ARMY AL&T
said. Of 250,000 events recorded by the sensors in theater, “only 60,000 of those probably represented some sort of blast or impact,” he said. “The sensors were actually very, very sensitive.”
MRMC attempted to correlate the sensor recordings to actual injury data or to data found in post-deployment health reassessments, to develop a model of blast injury, and found that “the sensor data correlated very, very poorly,” he said.
It will help, Gilman said, that the Generation II sensor will allow for wire- less download of data, versus plugging the earlier sensor into a USB port. “I do understand that the job of a young leader is to go downrange and bring Soldiers home, and it’s not primarily to collect data from helmet-mounted sensors.”
TBI Research Challenges TBI can be caused by injuries to the head from bullet fragments and shrap- nel, blunt impact injuries such as from a collision, or blast events such as the detonation of an IED. Blast, ballistic, and blunt impacts are separate phe- nomena, with different characteristics. The least understood are blast injuries.
What is known is that blast injuries can result in long-lasting neurologic and psychological problems. Body armor allows the lungs to tolerate blast effects, but the brain is exposed to blast levels in ways that medical experts are still trying to measure.
Experts from the military medical community agree that correctly under- standing the biomechanics of blast injuries is vital to the Army’s opera- tions, readiness, and health.
“The term itself causes a lot of confu- sion. … It’s a very, very broad spectrum of injury types,” said Michael J. Leggieri Jr., Director of DOD’s Blast Injury Research Program Coordinating Office within MRMC.
“We have a vast medical TBI research portfolio … focused on knowledge gaps,” Leggieri said at the Head Protection Summit: “How do we prevent injury? How do we quickly diagnose that injury? How do we reset? How do we return that person [to active duty]?
“There’s a lot we don’t know about this injury,” he said, although “there are many, many hypotheses about how this injury occurs. If we don’t understand the mechanism, there’s no way we can develop effective protection strategies.”
Continuum of Research The diverse body of TBI and PTSD research can be organized, as MRMC has done, along a continuum of care for the Soldier or patient, from prevention through assessment and finally, return to duty or long-term care.
TBI in particular “is still a very unique problem in our estimation, because we still don’t have a full, clinically well- accepted diagnosis,” said Gilman at the Army Science Conference. Instead, a diagnosis of TBI “is based on the subjective report of an exposure to an
TBI
event, and some reported or estimated proximity thereto, and then some symp- tom that occurs soon, or immediately after that event. And that symptom can be nothing more than disorientation. So right now we are still struggling to find the gold standard, and this is impacting every one of our efforts in terms of traumatic brain injury.”
Following the continuum (see chart below), these efforts include:
• Prevention and Protection—At least three pharmaceutical or nutraceuti- cal products, including the omega-3 fatty acid docosahexaenoic acid (DHA), hold promise for protecting the brain from injury. “If effective, then we can supplement rations with [DHA] and perhaps mitigate or ame- liorate the consequences of exposure to blast,” said Gilman.
• Early detection—Ultimately, the helmet-mounted sensor may be able to provide this capability, which could improve the outcome of a Soldier’s exposure to blast.
• Screening—Deficits in visual tracking performance are one manifestation of diffuse axonal
CONTINUUM OF TBI CARE DETERMINES RESEARCH APPROACH
Prevention and
Protection
1. Head Injury
Detection of Possible Head Injury
Return to Duty/Disability/Reclassification Assessment 2. Early
Screening (DoD
Guidelines) MEDICAL CAPABILITY NEEDED
Prophylaxis,Me dical Standards for Protec=ve Equipment
RDT&E: Military Opera2onal Medicine, Combat Casualty Care, Clinical and Rehabilita2ve Medicine Recovery
Objec=ve Measure of Head Impact Exposure
Valid Criteria & Objec=ve Head Injury
Screening Tool
Portable or Fieldable Diagnos=c Device
Medica=on Surgical
Technology Validated Defini,on
Nutraceu=cals, Standards for Helmets
HIGHLIGHTED RESEARCH
5 Studies DHA
Head Impact/ Blast Injury Dosimeter
4 Studies HMSS
Tracking, Ves,bular Ocular Assessment
and Technologies: EEG, TCD, Eye
RESEARCH SOLUTIONS Cogni,ve,
Behavioral, & Neurological Assessments , Biomarkers
(CT,
EEG, fMRI, DTI, MRS, etc.)
20 Studies EYE-TRAC
43 Studies BANDITS, NCAT MG James K. Gilman / MCMR-ZA (301-619-7613) (DSN 343-) /
James.Gilman@
us.army.mil Timecourse Rehabilita=on Valid RTD
Standards & Measures
3. Head Injury
Assessment
4. Head Injury
5. Treatment 6. Recovery Reset 7.
Medica=ons, Surgical
Procedures,
Interven=onal Technologies
118 Studies NNZ-2566, HBO2
UNCLASSIFIED
Evidence-‐Based Effec=ve
Rehabilita=on Interven=ons Measures of
Rehab Progress
26 Studies SCORE
Slide of 31 APRIL –JUNE 2011 31
RTD Standards, Evalua=on/ Measurement
4 Studies RTD
30 Nov 2010
Basic Science: 129 Studies; MODELING
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