http://bangornews.com/news/t/news.aspx?articleid=160513&zoneid=500By Meg Haskell
Wednesday, February 20, 2008 - Bangor Daily News
All members of the American armed forces will soon have their brain functions tested and recorded before and after deploying to a war zone, courtesy of federal legislation co-written by U.S. Sens. Susan Collins of Maine and Hillary Clinton of New York. The testing is seen as an important step toward recognizing and treating traumatic brain injury, or TBI, widely considered the "signature injury" of the war in Iraq and, increasingly, in Afghanistan as well.
Getting a jump on the federal policy, the Maine Army National Guard already has started testing soldiers brain function before deployment, perhaps the first group of "civilian soldiers" to generate computerized records of their cognitive performance.
Estimated rates of service-related traumatic brain injury, also known as concussion, vary, but some say that as many as 15 percent of all troops who have deployed to Iraq are affected. The physical trauma occurs most often when troops are the targets of roadside explosives or suicide bombers. The force of the explosion causes the brain to hit forcibly against the inside of the skull. The injury may be intensified inside soldiers protective metal helmets.
The most severe cases of TBI may be marked by visible wounds to the head and may cause irreversible and life-changing losses of brain function. But mild to moderate cases often are unaccompanied by any outward indication and may go unrecognized and untreated.
In the absence of a clear diagnosis, the physical damage of TBI may easily be confused with the psychological response of post-traumatic stress disorder, or PTSD, another common consequence of wartime violence. Both conditions can cause loss of concentration, trouble with language or numerical concepts, intrusive thoughts, depression, irritability and aggression.
The new policy of testing brain function throughout the active-duty military is authorized in the federal Heroes at Home Act. President Bush signed the measure into law in January, and servicewide testing is mandated to be included as part of the routine pre-deployment medical assessment beginning April 1.
The computerized testing program asks subjects to perform tasks designed to measure memory, distractibility, word discrimination, eye-hand response and other aspects of brain function. Since different areas of the brain are responsible for different functions, changes in performance on the test will alert clinicians to areas that may have been damaged.
Treatment, which typically includes rest, medications and graduated rehabilitation exercises, is targeted to restoring the specific functions that have been lost or altered.
In a telephone interview on Tuesday, Collins, who serves on the Senate Armed Services Committee, said her interest in TBI was piqued by a conversation with Rockport neurologist Bruce Sigsbee, who was at the time treating a former service member for TBI. His patient had initially been diagnosed with PTSD.
Sigsbee persuaded Collins that the best way to determine the presence of TBI and to differentiate it from PTSD was to establish each service members "baseline" brain function before deployment, and to repeat the test after deployment to see if changes are evident.
Collins said she had heard of a case in which a surgeon was deployed and came back having lost the ability to perform medical procedures.
"He didnt realize he had TBI," she said, "but that kind of loss would have been picked up" by the routine testing.
Collins noted that TBI is nothing new for combat troops, but Iraq is the first war zone where the use of roadside explosive devices has been the prevailing form of attack, and worsening conditions in Afghanistan portend an increase in TBI cases from that area as well.
The federal legislation also calls for support and training for family members caring for service members with TBI, and authorizes the Department of Veterans Affairs and the Department of Defense to explore the feasibility of using telemedicine to assess the brain function of troops still in the field who have suffered a head injury while deployed.
Testing of some active-duty troops already has begun.
Separately, the Maine Army National Guard began testing troops late last year in preparation for deployments in January to Iraq and Afghanistan.
Dr. Patrick Tangney, the chief medical officer for the Maine Army National Guard, said Tuesday that about 200 soldiers took the approximately 40-minute test, using a computer cluster at Husson College in Bangor. The testing was voluntary, he said, but to the best of his knowledge no soldiers declined.
The Maine Army National Guard project is funded with a three-year grant from the Maine Health Access Foundation and is being carried out in partnership with a head injury specialist at Dartmouth Medical School in New Hampshire.
Tangney said some people will always be "uncomfortable" with the idea of having their brain function mapped, and that military culture has traditionally promoted a "suck it up and dont be a baby" mentality when it comes to psychological or physical injuries.
But the wars in Iraq and Afghanistan are giving rise to new awareness of and respect for PTSD and TBI, he said, since improved body armor and other equipment has allowed many troops to survive injuries that would have killed them in previous conflicts.
The goal of the testing program, he said, is to ensure that Guard members returning from combat can make the transition safely to civilian life.
Tangney said testing of Maine Army Guard troops will continue until its clear the federal program is effective and consistent.
"Were going to go ahead until the bigger system catches up with us," he said.
The Maine project, thought to be the only state-level program of its kind, also includes funds for training mental and physical health care providers in the treatment of traumatic brain injury.
Not sure what to think of this. I don't like seeing my senator co-writing anything with Mrs. Clinton, first off. Ha ha. How could this possibly be abused/misused?
I like the thought behind this, but, I'm not smart enough to know why I'm suspicious of it.
