Troops should be screened for brain injury, panel says

From The New York Times:

A long-awaited government report is calling on the military to test all new recruits for cognitive skills and then do large-scale studies of returning combat veterans to better evaluate and respond to traumatic brain injury, the signature wound of the Iraq war.

For years, veterans’ advocates and researchers have called for more careful investigation of head injuries — not just severe wounds but also “closed head” injuries, which do not produce visible damage and do not show up on CT scans.

Some doctors and veterans say the high blast impact of I.E.D.’s, the roadside explosives that have accounted for most head injuries to troops in Iraq, may be creating symptoms that differ from the sort of concussions suffered in sports or car accidents. Many veterans have complained of persistent, sometimes disabling symptoms like sleeplessness, dizziness and confusion that can resemble disorders like post-traumatic stress and can complicate disability assessments.

The report, released Thursday by the Institute of Medicine, a government advisory group that studies health and medical issues, recommends that the Departments of Defense and Veterans Affairs conduct careful studies “to confirm reports of long-term or latent effects of exposure to blasts.”

Some 5,500 military personnel have suffered brain injuries from mild to severe. The wounds account for an estimated 22 percent of all casualties in Afghanistan and Iraq — about twice the rate in Vietnam. Experts attribute this increase in part to better on-site medical care and body armor that allows ground troops to survive blasts that would otherwise be deadly.

Both the Veterans Affairs Department and the Pentagon have stepped up efforts to address the problem. In a telephone interview, Brig. Gen. Loree K. Sutton, director of the Defense Centers of Excellence for Psychological Health and Traumatic Brain
Injury, said there was “no daylight between the recommendations and actions the
Department of Defense has taken already” to better evaluate head injuries. She called that “a source of confidence, and reassuring.”

Civilian researchers said that they were encouraged by the report and that they hoped that the military would work with academic centers to study the injuries and therapies.

“We know how valuable these patients are in teaching us about recovery and about the plasticity of the brain,” said Jordan Grafman, chief of the cognitive neuroscience section of the National Institute of Neurological Disorders and Stroke and a principal author of a landmark study of head injuries among Vietnam veterans. “These are people who have an exceptional ethic of volunteerism; they volunteer because they want to help vets in the future.”

Tom Tarantino, a policy associate at Iraq and Afghanistan Veterans of America, who served as an Army platoon leader in Iraq in 2005, said careful assessment of head injuries was especially important in decisions on redeployment. “Our highest mental
health priority right now is to have face-to-face assessments done, by professionals, after redeployment.”