NEWS

Major advances occurring in traumatic brain injury care for veterans

New developments in traumatic brain injury prevention, diagnosis and treatment are certain to improve patient health among Soldiers, as well as improve Army readiness, said Tracie Lattimore, director of the Army's Traumatic Brain Injury program within the Office of the Army Surgeon General.


Lattimore said that new tests for assessing TBI are available this year. One such test allows providers to determine if a patient's eyes are tracking properly, and helps patients indicate if they are experiencing double vision or an increase of other symptoms. The test can determine whether or not "oculomotor dysfunction" is present, Lattimore said.

Oculomotor dysfunction, which involves the eye's inability to locate and fixate on objects in the field of vision, occurs in 40 to 60 percent of TBI cases, Lattimore said.

Also of benefit to providers and their patients are two new FDA-approved devices, including one called "BrainScope" and another called "InfraScan," Lattimore said.

Capt. Robert Jacoby, right, and Hospital Corpsman 1st Class Raymond Bedard, from Expeditionary Resuscitative Surgical System 19, prepare medical supplies aboard Royal Fleet Auxiliary ship Cardigan Bay. (U.S. Navy photo by Mass Communication Specialist 2nd Class Kevin J. Steinberg/Released)

BrainScope measures and analyzes the brain's electrical activity to aid in the evaluation of patients who are being considered for a head CT scan (to detect bleeding in a closed head injury). The BrainScope device is portable and rugged, and can be used in a variety of militarily-relevant scenarios. Lattimore said she is hopeful the devices can be distributed more broadly in the near future.

InfraScan uses near-infrared spectroscopy to detect potential brain bleeds, and is also meant for use in patients who are being considered for a head CT scan.

PREVENTION

Lattimore said a study of concussions among college athletes, including some at military academies, is gathering interesting data on TBI prevention.

The study, which is still producing information, indicates that someone who experienced TBI often had one or more sub-concussive hits in the hours or days leading up to the hit that resulted in concussion, Lattimore said. This indicates that those smaller hits had a cumulative effect.

The study is an effort between the National Collegiate Athletic Association and the Department of Defense Grand Alliance.

Another interesting finding from the study was that in 2002, concussed players were returned to play after a few days, and then experienced a more severe concussion just 5.2 days after the first concussion, Lattimore said.

Now, the NCAA keeps players out of the game until they are symptom-free -- on average, 12 to 14 days after the first concussion.

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With this increased recovery time after concussion, the average athlete did not experience a second concussion until 72 days after the first, and it was much less severe than the second concussion experienced by athletes in the 2002 study.

"This study validates the DOD's hallmark policy for concussion management in deployed settings, which beginning in 2010 removed Soldiers who sustained a concussion from duty until symptom-free," Lattimore said.

Lattimore said the study demonstrates that if a Soldier is removed from training or the war fight for an adequate recovery time, it results in an optimized capability when he or she is returned, while likely reducing the frequency and severity of additional injuries.

"That message needs to be communicated, not just to medical personnel, but to every Army leader," Lattimore said.

TREATMENT

The standard concussion treatment, from 2008 to 2016, had been informally called "cocooning," Lattimore said. The treatment required patients to not exert themselves physically or mentally, to not watch TV, to not exercise, and to get plenty of sleep until they recovered.

Medical professionals now understand that cocooning is the wrong approach, Lattimore said.

After reviewing literature and patient experiences over the last four-to-five years, it was found that the only activities that must be limited are those that exacerbate symptoms, she said.

The DOD started moving in this direction with the release of the progressive return to activity guideline for concussed patients, Lattimore said. However, the evidence has grown even stronger for this model since its release.

After 24 to 48 hours of rest, Lattimore said, patients should be encouraged to be active, as long as the specific activity does not put them at risk for another head injury or provoke their symptoms.

"This is an enormous paradigm shift from the 'cocoon care' model," she said.

Marine Corps Staff Sgt. Cary Chase lifts a set of dumbbells during a workout in the gym aboard the USS Bonhomme Richard while underway in the Pacific Ocean, Aug. 27, 2017. Marine Corps photo by Lance Cpl. Jonah Baase

With oculomotor dysfunction, it's now understood that rest will not resolve symptoms. Instead, effective treatment for oculomotor dysfunction often involves practicing muscle memory under the guidance of a physical or occupational therapist, Lattimore said.

If the patient fails the pen test, for instance, he or she might respond to another sensory input, such as an acoustic clicker attached to the end of a pen.

Many of the advances in TBI prevention, diagnosis and treatment, Lattimore said, are so new that the Army is just now finishing up the process of evaluating how best to incorporate them into assessment protocols.

Many Army medical personnel are not yet aware of the developments, she said. However by the end of this year, she said that updated tools and training will be available to push the information out across the Army.

History

This pilot shot down an enemy fighter at Pearl Harbor in his pajamas

Comfort is important when doing a hard job. If it's hot on the work site, it's important to stay cool. If it's hazardous, proper protection needs to be worn. And comfort is apparently key when the Japanese sneak attack the Navy. Just ask Lt. Phil Rasmussen, who was one of four pilots who managed to get off the ground to fight the Japanese in the air.

Rasmussen, like many other American GIs in Hawaii that day, was still asleep when the Japanese launched the attack at 0755. The Army Air Forces 2nd Lieutenant was still groggy and in his pajamas when the attacking wave of enemy fighters swarmed Wheeler Field and destroyed many of the Army's aircraft on the ground.

Damaged aircraft on Hickam Field, Hawaii, after the surprise Japanese attack on Pearl Harbor.

There were still a number of outdated Curtiss P-36A Hawk fighters that were relatively untouched by the attack. Lieutenant Rasmussen strapped on a .45 pistol and ran out to the flightline, still in his pajamas, determined to meet the sucker-punching Japanese onslaught.

By the time the attack ended, Wheeler and Hickam Fields were both devastated. Bellows Field also took a lot of damage, its living quarters, mess halls, and chapels strafed by Japanese Zeros. American troops threw back everything they could muster – from anti-aircraft guns to their sidearms. But Rasmussen and a handful of other daring American pilots managed to get in the air, ready to take the fight right back to Japan in the Hawks if they had to. They took off under fire, but were still airborne.

Pearl Harbor pilots Harry Brown, Phil Rasmussen, Ken Taylor, George Welch, and Lewis Sanders.

They made it as far as Kaneohe Bay.

The four brave pilots were led by radio to Kaneohe, where they engaged 11 enemy fighters in a vicious dogfight. Even in his obsolete old fighter, Rasmussen proved that technology is no match for good ol' martial skills and courage under fire. He managed to shoot down one of the 11, but was double-teamed by two attacking Zeros.

Gunfire and 20mm shells shattered his canopy, destroyed his radio, and took out his hydraulic lines and rudder cables. He was forced out of the fighting, escaping into nearby clouds and making his way back to Wheeler Field. When he landed, he did it without brakes, a rudder, or a tailwheel.

There were 500 bullet holes in the P-36A's fuselage.

Skillz.

Lieutenant Rasmussen earned the Silver Star for his boldness and would survive the war, getting his second kill in 1943. He retired from the U.S. Air Force in 1965, but will live on in the Museum of the United States Air Force, forever immortalized as he hops into an outdated aircraft in his pajamas.

(U.S. Air Force photo)

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