USA — Intrepid Center Merges Art, Science for Brain Treatment

BETHESDA, Md., June 28, 2010 — When the Nation­al Intre­pid Cen­ter of Excel­lence opened its doors here last week, the sense of hope in revers­ing the ris­ing tide of brain injuries and psy­cho­log­i­cal ill­ness in ser­vice­mem­bers was pal­pa­ble.

center's Computer-Assisted Rehabilitation Environment, or CAREN
Navy Lt. Cdr. Jena McLel­lan, a clin­i­cal tri­als coor­di­na­tor with the Nation­al Intre­pid Cen­ter of Excel­lence, demon­strates the center’s Com­put­er-Assist­ed Reha­bil­i­ta­tion Envi­ron­ment, or CAREN, vir­tu­al real­i­ty sys­tem to assess wound­ed war­riors with trau­mat­ic brain injury or post-trau­mat­ic stress, at the Nation­al Intre­pid Cen­ter of Excel­lence in Bethes­da, Md., June 23, 2010.
NICoE pho­to by Lin­sey Piz­zu­lo
Click to enlarge

From its warm design and fam­i­ly-friend­ly ameni­ties to its best-in-the-world diag­nos­tic and assess­ment equip­ment, the cen­ter boasts the con­ver­gence of art and sci­ence that offi­cials hope will become the new nor­mal in research­ing, diag­nos­ing and treat­ing trau­mat­ic brain injuries and post-trau­mat­ic stress disorder. 

As Deputy Defense Sec­re­tary William J. Lynn III said at the center’s June 24 ded­i­ca­tion cer­e­mo­ny, the need for such a cen­ter could not be more press­ing. Hun­dreds of thou­sands of ser­vice­mem­bers are believed to have suf­fered TBIs and PTSD dur­ing their ser­vice in Afghanistan and Iraq, and many go undi­ag­nosed, suf­fer­ing the “invis­i­ble wounds” of war with­out explanation. 

Gen. Peter Chiarel­li, Army vice chief of staff, was asked dur­ing tes­ti­mo­ny before a U.S. Sen­ate com­mit­tee last week why the mil­i­tary can­not bet­ter diag­nose brain injuries and PTSD. “I promise you it is not from lack of try­ing,” he said. “We are doing every­thing we can.” 

That’s where the Intre­pid Cen­ter comes in. Not a clin­i­cal care hos­pi­tal, the cen­ter instead is designed to accept on refer­ral those mil­i­tary mem­bers whom the ser­vices strug­gle to help, those whose injuries are so elu­sive to not be detect­ed, or that are unre­spon­sive to treat­ment devel­oped at base hos­pi­tals, which are lack­ing in prop­er equip­ment, staffing and exper­tise, offi­cials said dur­ing a June 23 media event. 

The Intre­pid Cen­ter holds the promise of prop­er diag­no­sis and treat­ment plans for those tough­est cas­es. The $65 mil­lion cen­ter on the grounds of the Nation­al Naval Med­ical Cen­ter hous­es $10 mil­lion in equip­ment, much of it unique to the cen­ter and a hand­ful of aca­d­e­m­ic research institutes. 

It includes brain imag­ing equip­ment that pro­duces up to 6,000 images per brain scan, Dr. Ger­ard Riedy, the center’s chief of neu­rol­o­gy, said. While stan­dard mag­net­ic res­o­nance imag­ing equip­ment allows for about 750 images most­ly show­ing the out­side struc­ture of the brain, Riedy said, the center’s three-dimen­sion­al imag­ing equip­ment shows every­thing from lesions of mild TBI on the brain’s sur­face to inter­nal brain func­tions, seen in real time. 

“It’s all non-inva­sive,” Riedy explained from the center’s “visu­al­iza­tion” room, sur­round­ed by a large, 3‑dimensional screen and mul­ti­ple small­er screens show­ing brain images. While a patient under­goes what seems like a stan­dard MRI or positron emis­sion tomog­ra­phy or CT scans in anoth­er room, Riedy and his staff of six assess col­or-cod­ed images of the brain’s mag­net­ic fields, wiring, and the like. One screen dis­plays the brain activ­i­ty when the patient is asked to do cer­tain tasks, allow­ing doc­tors to assess prop­er func­tion­ing, includ­ing psy­cho­log­i­cal stress. 

Riedy said his staff with be inter­op­er­a­ble, mean­ing they will process scans from mil­i­tary facil­i­ties and share their dis­cov­er­ies and obser­va­tions. “This stuff is not easy to do,” he not­ed, “and I have six peo­ple work­ing for me.” 

Down the hall from the brain imag­ing room, patients may enter vir­tu­al real­i­ty suites where they can be assessed on their reac­tion to being ful­ly immersed -– smells of burn­ing rub­ber or dead bod­ies includ­ed — in recre­at­ed scenes from Iraq or Afghanistan. Or researchers or clin­i­cians may test their dri­ving or shoot­ing abil­i­ty in sim­u­la­tors for their pos­si­ble return to duty. 

In anoth­er room, a patient may walk or run on a tread­mill sus­pend­ed on a mov­ing plat­form sur­round­ed by any num­ber of scenes that staffers cre­ate, from a street scene in Bagh­dad to a fish­ing pond in Ida­ho. The patient’s reac­tions to giv­en tasks allows staff to assess func­tions such as bal­ance, coor­di­na­tion, mul­ti­task­ing, reac­tion times and visu­al acu­ity, said Johan­na Bell, an oper­a­tor of the Com­put­er-Assist­ed Reha­bil­i­ta­tion Envi­ron­ment, or CAREN, machine. 

Such equip­ment may pro­vide the miss­ing link in prop­er diag­no­sis and treatment. 

“We’ve got no oth­er objec­tive mea­sures of TBI right now,” Riedy said. Ser­vice­mem­bers take writ­ten tests when return­ing from deploy­ment, but those aren’t con­clu­sive in the ways of brain scans and vir­tu­al real­i­ty equipment. 

Still, expen­sive equip­ment alone won’t solve the prob­lem of TBI and psy­cho­log­i­cal ill­ness in ser­vice­mem­bers. The center’s staff also offers hope of improved care, not only with their under­stand­ing of the sci­ence and equip­ment, but also in the art of work­ing with and under­stand­ing patients. 

“A lot of these patients just need an under­stand­ing that they are not crazy,” said Army Lt. Col. Matthew St. Lau­rent, assis­tant chief of occu­pa­tion­al ther­a­py at Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton, D.C. “There’s some­thing wrong in their brain tissue.” 

St. Lau­rent said he is hon­ored to be asso­ci­at­ed with the cen­ter, which he called “a place for us to come and learn” about the nascent sci­ence of com­bat-relat­ed TBI

In a sec­ond-floor open area sur­round­ed by win­dows and flood­ed with nat­ur­al light, St. Lau­rent and oth­ers can assess patients on var­i­ous types of exer­cise equip­ment to mea­sure their abil­i­ty to push, pull, car­ry, lift and per­form oth­er basic functions. 

A few steps away, patients can open a door into the center’s “Cen­tral Park,” a cir­cu­lar refuge of tran­quil­i­ty with sky­lights, green plants and park bench­es. Dis­play­ing the center’s open­ness for alter­na­tive ther­a­pies – in this case, ambi­ent ther­a­py — the room’s floor is a labyrinth of two-toned, pol­ished wood, invit­ing its guests to relax or con­front their trou­bles on its wind­ing paths. 

From the best diag­nos­tic and imag­ing equip­ment to the desire to make mil­i­tary fam­i­lies com­fort­able and engaged, staff mem­bers are clear about their goals. 

“Our ulti­mate goal is to get our mil­i­tary men and women back to duty,” St. Lau­rent said. 

Source:
U.S. Depart­ment of Defense
Office of the Assis­tant Sec­re­tary of Defense (Pub­lic Affairs) 

Team GlobDef

Team GlobDef

Seit 2001 ist GlobalDefence.net im Internet unterwegs, um mit eigenen Analysen, interessanten Kooperationen und umfassenden Informationen für einen spannenden Überblick der Weltlage zu sorgen. GlobalDefence.net war dabei die erste deutschsprachige Internetseite, die mit dem Schwerpunkt Sicherheitspolitik außerhalb von Hochschulen oder Instituten aufgetreten ist.

Alle Beiträge ansehen von Team GlobDef →