Traumatic Brain Injury Treatment, Research Pay Off

By Terri Moon Cronk
American Forces Press Service

BETHESDA, Md., March 26, 2013 – Service members who have suffered severe traumatic brain injuries and psychological ills can benefit from an intensive four-week program at the National Intrepid Center of Excellence here.

Dr. James Kelly, the center’s director, said that when service members with severe TBI fail to respond to conventional medical treatment, they often are referred to NICoE’s program, which finds the best methods to treat their conditions on an individual basis. The patients must also have a co-existing psychological health issue, such as post-traumatic stress disorder, depression or anxiety, Kelly said.

“If you add together all of those things in a person, that’s a very complex human condition,” he said. “It is our job to characterize that complex condition … and its effects on the brain, and look at what works to help them.”

The only center of its kind, the Defense Department’s NICoE offers a wealth of medical and alternative approaches for such service members, with medical professionals such as neurologists, therapists and counselors working in an interdisciplinary team approach, Kelly explained.

Because the team members are located in the same facility, he added, an occupational therapist and a speech therapist, for example, could see a patient together, discuss different approaches, and learn from each other. And because the teams comprise a variety of specialists, “every day we can ask, ‘Did we hit the mark?’ and if not, we say “Let’s try something different tomorrow,’” Kelly said.

“Whatever patients need, they get,” the director said, adding that NICoE does not operate in an assembly-line format, but rather as a “compact, intensive care” outpatient program that treats different patients with individualized forms of care that fit their particular needs.

“There’s a whole menu of things we have available to them,” Kelly said. “Not everybody gets the same ‘dose’ of sleep therapy, counseling or acupuncture, [because] everybody’s individual needs are addressed.”
Another key ingredient in treating service members with TBI is having their family members immersed in the treatment plan whenever possible, the doctor said. “We do our best to encourage [families to come to NICoE] because they are affected as well,” he noted.

When service members finish the NICoE program, they are equipped with a thorough discharge summary of their diagnostic evaluations, treatment plans, counseling and rehabilitation work to take home to their doctors, Kelly said.

“We think highly of the existing system and the health care providers,” he added. “Even though we have a unique opportunity that doesn’t exist anywhere else, it’s an unfair comparison to [put NICoE up against] anything else. I fully recognize our colleagues are doing good work.”

Stood up two and a half years ago, NICoE is considered the DOD hub of TBI research, Kelly said. The center also is designed to influence TBI and PTSD treatment in the military health system with its cutting-edge approach.

Located on the campus of Walter Reed National Military Medical Center, NICoE partners in TBI research with other organizations, including the nearby Uniformed Services University of the Health Sciences and the National Institutes of Health, among others in academia, Kelly said.

The concept for NICoE began when DOD invited Kelly, a former neurology consultant for the Chicago Bears football team, to join a group of doctors to examine how to treat service members who were exposed to blast injuries and other head trauma, Kelly said.

NICoE was privately funded by the Intrepid Fallen Heroes Fund, which also oversaw the construction and equipment of the $65 million 72,000-square-foot center. NICoE’s research, education and patient care have proven so successful, Kelly said, satellite clinics around the country now are in the works.

“We’re being seen as a model to export, rather than just consult, on cases, so the project has led to satellite clinics because of the success of [our] concept,” Kelly said.

Like NICoE, the clinics will be built with $100 million in philanthropic donations through the work of the Intrepid Fallen Heroes Fund. The clinics will be built at Fort Bragg, N.C.; Forts Bliss and Fort Hood in Texas; Fort Carson, Colo.; Fort Campbell, Ky.; Fort Belvoir, Va.; and Camp Lejeune, N.C.

NICoE officials estimate each of those clinics will see about 1,200 patients with TBI and PTSD per year. The most severe combat-related cases will still be cared for at the NICoE here.

The clinics also will benefit from NICoE’s advanced research practices. Service members fill out questionnaires before and after their stay, Kelly said. “We compare the differences” he added,, “and they are striking.”

The staff also observes service members’ actions and records vital signs to show changes, he said. Relief from headaches, sleep disturbances, balance issues and vision concerns improves the quality of their lives are noted, Kelly said. Patient data is compiled and used in NICoE’s research work to determine which treatments seem to help service members the most.

Another measure of success in the program is when former patients visit NICoE to advise the staff of how much their lives have changed for the better since their treatment, the director said.

Kelly said he sees the future of TBI research as “very specific” to characterize TBI on anatomical, physiological and emotional levels. Researchers also will look at the best forms of intervention that help to relieve symptoms and treat basic issues.

“We need to know what a person’s concussion looks like, compared to another’s,” he said. “Why do some people recover more quickly than others, and what can we do to help them?”

So far, the NICoE staff knows that certain approaches produce success, such as the patients’ complete immersion into the intensive care program and the interdisciplinary team approach, Kelly said. And when service members realize they have a TBI diagnosis and accompanying psychological issues that are real and treatable, they feel relieved and appreciate knowing there’s something to work on, Kelly said. “They’re validated by that,” he added.

The center’s director emphasized again that his staff’s ability to help patients doesn’t mean they weren’t getting good care before they were referred for the NICoE program.

“Our successes with patients who have been through [another] system should not be seen as a reflection of inadequate care,” he said. “Our job is to try something new, and that’s what we’ve done.”