Neuroimaging

While a routine Magnetic Resonance Imaging (MRI) picks up abnormalities in the brain structure of those with moderate and severe TBI, it does not always pick up abnormalities in those with mild TBI cases, Riedy explained. “We are trying here at the NICoE to use more advanced neuroimaging … to not only look at the structure, but also look at brain function, which we know can be disrupted in terms of memory issues, executive function issues and others.”

During the webinar, Riedy showed a comparison of a brain scan in which the standard MRI for microhemorrhage found a possible lesion in the corpus callosum, while NICoE’s advanced sustainability weighted images showed multiple lesions in the brain due to the injury.

As part of their current evaluations, patients also undergo FMRI studies to examine cognitive changes and Diffusion Tensor Imaging.

“Our goal is to eliminate some of these things we are looking at,” he said. “We are going to say, ‘well maybe spectroscopy is not the way to do it, or maybe diffusion tensor is not the way to do it, maybe a combination of susceptibility weighted imaging and functional imaging is the way to do it.’ So we want to look at all of these things, and then we are going to make recommendations to MTFs and VA about how they should be imaging.”

NICoE Offers State of the Art

The 150 patients treated at NICoE so far are active-duty servicemembers, mostly with mild to moderate TBI complicated by other psychological health conditions who are not responding to conventional therapy, officials said.

“Many of the patients we have seen have been in treatment for two, three, five, even seven years since their first injury back in 2003 and 2004, and they have failed to progress,” said Capt. Robert Koffman, NICoE clinical operations deputy director.

Troops stay at the Fisher House for approximately three weeks of evaluation, assessment and treatment planning. In addition to the advanced neuroimaging offered at the center, officials said the center is unique in that it uses an interdisciplinary approach to care.

Clinicians work to address sleep issues, decrease physical pain and decrease polypharmacy use, among other efforts. The center also offers complementary and alternative medicine approaches such as yoga, Tai Chi, breathing, recreational therapy, art therapy, acupuncture and music therapy.

The architecture of the 72,000-square-foot, two-story facility lends itself to healing, Koffman said. An atrium called “Central Park,” is a natural setting with plants, simulated sounds and different surfaces for troops to experience.

“Every aspect of this building has been considered in terms of the healing environment such as how bright it needs to be so that individuals with photo-sensitivity are not aroused,” he said. “The building itself has very graceful curves to it. There is nothing angular; it is very inviting. The colors are very natural and warm.”

NICoE deputy director Thomas DeGraba said the effects of the healing environment are being studied and that elements found to be beneficial could be reproduced at other MTFs.