Back to Top Skip to main content Skip to sub-navigation

The NICoE: Ten years of Healing ‘The Invisible Wounds of War’

Image of man hooked up to machine and walking on treadmill The National Intrepid Center of Excellence at Walter Reed National Military Medical Center houses the Computer Assisted Rehabilitation Environment (CAREN), a magnetoencephalography (MEG) machine used to analyze and train patient movement for peak efficiency and optimal execution. (WRNMMC photo).

Recommended Content:

Traumatic Brain Injury | Posttraumatic Stress Disorder | Centers of Excellence

The National Intrepid Center of Excellence first opened its doors to patients in June 2010, and Military Health System officials celebrated the 10th anniversary of the center, dedicated to advancing the nation’s understanding of and healing the invisible wounds of war, during a ceremony June 25 at the facility.

The interdisciplinary model of care developed at the NICoE, a part of Walter Reed National Military Medical Center, brings together neurologists, psychologists, family care doctors, psychiatrists, nutritionists, neuropsychologists, therapists, specialists and other professionals under one roof. This team collaborates in the diagnosis, treatment and care of MHS beneficiaries affected by traumatic brain injury (TBI) or those who may exhibit symptoms of post-traumatic stress (PTS). Their efforts have proven effective and allowed more than 90 percent of patients treated at the NICoE to continue on active duty in the armed forces, according to NICoE officials.

Research, treatment modalities and services at the NICoE include neuroimaging, art therapy, music therapy, animal-assisted therapy, audiology and vestibular care, a brain fitness center, driving assessment and rehabilitation, family education, and other complementary and integrative medicine techniques such as biofeedback, acupuncture and yoga. This Center of Excellence also houses the Computer Assisted Rehabilitation Environment, a magnetoencephalography machine used to analyze and train patient movement for peak efficiency and optimal execution, and a 3T Magnetic Resonance Imaging scanner, which provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging and echo planar imaging sequences.

Last year, more than 2,000 patients received care from NICoE providers in more than 34,000 clinical encounters in the four-week Intensive Outpatient Program, in TBI outpatient services, and in collaboration with inpatient teams from other WRNMMC directorates, figures from NICoE indicate.

Man painting a mask
The National Intrepid Center of Excellence at Walter Reed National Military Medical Center, which is celebrating its 10th anniversary this year, offers patients affected by traumatic brain injury and post-traumatic stress, driving assessment and rehabilitation, in addition to a number of other treatment modalities. (WRNMMC photo)

Navy Capt. (Dr.) Walter Greenhalgh, NICoE director, credited “the persistent, strong advocacy of leadership from WRNMMC, the National Capital Region Market, the Defense Health Agency and the Department of Defense” for NICoE’s ability to provide “safe, reliable and innovative” health care to the nation’s heroes and their families. He added that, WRNMMC’s leadership has “held a spotlight on NICoE while continuously pushing the NICoE team to strive to be the best that it can be, guiding NICoE to make the most of the amazing resources it’s been granted by the American people, while integrating TBI into the MHS’s Pathway of Care.”

“The WRNMMC leadership has held NICoE to the same high standards of safe, quality health care as they have with the rest of the hospital because the most deserving of patients and their families deserve nothing less,” Greenhalgh said. He added, how the standard of care has extended nationwide through the NICoE network of facilities and providers in the Intrepid Spirit Centers.

Dr. Thomas DeGraba, chief innovation officer and deputy director of NICoE, said what has remained unwavering since the center first opened its doors, is “the outstanding dedication and expertise of the NICoE staff to do what’s necessary at any cost to be able to help service members recover from the injuries they sustained in the protection of this country.”

DeGraba added that, NICoE helped break down the stigma of those treated for TBI and PTS. He explained how TBI and PTS were once thought to be untreatable, and troops were medically dischargedout of the service without a good strategy for recovery.

“This center, along with a number of colleagues through the MHS, have proven [TBI and PTS are treatable],” DeGraba said. “The brain does heal, and service members can come up with strategies to be able to deal with those stressors that have caused them challenges so they can get back to productive lives, as well as get back to the interpersonal relationships with their families and friends that many times are disrupted by TBI and psychological health issues,” he furthered.

Army Col. (Dr.) Andrew Barr, WRNMMC director, also saluted NICoE and its staff for its 10 years of serving the nation, its heroes and their families.

“These past few months and this global pandemic have shown us just how adaptable and resilient we can be in times of great uncertainty and change. NICoE has led the way at this time with innovative approaches to maintain our missions,” Barr said. He added that this is indicative of NICoE achieving countless examples of excellence during his decade-long history.

“The words ‘Center of Excellence’ are more than just buzz words,” Barr continued. “You are a center of excellence in the truest definition of the term. This is reflected in the patient care, research and education that happens here every day, and the tangible, positive improvements made in the lives of our patients and their families.”

“NICoE’s guiding principles of excellence, innovation, compassion, collaboration and honor are evident in all that you do, and your patient- and family-centered holistic approach to TBI research and care, serve as a model throughout the MHS and for many other health organizations across the globe,” Barr concluded.

In an interview published in the February 2015 National Geographic focused on “Healing Our Soldiers, Unlocking the Secrets of Traumatic Brain Injury,” Army Staff Sgt. Perry Hopman discussed how NICoE’s arty therapy program helped him.

Hopman, who served as a flight medic in Iraq, said about the art therapy, “I think this is what started me kind of opening up and talking about stuff and actually trying to get better.”

You also may be interested in...

Concussion Awareness V1

Infographic
8/3/2021
Social media infographic on September 17

According to the Defense Health Agency Traumatic Brain Injury Center of Excellence (TBICoE), 439,609 service members have been diagnosed with a first-time TBI since 2000. The most common form of TBI in the military is mild, and is also known as a concussion.

Recommended Content:

September Toolkit | Traumatic Brain Injury

Did You Know? Concussions - Mild TBI

Infographic
8/3/2021
Social media infographic for concussions

Concussions are the most common form or Traumatic Brain Injury in the Military. Be TBI ready!

Recommended Content:

September Toolkit | Traumatic Brain Injury

Brain Injury Awareness Month "Be TBI Ready" Infographic

Infographic
2/24/2021
March is Brain Injury Awareness Month. Be TBI Ready. A traumatic brain injury—or TBI—is a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as: mild, moderate, severe, or penetrating.

During Brain Injury Awareness Month, TBICoE and the MHS will promote the theme “Be TBI Ready” — recognizing that health care providers and others in the military community need to be aware of the latest educational trainings, research, fact sheets, and other available resources to prevent, diagnose, and treat TBI.

Recommended Content:

Brain Injury Awareness Month | Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBI Educators | Brain Injury Awareness Toolkit

Returning to Duty After Concussion

Infographic
2/24/2021
What's the best way to recover from a concussion? Returning to duty too soon after a concussion can lead to prolonged symptoms, decreased readiness, poor marksmanship, accidents and falls, and increased risk of more concussions. Progressively increasing activity in a step-wise manner can help you resolve your symptoms and return to duty safely. Ask your primary health care provider about TBICoE's Progressive Return to Activity to help you return to duty as quickly and safely as possible. Visit health.mil/TBICoE.

This TBICoE infographic gives an overview of the risks of returning to duty too soon after a concussion and explains how a progressive increase in activity can help get you back to duty safely. Returning to duty too soon after concussion can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of more concussions.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Provider Resources | Brain Injury Awareness Toolkit

Sleep After Concussion

Infographic
2/18/2021
Sleep After Concussion. Service members with TBI report 3 times more sleep problems. TBIs can happen anywhere, only 16.9 percent of TBIs happen while deployed. Visit health.mil/TBIFactSheets to learn more about sleep problems and how to improve them

"Sleep After Concussion" is intended for patients and caregivers of those who have sustained a TBI. The infographic reviews general information of sleep-related concerns and points towards additional educational resources.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Traumatic Brain Injury | Sleep | Brain Injury Awareness Toolkit

Sleep After mTBI

Infographic
11/19/2020
Sleep After mTBI

"Sleep After mTBI" is intended for providers to show the importance of screening and treating service members affected by sleep issues following mTBI.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Provider Resources | Brain Injury Awareness Toolkit | Sleep

Seizures among Active Component service members, U.S. Armed Forces, 2007 – 2016

Infographic
1/25/2018
This retrospective study estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. It also attempted to evaluate the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD. Seizures have been defined as paroxysmal neurologic episodes caused by abnormal neuronal activity in the brain. Approximately one in 10 individuals will experience a seizure in their lifetime. Line graph 1: Annual crude incidence rates of seizures among non-deployed service members, active component, U.S. Armed Forces data •	A total of 16,257 seizure events of all types were identified among non-deployed service members during the 10-year surveillance period. •	The overall incidence rate was 12.9 seizures per 10,000 person-years (p-yrs.) •	There was a decrease in the rate of seizures diagnosed in the active component of the military during the 10-year period. Rates reached their lowest point in 2015 – 9.0 seizures per 10,000 p-yrs. •	Annual rates were markedly higher among service members with recent PTSD and TBI diagnoses, and among those with prior seizure diagnoses. Line graph 2: Annual crude incidence rates of seizures by traumatic brain injury (TBI) and recent post-traumatic stress disorder (PTSD) diagnosis among non-deployed active component service members, U.S. Armed Forces •	For service members who had received both TBI and PTSD diagnoses, seizure rates among the deployed and the non-deployed were two and three times the rates among those with only one of those diagnoses, respectively. •	Rates of seizures tended to be higher among service members who were: in the Army or Marine Corps, Female, African American, Younger than age 30, Veterans of no more than one previous deployment, and in the occupations of combat arms, armor, or healthcare Line graph 3: Annual crude incidence rates of seizures diagnosed among service members deployed to Operation Enduring Freedom, Operation Iraqi Freedom, or Operation New Dawn, U.S. Armed Forces, 2008 – 2016  •	A total of 814 cases of seizures were identified during deployment to operations in Iraq and Afghanistan during the 9-year surveillance period (2008 – 2016). •	For deployed service members, the overall incidence rate was 9.1 seizures per 10,000 p-yrs. •	Having either a TBI or recent PTSD diagnosis alone was associated with a 3-to 4-fold increase in the rate of seizures. •	Only 19 cases of seizures were diagnosed among deployed individuals with a recent PTSD diagnosis during the 9-year surveillance period. •	Overall incidence rates among deployed service members were highest for those in the Army, females, those younger than age 25, junior enlisted, and in healthcare occupations. Access the full report in the December 2017 MSMR (Vol. 24, No. 12). Go to www.Health.mil/MSMR

This infographic documents a retrospective study which estimated the rates of seizures diagnosed among deployed and non-deployed service members to identify factors associated with seizures and determine if seizure rates differed in deployment settings. The study also evaluated the associations between seizures, traumatic brain injury (TBI), and post-traumatic stress disorder (PTSD) by assessing correlations between the incidence rates of seizures and prior diagnoses of TBI and PTSD.

Recommended Content:

Health Readiness | Posttraumatic Stress Disorder | Armed Forces Health Surveillance Division | Medical Surveillance Monthly Report

Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

Infographic
4/4/2017
Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

Recommended Content:

Traumatic Brain Injury
Showing results 1 - 8 Page 1 of 1

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.