Senate Armed Services Hearing on TBI/Concussions


Tillis

On December 13, 2017, Thom Tillis (R-NC), chairman of the Senate Armed Services Committee’s Subcommittee on Personnel, held a hearing to receive testimony updating the subcommittee on research, diagnosis, and treatment for traumatic brain injury/concussion in service members.  In introducing the hearing, Senator Tillis noted:  “Since 2000, the Department of Defense diagnosed over 370,000 service members with traumatic brain injury, with the majority of them diagnosed in non-deployment settings. This is not a unique problem within the Department of Defense however– it is a national problem.  Last year alone, there were about 2.5 million emergency room visits related to concussions in the United States, and medical experts believe there were many more concussed individuals who did not seek medical care. Congress must pursue multiple approaches to understand better the chronic effects of traumatic brain injury, including the long-term neurodegenerative problems associated with multiple concussive injuries.”

Screen Shot 2017-12-17 at 9.35.04 AM

The subcommittee members heard testimony from two panels.  The first panel consisted of Dr. David W. Dodick – Sports Neurology And Concussion Program Director, Mayo Clinic; Dr. Steven D. Devick – Chief Executive Officer King-Devick Technologies, Inc; and Dr. Christopher M. Miles – Associate Director, Sports Medicine Fellowship, Wake Forest University.  The second panel was comprised of Dr. Joel D. Scholten – Associate Chief Of Staff For Rehabilitation Services For The Veterans’ Affairs Medical Center, Washington, DC; Dr. David X. Cifu – Principal Investigator, Chronic Effects Of Neurotrauma Consortium, Department Of Veterans’ Affairs; and Captain (Dr.) Michael J. Colston, USN – Director, Military Health Policy And Oversight For The Assistant Secretary Of Defense For Health Affairs.

In the YouTube video below, Dr. Dodick of the Mayo Clinic gives a marvelous introduction pointing out that TBI/Concussion affects a wider segment of the population than is often recognized or reported, such as battered spouses, in addition to athletes and  soldiers.  Dr. Devick, an optometrist who has partnered with the Mayo Clinic to advance the utilization of the King-Devick Test, points out that there is a three-legged stool for rapid assessment of concussion, incorporating eye movement testing, balance testing, and cognitive testing.

Screen Shot 2017-12-17 at 9.47.25 AM

Here is the video presentation in its entirety, with the testimony by Doctors Dodick and Devick comprising the bulk of first half of the proceedings.  It is a very comprehensive presentation of the issues, and should be well worth your time in watching.

10 thoughts on “Senate Armed Services Hearing on TBI/Concussions

  1. From what I recall on statistics, only 1/10 TBI/concussions really get diagnosed via hospital visits. That means 3.75 million actually receive an injury. They are clearly underreported in the literature.

    • Agreed, Curt. Underreporting due to lack of recognition of the insult or, in some cases, a belief that ignoring or toughing it out is either more “virtuous” in some sense, or contributes to a self-determination to heal rather than to succumb to perceived vulnerability. Clearly there are many layers to this that have to be peeled in some instances.

    • It’s quite incredible to stop and think about the improbability of a senior student research project at ICO in the 1970s turning into this world-renowned test, and its association with the Mayo Clinic. How many optometrists have given testimony in front of a Senate Subcommittee on the significance of their contributions to such a widespread public health issue? My personal impression is that collectively our field has been slow if not reluctant to acknowledge the burgeoning influence of the K-D outside of our field, particularly with regard to peer-reviewed publications. No test in isolation is perfect, and one sees in Dr. Devick’s testimony how his thinking has evolved on incorporating the K-D into multifactorial matrices.

      • My interpretation of this, James, is that Dr. Dodick is acknowledging that the K-D has objectivity in terms of numbers, yet allowing subjectivity in an individual intentionally establishing a slower pre-season baseline. Here’s an interesting element I haven’t seen data on yet (of if I have, I can’t recall at the moment): Given that there is cumulative effect of concussion, and accepting the sensitivity and specificity of saccades as one index of concussion, one would not be surprised to see that with each insult comes a decrease in a given athlete’s subsequent pre-season baseline. Each year it would therefore be more believable if the athlete intentionally adopted a slower tracking time. I believe this is why the holy grail of mTBI/Concussion testing will be an algorithm comprised of multiple sets of data – from the macrocellular to the microcellular, and combining cognitive with neuro-sensorimotor function. For example, NFL players “under the tent” might put on an EEG skullcap that would objectively show slow or impaired brain waves compared to their baseline which would be objective, and motor screening that is akin to field sobriety testing. Taken together with a few key cognitive questions and the K-D test, one could envision close to a universal metric of impairment that minimizes though never completely eliminating subjectivity.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s