President-elect Obama has announced his new Secretary of Veterans Affairs and it is Gen. Eric Shinseki. He was severely wounded in Vietnam and spent 11 months in the hospital General Shinseki was the US Army Chief of Staff and was forced to retire by Donald Rumsfeld because he was not acting like part of the team. He dissented vigorously regarding the prosecution of the invasion of Iraq. His resolve cost him his job, and he has since been proven right.
His resolve will be tested again as the Bush Administration filled the VA with hacks, incompetents and apologists. James Nicholson followed the Bush party line right off a cliff. Then, General James Peake became Secretary. General Peake when in uniform, as the US Army Surgeon General, failed to acknowledge, prepare and deal with either Traumatic Brain Injury and mental health issues. As a civilian, he continued the policy as it might expose his incompetence. Hopefully, he will quickly retire from the practice of medicine, his tenure has been a disgrace.
General Shinseki should first resolve to clean-up the VAs administrative mess that fails to screen, admit and treat our wounded warriors. The VA would make Soviet apparatchiks blush with its indifference and ineffeciency. Second, he should immediately demote and fire the entire senior management of VA in mental health and traumatic brain injury. The signature injuries of OIF/OEF can be acknowledged and treated. The very capable staffs of many VA sites can be supplemented with civilian resources to get these service members squared away. The policy of denying benefits based on phony science and mindless research by both the DoD and VA can quickly come to an end. Finally, he must seek to chart an independent path; the DoD has an agenda quite seperate from treating and honoring our warriors.
Hopefully this action will signal to Military Health Systems that it is time to clean its house.
Showing posts with label m-TBI. Show all posts
Showing posts with label m-TBI. Show all posts
Saturday, December 6, 2008
MILITARY PERSONNEL WITH TRAUMATIC BRAIN INJURY AT RISK FOR SERIOUS LONG-TERM
The Institute of Medicine reported this week Military personnel who suffer severe or moderate traumatic brain injury (TBI) face an increased risk for developing several long-term health problems. This evidenced based study reported that conditions include Alzheimer's-like dementia, aggression, memory loss, depression, and symptoms similar to those of Parkinson's disease. Even mild TBI is associated with some of these adverse consequences, noted the committee that wrote the report.
In addition, the report notes that brain injuries sustained as a result of exposure to the force of an explosion without a direct strike to the head -- one of the most common perils for soldiers in Iraq and Afghanistan -- may be underdiagnosed due to the lack of research on blast injury. It calls for the U.S. Department of Defense and the U.S. Department of Veterans Affairs to step up clinical and animal studies of blast-induced neurotrauma (BINT).
The Healing Project would go further and immediately screen and database the 300,000 to 400,000 service members exposed to blasts.
"Explosive devices and other weaponry have become more powerful and devastating throughout the wars in Iraq and Afghanistan, and we are seeing much higher rates of nonpenetrating traumatic brain injury and blast-induced injury among military personnel who have served in these countries than in earlier wars," said George W. Rutherford, professor of epidemiology and preventive medicine and vice chair, department of epidemiology and biostatistics, School of Medicine, University of California, San Francisco, and chair of the committee that wrote the report. "It is important to identify and understand any long-term health effects of these injuries so that wounded service members do not lose valuable time for therapy and rehabilitation."
Studies conducted in Iraq by the Air Force Medical Service with the Headminder system would argue that up to 5% of exposures, that is 15,000 to 20,000 m-TBI injuries, would require additional follow-up. The DoD is only reporting 5,500 injuries total traumatic brain injuries. Furthermore, while animal studies are useful, replicating injuries in animals models are unlikely to provide necessary data to provide human clinical guidance. It is time to implement a web-centric longitudinal screening technology to track the evolution of these injuries in an epidemiologically sound fashion.
While we agree with the Institute in broad strokes, scientists and clinicians have been aware of the injuries and the likely outcome of these injuries since 2004. Neither the DoD or the VA has demonstrated any real interest in identifying or treating M-TBI dealing with its attendant co-morbidities. Both organizations have used research to delay the identification of and/or deny the very existence of the injuries. The report makes it clear blast concussion is not like a sports injury nor is it PTSD (two of the DoDs and VAs favorite excuses why they do nothing). Now that we have a change of government, it is time for Secretary of Defense Gates to clean out DoD HA and US Army Medcom. The delayers, the deniers and the dinosaurs need to be quickly cashiered and replaced by people who will get the job done now.
In addition, the report notes that brain injuries sustained as a result of exposure to the force of an explosion without a direct strike to the head -- one of the most common perils for soldiers in Iraq and Afghanistan -- may be underdiagnosed due to the lack of research on blast injury. It calls for the U.S. Department of Defense and the U.S. Department of Veterans Affairs to step up clinical and animal studies of blast-induced neurotrauma (BINT).
The Healing Project would go further and immediately screen and database the 300,000 to 400,000 service members exposed to blasts.
"Explosive devices and other weaponry have become more powerful and devastating throughout the wars in Iraq and Afghanistan, and we are seeing much higher rates of nonpenetrating traumatic brain injury and blast-induced injury among military personnel who have served in these countries than in earlier wars," said George W. Rutherford, professor of epidemiology and preventive medicine and vice chair, department of epidemiology and biostatistics, School of Medicine, University of California, San Francisco, and chair of the committee that wrote the report. "It is important to identify and understand any long-term health effects of these injuries so that wounded service members do not lose valuable time for therapy and rehabilitation."
Studies conducted in Iraq by the Air Force Medical Service with the Headminder system would argue that up to 5% of exposures, that is 15,000 to 20,000 m-TBI injuries, would require additional follow-up. The DoD is only reporting 5,500 injuries total traumatic brain injuries. Furthermore, while animal studies are useful, replicating injuries in animals models are unlikely to provide necessary data to provide human clinical guidance. It is time to implement a web-centric longitudinal screening technology to track the evolution of these injuries in an epidemiologically sound fashion.
While we agree with the Institute in broad strokes, scientists and clinicians have been aware of the injuries and the likely outcome of these injuries since 2004. Neither the DoD or the VA has demonstrated any real interest in identifying or treating M-TBI dealing with its attendant co-morbidities. Both organizations have used research to delay the identification of and/or deny the very existence of the injuries. The report makes it clear blast concussion is not like a sports injury nor is it PTSD (two of the DoDs and VAs favorite excuses why they do nothing). Now that we have a change of government, it is time for Secretary of Defense Gates to clean out DoD HA and US Army Medcom. The delayers, the deniers and the dinosaurs need to be quickly cashiered and replaced by people who will get the job done now.
Thursday, October 16, 2008
A Proven Technology Detects mild-Traumatic Brain Injury in Combat
On October 12 at the International Conference on Behavioral Health and Traumatic Brain Injury, St. Joseph's Regional Medical Center, Paterson, NJ, HeadMinder, Inc., presented results of the first Military IRB-approved prospective study to be conducted in-Theater.
The study compared the HeadMinder Cognitive Stability Index (CSI) computerized test battery and the Department of Defense (DoD) Automated Neuropsychological Assessment Metric (ANAM) with the Repeatable Battery for Assessment of Neuropsychological Symptoms (RBANS), a paper-and-pencil neurocognitive test currently used by the DoD to screen soldiers.
The study was designed by Lt. Col. (sep.) Gerald Grant, MD (USAF), Maj. William Isler, PhD (USAF), Maj. Monty Baker, PhD (USAF), David Erlanger, PhD (Chief Scientific Officer and co-Founder of HeadMinder), Tanya Kaushik, PsyD, and Col. Robert Seegmiller (USAF). The objective was to determine the validity and reliability of both computerized screening measures as compared to the RBANS. The CSI was accurate in assessing the severity of cognitive compromise following concussive blast injuries. The CSI Total Score correlated very strongly with the RBANS Total Score (.789) and also showed strong concurrent validity with the RBANS in the domains of Attention (.706) and Memory (.680), domains critical in the assessment of blast-related concussion. ANAM was not useful for identifying memory problems, the domain most frequently impaired on the RBANS, and only a subset of ANAM measures seemed useful for screening attention problems.
The CSI is a 30-minute, Internet-based, computerized test that provides automated, objective measures of attention, memory, response speed, and processing speed for initial evaluation of cognitive functioning. The CSI produces standardized reports that enable triage and decision-making appropriate to a user's qualifications – from medic to neuropsychologist to neurologist and other treatment team members.
Dr. David Erlanger, Chief Scientific Officer of HeadMinder, commented, "The CSI has now been shown, under combat conditions, to be the only telemedicine tool capable of serving the needs of the armed services. Especially given the large backlog of unscreened service members exposed to blasts, the HeadMinder System offers a simple, accurate, and objective screening method that can play a key role in identifying and treating servicemen and servicewomen with undiagnosed brain injuries. The CSI is unique in its ability to track improvement over time as soldiers travel between the Military Health System and the Veterans Administration and civilian medical resources. We believe the HeadMinder platform provides the Department of Defense the opportunity to fully comply with the Wounded Warriors Act by screening and tracking exposed service members' long-term well-being. If implemented today, the entire backlog could be cleared in less than two years."
After 5 years of ducking the issue, the DoD can get off their collective bottoms and start screening the 400,000 troops that have been exposed to blasts in Iraq and Afghanistan. While the study in no way implied that every service member exposed suffered m-TBI, it did imply that approximately 20,000 service members have suffered the injury. It is time to identify them and treat them. There is no need for mindless dead-end research projects.
Since S. Ward Casscells, MD , Undersecretary of Defense - Healthcare, has actively and willfully avoided detecting and treating both m-TBI and mental health issues, it is time to contact your representatives to start getting answers (find your representative, find your senator). His desire to deny disability payments and under report causalities is repellent.
A special note if you are represented by any of the following members:
Senator Patty Murray (D-WA)
Senator Hillary Clinton (D-NY)
Congressman Jack Murtha (D-PA)
Congressman Bill Pascrell (D-NJ)
Congressman Todd Platts (R-PA)
make an effort to contact them as they have taken leading positions to help service members with mild-Traumatic Brain Injury, PTSD and mental health issues.
The study was initially funded by the Henry M. Jackson Foundation. After funding was discontinued, the study was completed with funding provided by PanMedix, Inc., and HeadMinder, Inc.
PanMedix was founded in New York City in 1999. Initially focused on the development and deployment of assessment software, the company has evolved to encompass a full range of pharmaceutical and medical assessment services.
Founded in New York City in 1999, HeadMinder is a technology company that is dedicated to the development of Internet-based neurocognitive assessment tools. HeadMinder tests have been shown to be valid and reliable instruments for evaluating cognitive deficits in a range of injuries and illnesses, including concussion, mild-to-moderate TBI, Multiple Sclerosis, ADHD, Alzheimer's Disease, and chemotherapy-induced cognitive dysfunction in cancer patients.
The study compared the HeadMinder Cognitive Stability Index (CSI) computerized test battery and the Department of Defense (DoD) Automated Neuropsychological Assessment Metric (ANAM) with the Repeatable Battery for Assessment of Neuropsychological Symptoms (RBANS), a paper-and-pencil neurocognitive test currently used by the DoD to screen soldiers.
The study was designed by Lt. Col. (sep.) Gerald Grant, MD (USAF), Maj. William Isler, PhD (USAF), Maj. Monty Baker, PhD (USAF), David Erlanger, PhD (Chief Scientific Officer and co-Founder of HeadMinder), Tanya Kaushik, PsyD, and Col. Robert Seegmiller (USAF). The objective was to determine the validity and reliability of both computerized screening measures as compared to the RBANS. The CSI was accurate in assessing the severity of cognitive compromise following concussive blast injuries. The CSI Total Score correlated very strongly with the RBANS Total Score (.789) and also showed strong concurrent validity with the RBANS in the domains of Attention (.706) and Memory (.680), domains critical in the assessment of blast-related concussion. ANAM was not useful for identifying memory problems, the domain most frequently impaired on the RBANS, and only a subset of ANAM measures seemed useful for screening attention problems.
The CSI is a 30-minute, Internet-based, computerized test that provides automated, objective measures of attention, memory, response speed, and processing speed for initial evaluation of cognitive functioning. The CSI produces standardized reports that enable triage and decision-making appropriate to a user's qualifications – from medic to neuropsychologist to neurologist and other treatment team members.
Dr. David Erlanger, Chief Scientific Officer of HeadMinder, commented, "The CSI has now been shown, under combat conditions, to be the only telemedicine tool capable of serving the needs of the armed services. Especially given the large backlog of unscreened service members exposed to blasts, the HeadMinder System offers a simple, accurate, and objective screening method that can play a key role in identifying and treating servicemen and servicewomen with undiagnosed brain injuries. The CSI is unique in its ability to track improvement over time as soldiers travel between the Military Health System and the Veterans Administration and civilian medical resources. We believe the HeadMinder platform provides the Department of Defense the opportunity to fully comply with the Wounded Warriors Act by screening and tracking exposed service members' long-term well-being. If implemented today, the entire backlog could be cleared in less than two years."
After 5 years of ducking the issue, the DoD can get off their collective bottoms and start screening the 400,000 troops that have been exposed to blasts in Iraq and Afghanistan. While the study in no way implied that every service member exposed suffered m-TBI, it did imply that approximately 20,000 service members have suffered the injury. It is time to identify them and treat them. There is no need for mindless dead-end research projects.
Since S. Ward Casscells, MD , Undersecretary of Defense - Healthcare, has actively and willfully avoided detecting and treating both m-TBI and mental health issues, it is time to contact your representatives to start getting answers (find your representative, find your senator). His desire to deny disability payments and under report causalities is repellent.
A special note if you are represented by any of the following members:
Senator Patty Murray (D-WA)
Senator Hillary Clinton (D-NY)
Congressman Jack Murtha (D-PA)
Congressman Bill Pascrell (D-NJ)
Congressman Todd Platts (R-PA)
make an effort to contact them as they have taken leading positions to help service members with mild-Traumatic Brain Injury, PTSD and mental health issues.
The study was initially funded by the Henry M. Jackson Foundation. After funding was discontinued, the study was completed with funding provided by PanMedix, Inc., and HeadMinder, Inc.
PanMedix was founded in New York City in 1999. Initially focused on the development and deployment of assessment software, the company has evolved to encompass a full range of pharmaceutical and medical assessment services.
Founded in New York City in 1999, HeadMinder is a technology company that is dedicated to the development of Internet-based neurocognitive assessment tools. HeadMinder tests have been shown to be valid and reliable instruments for evaluating cognitive deficits in a range of injuries and illnesses, including concussion, mild-to-moderate TBI, Multiple Sclerosis, ADHD, Alzheimer's Disease, and chemotherapy-induced cognitive dysfunction in cancer patients.
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