Thursday, January 12, 2012

Military Study Aims to Aid Troops With Mild TBI

By Elaine Sanchez
American Forces Press Service

SAN ANTONIO, Jan. 12, 2012 – A team of experts at San Antonio Military Medical Center here has launched a military study aimed at improving outcomes for service members suffering from a signature wound of today’s wars: traumatic brain injury.

The Study of Cognitive Rehabilitation Effectiveness, dubbed the SCORE trial, is examining cognitive rehabilitation therapy’s value as a treatment for service members with mild TBI.

The Defense and Veterans Affairs departments teamed up on this study to determine the best treatment for combat troops who are experiencing mild TBI symptoms -- such as difficulties with attention, concentration, memory and judgment -- three to 24 months post-injury, explained Douglas B. Cooper, the study’s lead and a clinical neuropsychologist for the center’s Traumatic Brain Injury Service.

“We have a lot of great interventions to help … in the first few days after concussion,” he said in an interview with American Forces Press Service. “We can pull them out, get them rest and get them better.”

However, “we don’t have as many good interventions later on --six months, 12 months or two years post-injury,” acknowledged Cooper, who also serves as the director of the Military Brain Injury Rehabilitation Research Consortium.

The trial’s aim is to determine if cognitive rehabilitation therapy improves chronic mild TBI symptoms and, if so, which interventions work best, on whom and why.

Cognitive rehabilitation, Cooper explained, involves a variety of interventions that help patients with brain injuries reduce, manage or cope with cognitive deficits. It’s commonly used to treat patients with brain injuries, whether from concussions, penetrating brain injuries or strokes.

With vast experience in the field, Cooper said, he and his colleagues knew anecdotally that the therapy works, meaning it helps to improve memory and focus in patients. However, he added, experts have cited a lack of evidence-based research tying cognitive rehabilitation to successful treatment of brain injuries.

With a lack of in-hand research, insurance companies began to balk on covering it as a stand-alone treatment. For example, TRICARE, the military’s health care plan, won’t cover cognitive rehabilitation programs that haven’t been proven as effective stand-alone therapy for TBI, according to a TRICARE fact sheet.

Rather than step away from the therapy, Congress directed a series of studies to explore cognitive rehabilitation and its effectiveness among troops, Cooper said.

The Defense and Veterans Brain Injury Center took on the challenge and soon enlisted the help of DOD and VA experts. They took a year to write manuals to serve as a trial guide and began enrolling patients in SCORE in July.

They had only a few enrollment criteria: troops must have suffered a mild TBI while deployed in support of operations Enduring Freedom, Iraqi Freedom or New Dawn, and be three to 24 months post-injury, Cooper said.

They had no shortage of available participants. A TBI database shows that more than 202,000 service members suffered a TBI between 2000 and 2010, with the majority experiencing a mild TBI or concussion, according to the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. The center cited blasts, fragments, bullets, motor vehicle accidents and falls as the leading TBI causes within the military.

The team plans to treat 160 participants in six-week cycles over the course of two to three years, Cooper said. While in the trial, patients participate two times a day, five days a week, and are entered into one of four treatment paths, or “arms,” he explained.

These treatment paths involve a variety of interventions, and may include individual appointments, group sessions, computer treatments and behavioral health -- or a combination of several intervention types.

For the computer exercises, Cooper explained, service members complete a series of commercially available computer programs touted to improve “brain fitness.” These sessions take place in hospital and are proctored by clinic staff.

The programs are presented in a game-like format, he added. As they progress, troops earn “brain bucks” that can be used to outfit a virtual apartment with big-screen TVs and stereos. This suits technology-savvy service members, he noted, who often fall into the under-25 age range.

The team also is looking at the effectiveness of various treatment combinations, such as mental health care and cognitive rehabilitation offered together. More than 50 percent of TBI patients have a coexisting psychological disorder, oftentimes combat stress, Cooper explained, so wrapping the two treatments together makes sense.

An exercise typical of this approach is to have service members listen to a tape and be asked to focus on certain things in their environment, he said. This exercise is first introduced as a cognitive rehabilitation skill, but troops later see its benefits as a tool to overcome combat-related stress.

This integrated treatment is particularly useful for service members who aren’t willing to seek behavioral health care on their own, Cooper noted.

“There’s still a large stigma attached to mental health care,” he explained. “They may not want to seek behavioral health to get care, but are willing to talk to a psychologist while here getting care for a concussion.”

Cooper said his team will look at each treatment arm to see which interventions have proven most successful and for whom. In general, they’re looking for improvements in several areas: working memory, which is holding on to information; prospective memory, which involves remembering to perform a planned action or intention at the appropriate time; and simple attention, which is being able to process what someone is saying at the moment and then remembering what was said.

“We hope to not only look at what interventions work, but then look at subsets of patients -- these particular people haven’t shown as much improvement or people with multiple concussions may be harder to treat and so on,” he explained.

As Cooper’s team works to improve attention and focus, a parallel study at the medical center here is delving deeper into their patients’ brains. Participants of the SCORE trial also are invited to participate in the Imaging Support for Study of Cognitive Rehabilitation Effectiveness, known as the iSCORE study. For this study, experts use cutting-edge imaging technology to scan patients’ brains at certain intervals: before the SCORE trial, halfway through, after the trial and at 12 to 18 weeks later.

Imaging experts are hoping to learn more about people’s white matter track pathways in the brain, Cooper explained. “Is there something about these that will tell us why individuals are changing?” he asked. “Why are they getting better, and which ones are not able to get better?”

The best clinical trials, he added, raise more questions than they answer.

If the SCORE trial proves successful -- meaning it proves cognitive rehabilitation’s efficacy -- the goal is to determine which interventions are the most effective and then disseminate that information to VA and DOD centers, Cooper said. Civilian providers also may glean ideas that can aid them in the treatment of noncombat-related brain injuries, such as those from a car accident or a stroke.

Meanwhile, Cooper is hoping the study will have a direct, positive impact on troops’ well-being and their ability to return to active duty, and, on a bigger-picture level, the health care system as a whole.

Above all, he added, “we want to make sure they’re functioning and doing OK.”

The nation has an obligation to ensure service members get the best care and treatment possible, Cooper said.

“They need to feel taken care of, that their complaints are valid, and that they’re not alone in going through this process,” he added.

The SCORE trial, he said, “is accomplishing that and more.”

Panetta Hosts First Official U.S.-Netherlands Defense Meeting

By Karen Parrish
American Forces Press Service

WASHINGTON, Jan. 12, 2012 – Defense Secretary Leon E. Panetta hosted a Pentagon honor cordon today for his counterpart from the Netherlands during the two leaders’ first official bilateral meeting.

The secretary and Dutch Minister of Defense Hans Hillen discussed the new U.S. defense strategic guidance, bilateral defense cooperation issues, and ongoing operations and plans for transition in Afghanistan, Pentagon spokesman Navy Capt. John Kirby said.

The Netherlands has contributed troops to the International Security Assistance Force in Afghanistan since 2003. Currently, 183 Dutch troops are deployed to Regional Command South and the capital region, according to ISAF officials.

Panetta and Hillen also discussed U.S. force posture in Europe, the upcoming NATO defense ministerial meetings to be held in early February in Brussels, and the NATO 2012 Summit scheduled for May in Chicago, Kirby said.

While discussing NATO issues, the spokesman added, Panetta recognized and praised the Netherlands’ “traditionally strong voice and leadership in the NATO alliance.”

Navy Exchange Service Command Names New Chief Executive Officer

By Kathleen Martin, Navy Exchange Service Command Public Affairs

VIRGINIA BEACH, Va. (NNS) -- Navy Exchange Service Command (NEXCOM) and the worldwide Navy Exchange System NEXCOM welcomed its first chief executive Jan. 11.

In this position, retired Rear Adm. Robert J. Bianchi is responsible for the oversight of 104 Navy Exchange facilities with nearly 300 stores worldwide, 40 Navy Lodges, 158 Ship's Stores, Navy Clothing Textile and Research Facility and the Uniform Program Management Office.

"I am very pleased to have Rear Adm. (retired) Bianchi on our team," said Rear Adm. Mark Heinrich, commander, Naval Supply Systems Command. "He brings a wealth of experience to the table, and I have great confidence that he can lead NEXCOM into the future."

In March 2011, NEXCOM's flag billet was converted to a senior civilian position per the Secretary of Defense Track Four Initiatives Decision memo. Rear Adm. Glenn C. Robillard, Supply Corps, transferred in August 2011 after serving as the 29th and final commander of NEXCOM.

Bianchi is the first civilian chief executive officer of this organization. He joins NEXCOM after a distinguished 29-year military career as a Navy Supply Corps officer. Bianchi attended the University of North Carolina at Chapel Hill on a Navy ROTC scholarship, receiving a Bachelor of Arts degree in Mathematics. Upon graduation in 1982, he was commissioned as an Ensign in the Navy Supply Corps. He earned a Master's degree in Business Administration with distinction from Harvard University in 1992 and completed the Wharton School of Business Executive Development Program in 2003. Bianchi served in various senior leadership positions including assistant deputy chief of Staff for Fleet Readiness and Fleet Supply officer, U.S. Fleet Forces Command; Commander, Navy Exchange Service Command; deputy commander for Aviation, Naval Inventory Control Point; military advisor to the Deputy Under Secretary of Defense (Logistics & Materiel Readiness); and supply officer, USS Harry S. Truman (CVN 75).

NEXCOM's four independently functioning programs generated over $2.6 billion in sales in 2010 and provided $48.4 million to the Navy's Morale, Welfare and Recreation programs. NEXCOM's mission is to provide authorized customers quality goods and services at a savings and to support Navy quality of life programs. NEXCOM is an Echelon III command within the Naval Supply Systems Command (NAVSUP) Enterprise.

Combating Complacency in the New Year

By April Phillips, Naval Safety Center Public Affairs

NORFOLK, Va. (NNS) -- The Naval Safety Center reminds Sailors to remain vigiliant as they return to work after a long holiday season when many commands were on reduced work schedules.

Time to recharge the batteries is great for Sailors, but it is important to be ready to work now that 2012 is in full swing.

Many commands hold safety briefs, dubbed "Back in the Saddle," in January to reinforce this idea. Derek Nelson, author of the Naval Safety Center's (NAVSAFECEN) popular Friday Funnies Summary of Mishaps said these safety briefs are really intended to combat complacency.

"The problem with complacency is that it can strike almost anytime and you don't even realize it," he said. "It feels comfortable."

Nelson said he reads mishap reports every day to find material for his weekly Friday Funnies message, and a large majority of them involve complacency.

Fortunately, most of these mishaps are minor, which gives him license to poke fun at them. However, others wind up in his quarterly "Not so Funnies" message, which details serious mishaps that lead to death or severe injury - mishaps that are no laughing matter.

"Sometimes complacency is not just embarrassing, it's fatal," he said.

Nelson said the biggest examples of these are firearms mishaps.

"Almost always the mishap reports say the victims were highly experienced with weapons, but somehow they still managed to shoot themselves or someone else."

The complacency in these mishaps usually shows up when the victims forget the first rule of weapons safety: Treat every weapon as if it's loaded. Numerous firearms mishaps show that the victim accidentally shot him or herself while cleaning a weapon that was assumed to be unloaded.

Nelson said complacency also strikes deployed Sailors who fall into what he calls "The Groundhog Day Syndrome" after the movie where celebrity Bill Murray's character is forced to relive the same day over and over again.

"When you're doing the same thing day in and day out, you start to feel like you can do it in your sleep," he said. "The fact is you can't."

This truth is borne out by NAVSAFECEN survey teams who regularly visit ships and squadrons to help determine if they comply with various safety requirements. Lt. Christine Davy specializes in surveying how well Sailors complete their Planned Maintenance System (PMS) checks. She said this is an area where complacency can set in, and while Sailors may get away with improper maintenance for awhile, eventually it may lead to dire consequences.

"When you reach for that piece of equipment in an emergency, it needs to operate as advertised," she said, noting that proper and careful maintenance is the only way to ensure it will.

She said she takes a great deal of pride in training Sailors on how to thoroughly perform damage control maintenance, because it makes a real difference in life or death situations.

"People's blood is there to show the importance of maintenance. Ask the guys on the Cole, or the Whidbey Island, or the Stark," Davy said, referring to high profile incidents where Sailors had to use damage control equipment to save their shipmates' lives.

Nelson said the disturbing thing is Sailors know complacency is a danger, but still fall into the trap.

"I've been at the Naval Safety Center more than thirty years, and thirty years ago we wrote articles that said 'complacency kills,'" he said. "It still does."

For more information about combating complacency and to read the weekly Friday Funnies, visit

Navy Christens Littoral Combat Ship Coronado

The Navy will christen the Littoral Combat Ship (LCS) Coronado, Saturday, Jan. 14, during a 10 a.m. CST ceremony in Mobile, Ala.

The Assistant Secretary of the Navy for Research, Development & Acquisition, Sean Stackley, will deliver the principal address at the ceremony.   Susan Keith will serve as the ship’s sponsor.  Additionally, Keith helped launch the Coronado Historical Association’s “Home of a Naval Aviator” sign project and grew up with her father and stepfather serving in the Navy.  Vice Adm. Stanhope C. Ring, her father, was a pilot who commanded an aircraft carrier air group during the Battle of Midway during World War II.  Her stepfather, Rear Adm. Aaron Putnam “Put” Storrs III, belonged to the Navy’s first aerial acrobatic team, which was the forerunner of the Blue Angels.   The ceremony will be highlighted by Keith breaking a bottle of champagne across the bow to formally christen the ship, which is a time-honored maritime tradition.

The ship’s name recognizes the city of Coronado, Calif., and honors the city’s deep ties to the U.S. Navy.  Coronado has been home to Naval Air Station North Island and Naval Amphibious Base, since 1917.  Two previous ships have been named after this city:  USS Coronado, a Tacoma-class patrol frigate, earned four battle stars for supporting landings in New Guinea and Leyte during World War II and the USS Coronado, an Austin-class amphibious transport dock later re-designated as an auxiliary command ship, served as flagship for the Third Fleet and was decommissioned in 2006.

Designated LCS 4, Coronado is an innovative surface combatant designed to operate in littoral seas and shallow water to counter mines, submarines and fast surface craft threats in coastal regions.  The ship is capable of speeds in excess of 40 knots and can operate in water less than 20 feet deep.  Coronado will address a critical capabilities gap in the littorals and conduct the Navy’s mission to enhance maritime security by deterring hostility, maintaining a forward presence, projecting power and maintaining sea control.

A fast, agile, and high-technology surface combatant, Coronado will be a platform for the launch and recovery of manned and unmanned vehicles.  To meet increased demand for mission-tailored packages, its modular design will allow the ship to be reconfigured for antisubmarine warfare, mine countermeasures, or surface warfare missions on an as-needed basis.  The LCS class ships have the ability to swap out mission packages in a matter of days - adapting as the tactical situation demands.  The modular approach allows the Navy to incorporate new and improved systems into the fleet as advanced technologies mature, providing flexibility and evolving capability.

Coronado will be manned by two rotational crews, Blue and Gold, similar to the rotational crews assigned to large submarines.  These core crews are augmented by one of the three types of mission package crews and an aviation detachment.  The commanding officer of the Blue crew will be Cmdr. John Kochendorfer, from Dana Point, Calif.  The commanding officer of the Gold crew will be Cmdr. Michael “Shawn” Johnston, from North Carolina.  After commissioning, the ship will be homeported in San Diego, Calif.

Constructed by General Dynamics in the Austal USA shipyard in Mobile, Ala., Coronado is the second of the Independence-variant in the LCS class.

Media may direct queries to the Navy Office of Information at 703-697-5342.  For additional information about this class of ship, please visit the Navy Fact File at: .