Technology Makes For Efficient Application Of New mTBI Policy

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WASHINGTON, DC—Last summer, DoD issued a policy designed to speed detection of mild traumatic brain injuries (mTBI) on the battlefield. Now, using new technologies to make the process as efficient as possible, the policy is being implemented in theater, according to DoD officials.

“Currently the major TBI focus in theater has been the implementation of the 21 June DoD policy regarding mild TBI,” said Maj. Theodore Brown, preventive medicine physician for US CENTCOM. “This policy requires actions on the part of the servicemember, their leaders and medical personnel when servicemembers are involved in specific potentially concussive events.”

A mTBI may not have obvious symptoms, and those who suffer a concussive event may not seek immediate medical attention. A delayed diagnosis, however, can be detrimental to recovery. To address this issue a Directive-Type memorandum (DTM) was issued last June outlining specific scenarios in which mandatory medical screening must be conducted in theater for servicemembers exposed to potentially concussive events.

Brown, who is responsible for translating the policy to CENTCOM operations, said CENTCOM has developed an automated reporting module called the Blast Exposure and Concussion Incident Report(BECIR), so the tracking and reporting of all servicemember exposures to potentially concussive events in theater does not have to done manually. The BECIR is within the Combined Information Data Network Exchange, a system used to report significant operational events, he said. This will allow for “more comprehensive capture of exposures,” he said.

In addition, Brown said, soldiers exposed to a concussive event must undergo a medical evaluation documented in their electronic medical
record. To simplify the process, CENTCOM had the services agree on a single evaluation template which will be available in the electronic medical record system.

TBI Injuries

Brown spoke along with other DoD experts at a briefing held last month on the state of TBI research, evaluation and diagnosis as part of Brain Injury Awareness month. According to DCoE, more than 19,000 service-members were diagnosed with a mTBI last year.

Early diagnosis is thought to be key in helping patients recover from an mTBI, so health officials emphasized the importance of awareness by servicemembers and their families of the signs and symptoms of mTBI.

“We have no data that suggests otherwise, that the military cohort has different statistics than the civilian cohorts in that 85% of mild TBI patients improve within 90 days,” said Kathy Helmick, DCoE deputy director for TBI. “So many of the patients that do go home and continue with symptoms, we believe that to be the minority of the whole patient population that sustained concussion.”

TBI Research

In terms of new TBI research, Army Col. Jamie Grimes, MD, national director of the Defense and Veterans Brain Injury Center (DVBIC), said that the center will conduct “long awaited” head-to-head studies—one on the battlefield and the other stateside – to evaluate neurocognitive assessment tools. Those tools are designed to measure attention and memory, among other mental functions.

Congress mandated that all servicemembers have neurocognitive assessments before deployment to establish a cognitive baseline. That way, a comparison would be available if the servicemember later suffered a head injury in theater. Grimes said that nearly 800,000 of these predeployment neurocognitive assessments have been conducted so far using the Automated Neuropsychological Assessment Metrics (ANAM).

It is not clear, however, that the ANAM is the most effective tool for these assessments, Grimes said, adding, “Many of these cognitive tests are out there and there really has not been a study to look at which is best. DoD through Health Affairs chose in 2008 a specific test going forward so that there would be standardization across the services for the test, but we don’t really know if that is the best test.”

DVBIC also will conduct a study on the long-term effects of concussion. Commissioned by Congress, this longitudinal study will follow servicemembers and veterans from the ongoing conflicts over a 15-year period. The study will enroll a total of 1,200 participants of which 600 will be mild, moderate or severe TBI survivors; another 300 survivors will have some form of trauma, excluding a TBI; and the final 300 will have deployed and suffered no injuries.

New Weapon In TBI Fight: Lighter, More-Sensitive Helmets

helmet-mtbi.jpgThe military’s battle against traumatic brain injury (TBI) has a new weapon with deployment later this year of the next generation of helmet sensors that measure and store the impact of blasts and other events that soldiers may experience during battle. The new helmet sensors will be both lighter and more technologically advanced than previous versions.

Lt. Col. John Rickey, product manager for Soldier Protective and Individual Equipment in the Army’s Program Executive Office Soldier, told U.S. Medicine in an e-mail interview that the primary objective of these new helmet sensors is to “gather data to determine if head impact doses calculated from helmet sensor field data correlate with head injuries among the deployed soldiers wearing the sensors.”

Helmet sensors were first used on the helmets of servicemembers in December 2007 as a way to measure and store impact and/or blast data that can cause a concussion. The second generation helmet sensors have extended battery life, lighter weight, increased memory data storage, wireless operation and added 
accelerometer components to measure both linear and rotational accelerations.

The helmet fits and feels the same to the soldier with or without the sensor installed, according to Rickey.

In the future, the data gathered from these helmet sensors will be used for studies on how mTBI impacts the brain, he said. “The first step is to qualify the Gen II Helmet Sensor as an objective exposure monitor,” said Rickey. “Further extensive data analysis efforts and studies would be taken to determine if a head injury screening tool could be developed and employed to assist tactical commanders in assessing those soldiers who experience head impact-related events.

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