Commandant of the Marine Corps Gen. James F. Amos speaks with sailors and Marines at the Concussion Restoration Care Center at Camp Leatherneck, Afghanistan, Dec. 23, 2010. U.S. Marine Corps photo by Sgt. Brian A. Lautenslager

A new concussion care program being fielded by the Marine Corps in Afghanistan is giving psychiatrists, physicians and even chaplains and sergeants a better way to treat those with the No. 1 battle injury, military combat medicine experts said today.

Navy Cmdr. (Dr.) Charles Benson, 1st Marine Expeditionary Force psychiatrist and 1st Marine Division’s deputy surgeon, and Navy Cmdr. (Dr.) Keith Stuessi, director of the Concussion Restoration Care Center at Camp Leatherneck in Afghanistan, spoke with Pentagon reporters in a video teleconference.

The Navy-Marine Corps effort, launched in August and called the Operational Stress Control and Readiness Program, or OSCAR, has two parts, Benson said.

“The first part [includes] psychiatrists and psychologists who we field with the combat team,” Benson explained. “These are organic embedded assets in the division’s regiments and battalions. They live with the troops, train with the troops and get out in the field with them.”

Such an arrangement, he added, “allows the Marines to come forward to the psychologists and psychiatrists [and] kind of breaks down the barriers and allows the [providers] to become very effective at … delivering mental health care.”

The second part of the program offers special training to medical officers, corpsmen, chaplains, religious personnel and key leaders at the sergeant and first sergeant level so they can deliver basic mental health care to troops in harm’s way.

“Those folks constantly monitor their Marines,” Benson said, “helping them with simple issues and understanding at what point [a Marine with an injury] needs to be referred back for more comprehensive care.”

Together, the programs “have generated quite a bit of success out here in Afghanistan,” the psychiatrist said, treating concussions and musculoskeletal injuries – the No. 1 nonbattle injuries of the war.

Stuessi, a sports medicine doctor, described a typical Concussion Restoration Care Center success story.

“I first saw Lance Corporal Smith on Jan. 3, three days after he was medevaced to Bastion Role 3 hospital because of injuries suffered from [device roadside bomb] blast while on a routine convoy,” he said.

Smith was discharged from the hospital and referred to the outpatient concussion center, where he completed a questionnaire about the blast and his symptoms, and went through a neurologic exam and a neurocognitive test.

“Lance Corporal Smith and I discussed the symptoms – a constant headache, dizziness, trouble concentrating and sleeping, moderate low-back pain and occasional nightmares, along with repeated thoughts of the blast,” Steussi said. “Over the next 11 days, all these symptoms were addressed by our specialists, who are located under one roof.”

Smith saw a physical therapist, an occupational therapist and a psychologist, and then Steussi used acupuncture to treat Smith’s headaches and insomnia.

Between appointments, Smith stayed with other Marines at a wounded warrior facility.

“During his last visit,” Steussi said, Smith “was completely asymptomatic” and returned to his unit.

Although concussion is a physical injury, Benson said it’s related to mental health.

“When folks have a mild traumatic brain injury, sometimes their symptoms have a psychiatric flavor,” the psychiatrist said. “They might have difficulty sleeping or nightmares and anxiety along with that. And sometimes folks who have straight-up psychiatric symptoms like depression might also have insomnia and problems that look a mild traumatic brain injury.

“There’s an awful lot of overlap and symptomatology between the two entities,” he added. “We think it’s important to work on these as a team and address both issues at the same time to try to get a Marine back on his feet and heading in the right direction.”

Having psychiatrists and psychologists embedded in regiments and battalions gives troops who might not naturally turn to a mental health provider a range of ways to seek help, Benson said.

“Most of the best OSCAR and OSCAR Extender Program outreach happens when it’s not really a formal sort of thing,” he added. “It’s like when you’re sitting at breakfast eating your toast and a Marine sits across from you and says, ‘Hey, Doc, you got a moment?’ And then you start chit-chatting.

“Or you might be waiting in line or something and they know you because they see you out there in the field,” he continued. “They understand that you can relate to what they’re going through, and they feel more comfortable coming to chat with you.”

Ultimately, Benson added, the program should help to reduce the stigma attached to seeking mental health care.

“When you’re in combat, when you’re deployed, you’re going to have feelings,” he said. “Things are going to come up. It’s best if you talk about them and seek out help.”

Steussi said center providers have treated and returned to full duty about 320 concussion patients, collecting data on each case along the way.

“We’re in the process of reviewing the data so that in the future we can better treat Marines and sailors,” he added, “and use the information to [develop] policies for treatment here, out at [forward operating bases] and in the field.”

DVIDS
By Cheryl Pellerin
American Forces Press Service

U.S. Army Capt. Erik Johnson, an occupational therapist with the 173rd ABCT and Little Rock, Ark., native, helped spearhead the clinic to treat Soldiers who suffer from traumatic brain injuries from combat. The goal is to have the Soldiers recover and return to their unit without the delays that previously kept Soldiers out of theater for evaluations or treatment, he said.

The new clinic is the first of its kind here in Afghanistan, said U.S. Army Staff Sgt. Melissa Potter, the medical operations noncommissioned officer in charge of the 173rd ABCT, from Virginia Beach, Va.

The program allows Soldiers to stay at the clinic and receive treatment with Johnson and his assistant, U.S. Army Spc. Jessica Rivera-Mendoza, from New Castle, Del., for up to 14 days. It lets Soldiers get back in the fight and rejoin their units sooner than ever before.

“In the past, they would be medically evacuated out of theater,” Johnson said. “This is the first clinic of its kind. Our treatment program is definitely helping the 173rd identify symptoms as early as possible. It’s great to see these Soldiers make comebacks like this.”

The pilot program has caught the attention of military leaders at the Pentagon, including the Chairman of the Joint Chiefs of Staff, Adm. Mike Mullen, due to its tremendous contributions in reducing the time it takes to get Soldiers treated and returned to duty, said Johnson.

“Once a combat medic determines that there are signs of any head trauma, the Soldier is referred to the mTBI Clinic for treatment here,” said U.S. Army Spc. Ashley Marie Bordges, a medic with Brigade Support Battalion, 173rd ABCT.

Headaches, irritability, short-term memory loss and troubles with problem-solving skills are some of the most common symptoms that medics encounter following a minor traumatic brain injury, Johnson said.

U.S. Army Sgt. James Doyle Triplett, from Lawton, Okla., came to the clinic with concentration problems after his vehicle hit an improvised explosive device. He said that he had some difficulties thinking clearly, but Johnson and Bordges helped him improve dramatically.

To help patients, Johnson ensures that the clinic environment is a comfortable, quiet space that will make Soldiers feel at home and help them relax and rest. Letting the brain calm down after an IED or rocket propelled grenade attack is an essential part of the therapy.

U.S. Army Maj. Jay Baker, the 173rd ABCT Surgeon, from Escondido, Ca., said, “The program is ideal because exposing Soldiers to occupational therapy and new techniques like winding down time, resting in a dark quiet place for 24-48 hours and receiving medical or psychological help have proved to be highly effective.”

“In the past, Soldiers suffering from mTBI were sent back to home station due to the lack of a solid treatment plan, and the units were also losing Soldiers due to poor follow-ups (post-deployment),” Baker said.

But with a facility dedicated to mTBI treatment and a tracking system, no Soldiers here slip through the cracks, Potter said. This also identifies high-risk Soldiers and ensures that they receive follow up screenings after they return from deployment.

Treatment and recovery is also effective here because the patients will receive mTBI care with the support of their units nearby, without worry or guilt for having to leave to get treatment back in the U.S. or out of theater.

A close relationship between the doctor and patients also makes mTBI treatment at FOB Shank unique and successful.

“Captain Johnson is completely dedicated to his job and the Soldiers,” said Potter. “Because he is dedicated to the mTBI clinic, he is able to personalize his treatment plans and really get to know the Soldiers. He makes his patients feel at home and a part of the team. Soldiers are comfortable talking to him and coming to the clinic to receive care.”.

“Soldiers tell me all the time that when they were deployed to Iraq or Afghanistan in the past, they never had this program before, Johnson said.“It is a very important program for our patients. So far, about 150 Soldiers have come to the clinic for treatment and 100 percent have been returned to duty, Johnson said.

“We are doing some innovative things here and making some breakthroughs that lead the way in terms of treating these kind of traumatic brain injuries,” said U.S. Army Command Sgt. Maj. Nicholas Rolling, command sergeant major of the 173rd ABCT, from Camarillo, Ca. “What they have done with this clinic is awesome.”

DVIDS
Story by Staff Sgt. Bruce Cobbledick

The 3rd Medical Group currently houses a traumatic brain injury center where Elmendorf medical professionals have seen and treated more than 1,500 patients than the average practitioner sees at Elmendorf AFB.

TBI – as it is more commonly known – has become known as one of the most significant public health problems in the United States, and has quickly become identified as the “signature injury” of the war on terrorism. Between October 2001 and October 2007, there were approximately 1.64 million U.S. troops who were deployed and, of those, approximately 320,000 troops experienced a probable TBI during their tour.

According to the National Center For Injury Prevention and Control, “TBI is caused by a blow or jolt to the head or a penetrating head injury that disrupts the normal function of the brain.”

“Mild cases consist of a brief change in mental status or consciousness to ‘severe’ to consist of an extended period of unconsciousness or amnesia after the injury,” said Maj. Peter Osterbauer, 3rd Medical Group chief of Neurology Services.

Some common symptoms to look for in mild TBI are double or blurry vision, fatigue, reduced concentration, memory complaints, irritability, balance and coordination problems and ringing in the ears.

“Recoveries vary from person to person, although the chances for a quick recovery for mild TBI are relatively fair — 80 – 85 percent will fully recover over three to six months,” said Major Osterbauer. “Of the remaining 15 – 20 percent, some will recover over the course of a year or sometimes two. Most make a full recovery, but some make only a partial recovery, and some, unfortunately, make little or no improvement.”

“However, it is key to remember that not everyone who bumps their head or is exposed to a bomb blast has a traumatic brain injury,” he said.

Research is still being conducted, though it is still in the early stages. Researchers have a general idea of what’s on a macroscopic level, but there is still much to be known about the microscopic and biochemical changes that occur.

Major Osterbauer said it’s important to know that “there is still no magic pill that can cure a traumatic brain injury but what we can do is provide the body the support it needs while it recovers. This can include medications for symptomatic relief, nutritional support, counseling, or most often a combination of these; also education and reassurance play a big role.”

“Treatment is largely dependent on the severity of the TBI,” said Col. Kevin Blakley, 3rd Medical Operations Squadron commander. “In mild TBI, which constitutes the majority of cases, supportive patient education and a type of therapy known as cognitive-behavioral therapy are primary treatment methods for those whose symptoms do not spontaneously resolve.”

Although recovery time can be very spontaneous, it can range from days to weeks for the majority of victims.

Medical officials stress that it’s very important that family members take comfort in knowing that in most cases the symptoms will improve. Support is the most important factor in helping the injured family member in making a recovery, though aside from being supportive, it helps if they educate themselves about TBI and are aware of the resources available to help the victims.

“For more severe cases of TBI the family involvement should be much more comprehensive,” said Colonel Blakely. “If the family is looking for support there are numerous support groups for families; locally the Alaska Brain Injury Network is a good resource.”

US Air Force
by Senior Airman Amber Wescott
3rd Wing Public Affairs