'INVISIBLE WOUNDS' TREATMENT

FROM:  U.S. DEFENSE DEPARTMENT 
Director Discusses Innovations in 'Invisible Wounds' Treatment
By Terri Moon Cronk
American Forces Press Service

WASHINGTON, Sept. 13, 2013 - The Military Health System acknowledges that U.S. troops in previous conflicts haven't been subjected to the circumstances that surround 12 years of war in Iraq and Afghanistan, a senior Defense Department physician said here yesterday during a panel discussion at a warrior-family symposium.

Dr. James Kelly, director of the Defense Department's National Intrepid Center of Excellence, talked about his center's advancements in post-traumatic stress disorder and traumatic brain injury – signature wounds from the wars - in a panel discussion titled, "Innovative Mental Health Solutions – Today and Tomorrow."

The annual symposium is sponsored by the Military Officers Association of America and the National Defense Industrial Association.

Kelly cited problems that stem from the pattern of repeated deployments and training between deployments, combined with an all-volunteer force composed of members put themselves in harm's way time and time again. "It is not the pattern we've previously had in our military," he said.

The idea that the younger generation is somehow softer or in some ways more vulnerable doesn't hold water, Kelly said. "These people are tough as nails," he said to a round of applause from hundreds of audience members.

"What we need to do is innovate, look more in depth, and understand them as people and individuals that have been engaged in ways [for which] we simply have no good track record to point to and say, 'Here's what this is about, and here's what to do about it,'" he said.

Kelly said he and his staff learn as they go at the center, conducting research and treating service members in an intensive four-week program.

In a previous interview with American Forces Press Service, Kelly explained that when service members with severe traumatic brain injury do not respond to conventional medical treatment, they can be referred to the National Intrepid Center of Excellence, but they must also have a co-existing psychological health issue, such as post-traumatic stress disorder, depression or anxiety.

Kelly became NICoE's director five years ago. The center got underway when Defense Department officials invited him -- 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.

He and the other doctors were "willing volunteers" drawn to military health care and working with service members coming back from both wars because of blast-related injuries and a variety of other causes of concussions, Kelly said.

The need for innovation in research and in treating service members led to a concept of using "virtual reality war," with service members are immersed in a setting with a vision of what happens when they're inside a Humvee going down a road. The seat begins to vibrate as a bomb goes off, and the smell of burning rubber wafts into the vehicle. The hope, Kelly explained, is that while the service members are in a safe clinic setting, the experience can help them get past the traumatic events they brought back from deployments.

This use of virtual reality shows quantifiable metabolic changes deep inside the brain when it's dealing with stress, Kelly said.

"That's just one of the examples of the kinds of things that we're engaged in that is really novel, innovative," he added. "[It] bridges into areas of the mind ... in ways that traditional medicine -- certainly traditional neurology -- hadn't previously."

DOD TOUTS NICoE PROGRAM FOR TREATING SERVICE MEMBERS WITH SEVERE TBI

FROM: U.S. DEPARTMENT OF DEFENSE
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."

ARMY VICE CHIEF GEN. AUSTIN III TOURS TBI, PTSD TREATMENT CENTER

FROM: U.S. DEPARTMENT OF DEFENSE

Army Vice Chief Tours TBI, PTSD Treatment Center

By Terri Moon Cronk
American Forces Press Service

WASHINGTON, Dec. 20, 2012 - Army Vice Chief of Staff Gen. Lloyd J. Austin III toured the National Intrepid Center of Excellence here Dec. 19 to gain perspective on treatment for service members who have traumatic brain injuries and post-traumatic stress disorder.

Austin also visited wounded warriors at Walter Reed National Military Medical Center here, a trip officials said he makes on a regular basis. Austin and his wife, Charlene, have taken a particular interest in treatments for TBI and PTSD, two signature wounds of the wars in Iraq and Afghanistan, officials said.

Dr. James Kelly, NICoE director, led Austin's tour of the two-year old center. During the visit, chiefs of major specialties briefed the general on their treatment approaches.

Austin learned how those approaches are effective in treating service members by using such modalities as art and music therapy, relaxation, a sleep lab and counseling, all in a team setting over the course of four weeks. He viewed magnetic resonance imaging -- also known as MRI -- and saw MRI films showing the occurrence of TBI and PTSD in the brain.

Two golden retrievers and their handlers from Warrior Canine Connection also greeted Austin at NICoE. The Warrior Canine Connection is a nonprofit organization that works with NICoE service members while they are undergoing treatment. In an optional program, service members can learn to train the retrievers as service dogs that are paired with veterans who are mobility impaired, the dog handlers said.

Austin also was briefed on the satellite NICoE clinics being developed around the country at Army posts and Marine Corps bases. The sites include Fort Bragg, N.C.; Forts Bliss and Hood, Texas; Fort Carson, Colo.; Fort Campbell, Ky.; Fort Belvoir, Va.; the Marine Corps' Camp Lejeune, N.C., and a yet-to-be determined base in Southern California.

NICoE officials estimate each of those clinics will see about 1,200 patients with TBI and PTSD per year, while the most severe cases of the disorders are usually referred to the NICoE here.

"I'm very much encouraged and excited about the satellite clinics," Austin told Kelly about the NICoE concept. "They will be beneficial to [service members]."

"It's not every day NICoE gets a visit from the Army vice chief of staff," Kelly said, adding that Austin asked him about the progress on the Fort Belvoir satellite clinic, which is now under construction.

"His main concern today was how what we learn here influences the system [for treating TBI and PTSD]," Kelly said.

"His dedication to our service members in these circumstances is unquestioned," he added.

ADDITIONAL INFORMATION FROM WALTER REED NATIONAL MILITARY MEDICAL CENTER

The National Intrepid Center of Excellence (NICoE) is a DoD institute dedicated to providing cutting-edge evaluation, treatment planning, research and education for service members and their families dealing with the complex interactions of mild traumatic brain injury and psychological health conditions.

The NICoE was created to focus the collected wisdom and knowledge of our military, federal, academic and private industry partners to define the pattern of the disease state, identify definitive diagnostic criteria, advance novel treatments and share that knowledge with each other. Ultimately, together we can return our wounded, ill and injured service members back to productive lives.

The NICoE aims to be a leader in advancing traumatic brain injury and psychological health treatment, research and education. With its dedicated staff, the NICoE seeks to be an instrument of hope, healing, discovery, and learning for service members recovering from TBI and PH conditions.

ANOTHER KIND OF HERO



Rick Yount, executive director of the Warrior Canine Connection, works his Labrador retriever, Huff.

FROM: U.S. DEPARTMENT OF DEFENSE
Training Service Dogs Helps Heal Service Members
By Terri Moon Cronk
American Forces Press Service
BROOKVILLE, Md., Nov. 27, 2012 - The phrase, "a dog is man's best friend" has new meaning for service members undergoing treatment for post-traumatic stress disorder and traumatic brain injury at the National Intrepid Center of Excellence, at Walter Reed National Military Medical Center in Bethesda, Md.

While in treatment, service members can join a program to train dogs for veterans who are mobility impaired, said Rick Yount, executive director of Warrior Canine Connection.

"There are tens of thousands of warriors who are trying to transition back [into society]. There are also thousands of veterans on waiting lists who need trained service dogs," Yount explained.

At NICoE, Yount encourages service members to volunteer for the program, especially those who might not respond to traditional treatment.

"I tell them, 'While you're getting treatment, here's an opportunity to help train a dog for a veteran. You're still a part of the war effort," Yount said.

He said it's not just training a dog -- the service members are doing it to care for their fellow veterans.

The relationships developed between the service members and the dogs are symbiotic, Yount said, adding that the dog training is an intervention for their post-trauma stress.

Service members who join the dog training program at NICoE go through basic commands, and then move on to more complex tasks such as opening doors, turning on light switches and pulling wheelchairs, said Marine Corps Sgt. Jon Gordon, a former NICoE patient and now an intern in service-dog training.

Diagnosed with PTSD and TBI following two deployments to Iraq and one to Afghanistan, Gordon said when traditional therapies didn't seem to work for him, he was sent to Yount. Not enthused at first, Gordon said, he soon saw the power of training dogs.

"Working with them, you have to learn to regulate your emotions and tone of voice," he said.

The NICoE service members are taught to give authoritative commands, and praise the dog in a high-pitched, excited voice, Yount said.

It only took a few sessions with a black Labrador named Birdie for their relationship to click, Gordon said.

Gordon said he'd stayed in his apartment and avoided people, ordering in pizza for meals. But after meeting Birdie his life changed dramatically, he said.

Now when he has appointments at a Department of Veterans Affairs Medical Center, Gordon said he has to arrive early to answer all the questions about the dog. No longer avoiding people, Gordon said he is instead raising awareness of the service dog program for mobility-impaired veterans.

"When the veterans see Birdie, their faces just light up," he said.

Gordon plans to become an occupational therapist, using dogs with patients.

"It changed my life," Gordon said of the service dog program. While he used to get little sleep, he now gets about six hours each night, because Birdie is close by.

"It saved me from being a nobody and just another statistic," he said.

"When you see him making progress, it's rewarding," Gordon said of Birdie, "You see how you actually make a difference in training the dog."

Birdie "gave me a reason to get up in the morning and do something," Gordon added.

Yount said it's the release of the hormone oxytocin in the body that relaxes people who are around a dog.

"It's a powerful drug," he said.

Yount said the two goals of the program involve encouraging the healing capacity of the service member and motivating them to engage in the power of the warrior ethos. He recounted a visit from a member of Congress at NICoE, who asked a service member what he got out of the canine training.

"He told him, 'Before I started training this dog, my wife and I were getting ready to divorce,'" Yount said. 'I treated my 3-year-old son like a stubborn private. I used the "praise voice" on him, and it really taught me how to connect with my 3-year-old son on a 3-year-old level.'"

But training dogs is not an easy task, Yount said.

"Dogs have a natural ability to challenge leadership. Training is based on patience and assertiveness. It's a process," he said.

And the dogs learn how service members with PTSD and TBI react, Yount said. Those suffering from PTSD tend to keep to themselves but "a dog won't let you do that," he said.

"We have to come up with ways of retraining these warriors, because they go through training to keep their emotions from interfering in combat, and the trauma they experience in combat has that emotional numbing impact," Yount said. "Then how do we reboot them to 'come back' when they [return home to] infants, toddlers and teenagers?"

The next step is research, Yount said.

"We want to prove it and look at its efficacy," he said of the dog and service member bonding," he said. "We want to maximize the therapeutic effect of working with these dogs."

VETERAN'S PERSONAL STORY OF POST-TRAUMATIC STRESS DISORDER

FROM:  VETERANS ADMINISTRATION “VANTAGE POINT”
Back from the Abyss, and Ready to Serve Again
April 13, 2012 by David Daugherty
I experienced many difficulties transitioning to civilian life. With uncontrollable drinking, anger issues and post-traumatic stress disorder (PTSD), the perfect storm was brewing in me every day. When my volatility finally erupted, I couldn’t understand the fear and anger on peoples’ faces. I ran the streets for a very short while but the people out there made it clear I needed to go. Even though I felt dirty and low down in my heart, I still carried myself with the dignity and honor that the military provided me. Anyplace I went, except for Afghanistan and Iraq, I felt like a fish out of water.

When I finally began reaching out for help, I kept ending up in institutions. If something triggered me, it was like being in a firefight and calling to my buddies, but it seemed that everyone I called to only responded with disgust.

I found myself in the dark place between the judicial and mental health systems. Nobody could help me. Finally, when I was hospitalized, a doctor demonstrated how I was one step away from the abyss.

I had to shrug off the judgment of others, look past the fact that I was becoming an outcast, and accept the fact that society had no hope for me. An Iraq Vet I never met before picked me up the day I was discharged from the hospital and brought me to a halfway house.

I was shocked from the experience and only felt safe with my back to the corner in a large chair in that house. I had a Bible and the book Alcoholics Anonymous. During the day I stole food (mostly popcorn) and coffee from the kitchen while the other men were at work. I was nearly paralyzed with anxiety, the prescription medication made it worse, and the coffee calmed me slightly.

Over the last three years I’ve slowly built back up. I attained Chapter 31 (Vocational Rehabilitation) to earn credentials that will empower me to show others the way up and out. But there have been a lot of dark and lonely days. I’m not kidding when I say that it was one of those dark days of discouragement that I discoveredThe Mission Continues. I was able to understand why the founder did what he did.

I applied for a fellowship because I knew it would give me a leg up as an institution that would key in on my military strengths. After a few months of working with a Fellowship Program Associate who was tenacious about bringing out those strengths and applying them in a challenging, unfamiliar environment, I began to realize that The Mission Continues is not only uniquely equipped to understand me, their talk about “the next greatest generation” is not rhetoric. It’s real.

I am serving my fellowship at Sulzbacher Center for the Homeless in Jacksonville, Florida. After almost five months in my fellowship I am seeing how the choices I make to stay well and productive directly impacts the people around me. I get charged from seeing the tangible results of my efforts in helping individuals and strengthening various programs and service organizations. My hope is to see these individuals turn around and help someone else, and to see these alliances among programs and service organizations continue to draw people together for the greater good.

David Daugherty served 17 years in the military. He is a Veteran of the United States Air Force, and is currently inactive in the Army National Guard.