Please direct all media queries to the NICoE public affairs officer at nicoe.pao@med.navy.mil. If you are interested in learning more about our media guidelines please click here and if you wish to download our NICoE media kit click here.
The NICoE also utilizes ​social networking sites Facebook, Twitter and YouTube, to complement our internal and external communications by sharing news and information links about upcoming events, current research initiatives and general resources. Take a moment to “like” us on Facebook and follow us on Twitter and YouTube today!
Guided by recent studies linking mild traumatic brain injury to damaged white matter axons in the brain, the NICoE’s Neuroimaging Research Core, a part of the Research Directorate, has delved head first into developing the tools and software needed to accurately clinically diagnose mild TBI.
Until now, TBI has been difficult to diagnose because of the lack of physical clinical evidence of the injury. “The definition of a mild TBI is that there are no visible lesions in a standard radiology exam,” said Dr. Terry Oakes, chief of imaging processing at the NICoE.
In order to tackle this complex challenge, the Intrepid Fallen Heroes Fund equipped the NICoE with six state-of-the-art imaging machines: a magnetic resonance imaging (MRI) scanner, a positron emission tomography (PET) scanner with computed tomography (CT) abilities, a magnetoencephalography (MEG) scanner, an electroencephalography (EEG) scanner and a fluoroscopy x-ray.
interest to a disease process with the help of radioisotope tracers. When analyzed together, each scanner’s images complement the others’. Together, they present a holistic picture of the brain’s anatomical and functional activity.
NICoE patients are recruited for neuroimaging research within the first two weeks of the NICoE program. Neuroimaging scans are available “a la carte,” but most patients choose to have a MRI or PET-CT scan. Approximately 90 percent of the NICoE patient population elects to participate in neuroimaging research. Subjects perform resting state, memory and executive function tests for 90 minutes as researchers conduct detailed anatomical examinations and capture functional brain activity.
The long-term goal of the division is to establish clinical benchmarks, and to use data gathered at the NICoE to provide researchers with information to better evaluate, diagnose and treat this comorbid condition. Until then, NICoE researchers will continue to work on characterizing the disease and developing the techniques needed to detect and display characteristics of comorbid TBI and PH conditions.
Care at the NICoE goes beyond appointments with neurologists and evaluations by physical therapists.
While these critical components comprise an important aspect of the NICoE’s treatment plan, the NICoE’s approach to care encompasses so much more. Navy Chaplain CDR Ray Houk, head of the NICoE’s spiritual healing program, helps service members and their families examine not only their physical and mental states, but their spiritual states as well.
“The chief goal of the spiritual healing program is to help the patient identify, within their own history, tradition, culture and worldview, what is important to them and how that importance impacts their healing process,” said Houk, an ordained pastor of The Foursquare Church.
Every service member who is admitted to the NICoE, regardless of religious affiliation, denomination or preference, meets with the Chaplain during the second week of his or her treatment as part of an overall patient evaluation. In this initial meeting, Houk conducts a comprehensive spiritual assessment to get more acquainted with the individual. The assessment’s aim is to learn about the service member as a whole. It surveys the patient’s spiritual history, current spiritual practices, and any challenges he or she is experiencing that may be inhibiting the healing process.
“It looks at where they’ve been,” says Houk. “This is different than just looking at their religious practices, which may or may not be helpful to them. It links up to their spiritual health, which is how they’re feeling about themselves, the relationships they’re in and their family members. Really, it is about what is most important to them as a person, continued Houk.
Incorporating the spiritual assessment into service members’ overall treatment plan allows NICoE providers to learn more about the patient and what is causing him or her personal difficulty. Service members often cite grief, guilt and loss as being resultant feelings from moral injury or inner conflict Houk works with service members individually by listening to their challenges and offering suggestions or techniques that may help them on their path to recovery.
One of the techniques he teaches involves the labyrinth in NICoE’s “Central Park.” Popular among cathedral builders during the Medieval Ages, labyrinths were built into the cathedral floors for congregants who wanted to meditate on particular struggles confronting their lives. By slowly walking the labyrinthine circuits from start to finish, service members at the NICoE benefit from not only a relaxing environment, but also an uninterrupted chance to reflect on issues that may be causing them distress.
At the conclusion of their four week stay, Houk finds that many service members are more relaxed then when they first entered the NICoE’s doors. Teaching service members self-management skills—and then watching as they use these skills to manage strong emotion—is a hallmark success of the spiritual healing program. By helping service members better recognize, as Houk says, “self-compassion, self-awareness and self-control” in their own lives, the spiritual healing program compliments the NICoE’s many care modalities and helps the entire organization achieve its mission.
At the National Intrepid Center of Excellence, help and hope for wounded service members suffering from mild traumatic brain injuries and psychological health conditions comes in a variety of forms. Neuroimaging, physical therapy and acupuncture are all critical aspects of the NICoE patient-centric care model. Some of the less obvious contributors to patient wellness, however, are young, furry, four-legged canines who are partners in the healing process.
Rick Yount, a social worker with more than 25 years of experience, got involved in animal-assisted therapy 17 years ago. Today, Yount is the Executive Director of Warrior Canine Connection, Inc., a 501(c) 3 non-profit. The WCC is a therapeutic service dog training program that works with service members suffering from post-traumatic stress disorder to train service dogs that are later partnered with mobility-impaired veterans. The program draws upon the warrior ethos – a commitment to mission and team before self – to motivate emotionally numbed service members to help other service members. Training service dogs requires patience, consistency and the use of positive affect: behavioral traits that are inhibited by Post Traumatic Stress. The Warrior-Trainer’s role in conveying a sense of security to their young dogs during public field trips provides a reason to challenge their own intrusive thoughts and begin to experience their community as a safe place.
Yount began his career in social work assisting abused and neglected children in foster care. He was given a Golden Retriever puppy, Gabe, as a Christmas gift and started bringing him to work. Immediately, Gabe began connecting with children during difficult experiences, lessening their trauma. Yount soon began using Gabe regularly in his interactions with children and families and registered him as a therapy dog. He moved on to begin a collaborative program with the West Virginia University School of Service Learning called Golden Rule Assistance Dogs. The GRAD program taught troubled teens how to train mobility service dogs for placement in the community, two of which were placed with veterans.
Meanwhile, Yount began to learn about breeding service dogs and had his loyal companion, Gabe, evaluated as a stud. Through the GRAD program, Yount bred Gabe to another Golden Retriever. Five puppies from his first litter were placed as mobility service dogs. In 2008, Yount created the Paws for Purple Hearts program at a Veterans Affairs residential treatment facility as part of his thesis for a Master’s degree in Assistance Dog Education. Combat veterans training the PPH dogs under Yount’s instruction and guidance reported significant improvement in their PTSD symptoms, and Yount was inspired to continue his work.
Now at the NICoE, on the campus of Walter Reed National Military Medical Center in Bethesda, Md., Yount and the Warrior Canine Connection have 12 dogs and four breeders. As his young dogs mature under the guidance of the NICoE’s service members, Yount and his team are focused on maximizing the dogs’ therapeutic benefit for the NICoE’s particular patient population. As Yount says, dogs have been “serving humankind for 30,000 years,” and the NICoE provides his program access to the technology to better understand that human-animal connection.
While clinical guidance is limited, Meg Olmert, Director of Research and Development at Warrior Canine Connection, is busy identifying scientific evidence that supports the benefits of the human-animal bond. Oxytocin, a hormone often referred to as the “love molecule,” is released in both the animal and the human during interaction. This natural hormonal increase has a calming, connecting effect in humans that counters the fight-or-flight mechanism, an automatic physiological response to increased physical or emotional stress, often prevalent in combat veterans.
At the NICoE, patients involved in the program report feeling less depressed and anxious, more willing to interact with others, and better able to sleep. Their spouses and children are benefiting from their improved social and emotional skills. To Yount, Olmert and the rest of the team, it is clear that “something is going on underneath the skin.” A gap exists in best practices regarding placing service dogs with combat veterans with psychological health injuries. By working with the NICoE, the Warrior Canine Connection hopes to fill that void by creating and disseminating best practices based on solid research – not only to shape policy, but to educate and extrapolate this model to other sites across the country.
On a Friday in March 2011, on his farm in Brookeville, Md., Yount paid his last respects to his beloved Gabe, who was nearly 16 years old. A group of wounded Marines were onsite that day and had the opportunity to say goodbye to their steadfast ally, an opportunity not afforded to many during combat. For Yount, it was a proud, though somber, moment. Even Gabe’s last half-hour of life was therapeutic.
While art is an integrative part of the Healing Arts Program at the NICoE, the program itself actually employs many different types of artistic and creative modalities, such as creative writing, music and—of course—visual art. Together, these modalities complement each other and serve as a means of therapy and expression for service members with comorbid traumatic brain injuries and psychological health conditions. Walker has designed the program from the ground up, taking into account the needs and suggestions of the NICoE’s service member population. “We currently have a musician volunteer who provides guitar and piano lessons, and we have also partnered with the National Endowment for the Arts to bring Operation Homecoming, an expressive and creative writing project, to the NICoE,” Walker explains.
When service members meet with Walker, they share their history if they are comfortable. Most importantly, however, they share and discuss their goals for the program. “Depending on their goals, I tell them how art can help them meet and achieve those goals. So if it’s ‘I’m having trouble focusing,’ then I let them know art can help them focus by allowing them to spend time just sitting and concentrating on one project for a while,” says Walker. If there is a particular trauma they are trying to overcome, she helps them to create a project where they try to express that trauma and process it through their art.
The art therapist meets individually with every service member at least once during the NICoE program, and also holds weekly group sessions for each cohort. In the first week of the program, service members are encouraged to make masks, which Walker uses as an outlet for the identity struggles they may be facing as they begin the program. “During that first week they are processing so much that this gives them an opportunity to bring everything up and put it into the mask,” explains Walker. The session is two hours long, which gives the service members enough time to make their mask and to do a bit of writing to help them process what they have created.
After completing the program, most service members will tell you that making masks in their first week at the NICoE was really their “ah ha” moment. For many of these individuals, it’s their first foray into exploring the arts and really exploring themselves. Some will continue to pursue art once they get home, and Walker can tell countless stories of service members with whom she is still in touch, who continue to explore their creative writing or who have even gone so far as to set up an art studio in their home. But once again, it’s never just about the art; it’s about the tools that the process provides. Walker sees those who graduate from the program benefit from an increased ability to focus and improved frustration coping skills. She also understands the sense of mastery that comes from completing a project. In turn, this mastery can improve overall self-esteem and self-understanding.
Both the design and mission of this Satellite Center—and another to be built at Camp Lejeune in Camp Lejeune, N.C.—are mirrored after the original NICoE, which is located at the Walter Reed National Military Medical Center in Bethesda, Md. The goal of these individual centers is to bring the successful NICoE clinical program to installations throughout the country, increasing the overall number of service members with comorbid mild traumatic brain injuries and psychological health conditions who can be seen and treated at a NICoE facility. Placing these essential treatment and care facilities right in the soldiers’ communities will create more immediate access for thousands of service members throughout the military.
“The NICoE’s charge is to make visible what is invisible,” said Dr. James Kelly, director of the original NICoE. He also emphasized the importance of collaborating with these new Satellite Centers to create a network of treatment, research and education centered on mTBI and PH conditions.
The NICoE in Bethesda, Md., works to explore and research these different treatment options to see which are most effective. All of these practices will be shared with the NICoE Satellite Centers to expand this continuum of care.
Both Milo and Covel credit their success today to the men and women who worked with them at the NICoE, and are excited to help promote the expansion of the NICoE program.
“The staff at the NICoE led me back from a very dark place. Now I can see the light at the end of the tunnel and I’m looking to the future for the first time in a long while,” Covel said.
Both the Fort Belvoir NICoE Satellite Center and the Camp Lejeune location broke ground on Wednesday. During the ceremony, Mr. Richard Santulli, chairman of the Intrepid Fallen Heroes Fund, said that the IFHF hopes to fund more than seven centers located at military bases across the country. The IFHF relies on the donations of private citizens to meet this goal. To donate to the IFHF, please go to: http://www.fallenheroesfund.org/.
Mr. Arnold Fisher, honorary chairman of the Intrepid Fallen Heroes Fund, encouraged the crowd to begin this important work.
In the past ten years, the science of sleep has developed rapidly. Today, the NICoE integrates a full sleep assessment into its interdisciplinary care model, including appointments with a specialist, ongoing activity monitoring, and a night in a sleep lab. Every service member at the NICoE meets with Dr. Anthony Panettiere, a former Navy neurologist who now spends his days observing and treating the sleep habits of those suffering from traumatic brain injury and psychological health conditions. While their initial appointment occurs within their first two days in the program, by the end of the first week, they have spent a night in the sleep lab, attended an educational session about normal sleep and sleep abnormalities, and worn a special sensor for four full days and nights that tracks motion and from which Dr. Panettiere can identify the sleep habits of each individual service member.
By analyzing the findings of these many data sources, Dr. Panettiere has identified sleep apnea in an overwhelming majority of the nearly 130 patients he has seen. Identifying these patients’ root sleep issues early on in the program allows Dr. Panettiere to begin treating them right away, ensuring that other diagnostic exams and tests aren’t affected by a patient’s sleep deprivation. He shared anecdotally that service members who are extremely tired will test poorly on neurological diagnostic evaluations conducted prior to sleep studies. Once they have been diagnosed as suffering from sleep apnea or other sleep conditions, and begin receiving treatment, the same service member will test much better.
Being tired affects more than just a service member’s diagnostic evaluations, Dr. Panettiere explains. Exhaustion can affect cognition, cause headaches and increase pain in general. It also affects a service member’s mood and even their ability to lose weight.
“Sleep is addressed in their first week because abnormalities there cover most of what they come in with,” Dr. Panettiere said. “If we can recognize the sleep disorder right away, it overarches all those other things, [which can then] be better treated and we can get a better assessment.
Diagnosis is only half of the battle. Dr. Panettiere spoke of three main treatment options for people suffering from sleep apnea.
The first is one of the most common solutions, a Continuous Positive Airway Pressure machine, or CPAP. This is a mask that patients wear when sleeping that delivers compressed air throughout the night. The NICoE is able to secure a device for patients covered by TRICARE North shortly after diagnosis, and works closely with a team at Walter Reed National Military Medical Center to ensure service members have a good fit and are comfortable working with the device. The other types of treatment – an oral appliance, which is a dental device that helps to open the airway, or surgery – are not available during their time at the NICoE, but are built into the customized treatment plan that service members take with them upon graduation.
Dr. Panettiere was featured last week in a DCoE webinar about the NICoE sleep program. Listen to the webinar to learn even more information about how the NICoE is leveraging its interdisciplinary program to change the lives of service members suffering from traumatic brain injury and psychological health conditions: http://www.dcoe.health.mil/Training/MonthlyWebinars.aspx.
To connect with the NICoE online, find us on Facebook at the National Intrepid Center of Excellence, or follow us on Twitter @NICoEpage.
Today, Erin Mattingly, a speech-language pathologist at the National Intrepid Center of Excellence, is evaluating a patient and assesses his communication and cognitive abilities. “Now,” she says to him, “let’s take a look at this picture, can you tell me what this is?” This is part of a typical speech-language pathology evaluation session at the NICoE. The information gathered during this session will be shared with the interdisciplinary care team responsible for painting a comprehensive picture of each patient’s needs, with the goal of designing a treatment care plan that paves the way toward recovery.
Service members at the NICoE face an array of complications resulting from their comorbid traumatic brain injury and psychological health conditions. These complications often include short-term memory problems, inability to concentrate or multi-task, and difficulty with goal-setting and problem-solving. As Mattingly says, “Many of our patients have difficulty organizing thoughts, using words [or] remembering where they put things. When you have TBI and PH co-morbidity, these symptoms are exaggerated.” As a result, the speech-language pathology program is a vital aspect of the care provided at the NICoE.
Following each initial evaluation session, the speech-language pathologist provides recommendations to the interdisciplinary care team, which works to design a customized treatment plan. This spirit of collaboration is also fostered with military treatment facilities across the U.S. “I have made strong contacts with MTFs which allow me to collaborate and discuss referrals. Developing partnerships is important for the work that I do,” says Mattingly. While this is still an ongoing and evolving learning process, the NICoE speech-language pathologists are committed to their work with MTFs to allocate resources, discuss referrals and figure out ways to ensure the patients’ success.
“The main concern is to provide our service members with tools that will improve their day-to-day experience,” says Mattingly.
With this in mind, speech-language pathology follow-up sessions provide concise strategies for use in everyday life and with interpersonal interactions. “I teach our [service members] internal memory strategies, using acronyms, visualization and association,” Mattingly says. By engaging her patients in exercises designed to improve concentration and attention difficulties, Mattingly works with service members to improve accuracy in recalling information and improving their attention. These exercises, however, are not always easy. They require practice and repetition, which Mattingly achieves with a stop-watch and time-related goals. “They call me the tyrant but I know they like a good challenge,” Mattingly says with a grin.
In addition to helping find treatment options that improve a service member’s quality of life, the speech-language pathologists at the NICoE are dedicated to educating and empowering patients. As Mattingly says, “To me, education is critical in helping our service members navigate what they are experiencing.” Service members report feelings of frustration and confusion in their inability to carry out tasks they were once so easily able to tackle. Confronting this is complicated – especially while trying to explain it to one’s significant other. “Spouses often tell me ‘he doesn’t listen to me,’ so I am then able to explain that there may be an underlying cause to this behavior and we work together to come up with solutions,” says Mattingly.
Group classes form a significant part of this education. As part of the speech-language pathology program, Mattingly and her coworkers convene a weekly cognitive group class session developed to provide patients with general information about the program and the factors that affect cognitive ability and performance. “I want to focus on giving our service members confidence and empowering them. That’s why education is so important,” says Mattingly.
National Nurses week begins each year on May 6th and ends on May 12th, which is Florence Nightingale’s birthday. An English nurse, writer and statistician, Nightingale laid the foundation for professional nursing with the establishment of her School of Nursing at St Thomas’ Hospital in London in 1860. She rose to prominence for her pioneering work in nursing during the Crimean War. Through her implementation of hygiene improvements, quite revolutionary at the time, she is credited with reducing the hospital death rate from 42% to 2%. Nightingale was dubbed “The Lady with the Lamp” due to her habit of making rounds at night. As with other professional recognition days or weeks, this time is set aside to reflect upon and honor the unique contributions of nurses. This year’s National Nurse’s Week theme is: Advocating, Leading, Caring.
Did you know that since 1999, nurses have been ranked as the most trusted profession in America in Gallup’s annual survey that ranks professions for their honesty and ethical standards? Approximately 81% of Americans believe nurses’ honesty and ethics are “high” or “very high”. In the past eleven years, there has only been one year where nurses lost that top distinction; in 2001, firefighters were recognized as the most trusted profession.
1) ADVOCATE. Value what you do. Never miss an opportunity to educate or articulate the value nurses bring to the health care team—to the public, a patient or our health care colleagues. If you don’t value what you do, no one else will.
2) LEAD. Be professionally engaged. Read, discuss, and compare notes and knowledge in your workspace, in your facility, and on the local or national level. Understand the issues our profession is facing: the implications of the Affordable Care Act; changes in clinical practice; concerns of license portability; the education level for entry-level practice; online programs; and Doctorate of Nursing Practice as the entry-level for advanced practice. Do you belong to a professional organization? Get involved in groups that will help you better understand the profession, its successes and its challenges.
3) CARE. Find a mentor; be a mentor. It is a powerful relationship. RNs, reach out today to a student or junior nurse and offer to be there to guide them. To the younger nurses, keep us on our toes by challenging us professionally. We are counting on you to keep us moving forward as a profession. Collectively, we are a force to be reckoned with. We all have the privilege and responsibility of growing America’s next generation of nurses.
​To the nearly three million licensed registered nurses in America, thank you for the contributions that you make in advocating, leading and caring to provide safe, quality health care. Happy National Nurses Week.
LCDR McLellan joined the NICoE in 2010, before patient care had even begun. Before arriving, she thought she had done it all. She had experience in psych, cardiac critical care, med-surg, and labor and delivery. Working at the NICoE, however, is like no other experience she’s had. She expected to work with her team to better understand the complexities involved in the care of service members dealing with TBI and PH-related conditions. Once here, however, LCDR McLellan has also had to function outside of her comfort zone—a challenge she is willing to embrace.
“I am grateful for my job and I am passionate about my work here,” she says. This passion drives LCDR McLellan’s focus, empowering her team, helping them to succeed and serving as a resource to them. While the day-to-day may not always be easy, the overall goal for her team is constant, rewarding and dictates their actions every day.