0
© 2011 Bancroft | All rights reserved
Our Mission     Bancroft’s mission is to ensure that every person is given opportunities     for lifelong learning and ful...
TBI is a “signature injury” of the conflicts                 in Iraq and Afghanistan                   3Copyright –2011 Ba...
DoD TBI Definition (Oct 07)       Traumatically induced structural injury or       physiological disruption of brain funct...
DoD TBI Definition (Oct 07)       New or worsening of at least one of the following       clinical signs       • Loss of c...
Blast Injury       Predominant cause of       TBI in OIF/OEF       A significant number of       soldiers returning from t...
Blast Injuries       Primary-Explosion       • Blast wave strikes and compresses body       • Most serious damage sustaine...
Blast Injuries       Secondary       • Environmental material energized by         explosion strikes the body/brain       ...
Multiple Neurological Injuries       •         Skin breakdown       •         Penetrating Injury       •         Blast/con...
Blast Injuries Are Different       • Treated quickly and aggressively       • Occur under extreme stress       • Long term...
DoD Initiatives       •         Prevention       •         Surveillance       •         Screening       •         Diagnosi...
12Copyright –2011 BancroftBancroft Brain Injury Services        © 2012, Boyer, | All rights reserved
Baseline Testing Pre-Deployment       Neurocognitive Assessment Tool       (ANAM)/Automated Neuropsychological       Asses...
Screening       • Military Acute Concussion Exam (MACE)         (Aug 06)       • TBI screening for all medically evacuated...
MACE: Military Acute       Concussion Evaluation       • Developed by DVBIC and         released in Aug 2006       • Perfo...
MACE: Military Acute       Concussion Evaluation       • Alternate versions available       • Upcoming revision will inclu...
Post-Deployment Health Assessment/Reassessment (January 08)          17© 2011 Bancroft | All rights reserved
Diagnosis       Potential Objective Indicators       • Pupillary response/visual tracking       • Biomarkers       • Imagi...
Mild TBI/Concussion       • More difficult to identify       • Symptoms not unique to TBI                   19Copyright –2...
Possible Effects of TBI Acute       • Poor marksmanship       • Slower reaction time       • Decreased concentration      ...
Possible Effects of TBI       Chronic       • Reduced work quality       • Behavioral Problems       • Emotional Problems ...
Treatment       • Standardized Educational         Information       • New Protocol for 3 or more TBIs         within 12 m...
National Intrepid Center       of Excellence (NICoE)       • Located on Navy campus in         Bethesda, MD       • Dedica...
National Intrepid Center       of Excellence (NICoE)       • Generally to be used by those         who have refractory or ...
Toolkit and Pocket Guide                   25Copyright –2011 BancroftBancroft Brain Injury Services        © 2012, Boyer, ...
Treatment       Co-Morbid Conditions       • Sleep Disorders       • Substance Abuse       • Psychiatric Illness       • V...
Co-Morbidities Associated with mTBI      Chronic                                                                      Slee...
Treatment Research       • Clinical Trials       • Cognitive Rehabilitation       • Neuroprotective Medications       • Lo...
Blast Physics/                                                                  Blast Dosimetry              Neuroprotecti...
Challenges       • Undetected MTBI       • Force readiness/cultural barriers       • Improved Collaboration       • Effect...
Resources       • www.brainline.org       • www.braintrauma.org       •           www.maketheconnection.net       • www.dc...
Resources       • DCoE Facebook, Twitter, YouTube,       •           Multiple Mobile Smartphone Applications       • DCoE ...
Questions?                   33Copyright – © 2011 Bancroft | All rights Injury Services            2012, Boyer, Bancroft B...
Thank you                     for attending!                   34Copyright –2011 BancroftBancroft Brain Injury Services   ...
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Bancroft Traumatic Brain Injury in the Military

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This comprehensive look at traumatic brain injury in the military will examine the type, frequency, and effects of traumatic brain injury sustained in Iraq and Afghanistan. In the session we’ll explore the military’s response to diagnosing and treating traumatic brain injury. Participants will learn/understand what to look for with regard to signs and symptoms of TBI in returning troops and become familiar with the resources available for treatment.
For more information, visit www.bancroft.org

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Transcript of "Bancroft Traumatic Brain Injury in the Military"

  1. 1. © 2011 Bancroft | All rights reserved
  2. 2. Our Mission 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. Our Core Value 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 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. 2© 2011 Bancroft | All rights reserved
  3. 3. TBI is a “signature injury” of the conflicts in Iraq and Afghanistan 3Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  4. 4. DoD TBI Definition (Oct 07) Traumatically induced structural injury or physiological disruption of brain function as a result of external force to the head 4Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  5. 5. 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 5Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  6. 6. Blast Injury Predominant cause of TBI 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 6Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  7. 7. Blast Injuries Primary-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 7Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  8. 8. Blast Injuries Secondary • Environmental material energized by explosion strikes the body/brain Tertiary • Energy from explosion propels the body into stationery objects 8Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  9. 9. Multiple Neurological Injuries • Skin breakdown • Penetrating Injury • Blast/concussive injury • Skull base injury • Facial fractures • Vasospasm* • Pseudoaneuryms* • Sagital sinus injuries 9Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  10. 10. Blast Injuries Are Different • Treated quickly and aggressively • Occur under extreme stress • Long term course is unknown 10Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  11. 11. DoD Initiatives • Prevention • Surveillance • Screening • Diagnosis • Case Management • Treatment • Rehabilitation • Reintegration 11Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  12. 12. 12Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  13. 13. Baseline Testing Pre-Deployment Neurocognitive Assessment Tool (ANAM)/Automated Neuropsychological Assessment Matrics (May 09) • Computerized • 20 min 13Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  14. 14. 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 14Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  15. 15. 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 15Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  16. 16. 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 16Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  17. 17. Post-Deployment Health Assessment/Reassessment (January 08) 17© 2011 Bancroft | All rights reserved
  18. 18. Diagnosis Potential Objective Indicators • Pupillary response/visual tracking • Biomarkers • Imaging (DTI) 18Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  19. 19. Mild TBI/Concussion • More difficult to identify • Symptoms not unique to TBI 19Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  20. 20. Possible Effects of TBI Acute • Poor marksmanship • Slower reaction time • Decreased concentration 20Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  21. 21. Possible Effects of TBI Chronic • Reduced work quality • Behavioral Problems • Emotional Problems • “Unexplained” Problems 21Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  22. 22. Treatment • Standardized Educational Information • New Protocol for 3 or more TBIs within 12 months 22Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  23. 23. 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 23Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  24. 24. 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 24Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  25. 25. Toolkit and Pocket Guide 25Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  26. 26. Treatment Co-Morbid Conditions • Sleep Disorders • Substance Abuse • Psychiatric Illness • Vestibular Disorders • Visual Disorders • Cognitive Disorders 26Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  27. 27. Co-Morbidities Associated with mTBI Chronic Sleep disorders Pain 16.5% N=277 2.9% PTSD N=232 Substance abuse 81.5% 10.3% 68.2% 42.1% Psychiatric illness Vestibular disorders 12.6% 6.8% 5.3 TBI Visual disorders % N=227 66.8% 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 27Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  28. 28. Treatment Research • Clinical Trials • Cognitive Rehabilitation • Neuroprotective Medications • Longitudinal Study 28Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  29. 29. Blast Physics/ Blast Dosimetry Neuroprotection & Repair Strategies: Brain Injury Treatment & Clinical Improvement Prevention Rehabilitation & Field Epidemiological Studies Reintegration: Long Term (mTBI) Effects of TBI Complementary Alternative Medicine Concussion: Rapid field Assessment Force Protection Testing & Fielding 29Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  30. 30. Challenges • Undetected MTBI • Force readiness/cultural barriers • Improved Collaboration • Effective Treatment 30Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  31. 31. Resources • www.brainline.org • www.braintrauma.org • www.maketheconnection.net • www.dcoe.health.mil • www.dvbic.org • TBI Family Caregiver Guide • www.Afterdeployment.org 31Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  32. 32. Resources • DCoE Facebook, Twitter, YouTube, • Multiple Mobile Smartphone Applications • DCoE Blog • Yellow Ribbon Presentations 32Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
  33. 33. Questions? 33Copyright – © 2011 Bancroft | All rights Injury Services 2012, Boyer, Bancroft Brain reserved
  34. 34. Thank you for attending! 34Copyright –2011 BancroftBancroft Brain Injury Services © 2012, Boyer, | All rights reserved
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