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National Intrepid Team Cares for People with Traumatic Brain Injuries

BETHESDA, Md., July 22, 2016 — Explosive blasts, sports injuries, automobile accidents, falls – any of these can lead to traumatic brain injury, the cause of a third of all injury-related deaths in the United States.

In the United States, an estimated 1.7 million people suffer a TBI annually. Of them, 52,000 die, 275,000 are hospitalized and 1.365 million – nearly 80 percent – are treated and released from an emergency department. At the National Intrepid Center of Excellence in Bethesda, Maryland, doctors and specialists make it their mission to treat service members and their families who have TBIs.

NICoE, a directorate of Walter Reed National Military Medical Center, helps active duty, reserve, and National Guard members and their families manage their traumatic brain injuries and accompanying psychological health conditions through diagnostic evaluation, treatment planning, outpatient clinical care and TBI research.

Primary Care Physician

Dr. Gene Casagrande, team coordinator and primary care physician, served in the Air Force as a major before joining NICoE five years ago. He is the primary care physician for the service members and completes a medical examination and follow-ups with their medical testing and laboratory evaluations. He also coordinates their medical care between their various specialists.

“I got accepted into medical school in 1979, and I called my dad,” he said. “My dad is a butcher who worked three jobs to help put five kids through college. When I told him I got accepted into medical school, the look on his face was, ‘Good.’ When I called him a week later and said, ‘Dad, I joined the Air Force,’ he was the happiest man. He was amazing. It was partly for paying for education, plus I always felt this obligation to serve my country.”

Casagrande said that on Monday mornings, he can’t wait to get to work.

“My wife’s never seen me so happy,” he said. “This is a wonderful place to work. It’s the environment of the people I work with. Each one of us experiences that joy of watching someone turn that corner, of watching someone see some hope, of improving their overall health, whether it’s a reduction in headaches, an improvement in their energy level or an improvement in their sleep. To me, sleep is such a big, important part that we provide here but all of that creates that personal growth and a rewarding part of why I want to be here.”

He said the most rewarding part is seeing patients grow in their healing from week one to week four.

“The most important part is the instilling of hope,” he said. “I tell everyone, ‘I can’t promise you we’re going to make you better, but we’re going to do our darnedest to try.’ And we all do.”

Deputy Director

Dr. Louis French has been the NICoE’s deputy director for about a year and a half and has worked in the field of military traumatic brain injuries for more than 16 years. He oversees all of the clinical and research operations related to traumatic brain injury care at NICoE.

Early in the war, he was on the team that wrote the first theater concussion management guidelines and then worked with the Army surgeon general to survey the state of TBI care in the military.

“I’ve seen a lot in these years -- sad things, exciting things,” he said. “There are a lot of people who have sacrificed, and I want to attach some meaning to that. The meaning for me is learning as much as we can from that as possible. So I want to do the research. I want to do the clinical care.

“I want to advance the science so the sacrifices and the pain and everything else these people went through mean something in terms of the larger picture of healthcare in the military and that’s what drives me with this,” he added. “People come in sometimes very hopeless, and to be able to turn that around and to let people see what it’s like to recover and what it’s like to think about the next 70 years of their lives, what they’re going to do, it’s very gratifying.”

Art Therapist

Melissa Walker has been an art therapist and healing arts program coordinator at NICoE for more than five years. She is one of the clinicians who use art therapy as a form of psychotherapy to communicate with the patients about their experiences and their specific traumatic memories they may be working through.

Walker said working with the service members at NICoE is an honor.

“I like to say every day in this space is a gift, and for service members to be sharing these stories with a civilian who’s never experienced anything like they have and will never completely understand, I’m grateful that they are helping us understand in creating this artwork that inches us this much closer to what they’ve been through in their truths. I love that they can open up in this space.”

Walker said most of the patients can use the artwork to express their emotions, and it springboards them into speaking about difficult things. This helps them better interact with other providers at NICoE, and vice versa, she explained. Sometimes, she added, if the patients have opened up in their treatment sessions, they in turn express it in their artwork.

Walker said she was an artist growing up and believes all art forms are beautiful, but that she especially enjoys it at NICoE.

“If a piece is actually telling a story and means that much to a person, it’s incredible to be surrounded by that. This space really is special,” she said. “I’m very fortunate to be surround by color and the art making itself and to hear the brushes on canvas and to see them using their hands in such a tactile manner to work through trauma. It’s incredible for an artist to see that kind of process occurring.”


Navy Cmdr. (Dr.) Grant Bonavia has been the interim chief of NICoE’s research department and the chief of neuroimaging and measurement devices since late last year. He oversees the neuroimaging devices such as the PET CT, CT magnetoencephalography -- MEG for short -- and a number of other devices used to diagnose patients with TBI.

Bonavia said he joined the Navy because his father served in the Navy as an enlisted electronics technician on a destroyer. He said he enjoys the work and the science behind it.

“It really is a rewarding experience,” he said. “You get to work with a unique population of patients who’ve put a lot on the line for the country, and I like the science. Being able to work with combat veterans and hear their stories and what they’ve done for their country, it’s an honor. We appreciate what the service members have done for us, and want to do what we can to help.”

Dr. John Hughes, director of the MEG lab, served 25 years in the Navy and has been at NICoE for more than two years. He’s been a neurologist since 1994. He said he originally joined the Navy for a scholarship for medical school, but stayed in for more than that.

“There was a financial incentive, but that was long, long ago, and I long since have paid my time for that, so I’ve had the opportunity to have patients who have done extraordinary things, particularly the few years I spent with the Marines at Camp Lejeune [in North Carolina] who were always going on deployments,” he said. “This was before Iraq and Afghanistan. I had great admiration for them, and I really regarded it as a privilege and honor to be able to care for them and keep them fit for duty, so it became clear to me that a career in the Navy Medical Corps was for me.”

He obtained three subspecialties in neurology, cognitive neurology, clinical neurophysiology and sleep medicine while he was in the Navy. He said he continues to work in the field because of the science.

“I just have a tremendous passion for what I do, so for the neuroscience and neurology and also to be in this wonderful place at Walter Reed and NICoE,” he said. “I’m also attached to the Naval Medical Research Center, which is also a wonderful place doing tremendous research.”

Hughes said all of his fellow doctors and specialists are focused on providing care for those with TBIs and encourage anyone in the military who may think they have one to seek help.

“All of the health care providers are really passionate about helping people who have experienced TBI,” he said.

Service members should first seek help from their home station’s primary care physician or mental health professional, and then can be referred to the NICoE’s range of treatment options. These include the four-week intensive outpatient care treatment program, the one-week assessment track, ongoing outpatient care services, inpatient consultation, and a range of individual, nonpackaged diagnostic and evaluative options.

The benefit of coming to NICoE is that service members will have access to any one of these treatment options, depending on the need, with a streamlined evaluative pathway where many of the providers and services are on hand at the same location.

Final installment of a five-part series.

(Follow Shannon Collins on Twitter: @CollinsDoDNews)
Distribution channels: Military