During my graduate studies I took a neuroethics class. This is an excerpt of my paper on Traumatic Brain Injury in Military Personnel. I know the content and vocabulary may be a bit complex, but I believe it is well worth the effort to read.
Due to the prevalence of undiagnosed traumatic brain injury (TBI) in military personnel, proactive screening utilizing established tests employed in other applications would best identify those suffering from TBI. I suggest three readily available and portable tests (Stroop Task, Virtual Water Maze and Field Sobriety Test) currently employed in other applications that could potentially be most efficient in detecting traumatic brain injury in military personnel in the field.
Traumatic brain injury can lead to a diverse range of neuropsychological deficits, including attention, memory, processing speed, and executive functioning (Axelrod, Fichtenberg, Liethen, Czarnota, & Stucky, 2001). “Sixty-four percent (64%) of soldiers wounded in action in Operation Iraqi Freedom sustained blast injuries, according to the Office of the Surgeon General of the Army.” (http://www.hjf.org/research/feature_DVBIC.html) There is a lack of clear evidence as to whether or not the military proactively screens its injured personnel for TBI in the field. Due to the sheer numbers of traumatically brain injured personnel, the implication is that proactive screening should be conducted in the field to identify military personnel with closed head injuries where no visible signs of injury are present.
Due to the prevalence of undiagnosed traumatic brain injury (TBI) in military personnel, proactive screening utilizing established tests employed in other applications would best identify those suffering from TBI. I suggest three readily available and portable tests (Stroop Task, Virtual Water Maze and Field Sobriety Test) currently employed in other applications that could potentially be most efficient in detecting traumatic brain injury in military personnel in the field.
Traumatic brain injury can lead to a diverse range of neuropsychological deficits, including attention, memory, processing speed, and executive functioning (Axelrod, Fichtenberg, Liethen, Czarnota, & Stucky, 2001). “Sixty-four percent (64%) of soldiers wounded in action in Operation Iraqi Freedom sustained blast injuries, according to the Office of the Surgeon General of the Army.” (http://www.hjf.org/research/feature_DVBIC.html) There is a lack of clear evidence as to whether or not the military proactively screens its injured personnel for TBI in the field. Due to the sheer numbers of traumatically brain injured personnel, the implication is that proactive screening should be conducted in the field to identify military personnel with closed head injuries where no visible signs of injury are present.
Personnel sustaining injuries from blasts, motor vehicle accidents, falls or gun shot wounds to the head, who are medically evacuated to hospitals, are proactively screened. (J Head Trauma Rehabil, Vol. 21, No. 5, pp 398-402, 2006) Unlike visibly obvious wounds, closed head injuries can go undetected for years. “Proactive patient education, ongoing health screening with appropriate medical follow-up, and timely interventions for individuals with TBI are indicated.” (J Head Trauma Rehabil. 1998 Aug;13(4):47-57) Military personnel diagnosed with TBI report subjective symptoms that are unlikely to be measured through conventional means, such as diagnostic imaging.
Therefore, tests need to be devised that can capture and evaluate the subjective complaints expressed by undiagnosed TBI personnel. The nature of brain injury itself is damage to the core of the central nervous system. The brain is the organ we use to create and decipher our experiences and understand who we are as a person and our place in the world. Therefore, the brain itself becomes an unreliable source of detecting and measuring cognitive and motor function and selfhood. TBI military personnel often complain of symptoms of not feeling like themselves and experiencing difficulty navigating without bumping into obstacles and difficulty in completing routine tasks. This subjective reporting is not addressed by traditional measures of objective diagnostic imaging which may detect structural damage to the brain. Objective questioning to determine alert and oriented status (e.g., person, place and time orientation) too may be less than optimal in determining the functioning of the TBI person. One can potentially maintain person, place and time orientation while suffering from a disoriented selfhood, altered spatial orientation and an inability efficiently process information needed to complete routine tasks. Therefore, military personnel suffering from a traumatic brain injury could potentially be assigned where they are driving, utilizing hazardous equipment, handling weapons, making snap judgments and other tasks that require full capacity thinking and reflexes where theirs is lacking. There exists some established testing for the counterparts of TBI patient’s suffering from organic diseases with similar symptomatology. These are the three tests that I recommend:
Stroop Task: Publishing his PhD thesis in 1935, John Ridley Stroop devised a psychological test of mental (attention) vitality and flexibility. “The task takes advantage of our ability to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word ‘green’ is written in blue ink we will say the word ‘green’ more readily than we can name the color in which it is displayed, which in this case is ‘blue’.” The cognitive mechanism involved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else. (http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html)
Virtual Morris Water Maze: Devised by Prof. Richard Morris in 1984, the Morris water maze tested mice introduced into a pool where an unseen platform gave them access out of the pool. Around the pool are several markers as points of reference. When the mice are placed into the pool at the same point of entry they eventually recall the location of the platform. After repeatedly placing the mice into the pool they become familiar with the location of the markers in reference to the platform. Therefore, when placed into the pool at different locations the mice are able to identify the markers as a point of reference to where the platform is located.
In its virtual application, the Morris water maze was used to test humans by simulating the same pool scenario. In their research, Human spatial navigating deficits after traumatic brain injury shown in the arena maze, a virtual Morris water maze, Skelton, Ross, Nerad and Livingston found that TBI survivors were unable to remember the location of the hidden platform that was always located in the same place. (Brain Injury 20 (2): 189-203 Feb 2006) This test in particular is important in identifying TBI military personnel during wartime because of the significant implications in their ability to identify targets and their locations in reference to the positions of comrades and allies.
Field Sobriety Test: The Standardized Field Sobriety Test (SFST) is a battery of three tests administered and evaluated by trained examiners to obtain validated indicators of alcohol impairment. These tests were developed as a result of research sponsored by the National Highway Traffic Safety Administration and conducted by the Southern California Research Institute. As previously stated, TBI personnel often complain of difficulty navigating around objects. This battery of tests may aid in identifying TBI personnel experiencing balance and navigation difficulties, along with difficulty in following simple instructions. The test consists of three parts: the horizontal gaze nystagmus, the walk-and-turn, and the one-leg stand. (http://www.nhtsa.dot.gov/people/injury/enforce/deskbk.html#SFST)
Stroop Task: Publishing his PhD thesis in 1935, John Ridley Stroop devised a psychological test of mental (attention) vitality and flexibility. “The task takes advantage of our ability to read words more quickly and automatically than we can name colors. If a word is printed or displayed in a color different from the color it actually names; for example, if the word ‘green’ is written in blue ink we will say the word ‘green’ more readily than we can name the color in which it is displayed, which in this case is ‘blue’.” The cognitive mechanism involved in this task is called directed attention, you have to manage your attention, inhibit or stop one response in order to say or do something else. (http://www.snre.umich.edu/eplab/demos/st0/stroopdesc.html)
Virtual Morris Water Maze: Devised by Prof. Richard Morris in 1984, the Morris water maze tested mice introduced into a pool where an unseen platform gave them access out of the pool. Around the pool are several markers as points of reference. When the mice are placed into the pool at the same point of entry they eventually recall the location of the platform. After repeatedly placing the mice into the pool they become familiar with the location of the markers in reference to the platform. Therefore, when placed into the pool at different locations the mice are able to identify the markers as a point of reference to where the platform is located.
In its virtual application, the Morris water maze was used to test humans by simulating the same pool scenario. In their research, Human spatial navigating deficits after traumatic brain injury shown in the arena maze, a virtual Morris water maze, Skelton, Ross, Nerad and Livingston found that TBI survivors were unable to remember the location of the hidden platform that was always located in the same place. (Brain Injury 20 (2): 189-203 Feb 2006) This test in particular is important in identifying TBI military personnel during wartime because of the significant implications in their ability to identify targets and their locations in reference to the positions of comrades and allies.
Field Sobriety Test: The Standardized Field Sobriety Test (SFST) is a battery of three tests administered and evaluated by trained examiners to obtain validated indicators of alcohol impairment. These tests were developed as a result of research sponsored by the National Highway Traffic Safety Administration and conducted by the Southern California Research Institute. As previously stated, TBI personnel often complain of difficulty navigating around objects. This battery of tests may aid in identifying TBI personnel experiencing balance and navigation difficulties, along with difficulty in following simple instructions. The test consists of three parts: the horizontal gaze nystagmus, the walk-and-turn, and the one-leg stand. (http://www.nhtsa.dot.gov/people/injury/enforce/deskbk.html#SFST)
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