TBI In the Military Cynthia L. Boyer, Ph.D. © 2011 Bancroft | All rights reserved.

TBI In the MilitaryCynthia L. Boyer, Ph.D.

© 2011 Bancroft | All rights reserved

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By 2014 our distinct ability to deliver high quality individualized services in modern living, learning and working environments will exceed stakeholder expectations and secure Bancroft as the region’s elite provider of services to people with intellectual and developmental disabilities and brain injuries.

Our Core Value

Bancroft’s mission is to ensure that every person is given opportunities for lifelong learning and fulfillment.

We do this by altering perceptions, and by supporting those with intellectual and developmental challenges and acquired brain injuries in achieving their life goals as valued and respected members of our world.

Respect is our clearly defined core value that helps unify the organization and provide a framework for services, decision-making and working together.

Our Vision

Our Mission


Copyright – 2012, Boyer, Bancroft Brain Injury Services

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TBI is a “signature injury” of the conflicts in Iraq and Afghanistan



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DoD TBI Definition (Oct 07)

Traumatically induced structural injury or physiological disruption of brain function as a result of external force to the head



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DoD TBI Definition (Oct 07) New or worsening of at least one of the following clinical signs• Loss of consciousness or decreased

consciousness• Loss of memory immediately before or

after injury• Alteration in mental status (confused,

disoriented, slow thinking)• Neurological deficits• Intracranial lesion

DoD definition parallels standard medical definition• CDC, WHO, AAN, ACRM



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Blast InjuryPredominant cause ofTBI in OIF/OEF

A significant number of soldiers returning from the conflicts in Iraq and Afghanistan have this injury and will suffer long-term consequences



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Blast InjuriesPrimary-Explosion• Blast wave strikes and

compresses body• Most serious damage sustained

by air and fluid filled organs• Causes brain injury without

visible damage to the head/skull• Causes significant damage to

eyes, ears, lungs



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Blast InjuriesSecondary• Environmental material

energized by explosion strikes the body/brain

Tertiary• Energy from explosion propels

the body into stationery objects



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Multiple Neurological Injuries• Skin breakdown • Penetrating Injury• Blast/concussive injury• Skull base injury• Facial fractures• Vasospasm*• Pseudoaneuryms*• Sagital sinus injuries



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Blast Injuries Are Different

• Treated quickly and aggressively

• Occur under extreme stress

• Long term course is unknown



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DoD Initiatives• Prevention• Surveillance• Screening • Diagnosis• Case Management• Treatment• Rehabilitation• Reintegration



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Baseline Testing Pre-Deployment

Neurocognitive Assessment Tool(ANAM)/Automated Neuropsychological Assessment Matrics (May 09)• Computerized• 20 min



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Screening• Military Acute Concussion Exam

(MACE) (Aug 06)• TBI screening for all medically

evacuated at Landstahl Regional Medical Center (May 06)

• PostDeployment HealthScreening (Jan 08)

• VA TBI Screening



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MACE: Military Acute Concussion Evaluation• Developed by DVBIC

and released in Aug 2006

• Performed by medical personnel

• 3-Part Screening Tool – “CNS”

• Cognition• Neurological Exam• Symptoms



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MACE: Military Acute Concussion Evaluation• Alternate versions

available

• Upcoming revision will include recurrent concussion questions

• Can be used during exertional testing to ensure that cognitive function remains intact


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Post-Deployment Health Assessment/ Reassessment (January 08)



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DiagnosisPotential Objective Indicators

• Pupillary response/visual tracking

• Biomarkers

• Imaging (DTI)



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Mild TBI/Concussion• More difficult to identify

• Symptoms not unique to TBI



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Possible Effects of TBI Acute• Poor marksmanship• Slower reaction time• Decreased concentration



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Possible Effects of TBIChronic• Reduced work quality

• Behavioral Problems

• Emotional Problems

• “Unexplained” Problems



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Treatment• Standardized Educational

Information

• New Protocol for 3 or more TBIs within 12 months



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National Intrepid Center of Excellence (NICoE)• Located on Navy

campus in Bethesda, MD

• Dedicated 24 June 2010

• Serves Service Members (and their families) with complex TBI

• Primarily evaluative in nature


http://www.facebook.com/album.php?profile=1&id=156392117034


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National Intrepid Center of Excellence (NICoE)• Generally to be used by

those who have refractory or difficult-to-diagnose/manage conditions

• Provides case management and referral capabilities to leading experts in the field

• Full Operating Capability: Oct 2011


http://www.facebook.com/album.php?profile=1&id=156392117034


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Toolkit and Pocket Guide



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TreatmentCo-Morbid Conditions• Sleep Disorders

• Substance Abuse

• Psychiatric Illness

• Vestibular Disorders

• Visual Disorders

• Cognitive Disorders



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Co-Morbidities Associated with mTBI

PTSD N=23268.2%

2.9%16.5%

42.1%

6.8%

5.3%

10.3%

12.6%

TBIN=22766.8%

Chronic Pain N=27781.5%

Sleep disorders

Substance abuse

Psychiatric illness

Vestibular disorders

Visual disorders

Cognitive disorders

Lew, et al: “Prevalence of Chronic Pain, Posttraumatic Stress Disorder, and Persistent Postconcussive Symptoms in OIF/OEF Veterans: Polytrauma Clinical Triad”, Dept. of Veterans Affairs, Journal of Rehabilitative Research and Development, Vol. 46, No. 6, 2009, pp. 697-702, Fig. 1



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Treatment Research• Clinical Trials

• Cognitive Rehabilitation

• Neuroprotective Medications

• Longitudinal Study



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Blast Physics/Blast Dosimetry

Force Protection Testing & Fielding

Complementary Alternative Medicine

Field Epidemiological Studies (mTBI)

Rehabilitation & Reintegration: Long Term

Effects of TBI

Neuroprotection & Repair Strategies: Brain Injury

Prevention

Concussion: Rapid field Assessment

Treatment & Clinical Improvement



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Challenges• Undetected MTBI

• Force readiness/cultural barriers

• Improved Collaboration

• Effective Treatment



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Resources• www.brainline.org

• www.braintrauma.org

• www.maketheconnection.net

• www.dcoe.health.mil

• www.dvbic.org

• TBI Family Caregiver Guide

• www.Afterdeployment.org



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Resources• DCoE Facebook, Twitter, YouTube,

• Multiple Mobile Smartphone Applications

• DCoE Blog

• Yellow Ribbon Presentations



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Questions?



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Thank you for

attending!


TBI In the Military Cynthia L. Boyer, Ph.D. © 2011 Bancroft | All rights reserved.

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Transcript of TBI In the Military Cynthia L. Boyer, Ph.D. © 2011 Bancroft | All rights reserved.