Col­lab­o­ra­tive ap­proach leads to leaps in trau­matic brain in­jury treat­ment

Modern Healthcare - - COMMENT - By David Hovda In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at Send drafts to As­sis­tant Man­ag­ing Editor David May at

Since 2001, nearly 320,000 Amer­i­can sol­diers, sailors, air­men and women, Marines and Coast Guard per­son­nel have been di­ag­nosed with trau­matic brain in­jury. TBI was once con­sid­ered un­treat­able.

But if all works out, by the end of 2016 four new mil­i­tary sites will be pro­vid­ing treat­ment that has suc­cess­fully re­turned up to 92% of TBI mil­i­tary suf­fer­ers who have ex­pe­ri­enced it to full ac­tive duty, ready to han­dle the de­mands of fam­ily, com­mu­nity and ca­reer.

Seven years ago, a pri­vate foun­da­tion—the Intrepid Fallen He­roes Fund—asked a team of mil­i­tary and civil­ian brain spe­cial­ists in­clud­ing my­self to de­velop a new stan­dard of care for brain af­flic­tions. It was the first step in de­sign­ing a ded­i­cated TBI treat­ment and re­search fa­cil­ity that the fund was plan­ning to build. Fed­eral, aca­demic and in­dus­try part­ners formed a hub of in­tel­lec­tual ex­change to uti­lize the latest tech­ni­cal and clin­i­cal re­sources. This model of uni­fy­ing re­sources al­lowed for cut­ting-edge re­search and clin­i­cal care in TBI treat­ments for pa­tients un­able to re­spond to con­ven­tional ther­apy. It’s a col­lab­o­ra­tive ap­proach that should be em­braced in­side and out­side of healthcare.

Work­ing with Intrepid Fallen He­roes Fund ar­chi­tects, we de­vel­oped a build­ing the very shape of which was sculpted to im­ple­ment our pro­to­cols. The Na­tional Intrepid Cen­ter of Ex­cel­lence is now on the cam­pus of Wal­ter Reed Na­tional Mil­i­tary Med­i­cal Cen­ter out­side of Washington.

Our treat­ment pro­to­cols were un­like any that a tra­di­tional mil­i­tary or civil­ian pro­gram would have pro­duced. Us­ing the most ad­vanced find­ings of the brain’s func­tion­ing and self-heal­ing ca­pac­i­ties, we de­vel­oped an un­prece­dented-in-its-scope mul­ti­dis­ci­plinary ap­proach to brain trauma. Ev­ery tech­nique that had prom­ise in stim­u­lat­ing the brain to heal it­self was in­cor­po­rated. These ranged from ad­vanced neu­roimag­ing and vir­tual re­al­ity sim­u­la­tion to acupuncture and art ther­apy. We de­signed the sys­tem to be dy­namic, tak- ing ad­van­tage of de­vel­op­ments in brain science as they emerged and link­ing treat­ment and re­sponse data in a con­tin­u­ous-im­prove­ment feed­back loop.

Each en­ter­ing pa­tient was to be as­signed a care­giv­ing team. A typ­i­cal team’s ex­per­tise ranged from neu­ro­plas­ticity of the brain to spir­i­tual coun­sel­ing. The mem­bers were to meet jointly with the newly ad­mit­ted and de­velop a pro­gram that ac­counted for both re­ported symp­toms and their own ob­ser­va­tions. Then they were to im­ple­ment the pro­gram.

The Intrepid Cen­ter build­ing it­self com­bines wave­like walls and floor-to­ceil­ing north­ern ex­po­sure win­dows in the re­cep­tion area to ac­com­mo­date sen­si­tiv­ity of TBI-post-trau­matic stress dis­or­der suf­fer­ers to sharp corners and harsh light. Else­where, a vault-like room screens out elec­tro­mag­netic ac­tiv­ity in the en­vi­ron­ment to fa­cil­i­tate map­ping and tim­ing of a sub­ject’s brain ac­tiv­ity. A cir­cu­lar and plant-filled serene room al­lows pa­tients to re­lax and med­i­tate as well as to stim­u­late cer­tain cere­bral sec­tors to self-re­pair.

Af­ter fin­ish­ing the fa­cil­ity, the fund be­gan work on clin­i­cally ori­ented satel­lite cen­ters, known as Intrepid Spirit Cen­ters. With ar­chi­tec­ture sim­i­lar to the main fa­cil­ity, each satel­lite was to have a ca­pac­ity four to eight times as large—1,000 to 2,000 pa­tients a year. Three satel­lites opened in 2013 and 2014, at Camp Le­je­une in North Carolina, for Marines; Fort Belvoir in Vir­ginia, Army; and Fort Camp­bell in Ken­tucky and Ten­nessee, Army. Two more Army sites will open this year at Fort Bragg in North Carolina and Fort Hood in Texas.

Nearly two years of ex­pe­ri­ence with these fa­cil­i­ties has pro­duced a moun­tain of hard data on their ef­fec­tive­ness. The bot­tom line: Depend­ing on the fa­cil­ity, be­tween 82.5% and 92% of pa­tients emerge ready to re­turn to ac­tive duty and nor­mal life. These num­bers are in­clu­sive of all rea­sons that TBI suf­fer­ers at the satel­lite fa­cil­i­ties do not re­turn to full duty. On brain is­sues alone, the re­cov­ery rate at ev­ery fa­cil­ity ex­ceeds 90%.

Now the Intrepid Fallen He­roes Fund has be­gun rais­ing funds to build the fi­nal four planned satel­lites, all in the West. In ad­di­tion to Lewis-McChord, a jointly op­er­ated base in Washington state, they will be at Camp Pendle­ton in South­ern Cal­i­for­nia, for Marines; and Fort Car­son in Colorado and Fort Bliss in Texas, both for the Army.

Mean­while, the Intrepid Cen­ter and the satel­lite fa­cil­i­ties are shar­ing what they are learn­ing with the na­tional med­i­cal com­mu­nity. Ath­letes at ev­ery level, ac­ci­dent vic­tims and all other TBI suf­fer­ers will ben­e­fit—and doc­tors be­lieve their work is re­veal­ing sur­pris­ing se­crets about Alzheimer’s, Parkin­son’s, mul­ti­ple scle­ro­sis and stroke, too.

Fin­ish­ing the re­main­ing satel­lites will help ev­ery Amer­i­can, none more than the ser­vice men and women who are serv­ing our coun­try. Through science and col­lab­o­ra­tion, these fa­cil­i­ties are achiev­ing pre­vi­ously unimag­in­able re­cov­ery rates from a once all-bu­tun­treat­able con­di­tion.

David Hovda, Ph.D., is di­rec­tor of the UCLA Brain In­jury Re­search Cen­ter.

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