Bancroft Traumatic Brain Injury in the Military

Our Mission
Bancroft’s mission is to ensure that every person is given opportunities
for lifelong learning and fulfillment.
We do this by altering perceptions, and by supporting those with
intellectual and developmental challenges and acquired brain injuries in
achieving their life goals as valued and respected members of our world.

Our Core Value
Respect is our clearly defined core value that helps unify the organization and
provide a framework for services, decision-making and working together.

Our Vision
By 2014 our distinct ability to deliver high quality individualized services in
modern living, learning and working environments will exceed stakeholder
expectations and secure Bancroft as the region’s elite provider of services to
people with intellectual and developmental disabilities and brain injuries.

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TBI is a “signature injury” of the conflicts
in Iraq and Afghanistan

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Copyright –2011 BancroftBancroft Brain Injury Services
© 2012, Boyer, | All rights reserved

DoD TBI Definition (Oct 07)
Traumatically induced structural injury or
physiological disruption of brain function as
a result of external force to the head

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DoD TBI Definition (Oct 07)
New or worsening of at least one of the following
clinical signs
• Loss of consciousness or decreased consciousness
• Loss of memory immediately before or after injury
• Alteration in mental status (confused, disoriented, slow
thinking)
• Neurological deficits
• Intracranial lesion
DoD definition parallels standard medical definition
• CDC, WHO, AAN, ACRM
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Blast Injury
Predominant cause of
TBI in OIF/OEF

A significant number of
soldiers returning from the
conflicts in Iraq and
Afghanistan have this injury
and will suffer long-term
consequences

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Blast Injuries
Primary-Explosion
• Blast wave strikes and compresses body
• Most serious damage sustained by air and
fluid filled organs
• Causes brain injury without visible damage
to the head/skull
• Causes significant damage to eyes, ears,
lungs

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Blast Injuries
Secondary
• Environmental material energized by
explosion strikes the body/brain

Tertiary
• Energy from explosion propels the body
into stationery objects

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Multiple Neurological Injuries
• Skin breakdown
• Penetrating Injury
• Blast/concussive injury
• Skull base injury
• Facial fractures
• Vasospasm*
• Pseudoaneuryms*
• Sagital sinus injuries

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Blast Injuries Are Different
• Treated quickly and aggressively

• Occur under extreme stress

• Long term course is unknown

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DoD Initiatives
• Prevention
• Surveillance
• Screening
• Diagnosis
• Case Management
• Treatment
• Rehabilitation
• Reintegration

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Baseline Testing Pre-Deployment
Neurocognitive Assessment Tool
(ANAM)/Automated Neuropsychological
Assessment Matrics (May 09)
• Computerized
• 20 min

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Screening
• Military Acute Concussion Exam (MACE)
(Aug 06)
• TBI screening for all medically evacuated
at Landstahl Regional Medical Center
(May 06)
• PostDeployment HealthScreening (Jan 08)
• VA TBI Screening

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MACE: Military Acute
Concussion Evaluation
• Developed by DVBIC and
released in Aug 2006
• Performed by medical
personnel
• 3-Part Screening Tool – “CNS”
• Cognition
• Neurological Exam
• Symptoms
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MACE: Military Acute
Concussion Evaluation
• Alternate versions available
• Upcoming revision will include
recurrent concussion questions
• Can be used during exertional
testing to ensure that cognitive
function remains intact

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Post-Deployment Health Assessment/
Reassessment (January 08)

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Diagnosis
Potential Objective Indicators
• Pupillary response/visual tracking
• Biomarkers
• Imaging (DTI)

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Mild TBI/Concussion
• More difficult to identify
• Symptoms not unique to TBI

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Possible Effects of TBI Acute
• Poor marksmanship
• Slower reaction time
• Decreased concentration

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Possible Effects of TBI
Chronic
• Reduced work quality
• Behavioral Problems
• Emotional Problems
• “Unexplained” Problems

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Treatment
• Standardized Educational
Information
• New Protocol for 3 or more TBIs
within 12 months

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National Intrepid Center
of Excellence (NICoE)
• Located on Navy campus in
Bethesda, MD
• Dedicated 24 June 2010
• Serves Service Members (and
their families) with complex
TBI
• Primarily evaluative in nature
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National Intrepid Center
of Excellence (NICoE)
• Generally to be used by those
who have refractory or difficult-
to-diagnose/manage conditions
• Provides case management and
referral capabilities to leading
experts in the field
• Full Operating Capability: Oct
2011
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Toolkit and Pocket Guide

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Treatment
Co-Morbid Conditions
• Sleep Disorders
• Substance Abuse
• Psychiatric Illness
• Vestibular Disorders
• Visual Disorders
• Cognitive Disorders
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Co-Morbidities Associated with mTBI
Chronic Sleep disorders
Pain 16.5%
N=277 2.9% PTSD
N=232
Substance abuse
81.5% 10.3%
68.2%
42.1% Psychiatric illness
Vestibular disorders
12.6% 6.8%

5.3
TBI Visual disorders
%
N=227
66.8% Cognitive disorders
Lew, et al: “Prevalence of Chronic Pain, Posttraumatic Stress Disorder, and Persistent Postconcussive Symptoms in OIF/OEF
Veterans: Polytrauma Clinical Triad”, Dept. of Veterans Affairs, Journal of Rehabilitative Research and Development, Vol. 46,
No. 6, 2009, pp. 697-702, Fig. 1
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Treatment Research
• Clinical Trials
• Cognitive Rehabilitation
• Neuroprotective Medications
• Longitudinal Study

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Blast Physics/
Blast Dosimetry Neuroprotection & Repair
Strategies: Brain Injury
Treatment & Clinical Improvement Prevention

Rehabilitation & Field Epidemiological Studies
Reintegration: Long Term (mTBI)
Effects of TBI

Complementary Alternative
Medicine Concussion: Rapid field
Assessment
Force Protection Testing & Fielding

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Challenges
• Undetected MTBI
• Force readiness/cultural barriers
• Improved Collaboration
• Effective Treatment

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Resources
• www.brainline.org
• www.braintrauma.org
• www.maketheconnection.net
• www.dcoe.health.mil
• www.dvbic.org
• TBI Family Caregiver Guide
• www.Afterdeployment.org
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Resources
• DCoE Facebook, Twitter, YouTube,
• Multiple Mobile Smartphone Applications
• DCoE Blog
• Yellow Ribbon Presentations

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Thank you
for attending!

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Bancroft Traumatic Brain Injury in the Military

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