By By U.S. Army Sgt. Brent C. Powell, 3rd Brigade, 101st Airborne DivisionAugust 14, 2010
PAKTIKA PROVINCE, Afghanistan -- Insurgent attacks, improvised explosive devices and even vehicle rollovers are all common threats on today's battlefield that can cause a variety of injuries to Soldiers.
Some of the most common injuries are easy to recognize such as broken bones, bullet and shrapnel wounds. But there is another common injury, mild traumatic brain injury, which is much more difficult to spot, but still potentially life-threatening.
In order to effectively diagnose and treat MTBIs, a special clinic was established at Forward Operating Base Sharana in late April.
"The primary mission of the clinic is to treat mildly-concussed patients as far forward in the theater of operations as possible," said Maj. Jose R. Rafols, native of Miami, and officer-in-charge, MTBI Clinic, 626th Brigade Support Battalion, 3rd Brigade, 101st Airborne Division. "Our goal is to give the patients the restoration and rehabilitation they need so they can return to duty as soon as possible."
The mission has been challenging and has kept the clinic staff extremely busy. During the month of July alone, more than 70 MTBI patients came through the front doors for evaluation and treatment.
"Approximately 90 percent of the cases we see here are due to significant blast events," said Rafols. "The most common are rocket-propelled grenades hitting vehicles or exploding near Soldiers, or from vehicles hitting an improvised explosive device."
When patients first arrive at the clinic, the staff wants them to relax.
"We don't want them to do anything for the first 24-hours," said Sgt. Ryan M. Lahr, a certified occupational therapy assistant, MTBI Clinic, 626th BSB , 3rd Brigade, 101st Airborne Division "We want them to just unwind, and let their brain reset."
After the initial resting period, patients are given a thorough evaluation. One of the tools the clinic uses during the evaluation is the Military Acute Concussion Evaluation test.
"The MACE is a 13-part test that checks various systems in the brain," said Rafols. "It checks things such as the patient's ability to remember and do sequencing. It basically helps us figure out what they are having trouble with, and allows us to triage the patient according to what their test score is."
The MACE test is administered to the patients, and then given to them again every few days to monitor their progress. It's just one tool in the evaluation process.
"We also use neurological tests to see if there is something going on in the patient's brain that is throwing off their balance or their ability to do certain very complex movements," continued Rafols. "We test their strength, their balance, their vision on a cursory basis, and all the various subsystems of the brain that have to be working right for us to say the patients can return to duty."
In addition to testing, the staff looks for signs and symptoms of common brain injuries.
"Symptoms are very broad, but the ones we really look for are uneven pupils, slurred speech, poor balance, nausea and vomiting, poor executive function, memory lapses, loss of consciousness and blackouts," said Rafols. "If we find any of those [symptoms], our concern starts going up. We'll send them on to a combat support hospital as soon as possible, because they may have more than a mild concussion."
Once the evaluations are done, and the staff has a good idea of what is wrong, they can begin treatment.
One type of treatment the medics use is Nintendo's Wii gaming system and the Wii Fit program.
"The Wii system promotes balance, and helps patients re-establish vestibular abilities," said Rafols. "It also helps them work on hand-eye coordination, and fine and gross motor skills. All these things are needed to do common tasks such as driving a vehicle, doing dismounted patrols, shooting their weapon and operating a radio."
The clinic has seven-beds, which allow Soldiers to stay and rest at the facility for up to 14-days. Patients also have access to a variety of extra clothing and hygiene items, since many of them are brought in straight from the field.
"What we are trying to do with these clinics is to show that if injured patients can be treated early after exposure to a traumatic event, and they are given time to rest and allow their brain to reset, they typically do very well," said Rafols. "As a matter of fact, our return to duty rate here is 97.4 percent. The mindset of the clinic is to treat mildly-concussed patients very far forward. Let them rest. Give them some mild intervention, and then send them back to their unit so they can continue to function as part of their unit."
Although they are at the clinic to recuperate, patients seem to enjoy their stay.
"The treatment here has been great," said Sgt. 1st Class James R. Jones, platoon sergeant for 1st Platoon, Troop B, 1st Battalion, 33rd Calvary Regiment. "The staff is serious about what they do and their mission. They put a lot of effort into taking care of us."
There are currently three MTBI clinics in the Afghanistan theater. In addition to the clinic at FOB Sharana there are similar clinics at FOB Shank and FOB Fenty. There is also a proposal for a fourth clinic to open before the end of the year.
"The main thing Soldiers need to know about our clinic is that we are here to help them," said Lahr. "No matter how small their injury may seem to them, we can get them the help they need."