The Defense and Veterans Affairs departments are using their partnered programs to identify and treat traumatic brain injury, representatives of both departments said March 19 during a roundtable discussion on new advances in the field.
Kathy Helmick, deputy director for traumatic brain injury, or TBI, at the Defense Centers of Excellence, emphasized the importance of diagnosing brain trauma early, whether it’s the “invisible” injury such as a concussion, or a more severe form of TBI.
“The DOD goes hand-in-hand with the military services with early detection, understanding the barriers, and having the collaborators and partners in advancing the science,” Helmick said.
“We want to eliminate undetected mild brain injury, and we do that with aggressive screening programs,” she said.
Helmick said many academic institutions and agencies collaborate with VA and DOD on TBI to further the methods by which service members with TBI are treated. The National Institutes of Health in Bethesda, Md., and the Centers for Disease Control in Atlanta are two such agencies.
Helmick pointed out that standardized care for those with TBI is crucial.
“The more we standardize care, those tools help where we’re vulnerable [with] repeat concussions,” she said. “We know very little from the civilian world about what repeat [injuries] do over time, what their symptoms and complaints are and how quickly one recovers.”
Col. Jamie Grimes, Defense and Veterans Brain Injury Center, or DVBIC, director, also pointed to promising research initiatives to treat service members and veterans with TBI, such as a cognitive trial under way at the DVBIC in San Antonio.
“We think [the study] will be highly informative in cognitive rehabilitation for those with concussions,” she said.
Other initiatives include studies of service members with TBI who are followed before and after redeployment, and the role of the caregiver, which she called “critical.”
“What is the quality of life for care givers,” she asked. “In the military, there is a much higher percentage of parents taking care of wounded warriors. This is an opportunity to see what their quality of life is, what their needs are, how they access care, and how they take care of themselves to take care of their wounded warriors,” Grimes said.
“Now with trained personnel in theater to help with head injuries,” Grimes said. “[We can] get those evaluations, and get them into an enduring medical record, and the rest will be much more enhanced and valid,” she said of immediate TBI care. “Because those capabilities and resources are available in the field now, fewer consultations are sent stateside.”
Thousands of soldiers are getting training and education in TBI care and recognizing it, Grimes said. “Much of it is mandatory, and there’s a continuum to keep up that information, making sure soldiers know what to do,” she said.
And the training results are paying off, Grimes said. “We’ve found [soldiers] feel equipped before they go; that’s a main mission the [center] has, to reach out and make sure all are getting training beforehand.”
Grimes also has worked with clinicians of differing specialties on how to do interviews and get a history on those with traumatic brain injuries.
DOD and the VA began to partner during the first Gulf War, said Dr. Alison Cornish, senior VA liaison for TBI. The partnership progressed into Iraq and Afghanistan, she said.
“When this conflict started, those centers were ready to start, and we now have a polytrauma system of care,” she said, adding that a service member who has a severe, penetrating brain injury often has other injuries, so the ability to handle other wounds of war became necessary and clinical DOD and VA teams began to coordinate care.
Today, five polytrauma centers are situated regionally across the United States, Cernich said, complete with video teleconference centers to talk to other medical centers, the patient and families. And a patient’s medical care is coordinated before going into VA, she said, because of the interface with DOD.
“Today’s VA is not your grandfather’s VA,” she said, adding active-duty service members also are invited to use VA medical centers at no charge. “Military liaisons help active duty get back to duty at a functional level, and at the highest level possible.”
Cernich said all veterans and service members are evaluated for TBI, regardless of the complaint that brought them to the medical center in the first place, and since 2007, she said, adding that about 500,000 people have been screened.
Dr. James Kelly, director of the National Intrepid Center of Excellence at Walter Reed National Military Medical Center discussed the interdisciplinary care service members receive at the NICoE for TBI and post-traumatic psychological ills.
A month-long stay at the NICoE, he said, involves spending “all day, every day with the interdisciplinary team in speech therapy, family counseling, neurology and psychiatric evaluations to formulate a treatment plan to springboard them to health. Each treatment program is individualized, he said, and is altered as necessary.
Service members are encouraged to bring a family member, a good friend or a battle buddy is to the NICoE, Kelly said.
The expectation of recovery, instead of giving a patient a discouraging prognosis, is important to TBI healing, Helmick pointed out.
“We’re trying to change the wave of the past couple of years, and instead of saying, ‘you’re sick, and it’s chronic,’ we’re really trying to keep that expectation of recovery alive,” she said.
“It gives every veteran and service member hope that we’re trying [to get them back to where they're supposed to be], rather than get them out of their [military occupation] and away from what they truly love, what inspires them and is their essence of being,” Helmick said. “So expectations of recovery are extremely important in the concussive population.”
