Mild Traumatic Brain Injury Clinics for Bastogne blast victims

NANGARHAR PROVINCE, Afghanistan – Task Force Bastogne opened Regional Command East’s third operational Mild Traumatic Brain Injury clinic, directed by U.S. Army Maj. Priscilla Bejarano, at Forward Operating Base Fenty last month.

During missions, many TF Bastogne Soldiers have experienced the impact of improvised explosive devices. The explosions may only leave them with minor scrapes on the outside, but the effect they have on soldier’s brains can be quite severe.

The results of the explosions are usually an m-TBI or concussion - an injury caused by a blow or jolt to the head that briefly renders one unconscious or causes confusion. Acknowledging the severity of traumatic

brain injuries, Task Force Bastogne has followed the lead of two other clinics in Afghanistan to treat m-TBIs and lower potential risks to their Soldier’s future health.

“The risks can vary depending on the circumstances of the injury,” said U.S. Army Maj. Jose R. Rafols, 626th Brigade Support Battalion, TF Rakkasan’s m-TBI clinic officer in charge from Miami, Fla. “The soldier could incur serious neurological deficits and even death. Unchecked cerebral bleeds can cause sudden neurological changes and if untreated or undetected can lead to permanent cognitive and memory changes. The Soldiers who experience an m-TBI undergo evaluations and treatment that assess the post-blast event as an evolving injury, which can sometimes be subtle while other times it has profound cognitive, vestibular and physical symptoms.”

“The soldier’s ability to rebound from a concussion due to a blast event is degraded when he or she is exposed to multiple IED blasts in a short timeline,” said Rafols. “The short term picture is that soldiers are unable to perform multiple tasks or complex tasks due to their inability to concentrate. The long-term picture is that multiple exposures to significant blast events can increase the likelihood of seizures, Alzheimer’s disease, and Parkinson’s disease.”


“Right now there are three [occupational therapists] in country,” said Priscilla Bejarano, Company C, 426th Brigade Support Battalion, m-TBI clinic officer in charge. “All of us have been sent here to start a pilot m-TBI program. There are comprehensive practice guidelines that are put out by the Joint Theater Trauma System. What they have come up with, based on the research... the injuries that these guys are sustaining to their heads have some commonalities with football players or other people that might have had a brain injury, but we have some other things that go on with that,” said Bejarano of San Antonio, Texas.

One such assessment is the Military Acute Concussion Evaluation. Combat medics or corpsmen, usually the first responders post-blast, usually perform MACE. Patients evaluated with MACE are those who have been within 50 meters of a blast, hit their head or were in a vehicle accident. However, MACE is unable to determine everything in regards to m-TBI, but it is still an important tool for first responders and offers a glimpse into the post-concussed casualty’s neuro-cognitive profile.

The m-TBI clinics utilize a variety of activities for Soldiers that are held for more than 24 hours. The activities address cognition, memory, balance, coordination, proprioception (the ability to unconsciously perceive movement and spatial orientation), and the ability to perform their jobs.

“One activity that is mandatory for every Soldier is 24 hours of rest,” said U.S. Army Sgt. Raymond M. Borrego of Miami, Fla., Company C, 426th Brigade Support Battalion, m-TBI clinic non-commissioned officer in charge. “That gives the brain adequate time to readjust to the event that just happened and to make sure [that] they are recovering from the event that has happened. We also engage with our patients within their own hobbies and habits and such. You cannot ask someone who is not interested or does not like basketball to participate in a basketball-oriented type of game. They are not going to perform well and they are not going to enjoy it.”

Another tool that the clinics use is the Nintendo Wii. The clinic uses games in Wii-Fit to help Soldiers regain their balance and help in sequencing and memory tasks. Other activities used include card, video games and activities that stress balance and coordination. The staff also discusses the blast event with the Soldier to insure they have come to terms with what has occurred.

The Defense and Veterans Brain Injury Center, supported by the Department of Defense and the Department of Veterans Affairs, focuses on specialized treatment of traumatic brain injuries. They have partnered with combat medic, physician assistants, medical doctors, occupational therapist and physical therapists to gain a better understanding. Currently, the studies are in their infancy. The information gathered and used thus far in these programs has resulted in over 95 percent of Soldiers returning to duty.

The first operational m-TBI clinic in theatre was opened at Forward Operating Base Shank, in eastern Afghanistan’s Logar province, Jan. 29, directed by U.S. Army Capt. Erik Johnson. The second clinic became operational on April 28 at FOB Sharana, in eastern Afghanistan’s Paktika province, directed by Maj. Jose R. Rafols.

The Defense and Veterans Brain Injury Centers have partnered with combat medic, physician assistants, medical doctors, occupational therapist and physical therapists to gain a better understanding of mTBIs. Currently, the studies are in their infancy. The information gathered and used thus far in these programs has resulted in over 95 percent of Soldiers returning to duty.