BLAST Injury from Iraq/Afghanistan: a Pilot Study

Rough Draft

BLAST Injury from Iraq/Afghanistan: A Pilot Study

Background:

Three veterans were randomly selected to participate in a pilot study of hyperbaric oxygen treatment of traumatically brain injured servicemen conducted through Oxygen Rescue Care Centers of America. This study was provided on a pro bono basis and involved multiple providers and other support organizations who assisted in lodging, meals and travel expenses for the veterans, notably The Red Cross.

Our team attempted to determine neuro-cognitive and psychological test performance pre and post hyperbaric treatments. We provided SPECT brain scans, a medical exam including evaluation by Physical Therapist before and after receiving 40 hyperbaric oxygen treatments.

The veterans that were selected were from a pool of veterans that had been screened by phone and were determined to have profound symptoms of blast injury that included multiple episodes of loss of consciousness, profound short term memory loss, severe depression with two vets attempting suicides, one 3 times; comorbidities of vestibular dysfunction, complaints of joint and muscle ache/pains, light sensitivity, poor socialization skills including family disharmony and what they described as “down days” of self imposed isolation. Drug and alcohol abuse were noted in two vets described as self medication.

All three of these veterans received 40 HBOT at 1.75 to 2 ATA and aggressive rehabilitation for balance disorders and muscle/joint pains. The HBOT was delivered two times a day with 3 to 4 hours between treatments.

Findings:

Despite discharge without benefits on two vets and one discharge with 70% disability after exposure to 46 IED blast, 16 RPG blast and four grenade blast resulting in two losses of consciousness up to a minute long each and suffering seizure disorder (that was determined to be a “conversion disorder”); these vets were found to have a high correlation of brain injury identified by SPECT, psychological testing, observed clinical findings and patient history. Two of these vets were told they had no organic brain dysfunction by military physicians.

All three patients had significantly abnormal SPECT scans on initial evaluation. There were significant cognitive impairments identified on Neuro-psychological evaluation and significant physical findings regarding balance problems, navigating at night, positive Rhombergs Sign, with dynamic and static balance abnormalities. Debilitating headaches and other body/joint pains as well as light sensitivity, nightmares, lack of sleep and what they described as “down days”. Anger and impulse control were other issues expressed by these soldiers. Severe short term memory loss and need of GPS devices to prevent being lost in their home towns. Alcohol and drug abuse was reported by two vets as self medication.

Results:

Post treatment found marked clinical improvements in psychological scores, SPECT brain scans and improved balance, reduction in somatic complaints and sound sleep patterns. Improved affect and socialization skills were evident.

Discussion:

Blast injury is thought to be the result of rapid gas pressure changes during exposure to Improvised Explosive Devices.These pressure changes are believed by some to cause bubbles in the vascular system as well as other organs. (Similar to the bends in divers or as found in Casons Disease.) **Add discussion of Penumbra stunned but not dead brain cells** ?

Conclusion:

*These veterans have been seen as part of a pilot study for hyperbaric treatment of traumatically brain injured servicemen conducted through Cralle Physical Therapy, and to evaluate in these Veterans neurocognitive and psychological test performance pre- and post- hyperbaric treatments.

Neuro-Psychological Evaluation Comparisons (pre and post Hyperbaric Treatment)

*Veteran AB

Mood: “Very significantly less depressed, less anxious and less severe PTSD symptoms by test date #2. His MMPI-2 scores were significantly reduced by test date #2 indicating for the most part a very significantly improved mood”.

Attention: “Working memory was significantly improved and information processing speed demonstrated a very significant improvement”.

Memory: Delayed recall of previously learned verbal and non verbal material improved by at least significantly different levels”.

Executive Functions: “Verbal fluency under both phonemic and categorical conditions had improved very significantly by test #2. Switching between dual tracking task had improved significantly by test #2. Abstract thinking had remained unchanged.”

Language: Naming and simple word reading vocabulary had remained unchanged.

Motor: “AB demonstrated very significantly improved motor speed, strength and dexterity for both hands by test #2.”

Visuospatial: “AB’s copy of a design was unchanged by test #2.

*Veteran RB

Mood: “Very significantly less depressed, less anxious and less severe PTSD symptoms by test date #2. MMPI-2 scores reflected the very significant positive changes in RB’s anxiety, depression and PTSD symptoms.

Attention: “Working memory was overall essentially unchanged from test #1 to test #2 but information processing speed was very significantly improved by test #2.

Memory: Delayed recall of previously learned verbal and non verbal material was essentially unchanged by test #2.

Executive Functions: “Design fluency had improved very significantly by test #2. Verbal fluency under both phonemic and semantic conditions as well as switching between dual trading tasks and abstract thinking had remained essentially unchanged by test #2.

Language: Naming and single word reading vocabulary has remained essentially unchanged.

Motor: RB demonstrated very significantly improved right handed grip strength and significantly improved bilateral dexterity by test #2. Otherwise, all other maneuvers were essentially unchanged.

Visuospatial: RB’s copy of design was essentially unchanged by test #2 in this a measure of visoconstruction ability.

*Veteran JR (exposed to 46 separate IED blasts)

Mood: “Very significantly less depressed, less anxious and less severe PTSD symptoms by test date #2.

Memory: Significantly improved memory function.

Language: Significantly improved language function.

Visusospatial: Attention, spatial and executive functioning roughly equivalent to T1 baseline levels by the time of T2.

The actual test results reported by Jeffrey Gran, PhD are attached for a more complete report on the 5 hour Neuro-Psychological exams.

SPECT Scans before and after

Comparison report by William Maxfield, MD attached.