Intrepid Center merges art, science for brain treatment Published June 29, 2010 By Lisa Daniel American Forces Press Service BETHESDA, Md. (AFNS) -- When National Intrepid Center of Excellence officials opened the center's doors here last week, the sense of hope in reversing the rising tide of brain injuries and psychological illness in servicemembers was palpable. From its warm design and family-friendly amenities to its best-in-the-world diagnostic and assessment equipment, the center boasts the convergence of art and science that officials hope will become the new normal in researching, diagnosing and treating traumatic brain injuries and post-traumatic stress disorder. The need for such a center could not be more pressing, the Deputy Defense Secretary William J. Lynn III said at the center's June 24 dedication ceremony. Hundreds of thousands of servicemembers are believed to have suffered TBIs and PTSD during their service in Afghanistan and Iraq, and many go undiagnosed, suffering the "invisible wounds" of war without explanation. During a testimony last week, members of a U.S. Senate committee asked Gen. Peter Chiarelli, the Army vice chief of staff, why the military cannot better diagnose brain injuries and PTSD. "I promise you it is not from lack of trying," he said. "We are doing everything we can." The Intrepid Center is not a clinical care hospital, but is designed to accept on referral those military members whom the services struggle to help, those whose injuries that are so elusive they aren't detected, or that are unresponsive to treatment developed at base hospitals, because they are lacking in proper equipment, staffing and expertise, officials said during a June 23 media event. The Intrepid Center holds the promise of proper diagnosis and treatment plans for those toughest cases. The $65 million center on the grounds of the National Naval Medical Center houses $10 million in equipment, much of it unique to the center and a handful of academic research institutes. It includes brain imaging equipment that produces up to 6,000 images per brain scan, said Dr. Gerard Riedy, the center's chief of neurology. While standard magnetic resonance imaging equipment allows for about 750 images mostly showing the outside structure of the brain, the center's three-dimensional imaging equipment shows everything from lesions of mild TBI on the brain's surface to internal brain functions, seen in real time. "It's all non-invasive," Doctor Riedy explained from the center's "visualization" room, surrounded by a large, 3-dimensional screen and multiple smaller screens showing brain images. While a patient undergoes what seems like a standard MRI or positron emission tomography or CT scans in another room, Doctor Riedy and his staff of six assess color-coded images of the brain's magnetic fields, wiring, and the like. One screen displays the brain activity when the patient is asked to do certain tasks, allowing doctors to assess proper functioning, including psychological stress. Doctor Riedy said his staff will be interoperable, meaning they will process scans from military facilities and share their discoveries and observations. Down the hall from the brain imaging room, patients may enter virtual reality suites where they can be assessed on their reaction to being fully immersed -- smells of burning rubber or dead bodies included -- in recreated scenes from Iraq or Afghanistan. Researchers or clinicians may test patient's driving or shooting ability in simulators for their possible return to duty. In another room, a patient may walk or run on a treadmill suspended on a moving platform surrounded by any number of scenes that staffers create, from a street scene in Baghdad to a fishing pond in Idaho. The patient's reactions to given tasks allows staff to assess functions such as balance, coordination, multitasking, reaction times and visual acuity, said Johanna Bell, an operator of the Computer-Assisted Rehabilitation Environment machine. Such equipment may provide the missing link in proper diagnosis and treatment. "We've got no other objective measures of TBI right now," Doctor Riedy said. Servicemembers take written tests when returning from deployment, but those aren't conclusive in the ways of brain scans and virtual reality equipment. Still, expensive equipment alone won't solve the problem of TBI and psychological illness in servicemembers. The center's staff also offers hope of improved care, not only with their understanding of the science and equipment, but also in the art of working with and understanding patients. "A lot of these patients just need an understanding that they are not crazy," said Army Lt. Col. Matthew St. Laurent, the assistant chief of occupational therapy at Walter Reed Army Medical Center in Washington, D.C. "There's something wrong in their brain tissue." Colonel St. Laurent said he is honored to be associated with the center, which he called "a place for us to come and learn" about the nascent science of combat-related TBI. In a second-floor open area surrounded by windows and flooded with natural light, Colonel St. Laurent and others can assess patients on various types of exercise equipment to measure their ability to push, pull, carry, lift and perform other basic functions. A few steps away, patients can open a door into the center's "Central Park," a circular refuge of tranquility with skylights, green plants and park benches. Displaying the center's openness for alternative therapies. From the best diagnostic and imaging equipment to the desire to make military families comfortable and engaged, staff members are clear about their goals. "Our ultimate goal is to get our military men and women back to duty," Colonel St. Laurent said.