Dr. James Kelly: New Military Protocol for Three or More Concussions
Soldiers who have sustained three concussions will receive a more detailed, mandatory evaluation before returning to combat.
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After the 24-hour span of time, the soldier or Marine is again assessed in terms of their symptoms and the cognitive testing and a brief neurological score that will be a part of this to see, "Are they okay?" as best we can tell in that screening assessment. And then determined, if they are symptom-free and they have nothing wrong that anybody can detect on examination-- those individuals then will be released to return. Otherwise, they stay back. And there's even a different part of it now. The new protocol will require individuals who have had three concussions over a 12-month span, now that we're able to track it in this new system-- if we can say, "This is your third. You now undergo a more detailed evaluation before we clear you to go back." Even if they think they're fine after the third, and they pass the screening exam, if they've had three, they go to a different level of neurological evaluation. It's actually fairly common for individuals to have symptoms show up days, weeks, even months later. And what we advocate is watching, monitoring for those symptoms real-time, day to day, week to week, and so forth with a variety of things done to see, "Are you really who you were before the injury?" as best we're able to do that. Some of that has to do with, in the sports setting, having an opportunity to examine the athlete beforehand and then do comparisons to those earlier, pre-injury, assessments. That opportunity may also be available in the military before too long, and parts of it are being done now. But on a system-wide basis with thousands and thousands of people that are engaged in that kind of pre-deployment testing, we don't really have it all ironed out as to how to do that right and what measures are best and what way we can tell who that individual is at a given time in order to compare against all of what happens to them in the meantime, much of which is not concussive, and all of the other things that change a person because of a war experience. And we don't really pretend to understand all of those factors right now.
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.