1. An instrument of hope, healing, discovery, and learning

2. The National Intrepid Center of Excellence
Mission
We improve the lives of patients and families impacted by traumatic brain injury (TBI) through excellence and innovation
Vision
We aim to be a global leader in TBI care, research, and education
Guiding Principles
We are guided by the principles of excellence, innovation, compassion,
honor, and collaboration
May 2016

3. Founding the NICoE
In the wake of the wars in Iraq and Afghanistan, investigating TBI and its impact on PH is of high importance. The effects of combat-related TBI and PH conditions are expected to persist for years to come, making treatment and prevention advances extremely valuable. The NICoE opened in 2010 as a result of the generosity of the Intrepid Fallen Heroes Fund (IFHF), and continues to be an integral entity within the MHS continuum of care in the present day.
The IFHF, dedicated to the mission of helping service members and veterans, was established in This continued an effort begun in 1982 by Zachary and Elizabeth Fisher, founders of the Fisher House Foundation and the Intrepid Sea-Air-Space Museum in New York.
The Center for the Intrepid opened at Brooke Army Medical Center in 2007 for amputation prostheses and functional limb loss care.
The successful fundraising efforts of Zachary Fisher’s nephew, Arnold, have generated philanthropic contributions to the IFHF for advanced medical facilities for service members.
The NICoE is a gift from the American people through the IFHF, built at the WRNMMC in Maryland. The dedication ceremony was on June and treatment of patients began in October
The generosity of the IFHF has funded nine additional facilities, called Intrepid Spirit centers, which are located on major military bases throughout the country. They operate using a NICoE-influenced clinical care model with a focus on diagnosis and treatment.
May 2016

4. Medical Imperative: Challenging Comorbidity
TBI and PH conditions, such as Post-Traumatic Stress Disorder (PTSD), are complicated, and patients seen at the NICoE can have a combination of these conditions. Understanding the comorbid disease state is key to successful treatment.
The NICoE strives to find better ways to treat comorbid TBI and PH conditions through clinical interventions and contributes to knowledge and best treatment practices by researching areas of overlap.
Pain/Suffering
Comorbid symptoms may include:
Anxiety
Avoidance
Cognitive Deficits
Depression
Dizziness
Fatigue
Headache PH
TBI
May 2016

5. Clinical Programs Offered at the NICoE
NICoE Intensive Outpatient Program (IOP)
NICoE Outpatient Services
NICoE Evaluation
Track (NET)
Brain Fitness Center (BFC)
Patient Demographics:
Active-duty service members suffering from complex, comorbid TBI and PH conditions.
Program Description:
A four-week outpatient program with an innovative, interdisciplinary care model
Utilizes co-located teams of specialized providers
Patients meet with a team of providers that collects a comprehensive history, performs a clinical evaluation, and develops individualized patient- and family-centered treatment plans
Patient Demographics:
Active-duty service members, Guardsmen, Reservists, veterans, and their beneficiaries with mild, moderate, severe, and penetrating TBI.
Program Description:
An outpatient clinic that provides diagnostic evaluations and case management to ensure patients receive care that aligns with their sustained injury
Patients are able to attend treatment as long as clinical demands require
Patient Demographics:
Active-duty service members, TRICARE eligible adult beneficiaries, and veterans with a history of TBI.
Program Description:
A one-week evaluation program
A diagnostic and evaluation tool to provide clarity of TBI diagnosis and identify treatment recommendations
Patient Demographics:
Service members and beneficiaries with cognitive deficits. TBI not required.
Program Description:
Offers computer-based brain training programs, biofeedback, and mind-body opportunities for cognitive rehabilitation and enhanced mental performance
Investigates the effects of these programs through research protocols while supporting patients’ therapeutic goals and instilling healthy brain habits
May 2016

6. Clinical Capabilities
The NICoE delivers a broad range of patient- and family-centered assessment and treatment interventions, encompassing traditional medicine, advanced diagnostic techniques, and integrative medicine. NICoE TBI services include:
Acupuncture
Animal-Assisted Therapy
Art Therapy
Assistive Technology
Audiology
Biofeedback
Case Management
Cognitive Rehabilitation
Driving Assessment and Rehabilitation
Education
Family Counseling
Music Therapy
Neuroimaging
Neuropsychology
Nutrition
Occupational Therapy
Ophthalmology
Optometry
Physical Therapy
Primary Care
Psychiatry
Psychotherapy
Sleep Medicine
Speech Language Pathology
Spiritual Counseling
Vestibular Assessment and Treatment
May 2016

7. Typical Intensive Outpatient Program Experience
Weeks One and Two: Clinical Evaluation
Patients are exposed to the full spectrum of TBI services during Weeks One and Two. In partnership with their clinical team, the most effective treatment options are identified for patients’ unique health needs, and patients and families are educated on tools for TBI management and recovery.
This patient-centered care enables the clinical team to develop a tailored clinical treatment program for each patient, and support the patient in setting short- and long-term health care goals for the duration of the program and beyond.
Patients attend courses focused on improving confidence, setting goals, staying focused, and managing energy, which continues through Weeks Three and Four.
Weeks Three and Four: Treatment Planning and Family-Focused Participation, Now and Beyond
Based on evaluations and identified treatment options in Weeks One and Two, Weeks Three and Four are dedicated to establishing an effective individualized, ongoing treatment plan for the patient and family.
Families are also included in this time of exploration and planning, with the goal of providing the patient and their support system with the tools, skills, and education needed for sustained rehabilitation and reintegration.
Recommendations are shared with the patient, their family, and their home station treatment team to ensure continuity of care upon discharge.
May 2016

8. NICoE Outpatient Services
NICoE Outpatient Services identifies TBI and post-traumatic symptomatology
The program operates from a flexible, patient-centric model that provides individualized care and treatment plans for as long as medically needed
Rehabilitation team providers meet regularly to discuss and monitor patients’ needs
Treatments range from occupational and physical therapy to driving assessment and rehabilitation
May 2016

9. NICoE Brain Fitness Center
The BFC provides patients with computer- based brain training programs for cognitive rehabilitation and to enhance mental performance
The BFC instills healthy brain habits by providing cognitive-stimulating activities while supporting patients’ therapeutic goals
The BFC treats cognitive deficits from multiple causes including acquired brain injuries, psychological disorders, neurological diseases, and cognitive changes due to cancer-related treatments
May 2016

10. NICoE Inpatient Services
The NICoE inpatient consult service team (made up of a physician’s assistant, nurse practitioner, psychologist, and neurologist) sees every patient admitted to the hospital in wards and ICUs where there is concern of a sustained TBI and:
Provides a diagnosis
Helps the attending/primary care team manage issues (e.g. agitation, confusion, psychological distress)
Creates a discharge plan
Works with the family to understand the nature of the sustained TBI and potential impacts
The NICoE integration with WRNMMC included a functional integration with Ward 7-East. NICoE staff:
Work with admitted patients for case management services
Create an appropriate discharge plan
Provide continuity of care following discharge for local patients
Additionally, for those in another part of the NICoE care system, like the IOP, can be admitted to Ward 7-East if they experience a worsening of symptoms that require inpatient treatment.
Provides a diagnosis for what?
May 2016

11. NICoE Directorate Research
NICoE Directorate research is supported by the TBI Research Synergy Board (RSB), which was created to facilitate collaboration, maximize assets, and improve efficiency of TBI care and research efforts across the National Capital Region. The Uniformed Services University of the Health Sciences (USU), the NICoE Directorate, and the National Institutes of Health (NIH) collaborate through the RSB.
May 2016

12. Research Collaborations
Naval Hospital Camp Pendleton
Chronic Effects of Neurotrauma Consortium
Department of Veterans Affairs
Fort Belvoir Community Hospital
Naval Medical Center San Diego
Naval Medical Research Center
U.S. Army Medical Research and Materiel Command
U.S. Army Research Laboratory
Walter Reed Army Institute of Research
The Institute for Rehabilitation and Research (TIRR) Memorial Hermann
Intrepid Fallen Heroes Fund
Kessler Foundation
Drexel University
Harvard University
Northwestern University
University of Michigan
University of North Carolina
University of Pittsburgh
University of Utah
May 2016

13. Intrepid Spirit Centers
The generosity of the IFHF has funded nine additional facilities, called Intrepid Spirit centers, which are located on major military bases throughout the country. They operate using a NICoE-influenced clinical care model with a focus on diagnosis and treatment. Command and control of the Intrepid Spirit centers belongs to their respective Military Treatment Facility.
Open
Broken Ground
Future Site
Open for Patient Care:
Fort Belvoir, VA (September 2013)
Camp Lejeune, NC (October 2013)
Fort Campbell, KY (September 2014)
Fort Bragg, NC (January 2016)
Fort Hood, TX (March 2016)
Broken Ground:
Joint Base Lewis-McChord, WA (October 2015)
Future Sites:
Fort Bliss, TX (TBD)
Fort Carson, CO (TBD)
Camp Pendleton, CA (TBD)
May 2016