Effects of Concussions in Military Deployment and Training

This article discusses the effects of concussions sustained during military deployment and training. It highlights the challenges of diagnosing concussions and the importance of early diagnosis and management. The article proposes the use of impact sensors to detect and monitor concussions. The reliability and validity of the proposed test are also discussed.

Running Head: EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY
DEPLOYMENT AND TRAINING
Effects of concussions sustained during military deployment and training
<Name>
<Student Number>
<PSYC3020>
<2018, Semester >
<Tutors name and Tutorial group>
Word count 1970

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 2
Executive summary
Scientists are still trying to link the enduring effects of mild brain injury to relate chronic or
neurodegenerative problems. Despite the advancement in technology in terms of weapons and body
armor, the brain remains vulnerable to non-penetrating injuries such as extreme impacts on the
head and explosions during combat. The major challenge of diagnosing concussion with technology
is that there is no specific subsystem of the brain that is universally affected by the concussion. Early
diagnosis of a concussion remains a priority in order to prescribe the suitable therapeutic
management and deterrence of premature deployment to battle zones.

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 3
Introduction
The Committee on Head Injury Nomenclature of the Congress of Neurological Surgeons
(1966) explains concussion as, “a clinical syndrome characterized by the immediate and transient
posttraumatic impairment of neural function such as alteration of consciousness, disturbance of
vision or equilibrium, etc. due to brain stem involvement.” Later the American Academy in
Neurology (AAN) (1997) referred to concussion as “any trauma-induced alteration in the mental
status that may or may not include the loss of consciousness.” The First International Symposium on
Concussion in Sports in Vienna described concussion as a “complex pathophysiological process
affecting the brain, induced by traumatic biomechanical forces (2001).”
Concussion may be as a result of direct hit by a blunt object to the skull, neck, or face, or any
other part of the physique that in turns conveys a spontaneous force to the brain. The concussion
leads to neuropathological changes in the brain however, the impact is mainly manifested in the
functional capacity of the brain other than any structural changes in the head. There may not
necessarily be loss of consciousness registered after the concussion as the clinical and cognitive
symptoms will resolve sequentially (Giza & Hovda, 2001).
Barr, et al. (2008) states the effects of concussion as having compromised cognitive
functionality, reduced stability, and subjective post-concussive symptoms. A study on the impact of
concussion conducted on college football players revealed that players suffering from concussion
showed 85.2% complained of headaches, 77% had balance problems, and 69.4% reported feeling of
reduced cognitive function at the time of the accident. The evidence from the research suggested
that players suffering from subjective post concussive grievances and empirically evaluated cognitive
function impairment and stability related issues tend to recover fast from the injury, balance issues
are sorted within five days, full cognitive functions resume functionality within a week of the injury.
Traumatic brain injury (TBI) is prevalent in the U.S. military. Research by the Defense and
Veterans Brain Injury Center (DVBIC) indicates that between 2000 and 2011, 220, 430 soldiers had
suffered from Traumatic Brain Injury (TBI) of which 169,209 of these cases were classified as
concussions. However, just like in civilians, concussion might be problematic to detect and can be
perplexing to manage. This is because during standard imaging it shows no abnormalities, moreover;
both signs and symptoms of concussion are subtle (Iverson, Langlois, McCrea, & Kelly, 2009; Ling,
Bandak, Armonda, Grant, & Ecklund, 2009).
As of 2003, there were approximately 300,000 cases of concussion related to sports
reported. This number however is believed to be an understatement as many of the cases go
unreported or due to the lack of awareness of the constituents of concussive symptoms. However,
the cognitive functions of the athletes after a concussion are what are employed to determine the
suitability to return to play and the various rehabilitation strategies (Aubry, et al., 2002). The normal
procedure or established protocol of evaluating the cognitive functions of the brain after a
concussion is the short battery of Neuropsychological Test. This compares the performance of the
athlete pre-concussion period and post-concussion period. The scores between the two periods are
what are used to speak of the mental status during the post-concussion period. Nevertheless, this
method has gained considerable attention with many raising issues regarding the methodology
itself. Issues raised involve the setting in which the test occurs and the potential effect of other
factors such as age and learning difficulty has on the results of the NP test (Duhaime, et al., 2012;
Barr, McCrea, & Randolph, 2008; Giza & Hovda, 2001).

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 4
Early diagnosis of a concussion remains a priority in order to prescribe the suitable remedy
and instituting management practices and avoid the premature deployment to battle zones. The
presence of cognitive impairment following an accident leading up to the concussion are made by a
medical practitioner. Moreover, where the practitioner has no access to any baseline date, the
judgment made is based on the athlete’s performance relative to normative data (Aubry, et al.,
2002). It is relatively easier where the practitioner has access to baseline data as it becomes easier to
compare the possible changes in cognitive functions based on the scores. The method has gained
prominence and is advocated for by neuropsychologists and neurologists involved in sports
medicine. Neuropsychological testing has being successfully deployed in sport related brain trauma
injuries as a clinical measure for identifying the initial affect and track the recovery progress. The
results are often used to make critical decision regarding whether or not to resume play (Aubry, et
al., 2002; Barr, McCrea, & Randolph, 2008).
Increased evidence sourced from sports medical practice (Guskiewicz, et al., 2003; McCrea,
Guskiewicz, & Randolph, 2009)and animal run tests (Giza & Hovda, 2001) prove that potential cases
of concussion risk increased possibility of a repeat scenario of the concussion within the first ten
days of receiving the concussion. Injuries sustained during training are often mild and trainees often
go unchecked due to failure to report and in real combat situations, those with mild concussions
quickly resume full duty status. This highlights the importance of understanding the impact on the
cognitive and the physical functions of the brain associates with the concussion especially with the
increased chances of reoccurring (Schatz & Sandel, 2013).
Proposed research
Neuropsychological tests are essential in the identification, management, and evaluation of
concussion cases and assist in giving the green light for normal functioning of the patients. However,
the neuropsychological tests are prone to the human aspect (McCrea, Guskiewicz, & Randoplh,
2009). Factors such as depression, stress, fatigue, sleep deprivation, malingering, fear, increased
pressure environment and an understatement of the symptoms to avoid appearing weak may
influence the results of the tests. I propose using tools that combine science and technology
therefore eliminating some of the human factors. One of the key challenges in adequately
responding to concussion is in the recognition of the fact that a recruit may have sustained a head
injury and should be taken off practice until further investigation are carried out (Barr, McCrea, &
Randolph, 2008). As seen earlier chances of a concussion reoccurring are relatively high often
meaning the difference between life and death. The presence of a skilled medic, senior officer, or a
certified health care provider on the battlefront facilitates health evaluation of the injured soldier.
However, their presence is not always guaranteed due to inaccessibility of the soldiers, failed rescue
missions, or KIA or MIA soldiers. The decision to have a trainee excused from training comes from
the high above. Additional obstruction to the diagnosis of concussion is that the symptoms may not
manifest for some hours following the injury, as a result serious manifestation of the symptoms may
occur up to 24hours after the impact occurred (Duhaime, et al., 2012).
Science has over the years shown diversity in the manner in which concussions manifest
itself in the brain making it impossible to rely on a single assessment tool focusing on single
subsystem with an aim of establishing inconsistency in the functioning of the brain. This necessitates
a blended assessment approach taking into consideration cognition and emotive aspects of the
brain, balance, and aculomotor functions (Giza & Hovda, 2001).
The technology I am proposing involves attaching impact sensors on the headgear of
recruits. The impact sensors are expected to record the forces transmitted to the head during

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 5
collision. They can help detect linear and rotational forces applied to the skull. The sensors will
record and transmit in real time the number and severity of hits on the head over time. The relevant
people will be alerted once the hits reach a certain threshold. Several side-line assessments are
accessible to help with the recognition of concussion symptoms during training, influencing the
decision on whether the trainee will resume training or not (Aubry, et al., 2002).
Test design and evaluation
Participants: I propose using the recruits being recruited for training. The procedure will be two
faced whereby some of the recruits will participate voluntarily whereas for some it will be
involuntary. The Neuropsychological test will be carried out as it has already proved its value in
diagnosing concussions.
Design: this will be a longitudinal study where the data collected for the subjects will be observed
through the training period and once after they have left training and in active duty. The controlled
subjects who are the voluntary group will be exposed to stressful conditions, sleep deprivation, and
strenuous activities to factor in how such affects the results. Pre-test measures will have being
conducted on the army football team and those already in active combat situations.
Materials: besides having a professional diagnose the concussion using a Neuropsychological test, I
will need impact sensors such as the Gforcetracker, i1 Biometrics, BlackBox Biometrics, and X2
Biosystems’ xPatch. In collaboration with neurologists, we will identify the appropriate threshold
level of force. The impact sensors will report remotely to a reporting software so we will need hand
held mobile devices and computers.
Procedure: The impact sensors will be attached to the helmet or the patches placed on the neck or
behind the year. While calibrating the threshold of impact, the age of the recruit must be put into
consideration.
Reliability and validity criteria
By counting and measuring the velocity of the hits suffered in the head, we will gain valuable
data that will help in the prevention of concussion progressing to a full-blown brain damage. If the
test is reliable, I expect to see high correlation between the data collected from the impact sensors
and the conventional neuropsychological tests. The higher the impact recorded the same will reflect
in the sideline measures of psychomotor functions, working memory, cognitive, and decision-making
process. The same results are expected to be observed during the test-retest reliability having
factored in the human aspect of the test established by the control group. The results should
resonate with those of the pre-tests.
If the test is valid, I predict that:
1. Recruits who will have transmitted higher numbers and severity to the head will have a
slower response in their cognitive functions
2. Soldier in real combat situations will be transmitting higher numbers and severity especially
those in volatile areas such as Afghanistan and Iraq than those in training
3. Soldiers who have surpassed a given threshold will transmit a repeat episode of the same
over time since those who have suffered are at a heightened risk of suffering another brain
injury
Conclusion

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 6
Despite the advancement in technology in terms of weapons and body armor, the brain
remains prone to non-penetrating injuries such as collisions and explosions during combat (Orcutt,
2016). Practically, the scores from the neuropsychological tests potentially reflect on the general
status of the patient. The tests are designed to capture and evaluate the functioning of the brain
making the inclusion of the system related errors in the test scores an impediment in the
psychometric accuracy of the test (National Research Council, 2014; Schatz & Sandel, 2013; Barr,
McCrea, & Randolph, 2008). The major challenge of diagnosing concussion with technology is that
there is no specific subsystem of the brain that is universally affected by the concussion. Different
cases have different impacts with some complaining of severe headaches, deregulated sleep,
cognitive or emotional issues, and balance and equilibrium (Giza & Hovda, 2001).

EFFECTS OF CONCUSSIONS SUSTAINED DURING MILITARY DEPLOYMENT AND
TRAINING 7
References
Aubry, M., Cantu, R., Dvorak, J., Baumann, T. G., Johnston, K., Kelly, J., & al., e. (2002). Summary and
agreement statement of the first International Conference, Vienna. British Journal of Sports
Medicine , 3(6), 6-10.
Barr, W., McCrea, M., & Randolph, &. C. (2008). Neuropsychology of sports related injuries. In J.
Morgan, & &. J. Ricker, Textbook of clinical neuropsychology (pp. 660-678). New York:
Oxford University Press .
Duhaime, A., Beckwith, J., Maerlender, A., McAllister, T., Crisco, J., Duma, S., . . . Greenwald, &. R.
(2012). Spectrum of acute clinical characteristics of diagnosed concussions in college
athletes wearing instrumented helmets. Journal of Neurosurgery, 12(5), 547-559.
Giza, C., & Hovda, &. D. (2001). The neurometabolic cascade of concussion. Journal of Athletic
Training, 36, 228-235.
Guskiewicz, K., Mcrea, M., Marshall, S., Cantu, R., Randolph, C., Barr, W., & al, e. (2003). Cumulative
effects associated ith recurrent concussion in collegiate football players. Journal of the
American Medical Association, 290(19), 2549-2555.
Iverson, G., Langlois, J., McCrea, M., & Kelly, J. (2009). Challenges associated with post-deployment
screening for mild traumatic brain injury in military personnel. The Clinical
Neuropsychologist, 23, 1299–1314.
Ling, G., Bandak, F., Armonda, R., Grant, G., & Ecklund, J. (2009). Explosive blast neurotrauma.
Journal of Neurotrauma, 26, 815–825.
McCrea, M., Guskiewicz, K., & Randoplh, &. C. (2009). Effects of symptom free waiting period on
clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery, 65(5),
876-883.
National Research Council. (2014). Sports-Related Concussions in Youth: Improving the Science,
Changing the Culture. In R. Graham, F. Rivara, & M. F. al, Institute of Medicine. Washington
DC: National Academic Press.
Orcutt, M. (2016, June 9). Is This the Diagnostic Tool We’ve Been Waiting for in Concussion Testing?
Retrieved from MIT Technology Review : https://www.technologyreview.com/s/601619/is-
this-the-diagnostic-tool-weve-been-waiting-for-in-concussion-testing/
Schatz, P., & Sandel, &. N. (2013). Sensitivity and specificity of the online version of ImPACT in high
school and collegiate athletes. American Journal of Sports Medicine, 41(2), 321-326.