Walter Reed AMC, DC: Local DVBIC Activities

At Walter Reed Army Medical Center (WRAMC) are located both the largest site among the designated DVBIC sites throughout the United States and Germany, and the DVBIC Headquarters. At the Walter Reed clinical site, many of the service members who are air-evacuated from Landstuhl Regional Medical Center (LRMC) in Germany come directly to WRAMC to begin their medical care in the United States. A service member’s stay may be brief before continuing on to another CONUS destination, or it may be extended if a service member becomes attached to the Warrior Transition Brigade at WRAMC.

DVBIC is an integral part of the larger TBI program at the hospital, and the DVBIC clinical and educational programs increase the capacity and overall scope of services in the hospital. The DVBIC Site Director, Dr. Louis French, is also WRAMC’s TBI Director.

All of the service members whose injuries suggest a potential for having sustained a traumatic brain injury are given a TBI evaluation upon arriving at WRAMC. After a service member has been identified as having sustained a traumatic brain injury, the service member receives the necessary assessments and interventions from relevant disciplines to address current symptoms, both on an inpatient and outpatient basis. The outpatient TBI care for service members is coordinated through a weekly TBI clinic, where key individuals from various disciplines convene to discuss the service members’ needs and progress. DVBIC staff and resources contribute significantly to both the inpatient and outpatient clinical care provided to service members who have sustained a traumatic brain injury. Additionally, there are several DVBIC staff neuropsychologists who perform testing and make clinical assessments about the advisability of service members, who are undergoing the medical board process, to return to former military occupations or to stay in the service.

Because traumatic brain injury is not an isolated consequence of war-related trauma and injuries, a number of service members concurrently receive amputee rehabilitation while receiving traumatic brain injury rehabilitation at WRAMC. Their amputee rehabilitation is conducted in the Military Advanced Training Center (MATC), which is a state-of-the-art facility for service members who have amputated limbs or who have lost limb functioning. Within the MATC, service members have access to a virtual reality platform for vestibular therapy, firearms simulator training, a gait lab, a running track, workout equipment, a vehicle simulator, and activities to enhance fine motor functioning.

Due to the fact that traumatic brain injury has been more publicized and talked about during the current conflict than during previous conflicts, educational efforts have been targeted to help service members, family members, WRAMC staff and providers, and community members have accurate information about traumatic brain injury. This has been done through disseminating printed DVBIC materials, setting up informational booths, making presentations to specific groups, and beginning a monthly Traumatic Brain Injury Staff Lecture Series. The TBI Lecture Series was created to educate staff about topics related to traumatic brain injury that may be pertinent to their practice. Due to video teleconferencing capabilities, staff can participate in the training from remote sites throughout the country.

Because so many service members come straight to WRAMC from LRMC, it is a prime environment to consent service members to participate in research studies from the beginning of their TBI treatment. The DVBIC at Walter Reed Army Medical Center is actively recruiting for four IRB approved protocols. The first is the Defense and Veterans Brain Injury Center (DVBIC) WRAMC Prospective Traumatic Brain Injury Tracking Protocol. The purpose of this study is to ensure that all military and Department of Veterans Affairs (DVA) patients who have sustained a Traumatic Brain Injury (TBI) receive TBI-specific screening, treatment and follow-up, while at the same time collecting standardized patient outcome data. The second is the Defense and Veterans Brain Injury Center (DVBIC) WRAMC Core Evaluation Protocol. The purpose of this study is to integrate clinical outcomes research into the treatment of TBI patients. This involves the comparison of patient outcomes across a variety of treatment strategies.  The Military Blast-Related Traumatic Brain Injury: A Study of Neuroanatomical and Neurobehavioral Sequelae and Low Cost Clinical Intervention Protocol is the third study actively enrolling patients. This study seeks to provide information for healthcare/military policy makers on the consequences of blast-related TBI and to improve the care provided to military service members who have sustained a blast-related TBI. Specifically, this study aims to develop prevalence estimates for sequelae, both neuroanatomical and neurobehavioral, of blast-related TBI in a military population. This will be accomplished through neuro-imaging studies and a battery of questionnaires and interviews. Traumatic Brain Injury and Substance Use Disorders Among Injured Soldiers is the fourth WRAMC protocol. The purpose of this pilot study is to evaluate the extent and timing of the relationship between recent TBI and substance misuse among injured service members.