GyBill
09-15-2010, 01:44
Concussion specialists provide front-line care
By Gidget Fuentes - Staff writer
Posted : Tuesday Sep 14, 2010 18:15:42 EDT
Not long after 1st Marine Logistics Group set up a combat stress center last spring at Camp Leatherneck, Afghanistan, doctors saw a trend: As many patients came in with mild concussions as those who suffered from combat stress.
Marines and sailors rattled by blasts had few options for assessment or treatment, so many turned to the combat stress tent, which offered psychiatric care and psychological counseling. As thousands of Marines arrived at the camp amid more intense combat operations in Helmand province, business at the small center became brisk, said Cmdr. George Cowan.
“We took our four corpsmen and two physicians and we were turning and burning, so to speak, with all these patients,” said Cowan, a psychiatrist with Combat Logistics Regiment 15.
But help came this summer when 1st MLG deployed a specialized team from Camp Pendleton, Calif., focused primarily on assessing, treating and even healing concussions with a more holistic approach. The team also treats musculoskeletal injuries with physical therapy and rehabilitation.
With backing from the Bureau of Medicine and Surgery, and some muscle from Marines and Seabees, the team transformed two buildings at Leatherneck into the Concussion Restoration Care Center — the military’s first such facility.
In just the first week after its Aug. 26 opening, the center’s medical team saw 170 patients, said Cmdr. Keith Stuessi, the center’s officer-in-charge. “I anticipate that will go up significantly,” Stuessi said, with as many as 60 to 70 patients daily — most with injuries from improvised explosive device blasts — once the rehabilitation tent is fully equipped this fall.
“We are trying to keep Marines and sailors in the fight out here,” said Stuessi, a family practice and sports medicine physician who runs two sports medicine and rehabilitation therapy clinics at Pendleton.
Stuessi landed at Leatherneck in July and saw the large numbers of concussion patients at the combat stress center, with most suffering from the effects of mild concussions — headaches, ringing in the ears or dizziness — that didn’t require evacuation and treatment at other facilities. So the new, 2,000-square-foot center was designed with rehabilitation in mind, with specialists in physical and occupational therapy brought in, and medical experts at the stress center, like Cowan, tapped to help five days a week.
For Cowan, it was a natural fit.
“These IED blasts do not just affect one system. The Marines who come in, they are not just hurting physically, they are hurting emotionally,” he said.
The healing brain
Concussions are mild traumatic brain injuries. Often, combat troops dismiss the headaches, nausea, forgetfulness or other symptoms that can point to concussion, and they usually don’t realize some memory loss or even a slowdown in their reaction time. “It’s more than just a headache,” Cowan said.
The brain, Cowan said, is very resilient to mild injuries and often heals itself.
“Sometimes you just want to stand there and let the natural process of recovery go,” which isn’t always easy with hard-charging Marines, he said.
While some patients are referred to the center and others walk in on their own, Cowan suspects more Marines ignore symptoms and don’t get checked out. “How many of them are out there with these really bad headaches?” he said. “We are giving them a safe place, an effective plan, to improve and get them back into the fight.”
The concussion center follows a similar model as the stress center, providing immediate care, placing medical services close to units and enabling patients to rest, heal and return to combat more quickly. Patients can spend one or two days at the center or as long as a week or two, depending on their injuries, recovery and rehabilitation, the doctors said.
Assessment and testing
To help determine whether a patient suffers from a mild concussion or has an injury that hasn’t yet healed, the center’s staff uses traumatic brain injury questionnaires and a new computer-based tool that records a patient’s responses to help assess his attention, memory and thought process before and after an injury.
The Automated Neuropsychological Assessment Metrics, a tool that develops a baseline for a service member’s health and performance before and after an injury, is a cognitive assessment that takes about 20 minutes to complete. It’s performed before a deployment, then after a concussion or brain injury. The results of more than 300,000 assessments are maintained at a Washington, D.C., repository, Cowan said.
One test might show a Marine who took two-tenths of a second to respond to something before an injury now takes a full second, Cowan said. “It is not making the diagnosis for us. We are making the call clinically.”
The test helps gauge the healing progress — and even convince a service member he’s not ready to return to duty.
“Our biggest problem,” Stuessi said, “is keeping them here to heal. They all want to go back to their units.” But with the test, he said, “we can show them the brain isn’t just ready to go back.”
By Gidget Fuentes - Staff writer
Posted : Tuesday Sep 14, 2010 18:15:42 EDT
Not long after 1st Marine Logistics Group set up a combat stress center last spring at Camp Leatherneck, Afghanistan, doctors saw a trend: As many patients came in with mild concussions as those who suffered from combat stress.
Marines and sailors rattled by blasts had few options for assessment or treatment, so many turned to the combat stress tent, which offered psychiatric care and psychological counseling. As thousands of Marines arrived at the camp amid more intense combat operations in Helmand province, business at the small center became brisk, said Cmdr. George Cowan.
“We took our four corpsmen and two physicians and we were turning and burning, so to speak, with all these patients,” said Cowan, a psychiatrist with Combat Logistics Regiment 15.
But help came this summer when 1st MLG deployed a specialized team from Camp Pendleton, Calif., focused primarily on assessing, treating and even healing concussions with a more holistic approach. The team also treats musculoskeletal injuries with physical therapy and rehabilitation.
With backing from the Bureau of Medicine and Surgery, and some muscle from Marines and Seabees, the team transformed two buildings at Leatherneck into the Concussion Restoration Care Center — the military’s first such facility.
In just the first week after its Aug. 26 opening, the center’s medical team saw 170 patients, said Cmdr. Keith Stuessi, the center’s officer-in-charge. “I anticipate that will go up significantly,” Stuessi said, with as many as 60 to 70 patients daily — most with injuries from improvised explosive device blasts — once the rehabilitation tent is fully equipped this fall.
“We are trying to keep Marines and sailors in the fight out here,” said Stuessi, a family practice and sports medicine physician who runs two sports medicine and rehabilitation therapy clinics at Pendleton.
Stuessi landed at Leatherneck in July and saw the large numbers of concussion patients at the combat stress center, with most suffering from the effects of mild concussions — headaches, ringing in the ears or dizziness — that didn’t require evacuation and treatment at other facilities. So the new, 2,000-square-foot center was designed with rehabilitation in mind, with specialists in physical and occupational therapy brought in, and medical experts at the stress center, like Cowan, tapped to help five days a week.
For Cowan, it was a natural fit.
“These IED blasts do not just affect one system. The Marines who come in, they are not just hurting physically, they are hurting emotionally,” he said.
The healing brain
Concussions are mild traumatic brain injuries. Often, combat troops dismiss the headaches, nausea, forgetfulness or other symptoms that can point to concussion, and they usually don’t realize some memory loss or even a slowdown in their reaction time. “It’s more than just a headache,” Cowan said.
The brain, Cowan said, is very resilient to mild injuries and often heals itself.
“Sometimes you just want to stand there and let the natural process of recovery go,” which isn’t always easy with hard-charging Marines, he said.
While some patients are referred to the center and others walk in on their own, Cowan suspects more Marines ignore symptoms and don’t get checked out. “How many of them are out there with these really bad headaches?” he said. “We are giving them a safe place, an effective plan, to improve and get them back into the fight.”
The concussion center follows a similar model as the stress center, providing immediate care, placing medical services close to units and enabling patients to rest, heal and return to combat more quickly. Patients can spend one or two days at the center or as long as a week or two, depending on their injuries, recovery and rehabilitation, the doctors said.
Assessment and testing
To help determine whether a patient suffers from a mild concussion or has an injury that hasn’t yet healed, the center’s staff uses traumatic brain injury questionnaires and a new computer-based tool that records a patient’s responses to help assess his attention, memory and thought process before and after an injury.
The Automated Neuropsychological Assessment Metrics, a tool that develops a baseline for a service member’s health and performance before and after an injury, is a cognitive assessment that takes about 20 minutes to complete. It’s performed before a deployment, then after a concussion or brain injury. The results of more than 300,000 assessments are maintained at a Washington, D.C., repository, Cowan said.
One test might show a Marine who took two-tenths of a second to respond to something before an injury now takes a full second, Cowan said. “It is not making the diagnosis for us. We are making the call clinically.”
The test helps gauge the healing progress — and even convince a service member he’s not ready to return to duty.
“Our biggest problem,” Stuessi said, “is keeping them here to heal. They all want to go back to their units.” But with the test, he said, “we can show them the brain isn’t just ready to go back.”