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

Intrepid Spirit Centers promote healing from traumatic brain injury

Image of Military health personnel in physical therapy. Clinical care for traumatic brain injury often involves a component of adaptive physical therapy (Photo by: Naval Hospital Camp Lejeune, Marine Corps Base Camp Lejeune, North Carolina).

Recommended Content:

Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury Center of Excellence | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Defense Intrepid Network for TBI and Brain Health

For service members or veterans with traumatic brain injury and associated health conditions, life can seem like a living hell.

However, the military is working hard to improve the quality of life for those experiencing traumatic brain injuries (TBIs). One way is through the Defense Intrepid Network for TBI and Brain Health. This network is made up of the National Intrepid Center of Excellence (NICoE) and 10 Intrepid Spirit Centers (ISCs), and provides interdisciplinary, comprehensive neurological, psychological, physical, and lifestyle programs to active duty service members with TBI and associated health conditions, including post-traumatic stress disorder (PTSD), anxiety, and depression.

According to the Defense Health Agency's Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The most common form of mild TBI in the military is concussion, but even that can create complications for service members on active duty.

The multi-disciplinary outpatient program for mild TBI at the ISC at Fort Hood, Texas, has 300 to 350 active patients. Each patient, based on their individual treatment plan, may have several appointments per week, and general outpatient treatment duration is approximately six months.

"Ours is a readiness platform to help service members get back into the fight," said Director Scot Engel.

"When the TBI occurs in theater, we conceptualize the injury as affecting the whole person," Engel said. "We then create an individualized and synchronized treatment plan that is delivered by a top-shelf transdisciplinary ISC team."

"Since the ISC is one integrated center, there is a plethora of services offered, such as medical, psychological, rehabilitative, and pain management subspecialties."

Fort Hood ISC also offers a six-week, 40-hour per week intensive outpatient program consisting of 75% group work and 25% individual specialty care. The group work includes adaptive physical therapy, stress management, mindfulness, sleep therapy, cognitive rehabilitation, PTS treatment, pain management, art, music, yoga, health and leisure, and nutrition.

"We provide everything over six weeks to help the service member to build a skill set to manage their symptoms," Engel said.

"We view the injury as a consequence of war," Engel said. Cognition, memory, sleep, hyperarousal, stress, and pain are all outcomes of the injury to the brain, he added.

"We integrate a model called 'The War Within'," he said. "The model is a theoretical framework to drive the care. The model provides a metaphor to conceptualize the enemy within and is attempting to isolate, marginalize, and stigmatize the soldier, and eventually drive them to take their own life.

Military personnel using art therapy
At Intrepid Spirit Centers service members may use art therapy as a modality within their individual treatment plan (Photo by: Madigan Army Medical Center, Joint Base Lewis-McChord, Washington).

"What we try to do is to get the patient to a place where they are able to take back control of their personal narrative and defeat the enemy within."

The treatment team reinforces that the service member is not "inadequate, defective, or broken," but rather is at war with the enemy within.

Engel explained that providers can increase their effectiveness by entering into the warrior culture and partnering with the service member.

"We try to frame our program in military language and how to win. It's a different way of understanding," he said. "We enter the culture of the warrior. We need to adapt and adjust to their culture to create a victory."

Four weeks after the program concludes, self-report measure for PTS, depression, and sleep are significantly improved, Engel noted.

Patients also take an objective neuropsychological standardized test called Microcog during the first two days of the program and after four weeks outside the program. Microcog is a computer-based measure of cognitive function that is task based and looks at nine cognitive domains: general cognitive functioning; general cognitive proficiency; information processing speed; information processing accuracy; attention/mental control; reasoning/calculation; memory; spatial processing; and reaction time.

The Department of Defense uses a similar test for all soldiers preparing to deploy called ANAM, or Automated Neuropsychological Assessment Metric.

"We see highly statistical and clinically significant improvements in six of nine neuropsychological domains," Engel said.

One reason for service members' success is that they “have learned to modulate their affect," and as a result, their cognitive functioning seems to have improved, Engel noted.

"Their brain seems to be able to perform and function better on objective measures," he said. "The psychological 'noise' and pain become more manageable because of the simultaneous care provided."

Service members are aware of the model of care before deployment.

U.S. Public Health Service Capt. Alicia Souvignier, director, Warrior Recovery Center/ISC at Fort Carson in Colorado, explained that "service members are briefed pre- and post-deployment on concussions and the services of the ISC. We also have relationships with primary providers and behavioral health teams that refer patients to our clinic."

The outpatient recovery center at Fort Carson offers services in neurology, physical medicine, neuropsychiatry, social work, physical therapy, occupational therapy, speech language pathology, and music therapy to patients who have had more than one concussion in the past year or have symptoms of TBI/PTS.

It offers individual treatment for issues affecting the patient, including memory, attention, emotional well-being, anger management, dizziness/balance, sleep, and vision. There is also a six-week IOP that addresses symptoms of TBI in the interdisciplinary format.

Patients at ISCs have access to a nationwide TBI portal "that allows us to manage each patient's plan of care, track the patient, and regularly check in on progress of the patient toward goals," Souvignier said. “The portal also allows us to produce a comprehensive discharge plan to do a warm hand-off to the patient's primary care manager."

Each ISC uses the others as resources and "we are truly a team," she said; however, "each post has a different population and different resources, so the same solution doesn't always work everywhere."

A map showing where all the Intrepid Spirit Centers are located
Intrepid Spirit Centers are located at military bases in seven states, with planned expansions of two more ISCs. The National Intrepid Center of Excellence is located at Walter Reed National Military Medical Center in Bethesda, Maryland (Photo by: Defense Intrepid Network for TBI and Brain Health).

There are 10 state-of-the-art ISCs across the country. In addition to Fort Hood and Fort Carson, there are ISCs at Eglin Air Force Base, Florida; Camp Pendleton, California; Fort Bliss, Texas; Fort Campbell, Kentucky; Fort Bragg, North Carolina; Fort Belvoir, Virginia; Joint Base Lewis-McChord, Washington state; and Camp Lejeune, North Carolina. The overarching NICoE is located at Walter Reed National Military Medical Center in Bethesda, Maryland.

Dr. Thomas DeGraba, chief innovations officer of the NICoE, stressed the importance of the interdisciplinary model of care used across ISCs.

"We created NICoE as a proof of concept that an interdisciplinary, holistic, and patient-centric outpatient program can heal mind, body, and spirit from the invisible wounds of war," he said. "The model of care allows each ISC team to build a care plan for the individual service member."

Prior to the creation of the NICoE in September 2010, one of the biggest problems among the service members was the stigma of TBI and PTSD, DeGraba explained. "The feeling was that patient recovery could only plateau to a certain extent. Our mission was to break down that misconception."

The research done from interactions with the service members who participate in the program helps inform clinical practice guidelines for TBI that are a combined effort, not just for military specialty clinics, but for primary care physicians and neurologists in civilian practice, DeGraba expounded.

"The end goal is to place service members on a path to heal the brain from traumatic injury and psychological health conditions and allow service members to return to full active duty and be in control of those things that were taken from them in combat.

You also may be interested in...

On National Concussion Awareness Day, Learn the Truth about TBI

Article
9/16/2022
A mountain biker wearing a helmet bikes through hard terrain.

Separate the myths and truths around TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence

A History of the Combat Helmet and the Quest to Prevent Injuries

Article
4/25/2022
Lt. Gen. George S. Patton and Brig. Gen. Theodore Roosevelt Jr. are pictured here in 1943 wearing the standard M1 helmet, sometimes called the "steel pot." (Photo: 1st Infantry Division Courtesy Photo)

The combat helmet has evolved over time to improve protection against projectiles and shock waves to reduce the risk of fatal blows and traumatic brain injuries.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Our History | Injury Prevention

Concussion Care Pathway Streamlined for Better Results

Article
4/1/2022
Dr. Gregory Johnson, Tripler Concussion Clinic medical director, conducts a neurological exam on Army Spc. Andrew Karamatic, a combat medic, having him follow his finger with his eyes, at Tripler Army Medical Center, in Honolulu, Hawaii. Neurologic exams are part of the MACE 2 diagnostic tool to assess service members’ Acute Concussion Care Pathway. (Photo: Army Staff Sgt. Christopher Hubenthal, DMA Pacific – Hawaii Media Bureau)

The Defense Health Agency has developed a comprehensive clinical care program (Acute Concussion Care Pathway) to manage concussions based on the military medical community’s many years of experience with injured service members.

Recommended Content:

Traumatic Brain Injury Center of Excellence

Brain-Boosting Meal Plans Help Service Members with TBI

Article
3/30/2022
During the NICoE intensive outpatient program (IOP), staff nutritionist Ruth Clark teaches hands-on classes in the on-site patient kitchen. (Photo: Tahira Hayes (Ctr), NICoE/WRNMMC, NSA Bethesda)

Research has shown that dietary changes may help relieve symptoms that might complicate recovery from a traumatic brain injury (TBI), such as chronic pain, anxiety, depression, and sleep problems.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Nutritional Fitness | Total Force Fitness

Immediate Testing: How the Military Evaluates Risk For Brain Injuries

Article
3/28/2022
Pfc. Thomas Icenogle, a student in the Army’s Combat Medic Specialist Training Program at the Medical Education and Training Campus on Joint Base San Antonio-Fort Sam Houston, Texas, conducts a Military Acute Concussion Evaluation 2 (MACE 2) on Pvt. Alejandro Leija, while Pvt. Dominic Dubois refers to the MACE 2 card. (Photo: Lisa Braun, Medical Education and Training Campus Public Affairs)

MACE 2 allows for a quick assessment of traumatic brain injuries in the field and is similar to sports concussion checks.

Recommended Content:

Traumatic Brain Injury Center of Excellence

Five Clinical Tools To Help Assess and Treat TBI

Article
3/17/2022
An Army 'gun team' brace for the concussion of a 105mm howitzer during operations in Iraq in 2008. (Photo: Master Sgt. Kevin Doheny)

Here are five new ways that doctors can diagnose and treat mild concussions.

Recommended Content:

Traumatic Brain Injury Center of Excellence

Ask the Doc: Can a Concussion Affect Hearing and Vision?

Article
3/16/2022
Elizabeth Kirkpatrick, a physical therapist for the Fort Drum Traumatic Brain Injury (TBI) Clinic, New York, uses a model of the inner ear on Feb. 27, 2019, to demonstrate how a concussion can cause inner ear, or vestibular, damage which may result in dizziness, anxiety, depression, moodiness, balance problems and irritability to name a few. (Photo: Warren W. Wright Jr., Fort Drum MEDDAC)

Even a mild concussion can lead to hearing and vision problems.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | Vision and Hearing Loss Prevention | Hearing Center of Excellence | Vision Center of Excellence | Vision and Hearing Loss Prevention | Ask The Doc

Tackling Concussions: NCAA-DOD CARE Consortium Battles Brain Injuries

Article
1/6/2022
Naval Academy football team runs onto the field

Dr. Paul Pasquina and Dr. Terry Rauch recently discussed the NCAA-DOD Concussion Assessment, Research and Education (CARE) Consortium, the largest concussion and repetitive head impact study in history, on the NCAA’s “Social Series.”

Recommended Content:

Uniformed Services University of the Health Sciences | Traumatic Brain Injury Center of Excellence | Medical Research and Development | Injury Prevention

USU Co-leads Largest NCAA-DOD Concussion Study in History

Article
10/8/2021
A doctor looks at a patient's prosthetic arm.

The Uniformed Service University will co-lead the next phase of the largest concussion and repetitive head impact study.

Recommended Content:

Traumatic Brain Injury Center of Excellence

Back from the Brink: One Marine's Recovery from Suicidal Thoughts

Article
9/29/2021
Portrait photo of John Peck

After suffering a TBI in Iraq and losing all four limbs in Afghanistan, Marine Sgt. John Peck talks about his own experience and the differences in the ways in which individuals deal with traumatic life events.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Suicide Prevention Toolkit | Suicide Prevention | Mental Health is Health Care

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

Article
9/28/2021
Picture of blast waves during an explosion

A clear link between blast-related concussions and mental health symptoms like depression, anxiety, and PTSD, is shown in a series of recent studies.

Recommended Content:

Traumatic Brain Injury Center of Excellence

NICoE, NHRC Team Up To Make CAREN Technology Portable

Article
8/12/2021
A person walks in front of a large virtual reality screen.

Head-mounted display technology has become more affordable and accessible

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury Center of Excellence | The National Intrepid Center of Excellence

Caregiver Guide supports service members and veterans with TBI

Article
7/22/2021
Military family posing for a picture

Traumatic Brain Injury Center of Excellence’s 2021 Caregiver Guide provides specific tools to help caregivers manage TBI patient recovery.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury Center of Excellence | Education & Training Events

Aphasia, Caused by Stroke or TBI, is Frustrating and Little Known

Article
6/29/2021
A doctor looking at brain scans

Aphasia is an incurable disease usually caused by stroke that affects all forms of communication.

Recommended Content:

Total Force Fitness | Heart Health | Centers of Excellence | Traumatic Brain Injury Center of Excellence

Signs and symptoms of a stroke, and what to do about them

Article
5/18/2021
Infographic about the sign of a stroke

For Stroke Awareness Month, we highlight some of the most important facts about strokes in men and women.

Recommended Content:

Health Readiness & Combat Support | Traumatic Brain Injury Center of Excellence
<< < 1 2 3 > >> 
Showing results 1 - 15 Page 1 of 3
Refine your search
Last Updated: September 01, 2022

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.