New TBI Assessment Tool, Cognitive Stability Index

Full Article at: Study raises questions about military's brain injury assessment tool
By Katherine McIntire Peters kpeters@govexec.com May 24, 2010

Senior Defense Department officials have stressed repeatedly in public they are doing everything they can to provide the best care possible to U.S. troops injured in Iraq and Afghanistan. But that might not be the case for the tens of thousands of troops who have experienced some form of brain injury.

Four years ago, a group of Air Force doctors treating wounded soldiers at field hospitals in Iraq sought a better way to evaluate the impact of blast injuries on soldiers' brains when there were no visible head wounds -- a condition known as mild traumatic brain injury. Mild TBI can be deceptive, because it often occurs without any outward signs of trauma. A soldier can recover completely from mild TBI, but left undiagnosed and untreated, it can lead to serious impairment over time, especially if the individual is exposed to additional blasts later on.

Lacking an adequate tool to help determine when it was safe to send soldiers back to combat, Air Force doctors in 2006 began using an off-the-shelf, Web-enabled assessment tool called the Cognitive Stability Index, developed by a small, New York-based company called Headminder. At least one of the Air Force doctors had used it before, liked it, and believed it could work well in the field.

The CSI was developed in 1999 by David Erlanger, a neuropsychologist, to measure deterioration, improvement or stability in people whose brain function has been compromised, either through illness, disease or injury. It has been used in a number of drug research studies and clinical settings and has a good track record, doctors unaffiliated with Headminder told Government Executive.

The Air Force doctors in Iraq were impressed enough with the CSI's clinical performance in the field that they sought and received approval from a military institutional review board to conduct a scientific study comparing the CSI to two other tools the military uses: a computer-based tool the Army developed in 1984, called the Automated Neuropsychological Assessment Metrics; and a basic screening tool developed by military medical personnel in 2006 called the Military Acute Concussion Evaluation. The study compared all three instruments to a paper-and-pencil tool called the Repeatable Battery for Assessment of Neuropsychological Status, and was conducted from late 2006 through August 2007 on troops who had lost consciousness at least briefly, because that was the only way in battlefield conditions to know if a soldier had in fact sustained a concussion. RBANS served as the standard against which the others were measured, because it is used widely in the Veterans Affairs Department and private institutions and is considered a reliable measure of cognitive ability.

This was the first combat study of its kind approved by an institutional review board, a panel of experts charged with ensuring that biomedical research involving human subjects meets federal regulations."