Mild traumatic brain injury experts address athletic trainers
November 7, 2011
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- Fort Riley
MANHATTAN, Kan., Nov. 7, 2011 -- Whether it's a Kevlar or a helmet, a battlefield or playing field, Soldiers and athletes try to avoid concussions, but they can be a reality for both populations.
This commonality led to a partnership where experts at Fort Riley, Kan., who treat Soldiers for varying degrees of traumatic brain injury or concussions addressed a convention of athletic trainers from across the state of Kansas Nov. 6 at Kansas State University.
"We're basically using the same (tools). They use the term 'return to duty' and we use 'return to play' guidelines," said Amanda Beadle, head athletic trainer from Southwestern College in Winfield, Kan.
The difference between concussive events in Soldiers and athletes is that Soldiers often are in a dangerous situation with a lot of carnage, and they need to react and function in that situation for sometimes up to a few hours before being removed and treated, according to Dr. Nina Ainslie, medical director for the mild traumatic brain injury clinic at Fort Riley.
"That's why it's so important that we have the care that Soldiers provide (in deployed environments)," Ainslie said.
Soldiers who provide that care include combat medics who are comparable to athletic trainers on the field as well as occupational therapists who determine the treatment to heal from concussions and primary care providers who decide duty restrictions or whether or not to evacuate the Soldier from the theater of operations back to the states.
Maj. David Larres, an occupational therapist, returned in October from Afghanistan where he was responsible for treating Soldiers who experienced a concussive event and keeping as many Soldiers as possible in the fight.
"The closer we can keep Soldiers to their units, the faster they'll get better," Larres said.
Occupational therapists do not decide who stays in theater and who is evacuated or what restrictions or profiles are given to Soldiers -- a primary care provider has those responsibilities, Larres said.
While deployed, Larres said he wanted to conduct research to look at blast injuries separate from acute concussions like some that those caused in a vehicle rollover, but he wasn't able to get the research underway while he was there.
After Soldiers are medically evacuated or return home from deployment, the mTBI clinic on Fort Riley takes over their care and recovery. The clinic has a multi-disciplinary team consisting of primary care, case management, neuropsychology, occupational therapy, speech therapy, physical therapy, behavioral health, neurology and physiatry.
Ainslie explained the care each provider renders and how they work as a team to lead the Soldier through recovery.
"We have team meetings to discuss patients at regular intervals," Ainslie said.
The memory team, which is comprised of neuropsychology, occupational therapy and speech therapy helps Soldiers with memory lapses such as remembering to take all of their gear to work with them or struggling with attention or word finding, she said.
Patients with an mTBI may have anxiety or irritability, so behavioral health uses cognitive behavioral therapy, anger management and stress management to alleviate their symptoms.
Soldiers whose headaches aren't responding to treatment the primary care provider prescribes may see neurology and those who aren't responding well to physical therapy or have ongoing pain issues may see a psychiatrist. Ainslie also refers Soldiers outside the mTBI clinic to other disciplines like orthopedics if they may benefit from surgery.
Soldiers treated at the clinic are generally successful with about 75 percent returning to duty, 20 percent being medically separated or retired and five percent whose outcome is unknown because they move to another duty station.
In Ainslie's time at the clinic, there have been just two or three patients where TBI or cognitive damage was so severe they were found unfit for duty solely based on that diagnosis, she said.
One local trainer who meets with 4th Infantry Brigade Combat Team soldiers to provide her advice on their physical training regimen said she wanted to visit Fort Riley to tour the mTBI clinic and learn even more about what they do.
Another trainer said she learned about the military from a professional and personal perspective.
"I appreciate them coming and telling us how the military relates to athletic trainers. It was cool to see what they're doing for the military when they come home," Beadle said.