ARMY OCCUPATIONAL THERAPY: Then, Now & …...– Combat and operational stress control (COSC) –...

11/27/2018 1

ARMY MEDICINEOne Team…One PurposeConserving the Fighting Strength Since 1775

ARMY OCCUPATIONAL THERAPY:Then, Now & Future

COL Stan Breuer CPT(P) Michelle Luken

State of the Science16 November 2018

CPT Michelle Luken / [email protected] 16 November 2018Slide 2 of 21


Disclaimer

There are no financial relationships to disclose relevant to this presentation.

The view(s) expressed herein are those of the author(s) and do not reflect the official policy or position of Walter Reed National Military Medical Center, the U.S. Army Medical Department, the U.S. Army Office of the Surgeon General, Defense Health Agency, the Department of the Army, the Department of Defense or the U.S. Government.

mailto:[email protected]



Objectives

• Describe the role of Army Occupational Therapy (OT).

• Explain the evolution of Army OT: – Combat and operational stress control (COSC)– Concussion care– Human performance optimization (HPO) and injury prevention

(IP)




Army OT: Definition

The use of purposeful, meaningful activity that engages Soldiers in their occupational related tasks to optimize performance in any environment.




OT Mission and Vision

• Mission: Occupational Therapy optimizes Soldier performance and readiness, in both garrison and operational environments, in support of the Total Force.

• Vision: Occupational Therapy is the Army's premiere performance focused profession, ready to meet the ever-changing challenges of today and the future.




OCCUPATION(MOS/AOC TASKS)

ENVIRONMENT (Extrinsic Factors)

PERFORMANCE

PERSON(Intrinsic Factors)

PERFORMANCE &

READINESS

OT Performance, Readiness, & Recovery Model1




COMBAT AND OPERATIONAL STRESS CONTROL (COSC)




• 1984: Army Medicine identifies combat operational stress control (COSC) as a separate mission

• 1990: COSC unit deploys with Occupational Therapist and OT Assistant

Combat and Operational Stress Control Mission2

UNCLASSIFIED//FOUO




OT Roles in COSC3

OT focuses on Service Members’ functional performance• Prevention

– Unit needs assessment– Consultation and education

• Restoration & Reconditioning– Assess performance; identify stressors (person,

environmental, duty/occupation) – Engage in meaningful purposeful activity– Develop productive coping skills/strategies




CONCUSSION CARE




Concussion Care Center (CCC)4

• 2010: Established CCC’s in Afghanistan

• 2012: 11 CCC’s in Afghanistan

• 2013: Last CCC completed mission in Afghanistan




HUMAN PERFORMANCE OPTIMIZATION & INJURY PREVENTION




The Future5




HPO/IP OT Capabilities & Roles1

Performance & Readiness

PhysicalCognitive –

Mental

Health, Wellness, &

Rapid Recovery

Lethality

“Readiness is number one, and there is no other

number one.”-Gen Mark A. Milley

"I want every Soldier

deployable in the Army."

-SMA Dan Dailey




Soldier Readiness Test (SRT) Pilot Program1,5

• Medical augmentation teams embedded at the battalion level

• Employs unit-specific functional fitness training and integrated team approach to optimize medical readiness, performance and lethality






PERFORMANCE


PERFORMANCE &

READINESS

OT Performance, Readiness, & Recovery Model1




Individual Case Scenario

PERFORMANCE


Social SupportPractical or emotional

support from interpersonal relationships

Social & Economic Systems

Political or economic considerations

affecting housing, health, employment

Culture & ValuesCustoms, beliefs,

traditions

Constructed Environment &

Technology Infrastructure, public

spaces, tools

Natural Environment

Terrain, climate



PhysiologicalSleep, nutrition,

strength, flexibility, inactivity, stress

CognitiveProcess of thinking,

decision-making, memory, reasoning,

attention

SpiritualWhat has meaning for

the individual?

NeurobehavioralSystems that control

motor & sensory inputs (e.g. balance, coordination)

PsychologicalPersonality, self-esteem, mental

health, self-awareness, motivation

PERFORMANCE &

READINESS




Group HPO/IP Training Topics

• Running performance• Field environment• Ruck marching• “The other 23 hours”• Strength training• Marksmanship

RD: Review foods easy to prepare in a barracks or hotel room, and discuss non-perishable performance foods to keep on hand.

OT: Learn the effects of stress and sleep deprivation on the body and brain. Learn various stress management techniques (e.g. mindfulness, breathing, physical activity).

PT: Discuss the Soldier Athlete approach, exercises and soft tissue mobilization to prevent injury and enhance recovery & physical performance.

CSCS: Discuss risks of over-training – do you really need to do two a days to reach your strength & conditioning goals?




The Future5




Questions?




References

1. Merkle, S. Occupational Therapy in Performance Teams Information Brief. Natick, 10 September 2018.

2. Bacon B, Staudenmeier J. A Historical Overview of Combat Stress Control Units of the U.S. Army. Military Medicine, 2003; 168-9 (September).

3. Combat and Operational Stress Control, FM 4-02.51 (FM 8-51). Headquarters, Department of the Army, Washington DC, 6 July 2006.

4. Rehabilitation & Reintegration Division Traumatic Brain Injury (TBI) Talking Points. Office of the Surgeon General, Falls Church, July 2012.

5. Daigle, K. Soldier Readiness Test and Training Program Overview. Fort Bragg, 17 October 2018.


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