WASHINGTON, July 18, 2016 – Defense Medical Surveillance System and Theater Medical Data figures show that more than 339,000 service members have been diagnosed with traumatic brain injury since 2000.
Traumatic brain injuries, or TBIs, are a contributing factor to a third of all injury-related deaths in the United States, the numbers reveal.
In the United States, an estimated 1.7 million people suffer a TBI annually. Of them, 52,000 die, 275,000 are hospitalized, and 1.365 million — nearly 80 percent — are treated and released from an emergency department.
This is the first article in a five-part series on the National Intrepid Center of Excellence in Bethesda, Maryland, that will highlight its mission, the people who work there, its research and technology, its clinical programs and how it has helped one service member on his road to recovery.
The NICoE’s Mission
The NICoE, a directorate of Walter Reed National Military Medical Center, helps active duty, reserve, and National Guard members and their families manage their traumatic brain injuries and accompanying psychological health conditions through diagnostic evaluation, treatment planning, outpatient clinical care and TBI research.
Service members are referred from their home station’s primary care physician or mental health professional to the NICoE’s range of treatment options. These include the four-week intensive outpatient care treatment program, the one-week assessment track, ongoing outpatient care services, inpatient consultation, and a range of individual, nonpackaged diagnostic and evaluative options. The benefit of coming to NICoE is that service members will have access to any one of these treatment options, depending on the need, with a streamlined evaluative pathway where many of the providers and services are located together.
“The integration of medical care is amazing,” said Dr. Gene Casagrande, team coordinator and primary care physician. “We make decisions the same day amongst each other. My office is next door to the neurologist, as well as to the psychiatrist, so if any of us have a suggestion, we can walk down the hall and make those changes as needed. Communication is very important, and the patients appreciate that and see that interaction.”
For more than five years, the NICoE has treated patients with mild, moderate and severe TBIs. “We have a system of care where anybody who’s referred to us from anywhere in the world will have the most appropriate treatment option available to them,” said Dr. Louis French, NICoE’s deputy director. “We can move people back and forth between our various treatment platforms in our care system to make sure they are getting what they need.
“We can do very specialized assessments,” he continued. “We can do intensive treatments. We conduct research so we can better understand how people get better, under what conditions they get optimal recovery, and to pioneer new treatments and techniques that might not be available elsewhere.”
The NICoE also has a significant research mission, and NICoE researchers are studying the specialized evaluation techniques including neuroimaging, and treatments such as, art therapy, animal-assisted therapy, and other complementary and integrative medicine techniques such as biofeedback, acupuncture and yoga. Additional unique and highly-specialized tools, such as the Computer Assisted Rehabilitation Environment, a magnetoencephalography machine and a 3 Tesla magnetic resonance imaging capability aid in the NICoE’s mission as a clinical research institute.
With support from the American public, the NICoE is expanding its reach through the establishment of Intrepid Spirit centers, which will enhance a national pathway of care for TBI across to the nation. So far, centers have been established at Fort Belvoir, Virginia; Camp Lejeune, North Carolina.; Fort Campbell, Kentucky; Fort Hood, Texas; and most recently at Fort Bragg, North Carolina.
Treating the Whole Person
Using research and technology in conjunction with a team of neurologists, psychologists, family care doctors, psychiatrists, nutritionists, neuropsychologists and other specialists, NICoE providers are able to treat the whole person, French said.
“Our experience is that people don’t get better unless we treat the whole person,” he explained. “One of the sad realities is that the primary mechanism of injury that we’ve seen in the last few years has been explosions or blasts. And when you’re close to something that blows up, there are many ways you can get hurt.
“And we know that we need to start at the head and work our way down the body and treat the sensory impairments people have and the pain issues,” French continued. “We need to treat the emotional impact of what they’ve experienced. We need to treat the impact on the family. We need to treat the cognitive dysfunction. If we’re not targeting all those things, and you’ve fixed one but you haven’t fixed the sleep, you’re not fully successful.”
Casagrande said part of the treatment is educating spouses and caregivers.
“A lot of family members come here not knowing anything about TBI,” Casagrande explained. “There’s a significant education piece for the spouses, as well, to deal with — what it’s like to have someone with TBI and the various symptoms that are associated with that, including irritability issues, social withdrawal, avoidance and other behaviors TBI patients experience. Education plays a very important role here. We do have a family therapist on staff, and child care is available for the children who come here, so the spouses and service member can spend some time here at NICoE.”
Both doctors said treatment also includes education about many issues associated with TBI and psychological health, such as sleep and how important a role it plays. For this reason, all patients go through a sleep study within the first few days they are at the center, and get started on appropriate sleep therapies within a few days.
Casagrande expressed his amazement with the progress he sees in patients after four weeks at the NICoE.
“It’s one of the most rewarding parts about being at NICoE — watching someone get better in such a short period of time — and you just see it week by week,” he said. “I tell everyone, ‘I can’t promise you we’re going to make you better, but we’re going to do our darnedest to try.’ And we all do.”