Study Raises Questions About Military’s Brain Injury Assessment Tool

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By Katherine McIntire Peters Government Executive

Senior Defense Department officials have stressed repeatedly in public they are doing everything they can to provide the best care possible to U.S. troops injured in Iraq and Afghanistan. But that might not be the case for the tens of thousands of troops who have experienced some form of brain injury.

Photo: Joe Radle/Getty Images

Four years ago, a group of Air Force doctors treating wounded soldiers at field hospitals in Iraq sought a better way to evaluate the impact of blast injuries on soldiers’ brains when there were no visible head wounds — a condition known as mild traumatic brain injury. Mild TBI can be deceptive, because it often occurs without any outward signs of trauma. A soldier can recover completely from mild TBI, but left undiagnosed and untreated, it can lead to serious impairment over time, especially if the individual is exposed to additional blasts later on.

Lacking an adequate tool to help determine when it was safe to send soldiers back to combat, Air Force doctors in 2006 began using an off-the-shelf, Web-enabled assessment tool called the Cognitive Stability Index, developed by a small, New York-based company called Headminder. At least one of the Air Force doctors had used it before, liked it, and believed it could work well in the field.

The CSI was developed in 1999 by David Erlanger, a neuropsychologist, to measure deterioration, improvement or stability in people whose brain function has been compromised, either through illness, disease or injury. It has been used in a number of drug research studies and clinical settings and has a good track record, doctors unaffiliated with Headminder told Government Executive.

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