ORONO – Traumatic brain injury, affecting an estimated 15 percent of American troops who have deployed to Iraq and Afghanistan, is widely considered the “signature injury” of the current military conflicts. On Wednesday, about 30 civilian health care providers attended a daylong program at the University of Maine to learn more about diagnosing and treating TBI in the servicemen and -women they may treat in their practices.

Active-duty service members typically obtain their mental and physical health care from military-run hospitals and clinics. But the “citizen soldiers” of National Guard units, along with military reservists, usually return to their hometowns after a deployment and attempt to resume their disrupted lives. This means their health care is most often provided by nonmilitary professionals who may not be familiar with the problems associated with physical injury of the brain or the range of psychological responses to the dangers and stresses of combat.

Wednesday’s conference was aimed at familiarizing civilian health professionals with the nature of these disorders as well as with aspects of the military culture that may make identifying them more difficult.

About 2,500 Maine Army and Air National Guard troops have deployed to Iraq and Afghanistan since 2003. About 700 more are scheduled to deploy in the next two years.

“This is not going away,” said Maj. Mike Backus, a spokesman for the Maine Army National Guard, who spoke at the event on behalf of Maj. Gen. John “Bill” Libby, Adjutant General of the Maine Army National Guard.

Modern-day soldiers are more likely to survive deployment to Iraq and Afghanistan than their counterparts in previous wars, thanks in large part to improvements in vehicular and body armor, Backus said. But roadside explosives and suicide bombers have exacted a terrible toll nonetheless, both in the form of life-changing physical injuries and amputations and in the less visible but still devastating disorders associated with mild traumatic brain injury, or MTBI, and post-traumatic stress disorder, or PTSD.

The two conditions share many symptoms – including emotional instability, headaches, insomnia, fatigue, loss of concentration and slowed mental responses – but both too often go unrecognized and untreated, Backus said, affecting soldiers, families, friends, employers and society in general. The military has made “great strides” in addressing the mental health needs of soldiers in recent years, he added, but more needs to be done. “We owe it to our soldiers to provide the very best care we can,” he said.

Most soldiers absorb military values such as resilience, endurance and attention to detail, said Lt. Col. Andrew Gibson, a chaplain assigned to Joint Forces Headquarters at Camp Keyes in Augusta. The culture discourages complaining, and soldiers may fear ridicule, loss of respect and demotion if they acknowledge mental or physical distress.

For many, Gibson said, the culture is so ingrained that soldiers don’t realize they’re denying their symptoms. They may not recognize that their headaches, sleep problems, irritability and poor job performance are related to their deployment. It’s important for mental health care providers to help service members make the connection and feel safe in seeking treatment.

The conference featured information about an innovative partnership between the Dartmouth Medical School and the Maine Army National Guard. With funding provided by the Maine Health Access Foundation, the Guard has begun testing the brain function of each soldier before deployment and repeating the test upon the soldier’s return.

Using a computer-based sports medicine program known as ImPACT developed at the University of Pittsburgh, soldiers answer questions and respond to simple tasks designed to test their memory, reaction time, thinking process and other aspects of brain function. Differences between the pre-deployment baseline and the post-deployment results can be used to help identify brain injury, to determine which part of the brain is damaged, and to guide treatment.

While the full-time Army has recently initiated a similar testing program, Maine is the first state to adopt testing of Guard units with an eye to ensuring they get appropriate follow-up care in the civilian health care system once they return home.

ImPACT has been used for several years in sports medicine, helping trainers and physicians determine when it’s safe for a brain-injured athlete to resume playing. Returning to action before the brain has fully healed makes repeat injuries more likely and sometimes irreversible, said Mark Lovell, director of the sports medicine concussion program at the University of Pittsburgh and the developer of the ImPACT program.

Lovell stressed that service members and serious athletes are under similar internal and external pressures to return to the action. They may not accurately report their symptoms, and may not even recognize they’re injured. That’s why programs like ImPACT are essential, he said.

“People will say ‘I’m fine,’ but the data will show they’re not fine,” he said.

mhaskell@bangordailynews.net

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