Advancements in the Treatment of Traumatic Brain Injuries in Military Soldiers
In the past, the military’s approach to diagnosing head injuries was very limited. Military members were only screened for a concussion or brain injury if their head came into contact with a stationary object or if an object hit them in the head. It took years for medical personnel to realize that the force of a blast wave – the rapid increase in air pressure resulting from an explosion – can result in similar brain damage, or even worse.
A blast wave causes the skull to flex, where the brain is pushed against one side of the skull, and then rebound back in the other direction. The human brain undergoes a sudden change in intracranial pressure resulting in damage to axonal pathways, which are crucial to a healthy nervous system, and capillaries, which help supply blood to the brain cells. This damage can result in long-term impairment, such as behavioral abnormalities, reduced impulse control, emotional outbursts, violence, and even suicide.
In 2013, I completed my master’s thesis in forensic sciences. As a combat veteran, I chose to study traumatic brain injuries (TBIs) in military service members, specifically those suffered after the concussive blast wave of an explosion. After completing my thesis, I wrote a summation article on my findings.
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At the time, there was still limited medical and media coverage of the short- and long-term effects of TBIs on service members. In recent years, with the publication of new research, great strides have been made to improve care and prevention in this area.
Since 2012, all service members preparing to deploy to a combat zone must undergo a pre-deployment exam called the Automated Neuropsychological Assessment Metrics (ANAM). The computer-based assessment establishes a baseline for neurological functioning prior to deployment and takes about 20 minutes to complete.
ANAM establishes a person’s speed and accuracy of attention, memory skills, and thinking ability. When they return from deployment, service members who likely experienced a TBI repeat the exam to assess their neurological functioning after the concussive event. Results are compared with baseline scores and the information is used to help medical personnel determine proper long-term care.
There have also been much-needed changes to the helmets troops wear in combat. For many years, soldiers wore Kevlar helmets with webbing systems thought to protect the brain from various types of injury. However, it was found that this style of helmet not only fails to protect the brain, but actually traps a blast wave between the helmet and head in a phenomenon referred to as “under wash.”
Improvements to the original design have been made. Helmets are now made to cover more of the back and sides of the head, and foam pads have replaced the webbing to provide a type of seal between the helmet and head. This minimizes potential injury from a blast wave, but still does not prevent it.
The Army has also started to insert sensors in soldiers’ helmets to measure impact on the brain after a concussive event such as an explosion. This crucial information is used by medical personnel for further evaluation. The information collected by the sensors also contributes to the advancement of research on TBIs in service members. As of 2013, approximately 27,000 helmet sensors were in use in combat zones and training areas.
The Military Acute Concussion Evaluation (MACE) is another new addition to battlefield protocol. MACE is used to detect and evaluate the details of a concussive experience, as well as the neurological after-effects. Service members in leadership positions are issued a MACE cardwith questions to ask their injured soldiers after an event such as an Improvised Explosive Device (IED) explosion. The questions test the soldier’s ability to recall details of the event and their knowledge of the impact. Combined with their self-reported symptoms, which can include headache, nausea, dizziness and memory loss, a score is calculated. This score indicates whether further evaluation and medical attention is required.
New Developments for the Future
After limited testing, a drug called acetylcysteine appears to be helpful in reducing permanent TBI effects. Traditionally used to combat an overdose of Tylenol or to reduce the build-up of mucus in the lungs, acetylcysteine appears to assist with neurological recovery by providing antioxidant and neuro-vascular protective effects in animals. It has also been shown to reduce the typical auditory, balance and cognitive symptoms experienced after a TBI.
In 2014, experiments were conducted where acetylcysteine was administered to two groups of rats. One group was subjected to mild TBIs and the other to moderate TBIs. Results showed both groups experienced fewer side effects from the TBI after taking the drug. As of now, few trials have been conducted on humans, but it is expected this will be the next logical step. In future years, service members who have experienced a concussive event may be able to get help from this drug.
An additional advancement in the study of TBI detection is the use of specialized eye tracking technology. So far it has primarily been used in emergency rooms, but this advancement could also be used on the battlefield. The detection of concussions and TBIs, specifically when there is no brain bleed or skull fracture, has been a long-running challenge for medical personnel.
The eye tracking procedure and has been able to detect even mild concussions by studying the eye movements of patients while they watch a music video. Difficulty moving both eyes in the same direction suggests brain damage. The hope is to transfer this technology to war zones where combat medical personnel can use it to detect TBIs in military members who show few or no symptoms following a concussive event.
About the Author: Jennifer Bucholtz is a former U.S. Army Counterintelligence Agent and a decorated veteran of the Iraq and Afghanistan wars. She holds a Bachelor of Science in criminal justice, Master of Arts in Criminal Justice and Master of Science in Forensic Sciences. Jennifer has an extensive background in U.S. military and Department of Defense counterintelligence operations. While on active duty, she served as the Special Agent in Charge for her unit in South Korea and Assistant Special Agent in Charge at stateside duty stations. Jennifer has also worked for the Arizona Department of Corrections and Office of the Chief Medical Examiner in New York City. Jennifer is currently an adjunct faculty member at American Military University and teaches courses in criminal justice and forensic sciences. You can contact her at Jennifer.Bucholtz@mycampus.apus.edu.