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22 Cognitive and Psychological Profiles of a Specialized Military Force
- Ida Babakhanyan, Alia Westphal, Juan Lopez, Melissa Caswell, Angela Basham, Jason M Bailie
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 704-705
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Objective:
The Explosive Ordinance Disposal (EOD) community within the US Military is a specialized force in charge of the most fundamental aspects of the military operations in combat which include disarming and safely disposing explosive threats. EOD technicians have provided critical protection for our military and civilians exposed to improvised explosive devices (IEDs), which became the signature threat of both Afghan and Iraq wars. The nature of the job puts EOD technicians at high risk for blast exposures (from training and combat) resulting in traumatic brain injury (TBI) and sub-concussive head impact. Further, this population is exposed to high levels of combat with psychologically traumatic events. Given the groups neurological and psychological risk factors as well as their critical role in combat, we hypothesized that EOD technicians will present with increased psychological and neurobehavioral symptoms as well decreased cognitive functioning compared to other military personnel.
Participants and Methods:Participants were recruited from a military hospital with at least one diagnosed mild traumatic brain injury (MTBI). Exclusion criteria included TBI greater then mild severity and invalid performance on the Rey-15. Final sample included 10 EOD and 90 other military.
CognCognitive measures included Hopkins Verbal Learning Test-Reviseitive measures included Hopkins Verbal Learning Test-Revised (HVLT-R); DKEFS Color Word Condition 4 Switching (CW4), Trail Making Condition 3 Letter Sequencing (TM3) and Condition 4 Switching (TM4), and Paced Auditory Serial Addition Test (PASAT). Self-report measures included the Neurobehavioral Symptom Inventory (NSI), Key Behaviors Change Inventory (KBCI), Post-Traumatic Stress Disorder Checklist (PCL-M), Patient Health Questionnaire (PHQ), Combat Exposure Scale (CES) and Blast Exposure Threshold Survey (BETS). The Ohio State University Traumatic Brain Injury Identification Method (OSU) assessed TBI history.
Results:EOD were older (EOD M=38.4, SD=4.06; Others M=33.32, SD=8.08; p=0.05), had a higher pre-morbid IQ (EOD M=110.90, SD=7.64; Other M=101.59, SD=10.55; p=0.008), more combat deployments (EOD M=5.5, SD=2.37; Others M=3.55, SD=2.98; p=0.049) and exposure to wartime atrocities (CES, p=0.003). They had greater number of MTBI (OSU EOD M=6.67, SD=3.33; Other M=3.67, SD=2.34; p=0.007), blast related MTBI (OSU-TBI EOD M=2.33, SD=1.63; Other M=0.67, SD=0.91; p<0.001), and exposure to large explosives (BETS p<0.0001). EOD reported better attention skills (KBCI Inattention, p=0.016, d=0.82; Impulsivity p=0.047, d=0.67). There was a trend for EOD to have lower neurobehavioral symptoms (NSI Total, d=0.32), post-traumatic stress (PCL d=0.39), and depression (PHQ d=0.50); however, despite the moderate effect sizes (p’s >0.05). EOD presented with significantly better scores on DKEFS TMT3 (p=0.037, d=0.70), HVLT-R-Total (p=0.001, d=1.10), HVLT-R-Delayed (p=0.03, d=0.74), and attention/executive functioning skills (PASAT p=0.001, d=1.12). DKEFTS CW4 Switching (d=0.51) and TMT4 Switching were approaching significance (d=0.61) with EOD performing better.
Conclusions:As expected, the EOD sample in this study had higher number of combat deployments, greater exposure to combat atrocities (e.g., death), higher levels of exposure to large explosives, as well as a higher number of MTBI. Inconsistent with our hypotheses, despite these psychological and neurological risk factors, EOD performed better on cognitive measures of memory, attention and executive functioning. They also reported less problems with inattention and impulsivity. Results may reflect the impact of psychological and cognitive resiliency.
51 Impact of Blast Exposures on the Cognitive Abilities of Warfighters
- Ida Babakhanyan, Juan Lopez, Melissa Caswell, Angela Basham, Jason M Bailie
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 156-157
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Objective:
There is growing evidence to indicate that blast exposure military personnel experience throughout their career can have a negative impact on their brain health. The majority of research in the area of blast related neurotrauma has been focused on traumatic brain injury (TBI); however, the blast exposure may often be independent of TBI. It is common in both active duty military and veterans to report years of blast exposure from combat and training. The objective of this study was to explore the relationship between blast exposure and cognitive functioning in military personnel seeking treatment for a mild TBI.
Participants and Methods:Participants were recruited from a military hospital while enrolled in a multidisciplinary treatment program for TBI. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Exclusion criteria included invalid performance on a performance validity test and a symptom validity test. 97 participants were included in the analysis with an average age of 34.0 (SD = 7.9) and average 4.0 combat deployments (SD = 3.6). Blast exposure history was measured by the overall score from the Blast Exposure Threshold Survey (BETS) which assessed the frequency and duration of use of various blast sources. Outcomes included the Neurobehavioral Symptom Inventory (NSI) and the Global Deficit Scale (GDS) an objective measure of cognitive deficiency. GDS was calculated from seven measures: Hopkins Verbal Learning Test-Revised Total and Delayed Recall (HVLT-TR and HVLT-DR); DKEFS System Color-Word Condition 3 Inhibition (CW3), Color-Word Condition 4 Switching (CW4) and Trail Making Condition 3 Letter Sequencing (TM3), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores (M=50, SD = 10) were converted to deficit scores and averaged to calculate GDS. To adjust for nonnormal distributions, non-parametric statistics were examined.
Results:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s <.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).
Conclusions:The BETS was not related to GDS (rho = -.055); however, there was a significant correlation between higher levels on the BETS and better performance on measures of selective attention (PASAT rho = .307) and processing speed (SDMT rho = .218). The correlation between BETS and the other neuropsychological measures were not meaningful (all rho’s <.10). Those with an impaired GDS, did not differ from others on the BETS. BETS was also not associated with neurobehavioral symptoms (rho = .125). BETS had moderate correlations with number of combat deployments (rho =.483), severity of combat exposure (rho =.556). It was not related to education (rho = .004) or pre-morbid intelligence (rho =-.029).
3 Optimizing Cognitive Rehabilitation of the Injured Warfighter
- Jason M Bailie, Ida Babakhanyan, Paul Sargent, Juan J Lopez, Melissa Caswell, Angela Basham, Lori Barnard, Ana Siblesz, Erin Venza, Jennifer Zientz, Sandi Chapman
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- Journal:
- Journal of the International Neuropsychological Society / Volume 29 / Issue s1 / November 2023
- Published online by Cambridge University Press:
- 21 December 2023, pp. 668-669
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Objective:
Many individuals who experienced a mild traumatic brain injury (mTBI) have persistent cognitive complaints. Traditional cognitive rehabilitation (TCR) interventions were primarily developed for severe neurological injury which has limited effectiveness in rehabilitation of active duty military personnel who have the goal of returning to full military operational status. To remain on active duty, warfighters must have sufficient mental competency to safely and effectively function in complex environments such as combat. There is need for a cognitive rehabilitation approach that addresses demands of military personnel to expedite return to duty. The Strategic Memory Advanced Reasoning Training (SMART) program is novel alternative to TCR. SMART is an evidence-based advanced reasoning protocol that enhances cognitive domains essential to military readiness (e.g., mental agility, strategic learning, problem solving, and focus) and requires less than half of the treatment time. The objective of this study was to assess the efficacy of SMART compared to TCR in terms of overall recovery as well as change in specific cognitive domains.
Participants and Methods:Participants were recruited from a military treatment facility. All patients had at least one diagnosed mTBI as well as persistent cognitive complaints. Participants completed the Rey-15 to ensure performance validity. Final sample was SMART n = 28 and SCORE n = 19. Primary dependent measure was the Global Deficit Scale (GDS). GDS was calculated from: Hopkins Verbal Learning Test-Revised (HVLT-R); Delis Kaplan Executive Functioning System Color Word (CW) and Trail Making (TM), Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores were converted to deficit scores as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. Deficit scores were averaged to calculate GDS. For each measure, Hohen’s g was analyzed for effect size comparisons pre-post treatment.
Results:Average number of treatment hours was significantly lower in the SMART condition (SMART: M = 18.47 hours, SD = 2.17; TCR: M = 42.42 hours, SD = 3.79, p <.001). A repeated measures ANOVA showed a significant change on GDS post-treatment (F = 30.25, p < .001) with a large effect size (n2 = .402); however, the interventions did not differ on GDS change. Impact on cognitive domains was relatively equivalent for processing speed (SMART h = 0.67 vs TCR h = -.54) and executive function (SMART h = -0.92 vs TCR h = -.85); however, SMART had a larger impact on memory (SMART h = -0.81 vs TCR h = -.39). SMART resulted in large improvements in retention and recognition memory which were minimally impacted by TCR.
Conclusions:Both TCR and SMART had comparable effectiveness in improving cognitive impairment, though SMART was completed in less than half of the treatment time. Both interventions had large effect sizes on processing speed and executive functioning; however, SMART was more effective in improving long-term memory. Memory is an integral part of military readiness. Further investigation is required to determine the relative effectiveness of these two approaches to improving cognitive readiness of the warfighter.