Collaborative approach leads to leaps in traumatic brain injury treatment
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.