the confrontation they
faced, whereas those who were drafted involuntarily did not necessarily believe in the cause as
highly. This division of attitudes created conflicting values of democracy within the United
States (Greene, 1989).
According to Abraham Maslow, there are several basic needs that are common to all people
(Hitt, 1990). However at this time, Americas values did not strive to fulfill physiological,
security, belongingness, and self-esteem needs of the veterans. Many physiological needs were
ignored due to lack of proper healthcare and rehabilitation (Greene, 1989). Riots and negative
attitudes of the American people compromised security needs and providing veterans with
unsuitable community reintegration overlooked belongingness needs. Self-esteem needs were
disregarded due to the negative portrayal of the war through the media. (Greene; Hitt). This
ignorance towards the needs of military personnel proved unethical and hindered the soldiers
functional transition home from the war and their adjustments to new roles and routines (Figley,
1978). Due to the culture at this time, the negative mentality towards veterans created a rift in
both Americas medical and political ethical systems. This negative mentality set the stage for
the use of social contract ethics, as described by Hitt (1990) where social norms created the
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formation of American morals rather than the values the nation was founded upon. The
disregard of these American values led to lack of appropriate care for the returning military
personnel. Both physical and psychosocial needs were left unmet, resulting in high rates of
homelessness, suicide, psychiatric symptoms, poor adjustment to home life, unemployment, and
drug abuse (Figley; Zasler et al., 2013). Without proper treatment, these negative values, ethics,
and consequences became lifelong battles for returning veterans (Glantz, 2009).
Present

Recognition of persisting problems of veterans, especially TBI and Post-Traumatic Stress
Disorder (which was not formally diagnosed until the 1980s), has been earlier and more
complete in the current war Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF) than it was with the Vietnam War (Pillar, 2012). With the combination of TBI and PTSD,
known as the signature injury of the war, rehabilitation advanced to a more holistic and
community-based treatment specifically for the care of veterans (American Occupational
Therapy Association, 2013). From 2000 through 2013 the OEF/OIF wars have resulted from
280,734 diagnosed TBIs and even more have gone undiagnosed (Defense and Veterans Brain
Injury Center, 2013). The ultimate achievement of OT for this population is to offer veterans
hope and skills for occupational freedom (Platch & Sells, 2013).
In order to not let history repeat itself, America has gone back to its roots in valuing
human rights, justice, equality, and quality of life. This has been done through the creation of
many foundations and administrations aimed directly at caring for returning veterans who may
have been wounded physically or mentally during combat. Administrations such as the Wounded
Warrior Project and Warrior Transition Units have been established to help promote and/or
maintain optimal occupational performance. These administrations are founded upon life skills
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programs to support the service members integration to civilian life, which had been greatly
overlooked after the Vietnam War (Erickson, 2008). In addition to the creation of foundations
and administrations, new research is being conducted in order to provide evidence-based
treatment to clients to ensure best possible treatment. This research covers a broad spectrum of
approaches, which ranges from animal assisted therapy (AAT) to cognitive approaches to
treatment (Beck et al., 2012; Vanderploeg et al., 2008). The Army Medical Department and the
Office of the Surgeon General established the Proponency for Rehabilitation and Reintegration
(PR&R) to advance best practices, policy, advocacy, and research (Radomski, Davidson,
Voydetich, & Erickson, 2009). The Army OT program has also been established to provide
proper training and education to occupational therapists to facilitate treatment to American
soldiers all over the world (Johnson, 2013).
The incongruence to the American values of the Vietnam era and subsequent
consequences forced America to shift its view of the healthcare of veterans. In doing so, several
acts were instilled such as Veterans Health Care Facilities Capital Improvement Act of 2011,
The VOW to Hire Heroes Act, and The Veterans Opportunity to Work Act, to support returning
soldiers reintegration into their communities and civilian lives. Through this new legislation,
veterans are starting to receive proper healthcare and education/training to increase functional
independence and quality of life (House Committee on Veterans' Affiars, 2013).
OT has played a key role in the rehabilitation of wounded warriors, especially those
living with a TBI. The VA currently employs 750 occupational therapists whom are equipped
with unique and ideal qualifications needed to address complex functional issues that returning
veterans are facing (Hofmann, 2008). Home health programs, outpatient facilities, and inpatient
acute care units are just a few of the settings in which occupational therapists now treat returning
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veterans with TBI. However, it has become apparent in recent years that mental health needs of
veterans may not be receiving the OT they could benefit from due to lack of funding.
Fortunately, the American Occupational Therapy Association (AOTA) is aware of this issue and
has recently recommended that the House Committee of Veterans Affair conduct a hearing on
the rehabilitation and reintegration of veterans. AOTA also suggested collaboration with the VA
and the Department of Defense (DoD) to help with a smooth transition home from active duty
for those living with a TBI (Hofmann, 2008).
The overarching goal of occupational therapy for military personnel is to use strategies
to help them recover, compensate, or adapt so they can reengage with activities that are
necessary for their daily life (American Occupational Therapy Association, 2009, pp. 469).
However, providing care to nearly 1.5 million Americans currently serving in the military and
the 22.7 million veterans remains a challenge. The VAs mission, along with The Affordable
Care Act, is to serve Veterans by providing the highest quality health care available anywhere
in the world Americas Veterans deserve nothing less (U.S. Department of Veteran Affairs,
2013). Unfortunately current research has found that the military is failing to diagnose, treat, and
document brain injuries in veterans and insurance programs are not covering effective
rehabilitation for brain injuries. Veterans receive health benefits from the VA but access to those
services remains a challenge (American Occupational Therapy Association, 2013; Mojtabai,
Rosenheck, Wyatt, & Susser, 2003; National Public Radio & ProPublica, 2011).
This current situation brings about Hitts societal dilemmas, quality vs. price. Veterans
have every right to have a sense of entitlement when going to the VA to receive the benefits they
have earned. However, these benefits are not easily accessed or obtainable when they are most
needed (Glantz, 2009). American service men made a bargain when they signed up. They
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agreed to go fight for America anywhere in the world as long as their Congress and Commander
in Chief deemed it necessary for the sake of the nation. In return, the government agreed to take
care of their wounds both on the battlefield and when they got home (Glantz, pp. 138). This is
not only a societal dilemma, but also an organizational dilemma between customers vs. owners.
Owners want to ensure financial return on their investments whereas customers are more
concerned about the availability and quality of the product and services (Hitt, 1990). Although
the VAs intentions to provide these services are rooted in American values such as justice,
human rights, equality, and quality of life for all people, there is still a great need to ensure that
all military personnel are receiving benefits and services as needed (Glantz).
Future
According to AOTAs Centennial Vision We envision that occupational therapy is a
powerful, widely recognized, science-driven, and evidence-based profession with a globally
connected and diverse workforce meeting society's occupational needs" (American Occupational
Therapy Association, 2007, pp. 613). In order to do so, efforts must be increased to meet the
occupational needs of returning veterans. In accordance with occupational therapys core values
of altruism, equality, freedom, justice, dignity, truth, and prudence, occupational therapists must
continue to support foundations such as the Wounded Warrior Project and Warrior Transition
Units and continue to establish programs to support the occupational well-being of military
personnel (Peloquin, 2007). One of the biggest challenges for OT and the rehabilitation of
veterans include insufficient funding. AOTAs road to the Centennial Vision addresses
advocating to ensure funding for veteran care and increasing Congress awareness of residual
effects of war. In order to do so, AOTA leaders must continue to meet with VA officials to
support OTs role in the functional rehabilitation of veterans.
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Although there has been an increased awareness of returning veterans needs since the
Vietnam War, there is still room for improvement. In order to be congruent with AOTAs
Centennial Vision, more research and collaboration between AOTA, VA, and DoD must take
place. There is potential growth for the successful rehabilitation of soldiers both in the United
States and internationally. Rehabilitation must become more accessible to soldiers returning
home and on the battlefield. OT must continue to advocate for the need of their services when
treating military personnel. Occupational therapists must plan and provide interventions on the
basis of the service member's unique set of circumstances, goals, and functional performance
problems especially when treating TBI. Although more research must be conducted in order to
address OTs role in treating veterans who have sustained a TBI, areas including client
education, vision, cognition, emotional well-being, and the reintegration of life tasks and roles
are recognized as the domain of OT when treating this population (Radomski et al., 2009).
Potential challenges still exist due to a lack of financial resources making it essential for
leaders in the OT field to advocate for funding. In order to truly encompass the American values
of human rights, justice, equality, and quality of life, insurance policies must put the basic human
needs of returning veterans above financial rewards. In doing so, OT will play a key role in
helping soldiers reintegrate into their community and support health and well-being through the
participation in meaningful occupations.
Due to OTs extensive background in both cognitive and physical rehabilitation, there is a
huge potential for the future of this domain. Occupational therapists must continue to provide
treatment, based on OTs core values, both domestic and abroad to soldiers who volunteer their
services for the good of America to reduce residual consequences of war that hinder the
reintegration and participation of meaningful activities.
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References

American Occupational Therapy Association. (2013). Veteran and wounded warrior care.
Retrieved from http://www.aota.org/en/Practice/Rehabilitation-Disability/Emerging-
Niche/Veteran.aspx
American Occupational Therapy Association. (2009). AOTAs societal statement on combat-
related posttraumatic stress. American Journal of Occupational Therapy, 63, 469-470.
American Occupational Therapy Association. (2007). AOTAs Centennial Vision and executive
summary. American Journal of Occupational Therapy, 61(6), 613-614.
Beck, C., Gonzales, F., Sells, C., Jones, C., Reer, T., Wasilewski, S., & Zhu, Y. (2012). The
effects of animal-assisted therapy on wounded warriors in an occupational therapy life
skills program. United States Army Medical Department Journal, 38- 44.
Carey, M., Sacco, W., Merkler, J. (1982). An analysis of fatal and non-fatal head wounds
incurred during combat in Vietnam by U.S. forces. Acta Chirurgica Scandinavica
Supplementum. 508, 351356.
Defense and Veterans Brain Injury Center. (2013). DOD worldwide numbers for TBI.
Retrieved from http://www.dvbic.org/dod-worldwide-numbers-tbi
Erickson, M. (2008). The role of occupational therapy in warrior transition units. United
States Army Medical Department Journal, 21-24.
Figley, C. (1978). Stress disorders among Vietnam veterans. New York: Brunner-Routledge.
Finn, G. (1971). Occupational therapists in prevention programs. In R. Padilla (Ed.), A
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Association.

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Glantz, A. (2009). The war comes home. Los Angeles: University of California Press.
Greene, B. (1989). Homecoming: When the soldiers returned from Vietnam. New York: G. P.
Putnam's Sons.
Hitt, W. (1990). Ethics and leadership putting theory into practice. Columbus OH: Battelle
Memorial Institute.
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www.veterans.house.gov/legislation-page
Johnson, E. (2013). Army OT. Retrieved from
http://armyotguy.com/armyOTguy.com/Army_OT.html
Mojtabai R., Rosenheck R. A, Wyatt R. J., & Susser, E. S. (2003). Use of VA aftercare following
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Plach, H., & Sells, C. (2013). Occupational performance needs of young veterans.
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U.S. Department of Veteran Affairs. (2013). The Affordable Care Act, VA, and you. Retrieved
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