Understanding Helps Families, Soldiers Deal With mTBI
December 10, 2007
SCHWEINFURT, Germany - Mild traumatic brain injury, or mTBI, has been called the signature wound of the war on terror. Identifying and treating that injury has become a priority for Army medical commands worldwide.
A pilot mTBI testing program, using Automated Neuropsychological Assessment Metrics, has been developed to identify affected Soldiers. In Schweinfurt, the first-ever post-deployment screenings are being conducted as part of the reintegration process for Soldiers of the 2nd "Dagger" Brigade Combat Team, 1st Infantry Division.
"The screening is intended to take pre-deployment measurements for a baseline, then retest after the deployment to measure for differences," said Lt. Col. Daniel Duecker, Schweinfurt Health Clinic commander.
In the case of the Soldiers of the Dagger Brigade, however, no baseline reading was taken prior to their deployment. Consequently, Col. Mary Lopez, project officer in charge of the testing project, was unsure of what results - if any - her team would unearth.
"I didn't expect the testing to tell us much without the baseline for comparison, but the garrison commander (requested) it ... because it's the right thing to do for the Soldiers," said Lopez, who is a member of the Army's Surgeon General Office.
Lopez added that the range of results considered normal is broad, and of all the pre-screenings performed, "we've not found anyone that legitimately fell below the norms."
This is why having a baseline for comparison is more precise, as it allows for a comparison between the soldier's performance and his or her own norms.
What they found in testing Schweinfurt Soldiers, however, surprised Lopez and her team.
Thanks to key questions imbedded in the ANAM tests, Lopez and her team were able to identify Soldiers at risk for mTBI and recommend follow-up through the Schweinfurt Health Clinic.
The key factors in a case of mTBI include an injury event - such as a blow to the head - which causes an alteration of consciousness. Such "alteration" can be losing consciousness, seeing stars or simply being temporarily disoriented.
"Compared to those who reported no injury, we found significant differences in reaction time, concentration, and short term memory" in Soldiers reporting at-risk incidents, Lopez explained.
Results from the first groups to complete mTBI screening were provided to the area medical command.
"Col. Lopez's team was able to ... let the providers here know what they can expect to see in Schweinfurt, so that we can channel our resources in the best way to help these Soldiers," said Col. Theresa Schneider, Bavarian MEDDAC commander.
Once the pilot program is fully tested, Lopez hopes to push it out to medical facilities in theater, where Soldiers can be tested and their recovery tracked by the doctors downrange.
"Soldiers (with mTBI), like football players on the field, look physically normal, but they're different. Their reaction time is off, concentration is off, and in a war-time environment, that's very dangerous," Lopez said. With the ANAM tool, doctors will be able to monitor recovery in such a way as to ensure Soldiers are not returned to the fight until their recovery is complete.
"It is a treatable condition. They do recover," Lopez said, noting that patience, time and understanding are keys to coping with and treating mTBI.
Once a Soldier returns from a deployment downrange, family members may begin noticing he is irritable, sleepless, suffers from chronic headaches, trips over his own feet and seems to be suffering from memory problems.
This five-symptom cluster is a common sign of mTBI, with families often the first to notice such changes.
"The family is the most important element in any kind of rehab," Lopez stressed. "We see the Soldier for an hour or two; you are with him every day. It is important for families to understand what the recovery process is and what they can do to help."
"The (Soldier) is different, but they do recover. You have to understand that they are going to forget things and they're going to be irritable, but once the headaches stop and the sleeplessness ends, there will be improvement," the colonel said.
Indeed, Soldiers often may be reluctant to seek treatment, Schneider noted, and it may fall to the spouse to ensure the Soldier is helped. Overall, she said, "There are (many) avenues available: the clinic, family readiness group, chain of command and the chaplain. The important thing is to get people talking about and aware of the situation."