Brain Injury (TBI) Rehab In The Military: A Firsthand Look to the National Intrepid Center of Excellence (NICoE)

After a long trip on the Washington DC Metro from King Street I arrived at the Medical Center station.  Arriving was a relief until I saw the never ending stairway to heaven.  The escalator was so steep I had to hang to the handrails with both hands.  As soon as I started moving up the escalator I felt my balance getting unstable.  I avoided looking up or down. I simply kept a steady stare at the few steps right in front of me. After a long trip I arrived to the light and the city once again unveiled in front of my eyes.  The first thing I saw was the National Health Institute building, a little farther pass the NIH was an intersection that will take me right to the gate of the Naval Hospital.  I proceeded to show my ID to gain access to the hospital grounds.

Once I was inside the Naval Hospital compound I saw to my right the marvelous structure that houses the National Intrepid Center of Excellence or NICoE as many know it.  I had heard about the NICoE program in the past, but nothing prepared me for what I was about to see.  I was blessed to tour the facility and see firsthand what the NICoE is about.

Walking through a set of glass double doors, I could feel the relaxing environment that is created for Service Members to feel at ease.  The structure is curved with no straight lines; I could not see any corners in the structure either.  It is pleasant just to look at and appreciate inside. Throughout my tour I had the opportunity to meet a committed group of providers.  Just by the way they talk and conduct themselves I could sense their level of knowledge, compassion, care, and understanding of what Traumatic Brain Injury is. 

As I was brought to each of the areas, I was amazed by the technology they use to give treatment to so many TBI survivors.  They have the most advanced technologies for assessment and therapy I have ever seen.  Almost everything I saw made me feel as if I was getting cared for in a video game.  Many Veterans that have sustained a brain injury overseas are young and of the video game generation.  I can see the benefit of such advancements in the care of TBIs. 

Just to mention a few things that I saw firsthand include:

·         A driving simulator with an actual car cabin that features interactive roads that appear on screens in front of the simulator.

·         A Fire Arms Training Simulator. Right now the NICoE’s mission is to return service members to active duty, so this is important step in getting Soldiers and Marines comfortable with their weapons again. All weapons are coded out weapons that have a Bluetooth system adapted to them (non firing weapons).  These weapons are fired to a big screen featuring many different ranges and scenarios.  Sort of a realistic video game.

·         Virtual Iraq and Afghanistan.  Here Service Members are given goggles that allow them to immerse themselves in a virtual battlefield.  As they move their heads the images within the goggles move.  They also have a device that produces the smell of the battlefield we operate on.  It may be used in the future in a virtual re-immersion therapy method, placing the Service Member back in the experience where he/she initially sustained the TBI, allowing doctors to more accurately assess the individual needs of each patient.

·         I could see from a distance a room that had a Computer Assisted Rehabilitation Environment (CAREN). It is one of the eight in the world and features a motion platform, embedded treadmill, and virtual environments for evaluating and rehabilitating a patient’s vision, reaction time, gait and multi-tasking ability. This amazing technology also is meant to treat the vestibular system that causes balance problems to so many of us.  One stands on this platform as it moves at the same time an IMAX type screen displays the virtual environment in front of them.  (Pretty cool!!!)

·         The gym where physical therapy takes place is a state of the art area with lots of space and advanced exercise equipment.  It has a harness that hangs from ceiling rails to help those with balance problems or injured (or missing) limbs.

·         The structure has an apartment built in it.  This area targets rehab in household task, i.e. preparing meals, doing laundry, etc.

·          There is an amazing conference room that is equipped with projectors to present images in 3D.

·         The NICoE also features a place called Central Park where there is an indoor labyrinth, a huge natural skylight, lots of plants and places to sit and relax.  It also has different terrains, from rocky to bumpy terrains, this can be useful for the retraining of visual and balance problems.

·         The NICoE also is practicing “Family Centered Care”. The entire care program is built around the patient and their family (could be Mom, Dad, brother or sister, Aunt, Uncle, boyfriend or girlfriend.  The “family members” are determined by the patient).

I have to conclude that I am amazed and thoroughly impressed by the advancement that has been accomplished in the care of Traumatic Brain Injuries.  I could clearly see that the military is viewing those invisible injuries with a sense of seriousness and commitment.   If centers like NICoE succeed in the care of these injuries, it should be replicated across the Nation, not only throughout the military but also throughout the civilian sector too.  The technology is useful, but not alone, it takes compassion and understanding from those providing the care.  And the NICoE has a strong blend of military providers who know what it’s like to be deployed, as well as some of the brightest civilian doctors in the country.  We are all part of a historical time that is revolutionizing the care TBIs.  We have come far, but definitely the road ahead holds endless possibilities and infinite successes.  Congratulations to Dr. James Kelly and the staff at the National Intrepid Center of Excellence for a job well done!  Your commitment sets the example for many to follow.  

Different Terrains in Doors

Balance Training

Driving Training

*****The above images were obtained through open source online. The were altered by me to protect the privacy of the individuals.*****