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
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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.)

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

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