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Brain Injury Education for the Army

In response to the increasing incidence of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) among returning US soldiers from Iraq and Afghanistan, the Army started an education program in July to teach soldiers how to recognize symptoms of mild TBI (MTBI) and PTSD in themselves and others, and to know what treatment exists.

The program – called the PTSD/MTBI Chain Teaching program – stresses that seeking treatment for these injuries is imperative not only for individuals but for the collective unit, and that it is not something that should cause soldiers shame.

The goal is to educate more than 1 million soldiers — whether deployed overseas or at home, including those on active duty, the Army Reserve, and the Army National Guard — within 90 days of the launch, by October 18, 2007. At press time, families of soldiers were also eligible to participate in an educational program specifically tailored to them.

The one-hour classes will consist of video presentations, slides, and a standardized list of questions and answers about how to identify mild TBI and PTSD. Unit leaders will be taught first and then teach it to the soldiers, in a trickle-down manner through the Army chain of command.

Both mild TBI and PTSD include common symptoms — problems with concentration, memory, and irritability. But in PTSD, patients also complain about persistent nightmares and alarming memories; avoid people and places that remind them of the traumatic war event; have worsening anxiety; and chronic emotional numbness, according to the National Institute of Mental Health.

Kathy Helmick — a neuroscience nurse who is acting director of clinical and educational affairs at the Defense and Veterans Brain Injury Center (DVBIC) at Walter Reed Army Medical Center — said people with mild TBI have amnesia and often the diagnosis is made when the person is first injured. Other symptoms include headache, dizziness, and balance problems.

Deborah Warden, MD, national director for the DVBIC, emphasized the difficulty in determining if soldiers are suffering mild TBI or from the normal stress reaction from being at war.

According to Karen Fleming-Michael, a public affairs officer for the US Army Medical Research and Materiel Command, education and screening assessments are the two tools used to increase the awareness and detection of TBI. The new chain teaching program does not replace behavioral health assessment tools already used but rather reinforces the Army's efforts to promote quality health care, she said.

Dr. Warden said the DVBIC uses a screening tool created in 2004 to assess whether soldiers sustained but “shook off” mild TBI. The agency asks soldiers three questions: were they injured, did their mental status change, and what are their symptoms. A standardized mental status exam, called the Military Acute Concussion Evaluation (MACE) tool, is also used to evaluate concussions “in theater.” The military also plans to include screening questions for TBI on the post-deployment assessment form that returning soldiers complete.

Barbara Sigford, MD, PhD, national program director for physical medicine and rehabilitation at the Department of Veterans Affairs (VA), told Neurology Today that the MACE is intended for evaluation and screening of TBI at the time of the traumatic event. Since most US veterans come to the VA for care long after the actual traumatic event, they are using a similar tool to MACE that is appropriate for those veterans.

“We are finding it to be sensitive and a positive screen results in a referral for an in-depth complete evaluation by a specialty team,” she added.