New Air Force clinic to offer interdisciplinary approach to treating TBI and other invisible wounds Published April 4, 2017 By Peter Holstein Air Force Surgeon General Public Affairs FALLS CHURCH, Va. -- The Air Force is creating a new clinic that specializes in the treatment of invisible wounds, with an emphasis on traumatic brain injury, post-traumatic stress disorder and pain. The facility will be located at Eglin Air Force Base in Florida. It is still in the early planning phase, with the hope it will open in the summer of 2018. It will use an interdisciplinary team approach to treat invisible wounds, incorporating providers with many different specialties into the care team. Invisible wounds often appear as “comorbid” conditions, meaning they occur at the same time, and can be related. This article will focus on how the new clinic will treat TBI. The new clinic will serve as a hub location for patients with invisible wounds, offering care not available in other clinics. Eglin will house the clinic partly because of the patient population at the base makes it ideal for treating TBI. “It’s a potential TBI hotspot,” said Col. (Dr.) Caesar Junker, Chief of Wounded Warrior programs for the Air Force Surgeon General. “Eglin has Air Force Special Operation Command, 7th Special Forces Group, 6th Group Ranger Battalion and the tri-Service Explosive Ordnance Schoolhouse. Also, many special operators retire in that area. That all adds up to a higher rate of TBIs.” Many patients with TBI may also be suffering from PTSD, depression, anxiety, trouble sleeping, musculoskeletal complaints and pain. The interdisciplinary approach includes multiple specialists examining the patient, including neurologists, occupational therapists, physical medicine and rehabilitation physicians, sports medicine physicians, psychiatrists, pain doctors and primary care physicians. It’s an expensive and time intensive approach, says Junker, but worth it in the long run. “The specialists see the patient together, instead of sending the patient to multiple providers, one after another, and the patient sometimes never gets better,” says Junker. “Each specialist shares their viewpoint when they evaluate the patient, so the patient gets a better treatment plan with coordinated care, and gets better faster,” The new clinic will also help the Air Force develop standard clinical practices for diagnosing and treating TBIs. TBI and PTSD are often considered the “signature injuries” of 21st Century conflicts, which has led to major investments of time and money in research to develop diagnostic and treatment methods for TBI. Many of these methods have been proposed and studied, but not all have proved equally effective. The new clinic will be critical to the Air Force’s efforts to evaluate the many treatment and diagnosis methods, and identify the best care for TBI and other invisible wounds. Having a centralized location delivering specialized care will make this kind of systemic analysis possible. “We need to demonstrate to ourselves and to our patients that any intervention or diagnostic we use in their treatment is founded in good evidence that it leads to better patient outcomes,” said Col Mark Mavity, Air Force Surgeon General Special Assistant for Invisible Wounds and Wounded Warrior Programs. “The Eglin clinic will help orchestrate the dialogue to refine best practice, and also get them socialized and out to the field.” Another model for TBI care at the new clinic will be the Intensive Outpatient Program. Patients will come to the clinic and stay for 1-4 weeks, getting care on a regular schedule in time blocks similar to school. “Patients will take “classes” from occupational therapists, physical therapists, speech therapists, and art and music therapists. They will also incorporate meditation and yoga to lean tools to help them cope with their illness,” said Junker. “They are seen in groups of 6-10 patients, and go through the program together. After they complete the IOP, patients should have a much better understanding of their illness, treatment plan and diagnosis.” Ninety percent of TBIs are mild TBIs, commonly called concussions. They occur in everyday settings, like sports injuries, falls or car accidents. From 2000 through 2014, only 2 percent of TBI’s experienced by Airmen were deployment related. Many mild TBIs do not require specialized care, usually rest and over-the-counter pain medications. “It is very important to follow your provider’s instruction after a mild TBI,” says Junker. “If you resume activities too soon, the healing process may take much longer. Certain activities like playing videogames or working on a computer too soon after a concussion can tire the brain and make recovery more difficult.” The earlier a TBI, or other invisible wound, is diagnosed and treated, the quicker and more complete the recovery. “The key to recognition happens outside the MTF, with the members themselves, or more often, their wingman,” said Mavity. “If you recognize that someone in your unit has suffered an injury and is acting in ways they wouldn’t normally act, be a good wingman and help them get appropriate treatment and rest. Early recognition is a key component of self-aid and a buddy care tool that greatly benefits our force.” “We sometimes think that psychological or neurological wounds are somehow uniquely different from physical wounds. In a sense, we should look at these the same as any other medical condition or injury, and always strive to have evidence based practices.” For more information and resources about TBI, you can visit the Defense and Veterans Brain Injury Center.