Back to Top Skip to main content Skip to sub-navigation

DOD warfighter brain health draft plan has six priorities

Image of Military medical personnel looking at a patient's brain scan. Lorie Falaminiano, an MRI technologist at Naval Medical Center San Diego, conducts a scan of a patient's brain Aug. 3. Brain scans that occur on a more frequent basis during a warfighter’s military career and beyond are one of the six concerns and priorities outlined by operational service members. (Photo by Navy Mass Communication Specialist Seaman Luke Cunningham.)

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness | Brain Injury Awareness To Improve Readiness

Documenting how warfighters score on cognitive testing – from the beginning of their careers until after they leave military service – is one of six major concerns and priorities of service members being addressed in a plan for brain health that is in final draft form.

This change to looking at brain exposures and traumatic brain injury (TBI) across the warfighter’s entire career represents a “paradigm shift” in the Department of Defense’s approach, TBI specialist Kathy Lee told the Society of Trauma Nurses annual conference, held virtually March 26.

Lee, senior health policy analyst for DOD’s Health Affairs, discussed the comprehensive strategy and plan for warfighter brain health (WBH), which addresses brain health, brain exposures, including blast exposures, TBI, and long-term and late effects of exposures and/or TBI.

General physical and brain health assessments, scans, or tests “that occur on a more frequent basis over time across their military careers and beyond if deficits are identified” is one of the six concerns and priorities outlined by operational service members, according to Lee.

Dissemination of information on which “brain exposures are most damaging” and “outright disclosure if they are at increased risk of exposure or injury while performing a specific training activity” such as breaching walls or experiencing blast overpressure is another priority and concern for transparency.

There are “multiple, deleterious effects of exposures before traumatic brain injury actually occurs” as well as TBI itself, Lee said. Known and emerging brain exposures are: blast overpressure; blunt force/impact; projectiles; directed energy (high-powered microwave); chemical-biological toxins; and other environmental hazards, she explained.

Patient being prepped for a PET scan
Michelle Pribble, Naval Medical Center San Diego's lead nuclear medicine technologist, prepares a patient for a positron emission tomography (PET) scan in the hospital's Nuclear Medicine Department Oct. 6. A PET scan is used for revealing or evaluating conditions including brain disorders. (Photo by Navy Mass Communication Specialist Seaman Luke Cunningham.)

“Upwards of 86 percent of traumatic brain injuries are classified as mild” and are known as concussions, she said. “We can see 14,000 to 17,000 patient visits per month for TBI in the military health system, which is why we need standardized tools and research” to identify, control, and mitigate these brain exposures and TBIs.

The other four concerns expressed by service members are:

  • “Perceived disconnect” between operational efforts in preparation and training for combat and “medical communities translating brain health information to the service member in time to help them,” Lee said.
  • “Warrior mindset” that can discredit a service member’s own struggles or concerns “because they have a desire to complete their mission despite brain exposures, injury or illness” and “because they often compare themselves to other service members who may be in worse condition,” she said.
  • “Multiple concerns” over the newer emphasis on blast overpressure exposures and brain health and how safety and training changes may dilute training opportunities, deployment readiness and force lethality.
  • “Clinical tools, protocols, and research solutions” if the service member has been in the military longer and “may be noticing changes in functional abilities.”

All service members are required to take the Automated Neuropsychological Assessment Metrics test (ANAM) prior to deployment. The test has been in use since 2008 and has 10 domains to set up a baseline of cognition, which is one marker of brain health, Lee said.

“In fiscal 2019, we completed more than 220,000 of these assessments,” she said. “The WBH proposed plan will expand that requirement to include conducting the ANAM on all service members so that we can monitor and optimize cognitive performance and maximize combat effectiveness,” she said.

The WBH draft plan has 18 objectives and 53 associated activities along five “lines of effort” for “the deliberate, prioritized, and rapid development of end-to-end solutions,” Lee explained.

The five lines of effort are:

  • Optimize cognitive and physical performance
  • Identify, monitor, and mitigate brain exposures
  • Prevent, recognize, and minimize the effect of TBI
  • Reduce or eliminate long-term/late effects
  • Advance warfighter brain health science

The research and science objectives of the DOD plan are to “align brain health research and acquisition to current and emerging threats and operational requirements;” “maximize WBH research opportunities for partnerships with other government agencies, industry, and academia;” “enable researchers to have access to valid data regarding brain exposures and injuries and related brain health effects;” and “translate research findings into knowledge and materiel products, practice, and policies to maintain and optimize WBH,” Lee said.

Some of the research involves evaluating the late effects following blast and multiple TBIs by examining the brains of more than 200 service members from a repository at the Uniformed Services University of Health Sciences in Bethesda, Maryland, Lee noted.

Research includes examinations of clinical diagnoses, blood-based biomarkers, genetics, diagnostic imaging, and outcomes after treatment. A new rapid blood biomarker for TBI was cleared recently by the Food and Drug Administration for use in austere environments, adding to the armamentarium of biomarker tests.

The WBH plan is based on an Oct. 1, 2018, directive from DOD stating there should be a “single approach to brain health” in warfighters of all services that goes from brain exposure to TBI.

“Prior to this directive, there have been successful but disparate efforts,” Lee said.

The plan has been created through 18 months of field work and working groups, she noted. It is anticipated that the plan will be approved prior to the end of the fiscal year.

Her presentation was the first time the Society of Trauma Nurses had heard about the DOD plan, said society President Maria McMahon. It was noteworthy for practitioners because the DOD Warfighter Brain Health construct lends itself to nurse practitioner engagement in clinical practice, patient education, policy development, and emerging research.

Lee previously presented the data at December’s annual meeting of AMSUS, The Society of Federal Health Professionals, and the draft plan was part of a November 2020 themed issue of the Journal of the American Association of Nurse Practitioners.

You also may be interested in...

Tackling Concussions: NCAA-DOD CARE Consortium Battles Brain Injuries

Article
1/6/2022
Naval Academy football team runs onto the field

Dr. Paul Pasquina and Dr. Terry Rauch recently discussed the NCAA-DOD Concussion Assessment, Research and Education (CARE) Consortium, the largest concussion and repetitive head impact study in history, on the NCAA’s “Social Series.”

Recommended Content:

Uniformed Services University of the Health Sciences | Traumatic Brain Injury | Medical Research and Development

Dizziness and Visual Problems After Concussion

Infographic
1/4/2022
Dizziness and Visual Problems After Concussion

More than 80% of all concussions—also known as a mild traumatic brain injury— in the military are considered mild. Dizziness and visual problems are among the most common symptoms after concussion and often resolve within days or weeks. This infographic reviews common signs and symptoms to look out for.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Patient and Family Resources

TBI Hot Topics Bulletin, December 2021 Edition

Publication
12/8/2021

The TBI Hot Topics Bulletin is a product of the TBICoE research branch and provides a quarterly summary of TBI research relevant to health care providers. This issue covers research published July through September 2021.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury

2021 Q2 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis in the second quarter of calendar year 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Traumatic Brain Injury

2000-Q2 2021 DOD Worldwide Numbers for TBI

Publication
10/14/2021

TBICoE is the Defense Department’s office of responsibility for tracking traumatic brain injury data in the U.S. military. Here you’ll find data on the number of active-duty service members—anywhere U.S. forces are located—with a first-time TBI diagnosis from calendar year 2000 through the second quarter of 2021. The data is also broken down by each branch of the armed services.

Recommended Content:

Traumatic Brain Injury Center of Excellence | DOD TBI Worldwide Numbers | Centers of Excellence | Traumatic Brain Injury

USU Co-leads Largest NCAA-DOD Concussion Study in History

Article
10/8/2021
A doctor looks at a patient's prosthetic arm.

The Uniformed Service University will co-lead the next phase of the largest concussion and repetitive head impact study.

Recommended Content:

Traumatic Brain Injury

Back from the Brink: One Marine's Recovery from Suicidal Thoughts

Article
9/29/2021
Portrait photo of John Peck

After suffering a TBI in Iraq and losing all four limbs in Afghanistan, Marine Sgt. John Peck talks about his own experience and the differences in the ways in which individuals deal with traumatic life events.

Recommended Content:

Traumatic Brain Injury | Suicide Prevention | Suicide Prevention | Talking About Afghanistan

Concussion Linked to Depression, Anxiety and PTSD, Studies Show

Article
9/28/2021
Picture of blast waves during an explosion

A clear link between blast-related concussions and mental health symptoms like depression, anxiety, and PTSD, is shown in a series of recent studies.

Recommended Content:

Traumatic Brain Injury

NICoE, NHRC Team Up To Make CAREN Technology Portable

Article
8/12/2021
A person walks in front of a large virtual reality screen.

Head-mounted display technology has become more affordable and accessible

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | The National Intrepid Center of Excellence

Did You Know? Concussions - Mild TBI

Infographic
8/3/2021
Did You Know? Concussions - Mild TBI

Concussions are the most common form or Traumatic Brain Injury in the Military. Be TBI ready!

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness To Improve Readiness

Prevent Concussions

Infographic
8/3/2021
Prevent Concussions

Be TBI Ready!

Recommended Content:

Brain Injury Awareness To Improve Readiness

Concussion Awareness V1

Infographic
8/3/2021
Concussion Awareness V1

According to the Defense Health Agency Traumatic Brain Injury Center of Excellence (TBICoE), 439,609 service members have been diagnosed with a first-time TBI since 2000. The most common form of TBI in the military is mild, and is also known as a concussion.

Recommended Content:

Suicide Prevention | Traumatic Brain Injury

PRA Case Study Workbook

Publication
7/23/2021

This workbook, paired with corresponding PRA Training Video 8, is an interactive clinical case scenario to test your understanding in applying the Progressive Return to Activity. We hope this will help medical providers become more familiar with the PRA process when treating service members with concussion.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury

Caregiver Guide supports service members and veterans with TBI

Article
7/22/2021
Military family posing for a picture

Traumatic Brain Injury Center of Excellence’s 2021 Caregiver Guide provides specific tools to help caregivers manage TBI patient recovery.

Recommended Content:

Centers of Excellence | Traumatic Brain Injury | TBI Education and Training Events

PRA Training Video 6: The Return to Duty Screening

Video
7/22/2021
PRA Training Video 6: The Return to Duty Screening

In this lesson, we cover how to perform the Return to Duty, or RTD screening, which now includes both vestibular/physical and neurocognitive examinations. The purpose of the RTD screening is to objectively measure whether a service member is ready for return to full duty. Each video in the Progressive Return to Activity training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Provider Resources | Provider Education | Traumatic Brain Injury
<< < 1 2 3 4 5  ... > >> 
Showing results 31 - 45 Page 3 of 16
Refine your search
Last Updated: May 19, 2021

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.