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

DOD warfighter brain health draft plan has six priorities

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 Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit | Brain Injury Awareness Toolkit

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...

TBI Champion Micah Norgard

Video
11/16/2020
TBI Champion Micah Norgard

After 12 years as an infantryman, Norgard's biggest battle was recognizing the cumulative effects of multiple TBIs.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | A Head for the Future

TBI Champion Derek Poor

Video
11/16/2020
TBI Champion Derek Poor

While instructing hand-to-hand combat training, U.S. Army Special Forces veteran Derek Poor slammed his head against a wall and sustained a traumatic brain injury (TBI). Seeing stars and unable to shake his persistent, daily headaches, Poor sought help.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

Talking TBI: Talking to Kids

Video
11/16/2020
Talking TBI: Talking to Kids

While on patrol in Iraq, former U.S. Marine Corps Sgt. Maj. Gary Moran was knocked unconscious by an improvised explosive device, resulting in a traumatic brain injury (TBI). Gary and his son discuss how TBI affected their relationship early on and ultimately brought them closer together.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | A Head for the Future

Talking TBI: Going Back to School

Video
11/16/2020
Talking TBI: Going Back to School

Marine Corps veteran Chris shares his experience going back to school following his TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

TBI Champion Dalton Mask

Video
11/16/2020
TBI Champion Dalton Mask

Facing a long road to recovery following his TBI, Dalton remained positive and participated in the 2019 Warrior Games.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

TBI Champion Beth King

Video
11/16/2020
TBI Champion Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way — recumbent biking.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

Talking TBI: Connect with Others

Video
11/16/2020
Talking TBI: Connect with Others

Navy veteran Amanda Burrill and Army veteran Elana Duffy had a few things in common: They both lived in New York City, experienced traumatic brain injuries (TBI) while in service and were coping with the injuries alone. Until they met each other.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

MACE 2 Provider Training Video

Video
9/29/2020
MACE 2 Provider Training Video

This video illustrates how to conduct a MACE 2 training event. This video supports the MACE 2 and its training materials created by the Traumatic Brain Injury Center of Excellence.

Recommended Content:

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

Defense and Veterans Brain Injury Center Celebrates 25 Years

Video
3/12/2018
Defense and Veterans Brain Injury Center Celebrates 25 Years

Katherine Helmick, DVBIC acting national director, discusses DVBIC achievements and goals to advance service members' health care. DVBIC honors 25 years of military health care by continued dedication to research and treatment of traumatic brain injury.

Recommended Content:

Traumatic Brain Injury

Technician Discusses TBI Research

Video
5/20/2016
Photo of an Edgerton Shadowgraph, a technique which allows researchers to visualize shockwaves in a transparent medium so they can see the shockwaves in the air. Upon visualizing the shockwaves, researchers can measure their locations and use the timing from high-speed video cameras to determine a velocity, which is critical in indicating the shockwave’s pressure. Once researchers have all this information, they can tell the pressure impacted on the test subject. (DoD photo)

Richard Benjamin, lead physical science technician at the Army Research Laboratory at Aberdeen Proving Ground, Md., discusses using technology to better understand traumatic brain injuries.

Recommended Content:

Traumatic Brain Injury

A Head for the Future: Randy Gross

Video
3/25/2016
Randy Gross

When he was 23, Randy Gross was riding in a car with his seat belt off. The former Army staff sergeant sustained a TBI when the vehicle crashed. He sought help immediately, making a full recovery from his TBI and continuing to serve in the Army until 2006. Now, Gross helps those in the military with TBI as a regional education coordinator for DVBIC.

Recommended Content:

Traumatic Brain Injury

Head for the future

Video
3/14/2016
Woman putting on bike helmet

In 2005, a car struck Marine reservist Maj. Eve Baker head-on while she was biking to work in Honolulu. She flew face-first into the windshield, shattering her helmet — which likely saved her life.

Recommended Content:

Traumatic Brain Injury

TBI Awareness: Memorial Box

Video
3/27/2015
Image of a memorial box.

US Army Sgt Fox explains how his memorial box has helped him heal and remember meaningful events and people in his life.

Recommended Content:

Traumatic Brain Injury

Dr. Heechin Chae on The Mystery of the Brain

Video
3/23/2015
Dr. Heechin Chae on The Mystery of the Brain

Traumatic brain injury expert, Dr. Heechin Chae speaks on the mystery of the brain.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury

Army Sgt. R. Fox

Video
3/19/2015
Image of Army Sgt. Robert Fox

Army Sgt. Robert Fox describes his challenges with PTSD and how art therapy has helped him.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 3 > >> 
Showing results 16 - 30 Page 2 of 3

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.