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Assessment Tool Helps Traumatic Brain Injury Diagnosis

Wednesday, November 04, 2009
By Richard Searles | FHP&R Staff Writer

The Department of Defense took a major step forward in the testing, diagnosis and treatment of traumatic brain injury (TBI) last year when it issued guidance calling for all the services to conduct baseline pre-deployment neurocognitive assessments.  

The guidance, issued May 28, 2008, called for service members to receive an assessment that measures cognitive performance in areas most likely affected by mild TBI prior to deployment. Individual results from the assessment serve as a baseline in monitoring changes in a service member's cognitive function. 

The neurocognitive assessment tool selected by DoD to accomplish this requirement was the Automated Neuropsychological Assessment Metrics (ANAM). The ANAM is a computerized assessment tool which measures attention, judgment, memory and thinking ability.

ANAM has been under testing and development for the assessment of cognition and human performance for over 20 years. The selection of ANAM was based on its long history of use by the military and civilian sector as well as its support in the scientific literature.

“The pre-deployment ANAM assessment has value in that it may be used to establish a cognitive baseline using the service member's own norms as well as inform health care providers should the service member be subjected to a blast event,” said Elizabeth Fudge-Morse, senior health policy analyst for Force Health Protection and Readiness.

With baseline data available for comparison with post-event ANAM assessments, medical providers are armed with important objective information that can be used in conjunction with other clinical findings in diagnosing TBI, even in its mild form.  
           
“Many times service members may have no visible external injuries after involvement in a blast event yet experience a mild form of brain injury or concussion and symptoms may go unnoticed,” said Fudge-Morse.

“Symptoms of mild TBI may include slower reaction time, headaches, irritability, memory impairments, and sleep difficulty,” she said. “The ANAM may note cognitive changes that can assist the provider in making the decision to return the service member to duty or implement a treatment plan for the condition.”

According to data released on April 15, 2009, by the Defense and Veteran Brain Injury Center (DVBIC), 231,925 service members have been administered the ANAM.

Although ANAM has proved to be valuable tool, DoD continues to look for ways to improve the testing, diagnosis and treatment of TBI.

“There's ongoing research by the services to document the effectiveness of ANAM,” said Fudge-Morse. “DVBIC is in the process of conducting a head-to-head comparison study of other automated cognitive tools to ensure we continue using the best instruments available.”

ANAM results are part of service members' medical records. The results are treated as protected personal health information, and kept confidential using encryption technology and stored in accordance with the Privacy Act of 1974 and the Health Insurance Portability and Accountability Act of 1996.

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