LRMC Synapse Program: Helping service members with TBI

by Dr. Kendra Wagers
Landstuhl Regional Medical Center, rehabilitation psychologist/TBI research coordinator

Traumatic Brain Injury has been called the signature injury of the wars in Afghanistan and Iraq, and after 10 years at war, many of our service members have been repeatedly exposed to events that have the potential of causing a brain injury.

More than 1 million military personnel have deployed since 2001 in support of Operation Enduring Freedom in Afghanistan or Operations Iraqi Freedom and New Dawn in Iraq. Current deployment operations have involved service members in ground combat and hazardous security duty.

TBI is the most prevalent injury among warfighters during OND, OIF and OEF as a result of contact with enemy forces or weapon systems – mortars, improvised explosive devices, rocket-propelled grenades – and from head impacts from accidents, enemy action or other factors. 

Deployment, therefore, could include being exposed to gun shots, blast exposures and other significant potential TBI generating events. Given the significant length of the war and repeated deployments of service members to dangerous duty assignments downrange, there is an increased risk of exposure to possible TBI events as well as increased risk of increased symptoms arising from repeat exposures. Landstuhl Regional Medical Center has developed an intensive rehabilitation program to help, called Synapse, which focuses on providing care to service members who experience TBI.

This interdisciplinary team approach was developed as a response to the dynamic nature of potential TBI events service members could experience. Service members at war are particularly at risk of TBI, resulting from combat blast injury, which is usually characterized as resulting from primary (e.g., exposure to over pressurization wave from blast), secondary (e.g., impact from blast, debris), tertiary (e.g., impact after displacement), or quaternary (e.g., burns, inhalation of toxins, hypoxia, psychological effects) blast effects.

Such blasts effects can produce profound traumatic injuries in the brain, including damage to the parts of the brain that make vision possible, affect auditory processing, impact balance and coordination, impair cognitive functioning, and/or impede occupational performance. Our team of clinicians works to collaborate and individualize care for our service members, to educate them on the recovery from injury, and foster greater understanding of what they can do to protect themselves.
LRMC’s Synapse program has a strong clinical team consisting of three TBI neurology providers, a clinical psychologist, a TBI optometrist, an audiologist, two physical therapists, two speech therapists, an occupational therapist, a rehabilitation psychologist and several nurse case managers. The entire team evaluates service members experiencing TBI and determines if intensive services would support the service member in their return to full duty.

Providers often collaborate on care evaluating the patient in an integrated service delivery environment to maximize therapeutic gain. The intensive program at Landstuhl is individually developed to meet a service’s unique symptom presentation and can be a few weeks or up to eight weeks long as appropriate.

The team also works closely with command to review job function and performance and tailor treatment toward addressing specific job capacities each service member may need to function within their military occupational specialty. Follow-up services and treatment plans are developed at discharge and can often be implemented via telemedicine, home therapy programs or with local providers at the patient’s home base of record.

A vital component to our discharge and follow-up plan is educating service members and their support system on engaging in their own recovery and considering all the factors in their lives that influence a positive course of rehabilitation.

A positive course of recovery from brain injury begins and ends with education. Education and outreach to command is not only an integral part of the intensive program, it frames our service delivery. Every component of our intensive program emphasizes the importance of a holistic and dynamic recovery process. As one TBI specialist has written, re-framing how we think about an issue to create a positive outlook can be a vital part of recovery. Developing awareness, understanding and education on the expected course of recovery from brain injury creates empowerment. Empowerment is how we build function, create a sense of normalcy and develop self efficacy. Efficacy powers us toward our goals.

The goal of the intensive Synapse program is to offer a comprehensive intensive TBI program that complements the TBI care throughout the European theater. We also work closely with TBI providers throughout the European theater to coordinate care, disseminate educational resources and foster recovery. Our mission is to not ameliorate symptoms but foster understanding and recovery.

If you would like to learn more about the program, call the LRMC TBI Rehab Clinic at 590-5601 or 06371-9464-5601.