Article Published: July 21, 2014
Article Published: July 21, 2014
By Tim Hayes, Contributing Writer
To a U.S. Marine, “mission and teamwork” represent critical factors in achieving success. Understanding and executing the mission remain core elements in the training of a Marine. Staying in the moment. Engaging with the elements and activity around you. The focused mind of a Marine is his greatest tool, his first and last line of defense, his best friend.
Therefore, when wounds, injuries, illness or the chronic stressors of multiple combat deployments affect a Marine’s mind, the wounds can be both physical and emotional.
A special program, funded by the federal Department of Defense and involving multi-disciplinary researchers from the University of Pittsburgh and a dedicated group of veterans from the United States Marine Corps, provides a comprehensive means of helping returning military cope with and overcome those physical and emotional challenges inherent in the transition to civilian life.
The transition from the military to civilian life and the emotional side of the equation get addressed through the “Semper Fi Odyssey” (SFO) experience: a week-long intense transition program held at Outdoor Odyssey, founded by Major General TS Jones (USMC-Retired), in the Laurel Mountains between Ligonier and Johnstown, where Marines, Soldiers, and Sailors gather to share their experiences, difficulties, and successes, and learn to use transition tools while establishing ongoing relationships with older veterans who have “walked in their shoes” and serve as Team Leaders and Mentors.
Attending to the physical issues of this group falls to the University of Pittsburgh, where world-leading research and technology are being put to use to both map broken neurological connections in the brain and track their restoration and growth.
“When you consider that only a very small percentage of the U.S. population serves in the military, and that a small percentage of that group enters a wartime theater, and that an even smaller percentage of those servicemen and women are wounded, injured or ill—you can then appreciate the debt we owe them,” said Dan Pultz, a Marine veteran from the Vietnam era who serves as the Senior Team Leader and a Mentor of the Semper Fi Odyssey transition program that is led by Major General T.S. Jones (USMC-Retired).
“I cannot thank you enough for everything you, Maj. Gen. Jones, and the rest of the SFO team did for me and the rest of the group last week. As you and I discussed, with many of the Marines in the groups, you could see the level of confidence and self-realization just blossom and open up in many of them. I walked away from the week telling people, ‘I am a changed man,’ and so are many others.” –Testimonial from a Marine, describing his Semper Fi Odyssey experience
Traumatic Brain Injury, or TBI, and Post Traumatic Stress, or PTS, act as the fundamental issues underlying the physical and emotional issues faced by participating veterans in these programs. TBI and PTS, which Pultz characterizes as “the signature wounds of the Iraq and Afghanistan wars,” may lead to Post Traumatic Stress Disorder (PTSD), as well as sleep, memory, attention, and cognitive issues and more.
“TBI makes it difficult for these veterans to make a plan for the rest of their lives,” Pultz explained. “Many of the groups from the Marine Corps’ Wounded Warrior Regiment that participate in the Semper Fi Odyssey transition program aren’t ready for a job or to go back to school because they can’t focus sufficiently.”
Targeted Evaluation Action and Monitoring of Traumatic Brain Injury—better known by its acronym “TEAM TBI”—is a $4 million, multi-site Department of Defense study targeting treatment to parts of the brain where broken connections can be determined.
Pitt serves as the lead investigator of TEAM TBI, which also includes the Navy Medical Center in San Diego, Calif., and the DOD National Intrepid Center of Excellence in Bethesda, Md.
According to Dr. Ron Poropatich, Executive Director of The Center for Military Medicine Research at Pitt, veterans participating in this program have images of their brains taken using high-definition fiber tracking. A 3-Tesla MRI is utilized: the highest powered machine of its kind.
Through this technology, nerve fiber connections in the brain can be “seen” and identified. Pitt is the only facility in the world capable of taking such advanced inside-the-brain readings, Poropatich said.
TEAM TBI doesn’t stop there, however: it looks at all potential trajectories for veterans suffering from TBI, including sleep, attention, memory, cognition, pain (migraines), ocular accommodation, vestibular (balance) and exertion issues. Through clinical intervention and follow-up, experts from each of these medical disciplines meet at a formal adjudication to fashion an individualized clinical intervention follow-on program (mCIFO) that combines clinical intervention, coaching and remotely monitored self-management using a “TBI Toolkit” especially prepared for each participating veteran.
This “TBI Toolkit” mobile health platform contains an iPad and customized software to help the veteran with tangible exercises and activities to address any issues with sleep, attention, memory and cognition—along with pain, vision, balance and exertion. After six months, the veteran returns to Pitt for a follow-up evaluation to see how well the mCIFO, “TBI Toolkit” and mobile health platform have been used, and with what level of success in improving emotional, mental, and physical health.
“The mCIFO, “TBI ToolKit” and mobile health approach depends on four elements working together—the patient, the professional clinical interventionist, the Semper Fi Odyssey ‘coach’ role played by Dan Pultz to stay in ongoing personal contact with the patient to offer encouragement and keep the focus strong, and the multi-disciplinary clinical researchers who help make the diagnoses and craft the individualized mCIFO plan for each veteran,” Poropatich explained.
“TEAM TBI can serve as the forerunner of treatment at lower cost for victims of stroke and Alzheimer’s Disease,” he added, “but it’s vitally important to remember that we are still at the research stage. Nothing has been conclusively proven yet to succeed here. Our reality check is that we don’t yet know the results, within the parameters of well-defined research.”
The TEAM TBI studies at Pitt began last March with 120 patients planned for enrollment in Pittsburgh, and will continue for three years, Poropatich said. The Semper Fi Odyssey transition program preceded TEAM TBI, providing the Pitt researchers with a ready-made population of participants, he said.
“I personally walked away from last week with a whole new perspective on life, my passions, the way I treat others, and how I move forward with a clear mind and confidence in how I am going to accomplish many personal and professional goals.”
–Semper Fi Odyssey participant testimonial
“We have countless veterans with traumatic brain injury and post traumatic stress,” Pultz said. “All of the people we see with these problems have sleep issues. You can’t heal the brain without sleep, without rest. So much of the work done on TBI and PTS to date had not viewed or addressed sleep as a key issue the way TEAM TBI has.
“That’s one of the great differentiators and advancements of the approach being taken here. TEAM TBI brings together all protocols related to traumatic brain injury under one roof, so that the veterans we work with receive a comprehensive treatment strategy. Typically, the brain has been looked at in a narrow way, but the partnership between SFO and TEAM TBI is changing that.
“Pittsburgh is the go-to city for this research,” Pultz continued. “We have a higher concentration of veterans here, and the unique research and clinical capabilities available at Pitt provided the perfect fit.”
“There definitely was some serendipity at work here in bringing all of these people and organizations together,” echoed Poropatich. “Dan appeared as a last-minute replacement at an event I attended, and spoke about Semper Fi Odyssey. It turned out to be a very a happy accident. People coalesce when hearts and souls come together, and that certainly was the case in this instance.”
The McGowan Institute for Regenerative Medicine (MIRM) at Pitt is a strong partner with the University’s Center for Military Medicine Research (CMMR), and brings together a multi-disciplinary research focus to solve medical needs for both military and civilian populations. The MIRM comprises a number of departments and organizations across academia promoting the development of medical solutions in areas such as medical devices, cell therapy, and tissue engineering.
In fact, advancements in using stem cells taken from fatty deposits in one part of the body to create a natural “cushion” for more comfortable use of prosthetics have been achieved at Pitt’s Department of Plastic Surgery, along with neuroscience breakthroughs in helping to convert “instructions” from the brain of a paralyzed individual into actual motor skills as performed by an artificial “sleeve” worn on the person’s arm and hand. Poropatich stresses here, though, that these achievements must still be considered as unproven, pending the results of more research and testing.
“Our role is to identify Pitt investigators doing research related to defense, and there are so many areas at Pitt where this is relevant,” he said. “We introduce researchers to Veterans Administration and Department of Defense opportunities, with the shared objective of improving the health outcomes for military veterans and their families. We also support the technology development and hopefully the transfer of those technologies into viable businesses someday, which helps the economy of Pittsburgh.”
Making the most of the opportunities that surround you—harkening back to the Marine mantra of “Mission and Teamwork”—CMMR manifests one of the recommendations voiced by Maj. Gen. Tom Jones (USMC-Retired), at the Semper Fi Odyssey program, which he helped to establish and where he has led 43 SFOs over the past seven-plus years.
“You’ve got to grow where you’re planted,” he instructs the Marines with an ingrained intensity as only a Marine General in the United States Marine Corps can command.”
PTSD and TBI remain the signature wounds among most of the SFO transition program participants. An open forum to share experiences, disappointments, successes, future life plan building, mock job interviewing and other practical skills to help with the transition into civilian life—under the firm, yet empathetic, leadership of Jones and Pultz—has created an environment where these warriors can once again achieve success.
The peaceful mountain setting of the SFO transition program—where participants face a week with no cellular service or wi-fi connection—forces an unavoidable “unplugging” from the pressures and distractions of the outside world. This intentional isolation helps the Marines deal with the after-effects of what Semper Fi Odyssey Medical Director Dr. William Nash called the “warrior brain.”
“The effect of stress on the brain affects addiction and decision-making capabilities,” Nash explained. “It is possible to become addicted to combat, which makes civilian life unbearably boring. This unrest ‘lives’ in the nucleus accumbens section of the brain, and can produce an intense euphoria from ending a human life with just a small movement of a finger against a trigger.
“The brain keeps searching for an alternative that provides the same level of excitement, which means a ‘fire alarm’ in the brain goes off when there’s no actual danger—that’s PSTD,” he said.
The mind is the Marine’s best friend. Helping that friend return to its fullest and most effective condition remains the shared objective of both Semper Fi Odyssey and TEAM TBI programs. They lead the nation in addressing both sides of the challenge—physical and emotional—our returning veterans face.
“Medical issues are very difficult to solve, but they are solvable,” Maj. Gen. Jones said. “Build a team to help with these things, and that’s the first step. That is what Semper Fi Odyssey is structured to do. I’ve not seen one story yet from this program where a Marine was in a one-man fight.”