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.

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