Program Offers Hope for Treating Brain Injuries

By Donna Miles

American Forces Press Service

BETHESDA, Md., Sept. 27, 2010 – Valerie Wallace was at her wits’ end when she first heard about a novel traumatic brain injury treatment program under way here at the National Naval Medical Center.

Her 22-year-old son, Army Sgt. John Barnes, was wounded in southwestern Iraq in 2006 during a mortar attack while he was deployed with the 101st Infantry Division.

He had slipped into a coma for 12 days, remembering nothing of the attack when he regained consciousness with a severe traumatic brain injury. He recognized his family members’ faces, but had lost much of his verbal and motor skills as well as his short-term memory.

After two months at Walter Reed Army Medical Center in Washington, followed by treatment at the Department of Veteran Affairs’ Tampa Polytrauma Rehabilitation Center, in Tampa, Fla., Barnes seemed on the road to recovery, his mother recalled.

But a fluid buildup within his brain stopped that progress cold, requiring an emergency craniectomy to relieve swelling. From there, as Barnes began his rehabilitation almost from square one, he fluctuated between extremes. At one point, his recovery was so successful that he’d started living independently and enrolled in college, but at other times, his condition was so dire that his mother feared he was spiraling out of control.

“Then the [post-traumatic stress disorder] set in and he began self medicating with whatever he could get his hands on,” his mother recalled. “It was just a disaster.”

The problem, she said, was that no program within the military, the VA or the civilian community treated all three of Barnes’ afflictions -- TBI, PTSD and substance abuse – simultaneously. “There was no place I could find capable of treating all three of these issues,” she said. “But I truly believed that they were all correlated and needed to be treated together.”

The one private program discovered online failed miserably, she said. After six weeks of treatment, Wallace’s son returned home “hostile, disrespectful and bitter,” she recalled, and lacking the supervision he now required, had blown through tens of thousands of dollars.

It was only by chance that Wallace learned through a friend about the National Naval Medical Center’s psychological health and traumatic brain injury team. The little-known team was stood up here about two years ago to address the complexities of brain and mental-health injuries.

Dr. David Williamson, the team leader, admitted Barnes for about a month of close observation in the six-bed TBI unit known as “7 East.”

“This is an environment where we can do very detailed evaluations of brain functions after a brain injury,” he explained.

“We have a whole portfolio of brain injury specialists, treating clinicians who look at all the basic aspects of brain function, like movement, balance and vision, up through the higher brain functions like memory and personality and emotional regulation,” Williamson said. “And the [patient’s] time here allows us to put together a very sophisticated assessment of all these different areas of brain function, and to identify what the needs will be downstream.”

The team then provides families “a complete briefing on what to expect,” Williamson said, while releasing the patient for follow-up care, typically to a VA polytrauma rehabilitation center.

“We know certain types of brain injuries are more associated with mood swings or depression or communication problems or judgment impairment,” Williamson said. “And we will look at the brain scans and the behavior of the patient while at Bethesda, and form an assessment that put in place strategies now to prepare this family and begin to work with this ahead of time.”

Williamson calls this approach “proactive intervention.”

But as word gets out about the psychological health and traumatic brain injury team’s capabilities, Williamson finds he’s getting calls from family members like Wallace, some whose loved ones have struggled with traumatic brain injuries for five, even 10 years.

“We’ll bring those people back to Bethesda and do an intensive evaluation or reevaluation of their brain injury, and look at new strategies for treatment, or maybe add additional elements to the treatment plan,” he said.

For Wallace, the National Naval Medical Center’s psychological health and traumatic brain injury team restored hope she’d all but lost in finding help for her son.

She worked closely with the entire team, which she said treated Barnes’ problems holistically rather than piecemeal. “It brought a component of completion, dealing with all the complex issues of brain injury,” she said. “It’s everything: the behavioral problem, the cognitive problem, the physical problem.”

Wallace reserved her highest praise for Williamson, whom she said “understands traumatic brain injury inside out, backwards, forwards and sideways.”

Williamson “sees the big picture,” she continued. “It’s not one dimensional; it’s multidimensional. There is a lot of mental illness that can come up because of the brain injury, and he understands that.”

The treatment “has made all the difference in John,” his mother said, crediting the PHTBI team with saving his life.

“John would be dead by now if he hadn’t been able to get there last summer,” she said. “There’s no doubt about it.”

Unfortunately, Wallace’s story doesn’t end with a storybook “happily ever after.”

Her marriage dissolved during her son’s treatment. And her son, she noted, still has limited coping skills and occasionally self-medicates with an over-the-counter medication he knows the VA rarely screens for.

About four months ago, Barnes was readmitted to Bethesda for follow-on treatment by the PHTBI team. Wallace said she is resigned to the fact that it probably won’t be for the last time.

“John’s brain injury is never going to go away, and I don’t think there will ever be a real end to this,” she said. “I think that what will happen is that the need for interventions will become further and further apart. Instead of every three months, maybe it will be once a year. Then a couple of years from now, maybe it will be once every other year.”

That said, Wallace expressed hope her son will continue making progress under the PHTBI team’s guidance.

“It’s going to take a lot of time and consistency and dedication,” she said. “But that’s exactly what I’ve finally found in Dr. Williamson and his staff.”

(This is the last in a series of four articles about the military’s revolutionary new approaches to treating patients with traumatic brain injuries and post-traumatic stress.)