New DoD initiatives to detect concussion under study
April 11, 2011
By J.D. Leipold
WASHINGTON (Army News Service, April 11, 2011) -- The deputy director for traumatic brain injury at the Defense Centers of Excellence for Psychological Health and TBI said new initiatives will aid in the recognition of concussion while Soldiers are still in-theater.
Kathy Helmick told bloggers April 5, that in the past, servicemembers were diagnosed with concussion based on a symptom approach rather than an incident approach. Not until a servicemember started to show signs of concussion would they seek out medical help.
Defense Department policy now outlines specific events that indicate a high likelihood a servicemember could have sustained a concussion, she noted. Such events include being very close to a blast or riding in a vehicle that's been impacted by an explosion. Any direct blow to the head, be it from a sporting activity or a training exercise, now requires a medical evaluation.
Additionally, if a servicemember doesn't recognize they've had a concussion and is acting in ways other than usual, the individual can be command-directed to report for a medical evaluation.
"So any of those potentially concussive events will lead to a medical evaluation by a medic or a corpsman, which they go through utilizing a tool called the MACE, the Military Acute Concussion Evaluation," Helmick said. The objective behind MACE is to detect concussion as early as possible and keep a servicemember off the battlefield where they could possibly suffer another concussion before healing from the first.
In other words, a concussion left untreated by simple rest and aspirin could morph into a more serious form of traumatic brain injury, or TBI, from moderate to severe to penetrating, since concussion can be cumulative with each successive incident.
Just as MACE can aid in the detection of concussion, it can also confirm that a concussion didn't occur.
"That's important as well, to give confidence to the person that they've been checked out" said Helmick. "That is reassuring to the servicemember that they're good to go and can resume their mission and a full return to duty."
At present, one of DoD's tests to determine whether a servicemember has suffered concussion is the Glasgow Coma Scale. Even with the GCS, mild TBI is still a struggle to diagnose, added Helmick, because many times the brain scans are negative with a top score of 15. That means the patient can talk, knows where they are, who they and can follow simple commands.
But, according to Helmick, the GCS is not a very sensitive test for mild concussions, so DoD is looking at more objective tests other than a history and physical state of the patient.
"What we'd rather have, in addition to the history and physical exam, is an objective test that uses diagnostic markers, some of which include serum biomarkers -- testing proteins in blood, spit, saliva and sweat," she said.
"We're also looking at eye-tracking machines," she added. "These are devices that are placed on the eyes and can pick up problems with attention and concentration which can be indicative of concussion."
Machines which can measure the electrical patterns of brainwaves or Quantitative EEG are other devices being looked at to determine mild TBI.
Helmick said another possibility is the use of vestibular plates that a patient stands on to pick up idiosyncrasies in balance which can be indicative of changes that have happened deep in the brain stem that are consistent with concussion.
She noted there were a few more tests the department was studying but which aren't as far along in their evaluation on how well they work to pick up concussion. Helmick said it probably won't be one test, but rather a combination of objective markers that can help diagnose mild TBI on the battlefield.
"The brain is such a unique organ that we will probably always be mesmerized by it and never fully have the answers, but it's very challenging to try to understand and then create opportunities to enhance recovery," she said.