INS NYC 2024 Program

Poster	Poster Session 05 Program Schedule 02/15/2024 02:30 pm - 03:45 pm Room: Shubert Complex (Posters 1-60) Poster Session 05: Neuropsychiatry \| Addiction/Dependence \| Stress/Coping \| Emotional/Social Processes Final Abstract #11 Cognitive Rehabilitation and Military Blast Exposure Jason Bailie, TBICoE, Camp Pendleton, United States Ida Babakhanyan, TBICoE, Camp Pendleton, United States Andrew Darr, TBICoE, Camp Pendleton, United States Juan Lopez, TBICoE, Camp Pendleton, United States Melissa Caswell, TBICoE, Camp Pendleton, United States Angela Basham, TBICoE, Camp Pendleton, United States Category: Cognitive Intervention/Rehabilitation Keyword 1: traumatic brain injury Keyword 2: cognitive rehabilitation Keyword 3: treatment outcome Objective: There has been increasing concern in military medicine about the short and long-term consequences of low level blast exposure that U.S. service members (SMs) experience during their career. This blast exposure may consist of large blasts associated with improvised explosive devices (IEDs) as well as controlled blast exposures associated with SMs use of various weapon systems such as shoulder mounted rocket launchers. Blast exposures over a SMs career are associated with increased cognitive complaints as well as reductions in mental processing speed. The objective of this study was to determine if cognitive rehabilitation would be effective for participants who have a history of blast exposure from various sources. Participants and Methods: Participants were 110 active duty SMs recruited for a cognitive rehabilitation study that was focused on the impact of mTBI. Participants were on average 31.4 years old (SD = 7.7) with 4.3 lifetime mTBI’s (SD = 2.6); the most recent mTBI was on average 6.9 years prior (SD=6.3). Participants completed a manualized clinician directed cognitive rehabilitation program that consisted of 40-60 treatment hours over 4-6 weeks. Lifetime blast exposure was assessed by the Blast Exposure Threshold Survey (BETS). The BETS assesses lifetime blast exposure from 5 primary sources: [i] Small and medium arms (e.g., rifles), [ii] Large arms (e.g., grenade launchers), [iii] Artillery (e.g., Howitzer), [iv] Smaller explosives (flashbangs, small IEDs, landmines), and [v] Larger explosives (e.g., breaching explosives). A Generalized Blast Exposure Value (GBEV) summarizes all sources of blast exposure using a weighted formula. The primary outcome was change in Global Deficit Scale (GDS). GDS was calculated from 11 cognitive measures: Hopkins Verbal Learning Test-Revised Total Recall (HVLT-TR) and Delayed Recall (HVLT-DR); Delis Kaplan Executive Functioning System Color Word Conditions 1-4 and Trail Making Conditions 1-4, Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores for each cognitive measure were converted to deficit scores. T-score to deficit score conversions were as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. The deficit scores were averaged to calculate GDS. Participants were excluded if they did not pass performance validity testing. Results: A repeated measures analysis of variance indicated a positive reduction in GDS (p <.001, partial η² = .248) with the average GDS declining from 0.64 (SD=.68) to .29 (SD =.50). GBEV was entered as a covariate which was not significant in the overall model (p = .678). In a secondary exploratory model, all 5 BETS subscales were entered into the model but none were statistically significant (p’s > .05); however, subscale 3 reflecting Artillery exposures, approached significance but this was a small effect size (p= .052, partial η² = .038). Conclusions: Lifetime blast exposure experienced during a military career does not appear to be an important factor impacting the effectiveness of cognitive rehabilitation. Exposures to artillery fire over a career was the only element that appeared even remotely impactful but this was marginal and not statistically significant. Lifetime blast exposure should not be considered a contra-indication for SMs who are experiencing persistent cognitive complaints and seeking treatment.

Poster

02/15/2024
02:30 pm - 03:45 pm
Room: Shubert Complex (Posters 1-60)

Poster Session 05: Neuropsychiatry | Addiction/Dependence | Stress/Coping | Emotional/Social Processes

Final Abstract #11

Cognitive Rehabilitation and Military Blast Exposure

Jason Bailie, TBICoE, Camp Pendleton, United States
Ida Babakhanyan, TBICoE, Camp Pendleton, United States
Andrew Darr, TBICoE, Camp Pendleton, United States
Juan Lopez, TBICoE, Camp Pendleton, United States
Melissa Caswell, TBICoE, Camp Pendleton, United States
Angela Basham, TBICoE, Camp Pendleton, United States

Category: Cognitive Intervention/Rehabilitation

Keyword 1: traumatic brain injury
Keyword 2: cognitive rehabilitation
Keyword 3: treatment outcome

Objective:

There has been increasing concern in military medicine about the short and long-term consequences of low level blast exposure that U.S. service members (SMs) experience during their career. This blast exposure may consist of large blasts associated with improvised explosive devices (IEDs) as well as controlled blast exposures associated with SMs use of various weapon systems such as shoulder mounted rocket launchers. Blast exposures over a SMs career are associated with increased cognitive complaints as well as reductions in mental processing speed. The objective of this study was to determine if cognitive rehabilitation would be effective for participants who have a history of blast exposure from various sources.

Participants and Methods:

Participants were 110 active duty SMs recruited for a cognitive rehabilitation study that was focused on the impact of mTBI. Participants were on average 31.4 years old (SD = 7.7) with 4.3 lifetime mTBI’s (SD = 2.6); the most recent mTBI was on average 6.9 years prior (SD=6.3). Participants completed a manualized clinician directed cognitive rehabilitation program that consisted of 40-60 treatment hours over 4-6 weeks.

Lifetime blast exposure was assessed by the Blast Exposure Threshold Survey (BETS). The BETS assesses lifetime blast exposure from 5 primary sources: [i] Small and medium arms (e.g., rifles), [ii] Large arms (e.g., grenade launchers), [iii] Artillery (e.g., Howitzer), [iv] Smaller explosives (flashbangs, small IEDs, landmines), and [v] Larger explosives (e.g., breaching explosives). A Generalized Blast Exposure Value (GBEV) summarizes all sources of blast exposure using a weighted formula. The primary outcome was change in Global Deficit Scale (GDS). GDS was calculated from 11 cognitive measures: Hopkins Verbal Learning Test-Revised Total Recall (HVLT-TR) and Delayed Recall (HVLT-DR); Delis Kaplan Executive Functioning System Color Word Conditions 1-4 and Trail Making Conditions 1-4, Paced Auditory Serial Addition Test (PASAT), and the Symbol Digit Modality Test (SDMT). Demographically corrected t-scores for each cognitive measure were converted to deficit scores. T-score to deficit score conversions were as follows: >40 = 0, 35-39 = 1, 30-34 = 2, 25-29 = 3, 20-24 = 4, <20 = 5. The deficit scores were averaged to calculate GDS. Participants were excluded if they did not pass performance validity testing.

Results:

A repeated measures analysis of variance indicated a positive reduction in GDS (p <.001, partial η² = .248) with the average GDS declining from 0.64 (SD=.68) to .29 (SD =.50). GBEV was entered as a covariate which was not significant in the overall model (p = .678). In a secondary exploratory model, all 5 BETS subscales were entered into the model but none were statistically significant (p’s > .05); however, subscale 3 reflecting Artillery exposures, approached significance but this was a small effect size (p= .052, partial η² = .038).

Conclusions:

Lifetime blast exposure experienced during a military career does not appear to be an important factor impacting the effectiveness of cognitive rehabilitation. Exposures to artillery fire over a career was the only element that appeared even remotely impactful but this was marginal and not statistically significant. Lifetime blast exposure should not be considered a contra-indication for SMs who are experiencing persistent cognitive complaints and seeking treatment.