USA — Program Offers Hope for Treating Brain Injuries

BETHESDA, Md., Sept. 27, 2010 — Valerie Wal­lace was at her wits’ end when she first heard about a nov­el trau­mat­ic brain injury treat­ment pro­gram under way here at the Nation­al Naval Med­ical Cen­ter.

National Naval Medical Center in Bethesda, Md.
Valerie Wal­lace, right, calls the psy­cho­log­i­cal health and trau­mat­ic brain injury team at the Nation­al Naval Med­ical Cen­ter in Bethes­da, Md., a god­send in help­ing wound­ed war­riors like her son, Army Sgt. John Barnes, left, deal with the unseen scars of war.
Cour­tesy pho­to
Click to enlarge

Her 22-year-old son, Army Sgt. John Barnes, was wound­ed in south­west­ern Iraq in 2006 dur­ing a mor­tar attack while he was deployed with the 101st Infantry Division. 

He had slipped into a coma for 12 days, remem­ber­ing noth­ing of the attack when he regained con­scious­ness with a severe trau­mat­ic brain injury. He rec­og­nized his fam­i­ly mem­bers’ faces, but had lost much of his ver­bal and motor skills as well as his short-term memory. 

After two months at Wal­ter Reed Army Med­ical Cen­ter in Wash­ing­ton, fol­lowed by treat­ment at the Depart­ment of Vet­er­an Affairs’ Tam­pa Poly­trau­ma Reha­bil­i­ta­tion Cen­ter, in Tam­pa, Fla., Barnes seemed on the road to recov­ery, his moth­er recalled. 

But a flu­id buildup with­in his brain stopped that progress cold, requir­ing an emer­gency craniec­to­my to relieve swelling. From there, as Barnes began his reha­bil­i­ta­tion almost from square one, he fluc­tu­at­ed between extremes. At one point, his recov­ery was so suc­cess­ful that he’d start­ed liv­ing inde­pen­dent­ly and enrolled in col­lege, but at oth­er times, his con­di­tion was so dire that his moth­er feared he was spi­ral­ing out of control. 

“Then the [post-trau­mat­ic stress dis­or­der] set in and he began self med­icat­ing with what­ev­er he could get his hands on,” his moth­er recalled. “It was just a disaster.” 

The prob­lem, she said, was that no pro­gram with­in the mil­i­tary, the VA or the civil­ian com­mu­ni­ty treat­ed all three of Barnes’ afflic­tions — TBI, PTSD and sub­stance abuse – simul­ta­ne­ous­ly. “There was no place I could find capa­ble of treat­ing all three of these issues,” she said. “But I tru­ly believed that they were all cor­re­lat­ed and need­ed to be treat­ed together.” 

The one pri­vate pro­gram dis­cov­ered online failed mis­er­ably, she said. After six weeks of treat­ment, Wallace’s son returned home “hos­tile, dis­re­spect­ful and bit­ter,” she recalled, and lack­ing the super­vi­sion he now required, had blown through tens of thou­sands of dollars. 

It was only by chance that Wal­lace learned through a friend about the Nation­al Naval Med­ical Center’s psy­cho­log­i­cal health and trau­mat­ic brain injury team. The lit­tle-known team was stood up here about two years ago to address the com­plex­i­ties of brain and men­tal-health injuries. 

Dr. David Williamson, the team leader, admit­ted Barnes for about a month of close obser­va­tion in the six-bed TBI unit known as “7 East.” 

“This is an envi­ron­ment where we can do very detailed eval­u­a­tions of brain func­tions after a brain injury,” he explained. 

“We have a whole port­fo­lio of brain injury spe­cial­ists, treat­ing clin­i­cians who look at all the basic aspects of brain func­tion, like move­ment, bal­ance and vision, up through the high­er brain func­tions like mem­o­ry and per­son­al­i­ty and emo­tion­al reg­u­la­tion,” Williamson said. “And the [patient’s] time here allows us to put togeth­er a very sophis­ti­cat­ed assess­ment of all these dif­fer­ent areas of brain func­tion, and to iden­ti­fy what the needs will be downstream.” 

The team then pro­vides fam­i­lies “a com­plete brief­ing on what to expect,” Williamson said, while releas­ing the patient for fol­low-up care, typ­i­cal­ly to a VA poly­trau­ma reha­bil­i­ta­tion center. 

“We know cer­tain types of brain injuries are more asso­ci­at­ed with mood swings or depres­sion or com­mu­ni­ca­tion prob­lems or judg­ment impair­ment,” Williamson said. “And we will look at the brain scans and the behav­ior of the patient while at Bethes­da, and form an assess­ment that put in place strate­gies now to pre­pare this fam­i­ly and begin to work with this ahead of time.” 

Williamson calls this approach “proac­tive intervention.” 

But as word gets out about the psy­cho­log­i­cal health and trau­mat­ic brain injury team’s capa­bil­i­ties, Williamson finds he’s get­ting calls from fam­i­ly mem­bers like Wal­lace, some whose loved ones have strug­gled with trau­mat­ic brain injuries for five, even 10 years. 

“We’ll bring those peo­ple back to Bethes­da and do an inten­sive eval­u­a­tion or reeval­u­a­tion of their brain injury, and look at new strate­gies for treat­ment, or maybe add addi­tion­al ele­ments to the treat­ment plan,” he said. 

For Wal­lace, the Nation­al Naval Med­ical Center’s psy­cho­log­i­cal health and trau­mat­ic brain injury team restored hope she’d all but lost in find­ing help for her son. 

She worked close­ly with the entire team, which she said treat­ed Barnes’ prob­lems holis­ti­cal­ly rather than piece­meal. “It brought a com­po­nent of com­ple­tion, deal­ing with all the com­plex issues of brain injury,” she said. “It’s every­thing: the behav­ioral prob­lem, the cog­ni­tive prob­lem, the phys­i­cal problem.” 

Wal­lace reserved her high­est praise for Williamson, whom she said “under­stands trau­mat­ic brain injury inside out, back­wards, for­wards and sideways.” 

Williamson “sees the big pic­ture,” she con­tin­ued. “It’s not one dimen­sion­al; it’s mul­ti­di­men­sion­al. There is a lot of men­tal ill­ness that can come up because of the brain injury, and he under­stands that.” 

The treat­ment “has made all the dif­fer­ence in John,” his moth­er said, cred­it­ing the PHTBI team with sav­ing his life. 

“John would be dead by now if he had­n’t been able to get there last sum­mer,” she said. “There’s no doubt about it.” 

Unfor­tu­nate­ly, Wallace’s sto­ry does­n’t end with a sto­ry­book “hap­pi­ly ever after.” 

Her mar­riage dis­solved dur­ing her son’s treat­ment. And her son, she not­ed, still has lim­it­ed cop­ing skills and occa­sion­al­ly self-med­icates with an over-the-counter med­ica­tion he knows the VA rarely screens for. 

About four months ago, Barnes was read­mit­ted to Bethes­da for fol­low-on treat­ment by the PHTBI team. Wal­lace said she is resigned to the fact that it prob­a­bly won’t be for the last time. 

“John’s brain injury is nev­er going to go away, and I don’t think there will ever be a real end to this,” she said. “I think that what will hap­pen is that the need for inter­ven­tions will become fur­ther and fur­ther apart. Instead of every three months, maybe it will be once a year. Then a cou­ple of years from now, maybe it will be once every oth­er year.” That said, Wal­lace expressed hope her son will con­tin­ue mak­ing progress under the PHTBI team’s guidance. 

“It’s going to take a lot of time and con­sis­ten­cy and ded­i­ca­tion,” she said. “But that’s exact­ly what I’ve final­ly found in Dr. Williamson and his staff.” 

(This is the last in a series of four arti­cles about the military’s rev­o­lu­tion­ary new approach­es to treat­ing patients with trau­mat­ic brain injuries and post-trau­mat­ic stress.) 

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

Face­book and/or on Twit­ter

Team GlobDef

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

Alle Beiträge ansehen von Team GlobDef →