Intrepid Spirit Center tackles TBIs – The Fort Campbell Courier

Since Fort Campbells Intrepid Spirit Center opened more than two years ago, it has allowed staff to take a multidisciplinary approach to treating traumatic brain injuries and associated conditions.

The center consolidates many different specialties under one roof to optimize the efficiency of the treatment offered to patients. Elsewhere, the National Intrepid Center of Excellence close to Washington, other similar centers such as the one at Fort Hood, along with centers operated by the Navy and Marine Corps all have the same treatment philosophy as Fort Campbells Intrepid Spirit Center.

The Intrepid Spirit Center is using the heightened awareness about brain injuries during the Brain Injury Awareness Month observances in March to increase education about TBI on Fort Campbell. The monthlong observance is sponsored by the Brain Injury Association of America and supported by the Defense and Veterans Brain Injury Center.

Staff members from the center go to clinics and educate providers about TBI, said Dr. Lynn Giarrizzo, who has been at Fort Campbell since 2007, first as an active-duty officer where she served as chief of the anesthesiology department for two years at Blanchfield Army Community Hospital. As a civilian she came back and stood up the pain program at BACH, which is now part of the center.

Were educating about what we do, about what brain injury is, educating about the referral process and when we would like to see patients, Giarrizzo said. Because with Fort Campbell, with the active-duty it is a constantly changing population of providers. Every year well go out and there are people who havent heard the story.

Since 2000, approximately 350,000 Soldiers have been diagnosed with a mild TBI. More than 3.5 million people sustain a traumatic brain injury each year and 12 million Americans live with the impacts of a TBI, while 5.3 million have TBI-related disabilities. On a daily basis 137 people in the U.S. die from brain injuries.

While Soldiers often experience TBI during combat deployments, Intrepid Spirit Center staff are working to dispel the stereotype that this is the only way Soldiers sustain brain injuries. A Soldier can sustain a brain injury while doing training in the field, during combatives, because of a fall, or in a motor vehicle accident. Also, some less likely causes of TBI include electric shock, near drowning, seizures, strokes, substance abuse and as a result of an infection of brain tissues.

Many patients who experience a traumatic brain injury also have chronic pain associated with that, Giarrizzo said. There is the triad, if you will, of [post traumatic stress disorder], traumatic brain injury and pain. Those three go together quite frequently.

Brain injuries can cause headaches, visual disturbances, balance issues and memory loss. Chronic pain associated with TBI can negatively affect a Soldiers cognition.

The majority of patients who experience a mild TBI improve on their own by following the protocol of rest, avoiding further high impact exercises, Giarrizzo said. The majority of people get better just by doing that. But if there is somebody who has persistent headaches, memory loss, or just their symptoms do not resolve then the primary care provider can put in a referral to the Intrepid Center.

The patients referred to the center receive an evaluation by a primary care provider and undergo a series of test to screen them and help determine the treatment they receive. The tests include checks of Soldiers ability to multitask, plan, prioritize and problem solve. Communications tests measure Soldiers on their oral expression, reading comprehension and writing ability. Memory tests gauge Soldiers on both short-term memory and long-term memory. The center also checks Solders attention span and to see if they can focus or if they have divided attention. Soldiers will receive a treatment plan for each area that they struggled with during the testing.

Say someone comes in and they are having headaches and memory issues, the screening shows that they have severe insomnia and they are not sleeping, so before they come into the program they may be referred offsite to a sleep center, Giarrizzo said. But by and far, most people if theyve had a concussion or event in their past, they go into a process we call INSPIRE.

INSPIRE stands for Intrepid Spirit Introduction and Reception Meeting, where the patient will meet with team members including nurse case managers, primary care providers, physical therapists, speech therapists, behavioral health and occupational therapists.

The whole idea behind the INSPIRE interview is that the Soldier comes in and tells their story one time, Giarrizzo said. Because if they see the whole team they [wont] have to tell their same story six plus times. And sometimes the story is traumatic for them, so its better to get them in the room and have them tell their story and everybody hears the story and everybody has an opportunity to ask questions.

Based on the INSPIRE interview the Intrepid Spirit Center sets up a series of appointments for the Soldier with various sections housed in the Intrepid Spirit Center. The multidisciplinary approach was in its infancy at Fort Campbell before the opening of the center, but it has become the standard practice today.

Left untreated TBI can cause difficulties in Soldiers doing their job, and a lack of treatment can have a negative impact on Soldiers personal lives including personal relationship. The Intrepid Spirit Center, educates the Families of Soldiers afflicted with TBI and provides strategies to those Families for dealing with the injury, while the center also treats the Soldier.

The center has a yoga room, intake rooms, exam rooms, plus space for Family wellness, speech therapy, art therapy, occupational therapy, acupuncture, a gym, and a variety of equipment and devices to conduct all the tests. Among those devices are a quantitative electroencephalogram to help diagnose problems, as well as neurofeedback and biofeedback devices for treatment.

Since the center stood up the behavior health program has expanded and now features a PTSD intensive outpatient program.

[The Intrepid Spirit Center] will work on all aspects related to a traumatic brain injury, Giarrizzo said. So if a Soldier takes a concussive wave that can affect [his or her] balance so physical therapys treatment plan will be working on balance and occupational therapys treatment plan will be working on cognitive strategies. For chronic pain management the center has transitioned away from the use of opioids instead using alternative strategies including non-medication devices, such as alpha stimulation units, yoga, acupuncture, massage therapy and meditation. Soldiers can use these strategies even after they are discharged from the treatment program.

Heide Burton, an occupational therapist, helps Soldiers employ some of these strategies to assist them with pain.

The key to pain is really self- awareness, Burton said. So through mindfulness meditation [patients] are able to internalize, doing a body scan, realizing that they may be holding tension in some of those muscles and learning how to relax them. So if they are going to have to live with chronic pain, they do not have to live with chronic pain on the high end, but they can learn to live with chronic pain on the low end of the pain scale.

Treatment of pain is an important part of the treatment for TBI, Giarrizzo said. Because you can give [patients] all kinds of cognitive strategies and put them through the program, but they continue to be preoccupied because their headache is so severe or their back pain is so severe.

To help Soldiers with sleep, occupational therapists like Burton assists Soldiers at the center improve their sleep hygiene and employ other strategies such as controlled breathing that result in Soldiers falling asleep faster and getting more sleep.

Liz Lee, a speech therapist, assists Soldiers with strategies for memory problems, planning issues, decision making, prioritization and communication issues.

Her patients often start multiple projects but are unable to finish any of them and many are easily distracted. She said since the center uses a holistic treatment approach, it can help provide treatment to Soldiers having issues with pain as well as trouble sleeping. Pain and lack of sleep contribute to cognitive problems, so by assisting Soldiers with those it makes the overall treatment more effective.

So with speech therapy around here we tend to work a lot on memory ... and executive functions, Lee said. That is your higher thinking skills planning, organizing, word finding, sequencing, those kind of tasks. We can give them so many strategies that are compensatory, so when they leave so many of them will say I feel like I have a better handle of how to organize myself.

Lee said that treating Soldiers and improving their ability to function is extremely rewarding at the end of the day.

Every Thursday morning the entire team gathers for a meeting to discuss patients and their progression through treatment, as well as any issues the patients experience, so the team can address any areas where the Soldier is not doing well. As Soldiers receive treatment, the program will retest the Soldiers to see if they are improving, including Soldiers giving feedback that indicates if the treatment is working.

Yes there are things they can improve on, but when we identify areas where they struggle and if they continue to struggle with, despite maximizing treatment, then we move into more of a we need to show you strategies to show how you get by, Giarrizzo said.

The staff at the Intrepid Spirit Center works to identify TBI associated problems, presents a treatment plan, follows up with the Soldier throughout treatment and monitors the Soldiers progress because successful treatment is meant to eventually culminate in the Soldier returning to duty. In the final phase of the program, Soldiers will go through a final test called a Military Functional Assessment Program.

The MFAP is where the Soldier spends a week and they will go out and do Soldier tasks, Giarrizzo said. Tactical combat, casualty care, warrior tasks, battle drills, putting on your gas mask If they pass, a letter is drafted and they are returned to their units for full duty.

Consolidating into a central facility and taking the multidisciplinary approach has resulted in care that efficiently provides treatment for patients, but it also allows the Army to maximize its combat readiness.

Anything that we can do to minimize the time patients spend away from their unit, anything we can do to get them back in the fighting force, even shorten it in any way or fashion improves readiness, Giarrizzo said. Anytime I can keep a Soldier on active duty [who has] been hurting, that treatment has been effective and were able to help achieve their goals through whatever strategies we come up with for them is an accomplishment for us.

FAST facts

More than 2.2 million people sustain traumatic brain injuries in the United States every year.

50,000 people die from a TBI every year.

Every 13 seconds someone in the United States sustains a TBI.

More than 5.3 million Americans live with TBI-related disabilities.

40.5 percent of TBIs are caused by falls.

-Brain Injury Association of America

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Intrepid Spirit Center tackles TBIs - The Fort Campbell Courier