Veteranclaims’s Blog

September 27, 2010

National Naval Medical Center Treats TBI, PTSD, Substance Abuse all in One Place at One Time

This may be one of those little known but highly successful units that will be a godsend to some of the veterans out there suffering from multiple medical problems but for which there has not been a single source ready to deal with those multiple problems all within one unit

National Naval Medical Center’s psychological health and traumatic brain injury team

“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.”

Full Article at:
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.

Click photo for screen-resolution image
Valerie Wallace, right, calls the psychological health and traumatic brain injury team at the National Naval Medical Center in Bethesda, Md., a godsend in helping wounded warriors like her son, Army Sgt. John Barnes, left, deal with the unseen scars of war. Courtesy photo
(Click photo for screen-resolution image);high-resolution image available.
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.”

NNMC Practices Innovative TBI Approach
Story Number: NNS100812-04 Release Date: 8/12/2010 1:31:00
By Mass Communication Specialist 3rd Class Timothy Wilson, National Naval Medical Center Public Affairs

BETHESDA, Md. (NNS) — “National Naval Medical Center behavioral health providers have using an innovative approach to meet the needs of service members who face a long road to recovery.

Traumatic brain injury (TBI) patients often have multiple problems, including a wide array of physical wounds coupled with mental health issues, that need to be addressed simultaneously.

“Our mission is to screen every incoming casualty for the presence of TBI and other psychological or psychiatric complications of combat,” said Dr. David Williamson, NNMC Inpatient Psychological Health/Trau-matic Brain Injury (PH/TBI) program medical director.

Williamson said when a patient arrives to NNMC with a head injury; they first receive lifesaving care to stabilize their condition. In addition, every patient meets with a psychiatrist upon their arrival, regardless of injury type. The PH/TBI team practices a revolutionary policy of not waiting until people have trouble.

“We want behavioral health providers involved the minute the patient arrives at Bethesda,” said Williamson. “Alongside the trauma surgeons, our team is going in to evaluate the injuries and we are trying to predict and plan ahead what types of problems the patient will have from their brain injuries, so we can put services in place ahead of time.”

This approach has evolved after many years of developing the best practices to help the patients on their road to recovery. The inpatient unit officially began using this method of having an open line of communication between the behavioral health providers and medical doctors in April 2009.

“We will take a look at your pain, your wound, all the physical medicine rehab and psychological [aspects] all at the same time,” said Williamson. “You need balance and having everyone working together is the model that really has made the difference.”

The team also opens and maintains lines of communication with the patient’s family, teaching them how to adjust to life after injury.

“Sometimes family members need some special treatment or a referral for some special support,” said Williamson. “We do education, teaching about TBI and the other psychological health [issues] that we treat.”

Williamson said this is important because TBI symptoms may not be obvious for years. More than 50 percent of the patients the PH/TBI treats are outpatients years after their initial injury.

Brain injuries can create difficult medical problems to solve, said Williamson. The repercussions resulting from a TBI may include difficulties with balance and coordination, hearing and understanding speech, limb movement difficulties and loss of vision.

“[Post Traumatic Stress Disorder] PTSD isn’t the only psychological consequence of combat,” said Williamson. “We are interested in the higher brain functions as well [such as] memory, the ability to organize and multi-task, what controls personality and emotional regulation.”

Different areas of the brain control different functions of the body. The location of the injury will determine how the body is affected. This immediate evaluation will allow the behavioral health doctors to determine the best treatment options, he added.

“We are looking at what does the brain injury mean for this person, what things are affected, [and] what do we need to do to help them succeed in their rehabilitation,” said Williamson.

Brain injuries are a life-long condition because the brain tissue cannot regenerate, unlike a broken fracture or a skin wound, said Williamson.

“It’s not that we fix the injuries so the patient can perform the way they did before the injury, we change people’s expectations,” said Williamson. “Changing their ways of thinking can make a huge difference for the [patient] and their families.”

The PH/TBI staff consists of more than 80 specialists and support staff. At least twice a week, they will meet with a patient’s medical doctors to assess the status of the patient. This is to ensure that one treatment plan or medication from one doctor will not interfere with that of another.

“This multidisciplinary model of treatment with psychiatrists and psychologists in the same team as surgeons and rehab doctors is new and not practiced anywhere else in the world,” said Williamson.

This approach has drawn national media attention to the PH/TBI clinic at NNMC due to the success of the program.

For more news from National Naval Medical Center, visit”

1 Comment »

  1. TBI and PTSD will be major themes of up coming After Shock: Humanities Perspectives on Trauma conference, Nov 12-13, Washington DC.“Who Am I?” The Essence of Identity After Traumatic Brain Injury is one of conference workshops.

    Comment by victoria bonebakker — October 7, 2010 @ 9:19 pm

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