Dr. James Kelly: Building an Effective Military Baseline Test Platform for Brain Injury
Military experts are working to define what baseline testing for TBI would be most effective for pre- and post-deployment comparison, as well as for use in theater.
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The military is well into the process of doing baseline, or pre-deployment, neurocognitive assessments, mainly in the Army. They've been ahead of the game a bit. And so each service has its own opportunities to do these tests and gather the data and have it ready for comparison when the service members return post-deployment. But then the question becomes. "Can you get that information in theater to make use of it again if a concussion were to occur?" And that's cumbersome. It works some of the time and in certain areas, but technology isn't widely available in austere environments like Afghanistan. So you don't always have access to the information that you might want under those circumstances. Then the other part is, when somebody comes home and what you're comparing them against is a 20-minute snapshot of their cognitive performance on a computer laptop a year earlier, and all of what's happened in that year has occurred to you, we're not sure that we're getting valid information-- either about how they performed on the test beforehand nor on is it a meaningful reevaluation so much later and with so much water under the bridge, so to speak. So it's a part of an opportunity that we have to learn about what's affected these people, but it's really only part of it. We need to expand the assessment into other areas of human endeavor. But I think that the computer assessments will continue to be a part of it. It's just that it can't be over-simplified such that that's all you need. That would be a mistake. We could spend two days doing a variety of tests that I would like to see, and then you'd get somebody else in the room and you'd find a different combination of tests and so forth. I think that we're actually looking at those kinds of questions now to determine what are the proper combinations of tests to do before somebody goes, to compare against later when they return. And some of that actually is being done and has been done all along in the basic medical sense. Then there's the post-deployment health assessments, which are surveys, and reassessments three to six months later. And so those sorts of things then have to be looked at in detail in terms of what's real in that person's medical record. And so for a given individual, we have lots of opportunities to gather information and get it right. And if we expand it a little bit in terms of what we're looking at before that individual goes, we'll have a better baseline--kind of a platform on which to build-- and look again when they return as to what the nature of the problems are they may or may not have.
Posted on BrainLine October 20, 2010.
James Kelly, MA, MD, FAAN, a neurologist, is one of America’s top experts on treating concussions. He currently serves as Executive Director of the Marcus Institute for Brain Health.
Produced by Noel Gunther and Brian King, BrainLine.