Corpsmen learn how to operate with the Marines at Field Medical Training Battalion - East and West.

A Navy Physician’s Perspective on Traumatic Brain Injury Programs [Remarks to Congress]

Capt. Thomas Johnson, director, Intrepid Spirit Concussion Recovery Clinic at Naval Hospital Camp Lejeune, provided the following opening remarks to the House Armed Services Committee Military Personnel Subcommittee during a hearing on post-traumatic stress disorder and traumatic brain injury clinical and research programs, April 27.

NEW-LOGO-FINAL-NAVAL-HOSPITAL-formatted-PARKER-131216Chairman Coffman, Ranking Member Speier, distinguished Members of the subcommittee, thank you for providing me with the opportunity to share my perspectives as the director of the Intrepid Spirit Concussion Recovery Clinic at Naval Hospital Camp Lejeune.

Marine Corps Base Camp Lejeune and the surrounding area are home to approximately 50,000 warfighters and their families. Traumatic brain injury, or TBI, has been described as the signature injury of the wars of Afghanistan and Iraq. Approximately 80 percent of all TBIs are classified as mild. Individuals who have sustained a mild TBI may only experience subtle changes in mood, memory, sleep and balance. They have no visible signs of their injury but are often struggling to function at work, home, and in the community.

I remember vividly when I met with a Marine sergeant and his wife in the clinic. I asked him about his medical issues, and he responded that he just wanted me to “fix him” so he could deploy again with his unit back to Iraq. I then asked his wife what problems she was having. After a long, awkward silence, she burst into tears and told me she hardly knew her husband anymore, and he hardly knew her, because he had changed so much after returning from deployment with a TBI.

A concussion - also known as a mild Traumatic Brain Injury (mTBI) - is a disruption of normal brain function that occurs when the skull is hit, suddenly thrust out of position, penetrated, or struck by an external force.
A concussion – also known as a mild Traumatic Brain Injury (mTBI) – is a disruption of normal brain function that occurs when the skull is hit, suddenly thrust out of position, penetrated, or struck by an external force.

Tragically, the war does not end for these families when the service member comes home. It goes on and on every day as they struggle heroically to overcome the trauma of war.

The reality is that there is currently no diagnostic tool that is sensitive and specific for mild TBI. However, we have worked to overcome this by developing a holistic, integrated, interdisciplinary treatment model that employs a standardized evaluation that includes physical, psychological, and spiritual dimensions. We then use this information to diagnose and treat each of our patients. We treat these service members like warrior athletes and employ both traditional therapies as well as complementary and integrative medicine, to return them to the highest level of function possible after their injuries. We use minimal amounts of medication, almost no narcotics, and over 90 percent of them return to full duty upon completing our program.

The great sacrifices made by warfighters and their families compel us to do everything in our power to support them on their road to recovery. Research in the prevention, diagnosis, and treatment of TBI is one way to fulfill this great obligation. The Military Health System, in partnership with civilian academic institutions, has a robust research portfolio to address gaps in knowledge and improve care for service members with TBI. For example, we have developed a progressive return to activity protocol that gives providers guidelines on how to gradually increase activity in individuals in a way that maximizes recovery.

We are committed to caring for people like the retired combat decorated master chief petty officer who was a patient at Intrepid Spirit. He had been exposed to hundreds of blasts during his career. After he retired, he noticed an insidious decline in his cognitive function, to the point where remembering where he was going when driving, and then even driving itself, became difficult for him. After extensive work up, it became apparent that he had a brain injury.

FMTB-West 1To this point, DoD has an ongoing longitudinal study on traumatic brain injury incurred by members of the armed forces in order to better understand what happens to individuals like the master chief so they get the treatment they need. Because Intrepid Spirit Camp Lejeune is located where service members live and work, we are uniquely suited to support these important efforts.

Every day, as we work with service members – Sailors, Marines, Soldiers, Airmen and Coast Guardsmen who have sustained a TBI – we are reminded of the urgency and the importance of our mission. On behalf of the staff at Naval Hospital Camp Lejeune and patients like the Marine sergeant and the master chief I mentioned, we are grateful to the committee for your strong support. Navy Medicine is privileged to work hard at something that is so important and so rewarding.

I look forward to you questions.