San Diego Union-Tribune
September 20, 2007
Pg. 1 Base-line data sought in case of major injury
By Kristin M. Hall, Associated Press
FORT CAMPBELL, Ky. – Before they leave for Iraq, thousands of soldiers with the 101st Airborne Division line up at laptop computers to take a test: basic math, matching numbers and symbols, and identifying patterns. They press a button quickly to measure response time.
It's all part of a fledgling Army program that records how soldiers' brains work when healthy, giving doctors base-line data to help diagnose and treat the soldiers if they suffer a traumatic brain injury – the signature injury of the Iraq war.
“We don't want to wait until the soldier is getting out of the Army to say, 'But I've had these symptoms,' ” said Lt. Col. Mark McGrail, division surgeon for the 101st.
The mandatory brain-function tests are starting with the 101st and are expected to spread to other bases in the next few months. Base commanders will decide whether to adopt the program.
The tests provide a standard measurement for each soldier's reaction time, short-term memory and other cognitive skills. Those data would be used when the soldiers come home to identify mild brain traumas that can often go unnoticed and untreated.
About 7,500 Fort Campbell soldiers have completed the tests, said Dr. Robert Schlegel, a University of Oklahoma researcher who administers the 10-minute exams.
One question asks soldiers to memorize patterns on the screen and then identify them later among several other patterns. Other questions require soldiers to match numbers and symbols or complete simple addition and subtraction problems.
Brain injuries caused by explosions have become one of the most common combat wounds suffered in Iraq. Thirty percent of soldiers taken to Walter Reed Army Medical Center since 2003 suffered traumatic brain injuries, according to the Defense and Veterans Brain Injury Center.
The brain-injury center, which has seven facilities around the country, has seen 2,669 patients between 2003 and 2007. But doctors believe many less-obvious cases go undetected.
Sgt. Adam Wyatt, 22, has been close to 20 to 30 blasts from homemade bombs, rocket-propelled grenades or mortar fire during his past two deployments. But he has never been directly hit.
“The initial shock is a little disorienting,” Wyatt said. “Your first thought is seeing if anyone is wounded and suppressing enemy fire.”
Soldiers sometimes walk away from explosions with no obvious injuries. But the concussion from the blast can have a lingering effect that's not always immediately apparent.
“They look physically normal, but their neurocognitive performance is off,” said Col. Mary Lopez, a physician specializing in occupational therapy.
Most brain injuries are mild, and soldiers can recover with rest and time away from the battlefield. But the military estimates that one-fifth of the troops with these mild injuries will have symptoms requiring continuing care.
So little is known about traumatic brain injuries that the base-line readings could become a cornerstone for future study.
For example, it's unknown how close a soldier must be to a blast to suffer brain damage or whether being knocked unconscious makes a difference, said Jordan Grafman, a neuroscience researcher at the National Institutes of Health. Without base-line information, it's hard to say soldiers are more impaired after they suffer a serious brain injury.
The Army has faced complaints that some soldiers with brain damage were misdiagnosed. The Government Accountability Office is investigating reports that as many as 40 soldiers at Colorado's Fort Carson were misdiagnosed with personality disorders after suffering brain damage or stress-related injuries.
Lt. Col. Mark McGrail, division surgeon for the 101st, said mild brain injury is difficult to diagnose because soldiers often don't report symptoms such as headaches, dizziness, memory problems and irritability.
“The soldiers are by and large very motivated, and they don't want their team to go back out there without them, even though they know they had their bell rung and might not be at the top of their game,” McGrail said.
Some symptoms of traumatic brain injury also overlap with those of post-traumatic stress disorder, another common condition among Iraq war veterans. The brain-injury test also could help doctors differentiate between those conditions, Lopez said.
Sandy Schneider, director of Vanderbilt University's brain-injury rehabilitation program, said it's too early to tell how effective the tests might be at helping diagnose and treat brain injuries.
“We're finding out so much more about this injury because of this war, unfortunately,” Schneider said.
The brain tests have already been tried in pilot programs at Fort Bragg, N.C., with paratroopers who often suffer concussions during jumps, as well as with some soldiers who have deployed to Iraq, Afghanistan and Bosnia.
But the 101st is the first unit to use them on a large scale for every soldier preparing to deploy. The division is leaving for its third deployment, splitting between battlefronts in Iraq and Afghanistan.
One veterans group, however, is worried that the testing could be misused.
It wants to ensure that the Army doesn't use the results to deny treatment by claiming that soldiers' problems came from pre-existing conditions.
“We certainly think these tests should not be used to reduce the responsibility that the Army has to treat the soldiers who have served,” said Jason Forrester, director of policy for Veterans for America.