Navy Neuropsychology and TBI in Afghanistan

By Lt. Ana Soper, neuropsychologist, Naval Hospital Beaufort

Soper_CRCC
Lt. Ana Soper, neuropsychologist, at the Concussion Restoration Care Center, Helmand Province, Afghanistan. (Photo courtesy of Lt. Soper/Released)

A neuropsychologist looks at the impact of what a person’s brain does (memory, attention, and other types of cognitive functioning) on how he or she functions in day-to-day life.  

The neuropsychologist in Afghanistan helps warfighters and professionals understand the causes and consequences of suspected cognitive, mood, and personality changes. Neuropsychologists in the deployed setting have advanced training in diagnosing and detecting effects of traumatic brain injury (TBI), one of the signature injuries of the Afghanistan war. Did you know that for the past several years neuropsychologists have worked to promote force health protection in Afghanistan in several ways?:

1)  Prevention and early identification.  

Preventive actions taken by neuropsychologists can prevent warfighters with brain injuries from being overlooked. Neuropsychologists can also prevent the warfighter from being misidentified as having lasting symptoms due to TBI, when symptoms are due to other causes such as stress, sleep disruption, chronic pain, or medications. Neuropsychologists are trained to identify the impact of effort, fatigue, and stress on memory difficulties, so that if one does poorly on a memory test, for example, it is not misinterpreted as indicative of brain injury.

One benefit of having neuropsychologists at the front lines is that we can fully consider the contribution of combat stress to cognitive symptoms, and help ensure proper detection of the causes of symptoms early in the evaluation process. Neuropsychologists can then help triage warfighters to the most appropriate evaluation and treatment resources (e.g., Combat Stress Clinic) and avoid unneeded procedures in an environment where resources and time are limited.

2)  Expert educator.  

A neuropsychologist trained Camp Leatherneck’s Surgical Company unit members in appropriate use of TBI assessment tools, education and Department of Defense provider materials to all Camp Leatherneck medical staff. Neuropsychologists come to be routinely sought by physicians for their TBI expertise and help Commands understand their warfighters’ needs post-TBI.

3)  Maximizing the warfighter’s independence and success in the workplace. 

While most people’s symptoms following mild TBI heal within days, neuropsychological evaluation is essential when the warfighter has symptoms after TBI that don’t follow the usual course (e.g. trend toward improvement and resolution). Neuropsychologists determine any changes that may be necessary to the work day, anticipate safety issues that could arise in returning to duty, and help warfighters and Commands set expectations.  

The neuropsychologist has an arsenal of tests, together with training in psychological assessment, which help answer useful questions about return to duty, including whether the warfighter should independently perform complex tasks involving the ability to react quickly, sustain attention, switch gears, work on simultaneous tasks with competing requirements, and remember to perform needed tasks as part of the mission.

One role of the neuropsychologist is to protect people from the discouragement that might result from returning to work prematurely. In some cases where a person returns to work too soon, they can jeopardize their reputation and may come to be known as the person who had a safety lapse at work, despite all the other work they have done. Also, the brain that still needs to recover has to work ten times as hard, which may cause people to “rev their mental engine too high,” leading to burnout. On the other hand, if people who have healed from TBI return to work too late, this may lead to stress, depression, “feeling useless,” stigma, and boredom.

4)  Understanding the role of stress.  

Neuropsychologists provide a bridge for the warfighter, who may be accustomed to focusing on physical symptoms, to talking about stress. This occurs through discussion of the impacts of stress on memory and other cognitive problems. Neuropsychologists can explain the impact of stress on brain functioning in a way that makes sense to the warrior. The accumulation of chronic stress frequently accounts for changes in memory and attention/concentration in our era of multiple deployments.  

It is not uncommon for the warfighter to worry about memory efficiency in times when “the dust has settled.” Sometimes the cognitive testing we do with the warfighter provides reassurance to concerned service members that their memory is entirely normal, which helps give them the added confidence they need to do their jobs. Also, many people get too little sleep, have too much stress, and expect their brains to continue to function flawlessly.  Neuropsychologists help people understand this and can pass on strategies for better sleep and stress management.

5)  Treatment.  

The deployed neuropsychologist also provides psychotherapy to the warfighter in the Combat Stress clinic.  We provide solution-focused therapy to help people cope with operational stress, which simultaneously can resolve memory and concentration problems.  We also provide strategies to compensate for memory inefficiencies directly (cognitive rehabilitation).

These are just some examples of the critical roles that neuropsychologists play in support of the warfighter and the mission.  The challenges of providing neuropsychology services in the deployed setting are varied, but the rewards are greater.  Our role is becomingly increasingly well-integrated into Navy Medicine’s system of care in theater, and, thanks to the efforts of several “generations” of neuropsychologists who have served in Afghanistan, we are welcome collaborators with physicians in managing TBI care in theater.