MADIGAN ARMY MEDICAL CENTER, Joint Base Lewis-McChord, Wash. – Traumatic brain injury has been causing dramatic impacts on humans from our earliest days; this is especially true of military personnel who have been in combat situations. Medical science has made strides in recognizing and treating the resulting conditions. The Intrepid Spirit Center on Joint Base Lewis-McChord, Wash., hosted the Brain Injury Awareness Month Conference the last week of March to share the latest in current research and practice.
Vivian Ramage, a nurse educator with the ISC and coordinator for the conference, described it as, “a 3-day conference that highlighted current services, specialty provider education, latest innovative TBI-related research and acute concussion management tools and resources. This is the first year we have coordinated a conference, and look forward to making this an annual event.”
The conference was conducted both in person at the Center as well as on MS TEAMS. The slate of presenters included experts in the field of traumatic brain injury, post-traumatic stress disorder and neuroscience.
They also ranged across Army, Navy, Veterans Affairs and community agencies.
The conference got off to a good start with a presentation by Dr. Scott Wollman, a clinical neuropsychologist with Madigan Army Medical Center, which is the medical host and higher headquarters for the ISC.
Wollman’s presentation was titled, “PTSD and TBI: Neurobiological and Cognitive Effects,” and laid a foundation for a solid understanding of what happens in the brain when these forms of trauma occur.
“Research suggests that PTSD and other psychological factors are more likely contributing to the presence of persistent post-concussion symptoms/cognitive complaints,” noted Wollman.
Wollman led his audience through details on: brain anatomy and chemistry and how they are affected by PTSD; how many of the condition’s symptoms overlap with TBI to include irritability, cognitive deficits, insomnia, depression, fatigue and anxiety; how cognition and TBI are assessed by evaluating different forms of a patient’s memory, comprehension, reasoning and processing speed; and the long-term effects and treatments for patients who have both TBI and PTSD.
Wollman concluded that for the best outcomes what is needed is, “Emphasis on evidence-based treatments for PTSD, most importantly, psychoeducation.” A better understanding of cognitive functionality aids recovery.
Dr. Paul Savage, a retired Navy captain in internal medicine, provided information on research and treatments for post-concussive headaches, discussing different types of headaches as well as current trials and fielding specific questions on medications.
Two presenters drew connections between TBI and dementia, discussing the relationship between the two conditions.
Elaine R. Peskind, M.D., the co-director of the Veterans Affairs Northwest Mental Illness Research, Education, and Clinical Center as well as a professor at the University of Washington, gave some insight into the history and current state of dementia recognition and how it connects to TBI in her presentation, “Is Mild TBI a Risk Factor for Later Life Dementia?: New Research Findings.”
The JBLM ISC’s senior clinical research director, Jay M. Uomoto, PhD. detailed the historical milestones on the science of CTE – chronic traumatic encephalopathy – brain degeneration possibly caused by repeated head traumas.
The condition was introduced in the Journal of the American Medical Association in 1928 as “punch drunk syndrome” and has been studied, especially in the military community, ever since.
Uomoto concluded that findings from long-term studies that observe the same individuals to detect changes over time are still lacking to draw a solid connection between head trauma and dementia. He noted that some studies are occurring in this area with ISC and Madigan personnel that may fill in some of those gaps.
One aspect of the conference that was repeatedly on display noticeably emerged during Uomoto’s presentation – the cohesive and comfortable way the team in attendance related to one another.
Ramage offered an explanation of the character of the team saying, “Treatment of traumatic brain injuries requires a multidisciplinary clinical response. Often these injuries involve multiple specialties like neurology, psychiatry, psychology, physical and occupational therapy to name a few. It is our goal, to host conferences and events that support collaboration and consistent education on evaluation, diagnosis, treatment and research of TBIs.”
The multidisciplinary trait of the team was on display not only in the demeanor of the team and its interactions with one another, but in the variety of presentations offered. It mirrored the wide embrace of the ISC’s holistic care.
Dr. Rachel Satter, the ISC’s director and the conference’s sponsor, echoed this view by noting that the manner of the interdisciplinary team embodies the holistic care model.
In addition to a detailed walk through of the process behind the treatment at the ISC offered by Ramage, Kristen Benson, a regional education coordinator with the Defense Health Agency TBI Center of Excellence in Fort Belvoir, Va., and Casey Becker, also a REC, with the TBI CoE in Fort Campbell, Va., was an explanation of the Madigan Intrepid Spirit Transition Intensive Outpatient Program, a 5-week structured course that touches on everything from relationships and communication to pain management to personal finances. This is done through a wide-ranging menu of sessions that includes everything from meditation and yoga to cognitive behavioral therapy and journaling/creative writing.
Again, the term holistic comes into play.
The MIST Program, “Provides comprehensive treatment and educational programs, as well as a complimentary and integrative medicine approach within an interdisciplinary, holistic, and patient-centric rehabilitative care model,” noted presentation materials.
Through various individual and group activities and services, the participant addresses seven aspects to complete a body, mind and spirit rehabilitation – medical/psychological, physical, emotional, social, cognition, lifestyle and spiritual.
Filling out the array of presentations were ones from Angela Bossut, an art therapist with the ISC, Richard A. Giertz, Jr., the Center’s ombudsman and Dr. Lisa O’Block, a vestibular physical therapist.
Bossut described Creative Forces®: NEA Military Healing Arts Network as an initiative of the National Endowment for the Arts that partners with the U.S. Departments of Defense and Veterans Affairs, as well as Americans for the Arts and the Henry M. Jackson Foundation for the Advancement of Military Medicine.
Spread across seven Defense and five VA sites, this network makes use of clinical creative arts therapists, artists and craftspeople working in clinics, hospitals, on military bases and in community art centers helping Service Members heal and recover from trauma with the help of creative arts.
The American Art Therapy Association defines art therapy as, "An integrative mental health and human services profession that enriches the lives of individuals, families and communities through active art-making, creative process, applied psychological theory and human experience within a psychotherapeutic relationship."
Art therapy has long been a part of the ISC and its care.
Creative arts therapists lead participants through sessions of art making and sharing, sometimes in the community, sometimes at clinical sites.
O’Block got participants out of their seats to do some hands-on assessments during her presentation, “The Assessment and Management of Dizziness and Visual Disturbances Following Concussion/Mild TBI: Guidance for the Primary Care Manager.”
The conference attendees at the ISC worked in small groups to walk through the tests used to evaluate patients.
Despite some shortcomings with filming and streaming this activity virtually, this exercise brought the remote audience into the room and offered a visual component that informed and understanding of how to conduct screenings that would not have resulted from slides alone.
Giertz gave an overview of the role of an ombudsman, explaining their work of receiving complaints and working to resolve problems. An ombudsman is an important advisor for Service Members and their families as they are working through challenging times.
Ramage’s presentation also included information on the Defense Intrepid Network for TBI and Brain Health. JBLM ISC is 1 of 11 sites; two – Fort Bliss, Texas and Fort Carson, Colo., have yet to be built.
Just like the services of the ISC itself, the conference captured a wide swath of fields.
“Though in person seating was limited, the conference was widely attended virtually with representatives from multiple clinics and sites across the Defense Intrepid Network. Throughout the three days of presentations, over 90 providers, medical staff, and military leaders throughout JBLM and the DIN were in attendance. Those in attendance were able to refresh on concussion assessment and diagnostic tools, receive continuing medical education credits, participate in professional networking, and stay on top of the latest research in the field,” said Ramage.
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