WEBVTT

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All concussions with their population

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have a question

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like these . It

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got it cool . Well , thank you . Thank

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you so much for coming . Um There's a

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ton of great breakout presentations .

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I'm kind of bummed that I have to be on

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my own because there's a bunch of

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really cool topics that I'd like to be

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at . So I appreciate your time . I'm

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gonna make a civilian around a little

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dynamic . I really hate being stuck in

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one spot and I also as an audience

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member don't like when people drive on

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and uh my attention span is that the

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gold fish . So I'll keep it pretty

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quick and hopefully entertaining

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regardless if you have any touch points

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in your daily job with concussion or

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not . I think I have something for you .

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So I appreciate you being here . Um

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Thank you also to my , it uh Hunter ,

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brilliant director , uh my mental , his

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team , injury control and uh

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performance nutrition . This as you'll

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see in the XL slides . This is truly a

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collaborative effort uh at first per

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game 82nd where we've leveraged the

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expertise , competence , um and band ,

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frankly bandwidth to meet a need of our

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brigade and so I'm really proud of the

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team's effort and this is , uh , it's

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not my award . It's , it's our award at

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First Brigade . So we're super proud

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and um thankful for you also . All

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right . So I'll go very quickly

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background . We'll talk about some

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program improvement that we've done

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some lessons learned and then some

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takeaways . So , like I said , like

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regardless if you have any touch points

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with concussion , you know , whatever

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you see . Um there's some things that I

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have for you in your own H two F plans

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that I think will be helpful for you .

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So for the background , in 2023 like

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mid time show of hands , you guys

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familiar with Intrepid Spirit Center ,

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it's like TG I specialty clinic on most

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uh larger military installations . Our

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General Spirit Center at Fort Liberty

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uh home for Bragg , discontinued their

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acute concussion care clinic um due to

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manage shortage . And so the powers

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that be met uh H two F lead at the

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Martial uh TB IC uh Center of

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Excellence TB I or , or sorry , uh

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inter Spirit Center , they met um a

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couple of HDF teams in , in 82nd were

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already kind of um servicing this

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need uh in house . And so it was kind

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of decided that the HDF teams at for

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Liberty were to be the primary

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providers for concussion . And so

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we made a , a pretty robust

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TB I slash concussion recovery

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protocol , an acute concussion care

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clinic at H two F . At first we did and

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currently we see about 2 to 20

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paratroopers per week . We jump a lot .

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Now , if you were to talk to a

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counterpart in a different , maybe not

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airborne H two F , they like hardly

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ever see concussion . It's just not a

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big part of what they do . Um but it is

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a huge part of what we do ,

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particularly in our metal readiness

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section . So , uh in October

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2023 we rated it to uh be called

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devilish to have concussion . Uh BT

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because TB I is kind of um scary words .

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So , uh not many people know that M TB

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I or my TB I and concussion are

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synonymous terms . Same thing . Uh So

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we rebranded and made some cool changes .

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Here's the changes all of which are

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from necessity . So , uh a couple of

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the ones that I want to highlight , I'm

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not gonna read all of this live , but a

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couple of the big ones that I'm proud

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of are the mandatory discharges

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determination at four weeks . Um Does

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anybody have any touch points with

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concussion ? You guys see concussion in

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the military show hands ? No , no . Uh

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how . Ok . So the dod theologist tell

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you because that's not many hands . Uh ,

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the DH A dod you know , brain Injury

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Association of America , all the

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numbers that you see as far as like a

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normal trajectory of recovery for a

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concussion are like 7 to 14 days , uh ,

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10 being like the average , I'll tell

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you and those OTs in the audience that

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see concussions in a second . I see a

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few of you . It's on average longer for

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us for a variety of reasons . And so we

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have i affectionately call problem

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Children to develop that we see them

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for way longer than they should be seen .

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And so , uh , enacting the mandatory

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discharge determination four weeks .

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That's not us kicking them out . That's

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us taking a closer look and seeing , ok ,

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like this is taking longer than um

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where do do you actually belong here

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and where you need to go under the

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surveillance and tracking . We also do

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the N SI every week . And so it's

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essentially a patient self report

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symptoms tracker . You're not even

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actually supposed to give it a total

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score , it just gives you a trajectory

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of symptoms , self reported by that

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patient that does a couple of things .

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Most importantly , it shows the Trumpet

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Spirit Center when we send those

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referrals up , if needed that we're

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doing our due diligence that we're

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trying the progressive return to

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activity and that we're doing the N SI

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and that gets those referrals through

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those gates that can sometimes be

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tricky for providers . And then we

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increased it from three days to five in

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line with sports related concussion

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research . Um sub symptomatic aerobic

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exercise and movement frequently . It's

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much better than the old way that we

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used to treat concussions , which is

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called the cocoon method of recovery .

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So how many of you remember , have you

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ever had a concussion before ? And

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someone told you , hey , go to a

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dungeon for like two weeks and then

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you'll get better . Well , we know now

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in the medical community that that's

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actually counterproductive to normal

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recovery from a concussion , we

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actually need to be . And so that's our

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whole program is based on frequent

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touch points , moving their body ,

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giving them some low grade

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interventions of cognitive vestibular

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vision therapy , uh and making sure

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we're tracking those symptoms so that

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they can return to normal faster . Like

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General Tahan talked about this morning .

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Um It's all about return to duty and so

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that we can ensure that they go to a

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higher level of care when necessary ,

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quickly and effectively and then lastly

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just external problem . Uh Chris Anki ,

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uh captain in over at uh for Jackson uh

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did a great breakout panel and it's

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like uh uh essentially , it's all about

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collaboration with stakeholders in your

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area at H two F . And that's something

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that we really tried to , to improve

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upon . And his vastly improved care

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with our paratroopers is building those

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relationships with stakeholders . So

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interpret Spirit Center T BS and Red

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Excellence . Uh the battalion pas the

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medics , it's a team effort . All right ,

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this is something I built uh from the

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uh it's based off of the uh DH A

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concussion acute concussion care

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pathway . But for those of you who

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don't know , this is what normally

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happens . So we see , uh , you know ,

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mopping on the head and under accidents ,

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but the majority of our paratroopers

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that come see us are from air one

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operations . So point of injury happens

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on the drop zone . What do you think ,

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uh , they're supposed to get a , a two

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done , which is the military two

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concussion evaluation . It's the screen ,

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right ? Sometimes it happens ,

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sometimes it doesn't um even if it does

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happen without a person like me or a

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team like mine that makes it almost

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never put into Jesus . And you guys

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know in the room that if it's not in

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genesis it never happens . And so um

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after they get ma to or not , they are

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supposed to go to their P A get

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quarters maybe some minutes , probably

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out of time , something like that . And

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then they come see us , Tuesdays and

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Thursdays in the afternoon for a full

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light concussion evaluation . And then

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from there it starts the progressive

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return activity . Now , technically ,

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step one relative rest happens at that

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quarters , initiation and then to us ,

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and you'll see that on the next slide ,

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I'm gonna show you our , our uh

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concussion protocol , but essentially

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we are we own return . Like when they

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get injured , we have not only the

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bandwidth at H two F but the competence

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and the expertise to fill that role

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really well . And so that's uh it's

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something I'm proud of . Might be a

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little too small for you to see . But ,

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um , on the left you'll see the , um ,

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straight condition coach , uh , session

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guidelines . They , uh , follow that

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pretty closely . It's a stepwise

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approach , right ? But in strength

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coach language , uh , on the right ,

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you'll see the PT schedule that we

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follow . So Mondays and Fridays are

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straight coach and performance

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nutrition owned . And then Tuesday

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through Thursday is mental readiness ot

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um owned and athletic trainers help us

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out a ton with , uh , screening the

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cervical spine or any other MS K I or

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Coke or on the bottom left . You'll see .

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This is what I'm super passionate about

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is the return to duty of traditional

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testing . So there's two ways . So

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General Tahan , if you guys said in on

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General Ta s uh awesome uh speech this

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morning , she talks about like nuances

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of return to duty and having those

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conversations . This is what this is a

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vignette that I can share from J RT C

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last month . That's a 68 whiskey . He

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had a concussion about a week or two

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before coming to D RT C . Came to me .

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He was like , hey , sir , I wanna get

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back to my guys . I'm like , sit , I'll

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see you this afternoon with uh with

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your ach and your med bag . You got

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your plates . Now they're packed away .

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No worries , bring your ach and bring

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your , bring your men back . And so I

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did a quick uh alys which is the

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preferred method of cognitive

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exertional testing . So when you wanna

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say , hey , you've got a concussion ,

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your return to duty in the military ,

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it's got to be two things , cognitive

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and physical exertional testing . The

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preferred cognitive method is the anam .

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You can also use the cognitive portion

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of the mace two screen . So I gave him

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an anam and then the physical

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exertional testing , here's where I

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nerd out about it because I'm an ot and

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I like to think creative fraternity

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duty , uh , function type stuff . He's

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a medic so I could have him just do the

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two minutes of prescribed 16 R pe uh

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about 100 and 60 beats per minute ,

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just quick spike of the heart rate ,

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physical exercise . And I wouldn't be

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wrong . That would be in line with

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aggressive turned activity . Hello ,

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bru , I asked him , hey , what do you

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do ? You're a medic sit . I wanna make

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sure that you're ready to go back and

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be a medic . And so he did a ta uh

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simulated TA eight . So he did some IMT ,

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I do a little bit of this stuff . Oh ,

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you're going back on jump status ?

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Awesome . Let's look at some PLF type

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stuff , right ? Are you ready ? Uh ,

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we'll do it on the ground first and

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then we'll grade up , we'll do a 2 ft

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platform that I cut out for a second .

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Ok . Ok . Um , and then at the end we

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did a five minute teaching , uh

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teachable seeing . So we had to like

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drag our 68 mic sergeant Douglas who

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was there with us at D RT C had to drag

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him and go through his Martine diagram .

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Super fun . He had a blast . It gave

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him the confidence that he was ready to

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return to duty and it gave me the

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confidence as his provider . Hey ,

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you're not just going to like a

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crossfit type circuit workout to get

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back to normal . Um There's nothing

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wrong with that . We do that sometimes

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when we have to , but you're also like

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going that step further and using those

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M OS specific uh skills . So that was

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super fun . And I remember I did just

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see some like Christine de like single

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leg um unilateral work that we like to

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do in the dead . They're just more

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examples . Uh How do we create it ?

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Right ? I didn't take rock beans with

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me . Anybody know vision therapy . It's

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like the New York Far focus called rock

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beads . Uh I didn't take rock beads

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with me to JTC . I had a bunch of

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lacrosse balls in Miami in kids . So we

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did dor stuff . We did like peripheral

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awareness in coordinations type stuff .

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We did some uh V MS . Uh We did

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legit like skilled vision

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vestibular and cognitive therapy with

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field expedient methods and it was

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super fun . We had

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1100 jumpers at J RT C 28

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came forward and sought care uh for

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concussions and I returned

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26 of them to duty to get back into the

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exercise . And without that capability ,

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you would have had 28 is almost a

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platoon of paratroopers sitting in

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white cell at a CDC rotation , unable

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to go back and qualify in their medals

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with their units . So , super cool that

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we were able to do that . All right ,

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here's the lessons learnt and then I'll

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um do questions after to take with uh

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we learn to be clear on where we fit

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into the continuum of care and when to

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refer to a specialty clinic . So I get

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this question on the here you wait .

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You know what , like when do you start

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to dial it in and do like , you know ,

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if they're having primarily visual type

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symptoms , when do you focus more on uh

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vision therapy and then kind of shy

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away from vipul . Um My answer is we

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are an acute concussion clinic and if

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they need that dialed in care , they

13:34.669 --> 13:36.891
don't belong with us . They belong with

13:36.891 --> 13:39.830
TB I , the super proud of the level of

13:39.840 --> 13:42.059
therapy that we give them . It's

13:42.070 --> 13:44.409
awesome , but it's not that bad . There

13:44.419 --> 13:46.530
is so much low hanging fruit with our

13:46.530 --> 13:48.641
air tubers that we see that doing any

13:48.641 --> 13:50.530
of those things just moving their

13:50.530 --> 13:52.697
bodies , that active model of recovery

13:52.697 --> 13:55.309
gets , gets 95% of them back to normal .

13:55.320 --> 13:57.640
Super quickly , more quickly than if

13:57.650 --> 13:59.706
you were to just put them on profile

13:59.706 --> 14:01.872
for two weeks and have them sit out of

14:03.799 --> 14:05.966
in order to ensure the highest quality

14:05.966 --> 14:08.077
care because we need to have a strong

14:08.077 --> 14:10.188
relations is huge as I went to with ,

14:10.188 --> 14:12.929
uh with uh Chris , um at Fort Jackson .

14:12.940 --> 14:15.162
This is something that we've strived to

14:15.162 --> 14:17.273
do . We can always do a better job of

14:17.273 --> 14:19.496
it , but it's something that has vastly

14:19.496 --> 14:21.718
improved . Our impact for the character

14:21.718 --> 14:23.940
is building relationships with the Drug

14:23.940 --> 14:23.799
Spirit Center . Has anyone tried to

14:23.809 --> 14:26.090
refer anyone to the to and Drug Spirit

14:26.099 --> 14:28.820
Center ? How hard is it ? That's very

14:28.840 --> 14:31.840
nice . So that's what ? So when I came

14:31.849 --> 14:33.960
in , I was like , oh man , everyone's

14:33.960 --> 14:35.960
telling me , oh my gosh , it's like

14:35.960 --> 14:38.016
near impossible , you know , uh it's

14:38.016 --> 14:40.238
impossible to get someone to transfer ,

14:40.238 --> 14:42.238
right . The referral guidelines are

14:42.238 --> 14:44.349
unbelievable . I just went and talked

14:44.349 --> 14:46.071
to the director . She's a well

14:46.071 --> 14:48.238
intentioned great provider that deeply

14:48.238 --> 14:50.460
cares for our soldiers . She's not some

14:50.460 --> 14:52.682
like evil Mimi that doesn't want to see

14:52.682 --> 14:54.793
anyone . She's just super undermanned

14:54.793 --> 14:56.905
and she needs to trust that she needs

14:56.905 --> 14:58.905
to trust that providers like myself

14:58.905 --> 15:00.960
that touch paratroopers and , and do

15:00.960 --> 15:03.127
the concussion thing are doing our due

15:03.127 --> 15:02.780
diligence . And so building that

15:02.789 --> 15:05.289
relationship has been amazing . And

15:05.299 --> 15:08.440
then uh as I uh spoke to you earlier ,

15:08.450 --> 15:10.450
uh it's h to represent , is it best

15:10.450 --> 15:12.450
when it's collaborative when no one

15:12.450 --> 15:14.728
cares uh who gets the credit takeaways ?

15:14.820 --> 15:17.042
Really ? The number one takeaway , uh ,

15:17.042 --> 15:20.070
for me is uh , quote two , be positive

15:20.080 --> 15:22.413
to support your brigade as an A to F to ,

15:22.413 --> 15:24.580
to meet needs when they arise . And so

15:24.580 --> 15:26.802
regardless if it's concussion , if it's

15:26.802 --> 15:28.858
ABC P stuff , if it's best range and

15:28.858 --> 15:31.024
best S A or whatever , you're , you're

15:31.024 --> 15:33.179
um doing , it's ultimately a brigade

15:33.210 --> 15:35.266
for man to run the program and being

15:35.266 --> 15:38.469
postured to get to . Yes , as an A F

15:38.479 --> 15:40.701
team is super important and then do the

15:40.701 --> 15:42.923
things that you solder and the pas do .

15:42.923 --> 15:45.190
So , the reason why our program is so

15:45.200 --> 15:47.929
good is because we're pas we know what

15:47.940 --> 15:49.718
it feels like to jump out of an

15:49.718 --> 15:52.030
airplane and to land safely and

15:52.330 --> 15:54.830
harnessing . That is what makes our

15:54.840 --> 15:58.700
program so good questions . Sorry , go

15:58.849 --> 16:01.150
on . I've got like three minutes , two

16:01.159 --> 16:04.849
minutes . Are you talking ahead ? No ,

16:04.859 --> 16:08.719
they're not working . Ok . Do I click ?

16:08.729 --> 16:11.159
Keep clicking ? Yes . Oh , what if

16:11.169 --> 16:13.336
there's no , it'll come up . I ask one

16:13.336 --> 16:15.502
for me when it pops up . There we go .

16:15.502 --> 16:17.502
Um So you , you've been addressed ,

16:17.502 --> 16:19.558
responding to concussions ? Is there

16:19.558 --> 16:18.909
anything you're doing on the , the

16:18.919 --> 16:22.000
education or prevention side ? Yeah .

16:22.010 --> 16:25.690
Um ok , so we're

16:25.700 --> 16:28.799
educating our baton pas our meadows ,

16:28.809 --> 16:30.865
our medics on what that looks like .

16:30.865 --> 16:32.476
But more importantly , we're

16:32.476 --> 16:34.698
integrating with Mary Howe and the TB I

16:34.698 --> 16:36.698
Center of Excellence because that's

16:36.698 --> 16:38.865
legit what they do all day and they're

16:38.865 --> 16:40.976
way better at it than , than we are .

16:40.976 --> 16:43.198
So coordinating training with them . Uh

16:43.198 --> 16:45.031
we still need to get those dates

16:45.031 --> 16:47.979
planned but they , you know , so let

16:48.299 --> 16:50.609
them , what's the , how do you get AM

16:50.619 --> 16:52.619
results ? Who interprets it and how

16:52.619 --> 16:54.341
beneficial is that add to your

16:54.341 --> 16:56.230
concussion program ? Um So the AM

16:56.230 --> 16:58.530
program office in J BS A , uh they're

16:58.539 --> 17:00.428
very responsive , contractually .

17:00.428 --> 17:02.595
They're obligated if you send an email

17:02.595 --> 17:04.706
or call them , they are contractually

17:04.706 --> 17:04.579
obligated to get back to you in about

17:04.589 --> 17:06.714
an hour , average time like 5 to 10

17:06.724 --> 17:08.755
minutes . Uh So they send you the

17:08.765 --> 17:10.987
results , you have to go to a formal AM

17:10.987 --> 17:12.765
provider training to be able to

17:12.765 --> 17:14.598
interpret that . And then uh how

17:14.598 --> 17:16.709
beneficial is that super beneficial ?

17:16.709 --> 17:19.295
It uh is one of the primary ways we

17:19.305 --> 17:21.416
have those return of duty discussions

17:21.416 --> 17:24.270
and determinations just how you want at

17:25.670 --> 17:28.499
the bottom elevating or referring

17:28.509 --> 17:30.509
externally . When you have to learn

17:30.509 --> 17:32.620
certain criteria , you look for you ,

17:32.620 --> 17:34.787
you started doing this . Yeah . How do

17:34.787 --> 17:36.898
you handle elevated care or referring

17:36.898 --> 17:39.009
external ? Uh Well , when they're not

17:39.009 --> 17:38.739
following the normal recovery

17:38.749 --> 17:41.318
trajectory , which is at 10 to

17:41.678 --> 17:45.009
14 when , when they start in like three

17:45.019 --> 17:47.948
weeks and mind you , we have weekly

17:47.958 --> 17:50.125
follow up uh follow up evaluations and

17:50.125 --> 17:52.347
we do a pretty thorough evaluation . So

17:52.347 --> 17:54.402
if there are co occurring VH stuff ,

17:54.402 --> 17:57.969
PTSD stuff , MS A I stuff , potentially

17:57.979 --> 18:01.439
MEB separation pending obligation type

18:01.449 --> 18:04.660
stuff that muddies the waters and those

18:04.670 --> 18:07.219
specific cases are really at risk for

18:07.229 --> 18:09.451
what we call persistent post concussive

18:09.451 --> 18:11.340
symptoms , which uh it used to be

18:11.340 --> 18:13.396
called post concussion syndrome . Um

18:13.396 --> 18:15.062
And so we take a really close

18:16.900 --> 18:18.956
ultrasounds , right ? Um There was a

18:18.956 --> 18:21.067
one that dropped off the screen , but

18:21.067 --> 18:21.050
it was asking how do you integrate the

18:21.060 --> 18:23.400
sleep ? Do you address that at all ?

18:23.500 --> 18:26.099
Super important . Um There's actually a

18:26.109 --> 18:29.270
cool like slide uh we call symptoms

18:29.280 --> 18:31.449
overlap in the symptoms , overlap

18:31.459 --> 18:33.570
within the concussion care space . Um

18:33.570 --> 18:36.020
So if you see like a graph of like , OK ,

18:36.040 --> 18:39.030
uh sleep disruption uh or sorry ,

18:39.040 --> 18:42.750
concussion PTSD depression , you have

18:42.760 --> 18:44.704
sleep disruption in all of those .

18:44.760 --> 18:46.816
You'd have like some sort of anxiety

18:46.816 --> 18:49.038
and all of those , you have all these .

18:49.038 --> 18:51.093
So it's like it's really hard to pin

18:51.093 --> 18:53.204
down on one thing and they all are so

18:53.204 --> 18:55.430
intertwined . Um how we address it is

18:55.439 --> 18:58.180
we do a weekly sleep class and if they

18:58.189 --> 19:00.411
don't benefit from just general sort of

19:00.411 --> 19:02.133
sleep hygiene and conservative

19:02.133 --> 19:04.300
management , then we will uh follow up

19:04.300 --> 19:06.356
with and one on one potentially do a

19:06.356 --> 19:08.411
stop bang or a um a sleep study . Um

19:08.411 --> 19:10.633
I'll tell you most of the time though ,

19:10.633 --> 19:12.689
they just aren't doing what they say

19:12.689 --> 19:14.856
they're doing . Like when you ask when

19:14.856 --> 19:16.856
you really start to dig and they're

19:16.856 --> 19:16.420
like , oh no , no , like my sleep

19:16.430 --> 19:18.597
hygiene is like legit . I like , don't

19:18.597 --> 19:20.597
open my phone at night and then you

19:20.597 --> 19:22.763
like really kind of dig in their sleep

19:22.763 --> 19:25.300
hygiene . Fair enough . Um I don't know

19:25.310 --> 19:27.366
what it is . But locally you do . Do

19:27.366 --> 19:29.699
you use the Buffalo treadmill test ? No ,

19:29.699 --> 19:31.977
you don't . Uh , it's a treadmill test .

19:31.977 --> 19:34.088
It's like a step wise . Um , it takes

19:34.088 --> 19:36.260
you , it's almost like a , uh , vo two

19:36.270 --> 19:39.589
max treadmill test or , um , something

19:39.599 --> 19:41.599
similar where you go in a step wise

19:41.599 --> 19:43.321
fashion . It's been clinically

19:43.321 --> 19:45.432
validated . Uh , we don't mostly just

19:45.432 --> 19:47.266
because we don't have a , um , a

19:47.266 --> 19:50.750
treadmill and , um , that's just not my

19:50.760 --> 19:53.093
style . I'd rather just like , you know ,

19:53.093 --> 19:55.316
move and , uh , and we use other things

19:55.316 --> 19:57.427
to return them to duty and to measure

19:57.427 --> 19:59.649
progress . Ok . I think we got time for

19:59.649 --> 20:01.704
one last question . Officers of your

20:01.704 --> 20:03.816
team , specifically the civilians and

20:03.816 --> 20:05.871
contractors D CMO certified . So you

20:05.871 --> 20:08.038
can ensure the screens are completed .

20:08.038 --> 20:11.020
And ASAP , yeah . You know , because if

20:11.030 --> 20:13.363
you've been in airborne unit , you know ,

20:13.363 --> 20:17.079
uh , that often , um , like if it's a

20:17.089 --> 20:19.150
first brigade line , meaning first

20:19.160 --> 20:21.216
Brigade owns those shoots , they own

20:21.216 --> 20:23.216
that jump oftentimes it's not First

20:23.216 --> 20:25.327
Brigade , it's pulling med coverage .

20:25.327 --> 20:27.493
It's like another brigade . So it sort

20:27.493 --> 20:29.216
of gets messy . Um , yes , our

20:29.216 --> 20:31.049
civilians are , are , uh , D CMO

20:31.049 --> 20:33.271
certified and they do help a lot , uh ,

20:33.271 --> 20:35.493
when they can , but we could , we could

20:35.493 --> 20:37.549
certainly be doing it more often and

20:37.549 --> 20:39.716
that does help , uh , make sure this ,

20:39.716 --> 20:43.300
um , mace tubes are done in the XP A

20:44.449 --> 20:46.671
awesome . That's our time . Thank you ,

20:46.671 --> 20:46.199
Kevin Co