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Two important initiatives are underway to help define those service members affected by brain injury. The initiatives are organizations known as the Center for Neuroscience and Regenerative Medicine and the National Intrepid Center of Excellence, or "NICoE." These two collaborating programs will play key roles to address traumatic brain injury (TBI).

The Department of Defense, from a fiscal 2008 supplemental bill, provided $70 million to the Uniformed Services University for the Health Sciences (USU) to establish the Center for Neuroscience and Regenerative Medicine. The center will study blast injury to the brain and posttraumatic stress disorder (PTSD) by examining the combat casualties cared for at Walter Reed Army Medical Center in Washington, D.C., and National Naval Medical Center in Bethesda, Maryland. The acting director of this center is Regina Armstrong, PhD, a USU professor of Anatomy, Physiology and Genetics, professor of Neuroscience and professor of Molecular and Cell Biology.

Dr. Armstrong has played leading roles in neuroscience education at USU as the director of the Neurosciences graduate program for six years, and nationally, as treasurer and member of the Executive Committee of the Association of Neuroscience Departments and Programs. She has led research efforts at USU and served as director of the Translational Research Program of the Defense Brain and Spinal Cord Injury Program, and of the Comprehensive Neuroscience Program. She now serves on the oversight committee for the Blast Lethality and Injury Program.

The center's acting co-director is Walter Koroshetz, MD, who is the deputy director of the National Institute of Neurological Disorders and Stroke. The Defense Department is collaborating with the National Institutes of Health (NIH) in a unique tie as the institute has a strong capability with sophisticated neuroimaging technology at the NIH Clinical Center. In October 2008, USU President Charles L. Rice, M.D., and NIH Director Elias Zerhouni, M.D., signed a Memorandum of Understanding to accomplish these efforts.

The Center for Neuroscience and Regenerative Medicine will focus on moderate to severe brain injuries more than mild TBI with an emphasis in these areas: Neuroregenerative medicine to restore neurological function; improving neuroimaging to diagnose TBI and PTSD; neuroplasticity as a tool to improve TBI therapeutic outcomes; and rehabilitation medicine for TBI and PTSD.

The second initiative is an effort to crystallize knowledge about health issues related principally to psychological health and TBI. The Department of Defense, with support from the Department of Veterans Affairs, is working with the Fisher Foundation to create the National Intrepid Center of Excellence (NICoE). The 72,000-square-foot facility, to be located inside the gates of the National Naval Medical Center, will share the campus with the university and the future site of the new, consolidated Walter Reed National Military Medical Center.

NICoE will provide advanced diagnostics, initial treatment and Family education for service members with posttraumatic stress disorder or TBI, and will interface with components of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE) which is DoD's network orchestrator for psychological health and TBI. It is currently a project being funded by the Intrepid Fallen Heroes Fund and construction is anticipated to be complete by the end of 2009.

The director of NICoE is Dr. James Kelly who is leading many of the DCoE collaborative efforts addressing TBI and PTSD. Dr. Kelly comes to NICoE from the University of Colorado Denver School of Medicine where he was Professor of Neurosurgery and Physical Medicine & Rehabilitation. He is a Fellow of the American Academy of Neurology and an Examiner for the American Board of Psychiatry and Neurology. Dr. Kelly has participated on advisory boards at the Mayo Clinic, at the Institute of Medicine in Washington, D.C., and at the Centers for Disease Control. He continues to be actively involved in all aspects of TBI research. His scientific publications have appeared in numerous medical journals and he is invited to speak on a variety of neurological topics across the U.S. and abroad.

In addition to NICoE, two other DCoE components performing interface functions touching on regenerative medicine are the Defense and Veterans Brain Injury Center which covers the entire spectrum of TBI care, and the Center for Deployment Psychology out of USU. The latter promotes the education of military and civilian psychologists and other behavioral health specialists about psychological and behavioral health issues pertaining to the deployment of military personnel and their Families.

The director of the Defense and Veterans Brain Injury Center, Air Force Colonel-select Michael Jaffee, indicates that the initiatives are "geared to providing assistance to ambulatory patients with persistent problems who have not responded to treatment."

"We are so excited about the team efforts to provide the best care for those with brain injuries," said Brig. Gen. Loree Sutton, DCoE's director. The conflicts in Iraq and Afghanistan have brought pronounced visibility to injuries that wouldn't have reached stateside from previous conflicts. Battlefield medical advances have saved the lives of many but there are new challenges with an increased population of severely injured needing proper treatment. Those challenges are both in systemic claims processing and outpatient infrastructure. A motivated Sutton says, "It has become such an important issue to deal with and we are making great strides. People from the collaborating agencies tell me unequivocally that it is a privilege to be working for those who are making such enormous sacrifices."

A major part of the genesis of this collaborative effort is the exploration of using a patient's own stem cells to regenerate replacement skin, tissue and other body parts. Conducting that exploration is the Armed Forces Institute of Regenerative Medicine, part of the US Army Medical Research and Material Command at Fort Detrick in Frederick, Maryland.

Recognition of a knowledge gap with prevalent psychological health injuries from Operation Iraqi Freedom and Operation Enduring Freedom led to the funding by Congress to find new diagnostic tools and innovative approaches to increase neuroplasticity. Such tools are critical to a better understanding of TBI. That is especially true with mild brain injury, which often go undetected because of few or very subtle changes not easily discerned in routine exams. When appropriate, use of regenerative medicine will address brain injury at the organ, cellular and molecular level.

A detailed information paper on Neural Stem Cell Research follows this article. Also, more information on the Center for Neuroscience and Regenerative Medicine can be found at http://www.usuhs.mil/cnrm/. Information on the National Intrepid Center of Excellence can be found through the Intrepid Fallen Heroes Fund site at http://www.fallenheroesfund.org/National-Intrepid-Center-of-Excellence.aspx. The Web site for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury is http://www.dcoe.health.mil/.