Information about Clinical Services for Health Care Providers
The clinical program at the Center offers thorough, evidence-based medical evaluations to veterans who were deployed and have unexplained symptoms. The clinical evaluation will include:
Review of Medical Record
The multidisciplinary clinical team will conduct a review of the veteran's medical record. Additional tests may need to be ordered by the primary care provider prior to the patient arriving to the Center.
Extensive History and Physical Examination
This is a 2-hour evaluation conducted by a physician or advanced practice nurse with expertise in deployment related health concerns and symptoms. Our clinical staff includes specialists in neurology, physiatry, internal medicine, and occupational medicine, all experts in the diagnosis and management of persistent fatigue and pain. Other referrals to specialists can be made, if necessary.
Exposure Assessment
An environmental/occupational medicine physician offers a consultation
to patients who are concerned about environmental exposures, particularly
deployment-related. Risk of exposure and how it may contribute to current
health problems are discussed.
Please click on
Exposure Clinic to view the details.
Psychological Interview
This interview complements the history and physical exam and will further assess concerns and current and past life stressors. Preliminary diagnoses are made and recommendations for treatment/therapy are offered. Treatment recommendations may include Cognitive Behavioral Therapy (CBT). This is a therapeutic approach that uses specific cognitive and behavioral techniques to produce meaningful changes in target symptoms. The techniques have a scientific foundation based on social learning and cognitive principles. This model suggests that regardless of origin, unexplained symptoms can be treated effectively by identifying facilitative factors, and using cognitive and behavioral strategies to modify them. The key to this approach is to extinguish the cycle that stimulated rest or activity and replace it with tolerance and gradual change. Establishing a regular pattern of planned, consistent, graded exposure to activity is expected to weaken and break the association of symptoms with cessation of activity. The techniques used to produce change are based largely on the development of problem solving skills and understanding the causes of change.
Neuropsychological Screening
If a veteran is experiencing difficulties with attention, concentration, or memory, we will administer a brief cognitive screening battery. The ANAM (Automated Neuorpsychological (sp) assessment matrices), a computerized neuropsychological screening tool, allows us to estimate whether response latencies, information processing and memory functions are within normal limits compared to other individuals that have a similar demographic background to the veteran. If cognitive dysfunction is suspected, the veteran will be referred for further evaluation.
Fitness Testing/Graded Exercise Therapy
Patients are asked to complete a submaximal bicycle exercise test to determine his/her exercise capacity. Results from the exercise test are based on heart rate responses to standard resistance on the bike and are reported as estimates of aerobic capacity (VO2 peak estimate). The results are then presented in terms of aerobic fitness for the individual's age and gender and a table of values is provided to illustrate, what percentile he/she falls in. The heart rate response to bicycle test and the estimated peak fitness values are also reported in graphic form for both the physician and the patient.
Education Module
As part of our effort to improve communication we have applied a particular communication approach, Risk Communication, to guide us in all of our clinical and educatonal efforts. We utilize this approach in the information we distribute and in developing physician-patient communication techniques for providers to apply in helping patients with illnesses with no known medical cause.
At the beginning of the NJ WRIISC clinical evaluation visit, each veteran is presented with a customized "education binder" containing general deployment-related health information as well as fact sheets pertaining to each individual veteran's health concerns. Once the veteran has an opportunity to browse through the material, an ERC specialist is available to answer all the questions the veteran may have.
At the conclusion of a veteran's clinical evaluation a clinical team member will meet with him/her to discuss his/her recommendation plan and possible barriers to implementing reccomendations. This is also an opportunity for a veteran to express his/her opinions and beliefs about the Center and his/her participation in center activities. After the veteran recieves a copy of the evaluation report our staff social worker will contact the veteran to address and possibly resolve adherence issues.
For a list of upcoming WRIISC educational events for providers please click here.