Skip to main content

Military Health System

Test of Sitewide Banner

This is a test of the sitewide banner capability. In the case of an emergency, site visitors would be able to visit the news page for addition information.

Defense Intrepid Network Supports Service Members Across the Continuum

Image of U.S. Marine Staff Sgt. Anthony Mannino plays guitar as he receives music therapy as part of his traumatic brain injury treatment and recovery. Kalli Jermyn, a music therapy intern, observes, instructs, and works with Mannino. The therapy is conducted at the National Intrepid Center of Excellence, at the Walter Reed National Military Medical Center in Bethesda, Maryland. (Department of Defense photo by Marvin Lynchard). U.S. Marine Staff Sgt. Anthony Mannino plays guitar as he receives music therapy as part of his traumatic brain injury treatment and recovery. Kalli Jermyn, a music therapy intern, observes, instructs, and works with Mannino. The therapy is conducted at the National Intrepid Center of Excellence, at the Walter Reed National Military Medical Center in Bethesda, Maryland. (Department of Defense photo by Marvin Lynchard)

The Defense Intrepid Network for TBI and Brain Health’s Continuum of Caring, Healing, and Thriving initiative, headquartered at the National Intrepid Center of Excellence in Bethesda, Maryland, is a comprehensive interdisciplinary approach to address the full continuum of traumatic brain injury, behavior health, and brain health.

Over the past 22 years, more than 468,000 service members have sustained a TBI. The majority of TBI events occur in training: Breaching, anti-tank weapon use, combatives, parachute jumping, and blast exposure, according to the Traumatic Brain Injury Center of Excellence.

This high rate of TBI affects the readiness of the U.S. armed forces. To ensure a medical ready force, we must engage service members prior to an initial TBI event. This is the beginning of the continuum of care.

“We know the service members at highest risk for TBI and associated conditions and recognize the importance of preparing them for the careers they go into,” said U.S. Navy Capt. Carlos Williams, director of the NICoE. “In fact, to gain a better understanding of how widespread brain injuries are and the impact these injuries can have on our service members, we should also begin to more closely engage our aviation and undersea communities.”

“During this pre-TBI phase, we must use foundational tools such as education, integrative health services, and other best practices to build resilience and, when possible, prevent the event or complications altogether,” he said.

A goal of the continuum of care is to partner with the operational community and others in the TBI clinical, research, and academic spaces to educate service members and their families about TBI, its effect on brain function, and activities to help restore the brain immediately after an injury or after having persistent symptoms for many years.

In addition, service members can be taught elements of the integrative health services that are a part of the Defense Intrepid Network’s patient-centric interdisciplinary care model. These may include yoga, meditation, breath work, and art therapy to help process fragmented trauma memories and be used life-long to address future trauma and build resiliency, said Dr. Thomas DeGraba, chief innovations officer for the NICoE.

The continuum aligns with the Warfighter Brain Health Initiative that supports prevention and establishes resilience in the pre-TBI state.

The five lines of effort of the Warfighter Brain Health Initiative are:

  • Optimize cognitive and physical performance
  • Identify, monitor, and mitigate brain exposures
  • Prevent, recognize, and minimize the effect of TBI
  • Reduce or eliminate long-term/late effects
  • Advance warfighter brain health science

The next step in the continuum of care is treating those with TBI. For service members who visit the NICoE, one of the 11 Intrepid Spirit Centers or two clinics in the Defense Intrepid Network, the interdisciplinary care model enhances their trajectory of recovery with skills-based training and education. Patients can go at their own pace and process things in a safe environment at one of the ISCs or clinics.

After treatment, the continuum facilitates continued healing, recovery, and the transition to full duty or civilian life through a network of partnerships across the Department of Defense, Department of Veterans Affairs, non-governmental military and veterans support organizations, academia, industry, and the TBI community.

These partners provide top quality follow-up care, case management, peer support groups, and other services to assist in healing and thriving.

“Any organization that offers resources to our beneficiaries, we hope to identify them and help our members take advantage of those resources. Simply put, the continuum ensures that we prepare for, treat when needed, and continue to support lifelong recovery so that no one is left behind,” said Williams.

It also means continually evaluating how service members respond to care in the Defense Intrepid Network, which leads to constant updating of best practices throughout the continuum.

“I am excited for the future of the Defense Intrepid Network,” said Williams. “It is built on inclusiveness and allows participation from providers and experts across the Military Heath System and beyond to contribute to improving care and quality of life of our service members.”

You also may be interested in...

Intrepid Voices Newsletter March 2023

Publication
3/1/2023

Intrepid Voices Newsletter, March 2023 is a product of the Defense Intrepid Network for TBI and Brain Injury.

NICoE Deputy Director Receives Department of Defense's Highest Civilian Honor

Article
1/27/2023
U.S. Army Lt. Gen. (Dr.) Ronald J. Place  and Dr. Louis French at award ceremony

The work of one of the Department of Defense’s foremost experts on the treatment of traumatic brain injury was recently honored with the department's highest award given to career DOD civilian employees.

Art Therapy at the National Intrepid Center of Excellence

Video
3/23/2022
Art Therapy at the National Intrepid Center of Excellence

Adrienne Stamper, an art therapist at the National Intrepid Center of Excellence (NICoE), provides a window into the process of healing through art therapy. Art therapists are master’s-level behavioral health professionals who are trained to use art as a vehicle for non-verbal thoughts, emotions, and experiences. At NICoE, the service members have freedom of self-expression and use a wide range of media such as painting, sculpting, drawing, wood-burning, collaging, and creative writing. Stamper explains the scientific basis for why traumatic survivors struggle to put their experience into words, and how art therapy can enable them to find their voice. By working with imagery, the emotional brain, and the physical body, art therapy helps to integrate and restore a sense of control over these painful memories. Stamper walks us through the studio, sharing stories of service members who found healing through art therapy, and shows us the faces of the invisible wounds of war.

Dance and Movement Therapy at the National Intrepid Center of Excellence

Video
3/16/2022
Dance and Movement Therapy at the National Intrepid Center of Excellence

Liz Freeman, lead dance/movement therapist; and Kristine Keliiki, dance/movement therapist at the National Intrepid Center of Excellence (NICoE), discuss the many ways they use dance movement therapy (DMT) to help patients at the NICoE. DMT is the psychotherapeutic use of movement to promote emotional, social, cognitive, and physical parts of a person in order to improve health and well-being. This brings the body into the treatment process to address behavioral health and rehabilitative goals. Freeman and Keliiki also discuss the history of DMT, citing its birth through a dance for communication program in the Federal Psychiatric Hospital St. Elizabeth’s in the 1940s. March 13 to 19 is Creative Arts Therapies Week. To celebrate, the NICoE created videos highlighting a day in the life of some of our creative art therapies at the NICoE. This video is part of a multipart series.

Music Therapy at the National Intrepid Center of Excellence

Video
3/16/2022
Music Therapy at the National Intrepid Center of Excellence

Nate McLaughlan is a board-certified music therapist at the National Intrepid Center of Excellence (NICoE). In this video, he discusses the many way music therapy can help patients at the NICoE. He explains that music therapy uses music-based experiences to address identified symptoms and goals with a music therapist who is trained to use elements of music to promote physical, mental, and social health. McLaughlan also describes the different approaches he takes with NICoE patients. They vary from introducing someone to playing an instrument for the first time, revisiting an instrument, figuring out listening strategies, organizing an intentional playlist, and writing music. The music therapy program at the NICoE helps service members and their loved ones connect with themselves and others through music listening, discussion, and making. A unique part of the NICoE music therapy program is each cohort of service members experience interventions as a group, helping ease them into this journey together. March 13 to 19 is Creative Arts Therapies Week. To celebrate, the NICoE created videos highlighting a day in the life of some of our creative art therapies at the NICoE. This video is part of a multipart series.

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

TRIP initiative bridges the gap between TBI research, clinical care

Article
5/13/2021
a statue of a broken circle

The Defense Intrepid Network launches the TRIP initiative to translate research findings into clinical practice.

MHS Minute March 2021

Video
4/1/2021
MHS Minute March 2021

March marked Brain Injury Awareness month in the military. We're spotlighting efforts across the MHS to combat Traumatic Brain Injury (TBI), and better understand how TBI impacts our Service members. For more information about the National Intrepid Center of Excellence (NICoE), go to walterreed.tricare.mil/NICoE For more info on the Traumatic Brain Injury Center of Excellence (TBICoE), go to Health.mil/TBICoE

New NICoE director sets an ambitious agenda for the future

Article
3/8/2021
Military personnel wearing face mask while talking to each other

The accomplished new leader of the NICoE and Intrepid Spirit Center network has plans for increased services and a higher profile for the unique care center.

Page 1 of 1 , showing items 1 - 9
Refine your search
Last Updated: March 10, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery