Thousands of military service members have experienced concussion or mild traumatic brain injuries (mTBI) in the wars in Iraq and Afghanistan. Military medical personnel who make return-to-duty decisions often rely on input from occupational and physical therapists who have treated these wounded warriors, but traditional rehabilitation assessments are problematic because of ceiling effects, lack of face validity for military stakeholders, and inadequate sensitivity to duty-relevant vulnerabilities after mTBI. A new grant from the United States Army Institute of Environmental Medicine (USARIEM) will help UNC Chapel Hill Division of Physical Therapy Professor Karen McCulloch, PT, PhD, NCS, and an interdisciplinary research team address these deficiencies by further developing a new assessment protocol specifically designed for military service members who have sustained mTBI. The USARIEM grant will fund the next two years of the project, titled “Assessment of Military Multitasking Performance: Validation of a Dual-Task and Multitask Protocol” or AMMP. The team of civilian and military occupational and physical therapy researchers will use the time to continue evaluating the efficacy of this new protocol and to refine its procedures for future implementation by therapists.
“Traditional assessments do not fully take into account the intense physical demands and extreme environmental conditions that military service members face, particularly in the theater of war,” said McCulloch. “We have developed the AMMP to more accurately replicate the activities that a soldier needs to be able to perform in order to successfully and safely return to duty.”
The AMMP is intended to measure both high-level mobility skills and simultaneous cognitive challenges, a combination that can often prove difficult for wounded warriors, according to reports from therapists and military decision makers. The battery includes tasks such as Run-Roll-Aim, in which a service member runs, rolls, avoids obstacles, and aims at visual targets with a simulated weapon, and the Duty Roster Task, which asks a soldier to schedule staff duty while monitoring a recording of a staff meeting and noting what is important to a specific unit.
Having service members perform tasks that relate directly to real-world scenarios should provide decision makers with additional information to help them determine whether a soldier is ready to return to duty following a mTBI. Researchers have also found that service members are more enthusiastic about participating in assessments that seem relevant to what is actually expected of them as soldiers.
Over the next two years of the project, the research team will pursue the following objectives:
- Evaluate inter-rater reliability for each dual-and complex task using healthy control service members and a comparison group of those with mild brain injury.
- Correlate scores on tests of neurobehavioral domains, dual-tasks and multitasks in healthy control service members and those with mild brain injury.
- Determine ability of dual-task and multitask test items to discriminate between healthy control service members and service members with mild brain injury.
Dr. McCulloch also has received funding as an Oak Ridge Institute for Science and Education (ORISE) fellow through the Rehabilitation and Reintegration Division (R2D) of the Army Office of the Surgeon General. The R2D was established in 2007 to institute Army-wide standards of care for rehabilitation and transition of injured soldiers, including those with traumatic brain injury. In her role as an ORISE fellow, McCulloch offers consultation on issues related to mTBI as directed by Army leadership. This can include the instruction of therapist providers about mTBI, the development of standards of care in theater when a concussion is suspected, and the development of research capacity focused on mTBI.