VDBC – NDAA 2004. Membership: 13 Member commission – 12/13 Mil Experience. (4/13 Flag/General Officers). Chairman : James Terry Scott , LTG, USA (Ret) 2 Congressional Medals of Honor 2 Distinguished Service Crosses 9 Silver Stars 6 Distinguished Flying Crosses Senior Coordinating Group was stood up to provide a steering entity for DoD’s efforts in the wake of all recommendations. It has since evolved into the Senior Oversight Group which is sort of the Senior Coordinating Group with an expanded and more structured role. Co-chaired by DEPSECDEF and Secretary Mansfield. Actual structure & duties/responsibilities are being briefed to the leadership today for final approval. Commission: Honorable Bob Dole and Donna Shalayla IRG Honorable Togo West and Jack Marsh
Under the leadership of Army Brig. Gen. Loree K. Sutton, special assistant to the assistant secretary of defense for health affairs, DCoE was created in November 2007
An issue of relevance to OIF is that returning service members often report exposure to repeated blasts and other concussive events. We know that recovery is impaired with repeated concussions. The worst case scenario is “second impact syndrome” in which a second impact received before the brain has had a chance to heal from a prior injury can lead to an extreme chain of biochemical events that can actually result in death. So it is important to assess for exposure to prior events, to follow these patients more closely and have different expectations regarding the expected level of symptoms and rate of recovery.
R3 = Rehabilitation, Recovery & Reintegration
Listed here are common postconcussive symptoms in the three areas. Common physical symptoms that we see include headaches and dizziness or balance problems. In terms of emotional symptoms, irritability and mood lability are particularly common in returning servicemembers. Cognitive complaints most commonly endorsed include poor concentration and short term memory problems.
The sites in gray have both RECs & RCCs but do not gave regional responsibilities.
Our treatment of mTBI follows evolving evidence-based clinical practice guidelines, to induce: VA/DoD mTBI CPG DoD Clinical Guidance (2008) In-theater mTBI CPG … which are consistent with National standards.
Accumulation of abnormal Tau protein in the form of NFTs and NTs in the brain has been confirmed to cause neurodegeneration, cognitive impairment and dementia. A study commissioned by the NFL reports that Alzheimer’s-like memory-related disease appears to have been diagnosed in the league’s former players vastly more often than in the national population – including a rate of 19 times the normal rate for men ages 30 through 49. - Study conducted by University of Michigan’s Institute for Social Research
Clinical Care in Neurotrauma: Nursing Perspectives Department of Defense Programs to Support TBI Care Kathy Helmick, MS, CRNP, CNRN Deputy Director, TBI, Defense Centers of Excellence for Psychological Health and TBI
High Level Attention Mental Health Task Force Independent Review Group (IRG) Task Force on Returning Global War on Terror Heroes DoDIG Review of DoD/VA Interagency Care Transition Veterans Disability Benefits Commission (www.vetscommission.org) Commission on Care for America’s Returning Wounded Warriors
The Structure Personnel , Pay & Financial Spt Disability System Disability Advisory Council Overarching Integrated Product Team (OIPT) Full-time staff and VA Detail Case Management Summit BEC/HEC Working Group CPI Group Incoming from other commissions Red Cell TBI/Psychlogical Health Case Management DoD/VA Data Sharing Facilities Clean Sheet Review Legislation & Public Affairs 1 2 3 4 5 6 7 Senior Oversight Committee (SOC) Co-Chairs: DEPSECDEF and DEPSECVA 8 As of June 29, 2007
National Defense Authorization Act 2008 SEC. 1621. CENTER OF EXCELLENCE IN THE PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF TRAUMATIC BRAIN INJURY. (a) In General- The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of traumatic brain injury, including mild, moderate, and severe traumatic brain injury. SEC. 1622. CENTER OF EXCELLENCE IN PREVENTION, DIAGNOSIS, MITIGATION, TREATMENT, AND REHABILITATION OF POST-TRAUMATIC STRESS DISORDER AND OTHER MENTAL HEALTH CONDITIONS. (a) In General- The Secretary of Defense shall establish within the Department of Defense a center of excellence in the prevention, diagnosis, mitigation, treatment, and rehabilitation of post-traumatic stress disorder (PTSD) and other mental health conditions, including mild, moderate, and severe post-traumatic stress disorder and other mental health conditions.
What is the Defense Centers of Excellence for Psychological Health and TBI (DCoE)?
DCoE is a DoD organization that, in close partnership with the Department of Veterans Affairs, leads a national and international collaborative network of other governmental organizations, military and civilian agencies, community leaders, advocacy groups, clinical experts and academic institutions in helping service members with psychological health and traumatic brain injury issues.
DCoE’s work focuses on assessing, validating, overseeing and facilitating programs which aid service members with resilience, recovery and reintegration for psychological health and traumatic brain injury issues.
GOAL : A cultural change in Warfighter management after concussive events: identification and documentation of the incident, treatment close to point of injury, and expectation of recovery with early treatment.
VISION : Every Warfighter trained to:
Recognize the signs/symptoms
Equipped to reduce the effects
And in the event of an injury –
Treated early to minimize the impact and maximize recovery from TBI.
MISSION : Produce an educated force trained and prepared to provide early recognition, tracking, treatment & documentation of TBI in order to protect Warfighter health.
9.a. During this deployment, did you experience any of the following events? (Mark all that apply)
Blast or explosion (IED, RPG, land mine, grenade, etc.)
Vehicular accident/crash (any vehicle, including aircraft)
Fragment wound or bullet wound above your shoulders
Other event (for example, a sports injury to your head) . Describe:
9.b. Did any of the following happen to you, or were you told happened to you, IMMEDIATELY after any of the event(s) you just noted in question 9.a.? (Mark all that apply)
Lost consciousness or got “knocked out”
Felt dazed, confused, or “saw stars”
Didn’t remember the event
Had a concussion
Had a head injury
9.c. Did any of the following problems begin or get worse after the event(s) you noted in question 9.a.? (Mark all that apply)
Memory problems or lapses
Balance problems or dizziness
Ringing in the ears
Sensitivity to bright light
9.d. In the past week, have you had any of the symptoms you indicated in 9.c.? (Mark all that apply)
Memory problems or lapses
Balance problems or dizziness
Ringing in the ears
Sensitivity to bright light
Positive screen = concurrence to all four questions Positive screen ≠ concussion diagnosis Need clinician confirmation to diagnose concussion Post-Deployment Health Assessment/ Reassessment (January 08)
TBI Case Management Standard Operating Procedure (SOP): get this at www.dcoe.health.mil
TBI Community of interest newsletter
DVBIC Regional Care Coordination program
Coordination with Federal Recovery Coordination program
Please visit www.dvbic.org to obtain contact information for your regional education or care coordinator. DVBIC Regional Education and Care Coordination Areas MONTANA WYOMING IDAHO WASHINGTON OREGON NEVADA UTAH CALIFORNIA ARIZONA NORTH DAKOTA SOUTH DAKOTA NEBRASKA COLORADO NEW MEXICO TEXAS OKLAHOMA KANSAS ARKANSAS LOUISIANA MISSOURI IOWA MINNESOTA WISCONSIN ILLINOIS INDIANA KENTUCKY TENNESSEE MISS ALABAMA GEORGIA FLORIDA SOUTH CAROLINA NORTH CAROLINA VIRGINIA WV OHIO MICHIGAN NEW YORK PENN MARYLAND DELAWARE NJ CT RI MASS MAINE VT NH ALASKA HAWAII WRAMC Landstuhl, Germany Fort Bragg BAMC & Wilford Hall Fort Hood Camp Lejeune NMC San Diego & Camp Pendleton Palo Alto, CA Fort Carson, CO Minneapolis, MN Charlottesville, VA Johnstown, PA DVBIC HQ- Washington, DC Richmond, VA Tampa, FL San Antonio, TX
Continuum of Care Prevention Surveillance Screening / Assessment Diagnosis Case Management Treatment Rehabilitation Reintegration
Foundation for other cognitive functions/goal-directed behavior
Efficacy of attention training established
True memory impairment vs. poor memory performance from inattention
Evidence to support development of memory strategies and training in use of assistive devices (‘memory prosthetics’)
Evidence to support group sessions in conjunction with individual goal setting
Evidence to support training use of multiple step strategies, strategic thinking and/or multitasking
Compensatory vs. restorative therapy
Cognitive Rehabilitation for Mild TBI: Demonstration Project - April 2010
Implementation at 13 MTFs
Subsequent discussion with the Services resulted in modification of the 13 to the following: Ft. Bragg, WRAMC, Redstone Arsenal, Ft. Campbell, Ft. Gordon, BAMC, Ft. Stewart, Ft. Riley, Wilford Hall, Elmendorf, Camp Pendleton, Portsmouth, Camp Lejeune, and San Diego. (Out: Ft. Hood and 29 Palms) (In: Ft. Stewart, San Diego)
Beginning in Aug 2010, each MTF will track outcome measures identified in the Clinical Guidance Document
Handbook for Family & Friends of Service Members Before, During, and After Deployment
Cumulative Concussion and Longitudinal Effects
Congressionally mandated 15 year longitudinal study
Addition of MACE question on initial evaluation about cumulative concussion and DTM data
Follow Electronic Health Record through system and VA
Coronal sections immunostained for tau with monoclonal antibody AT8 and counterstained with cresyl violet McKee AC, Cantu RC, Nowinski CJ, et al, J Neuropathol Exp Neurol Volume 68, Number 7, July 2009
DoD TBI Research Initiatives 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