An investigation by ProPublica and National Public Radio (NPR) has revealed that the military program to test soldiers’ brain function before and after deployment may be inadequate. Through a rushed effort by lawmakers to respond to Traumatic Brain Injury as “the signature wound” of the Iraq and Afghanistan wars the Automated Neuropsychological Assessment Metric or ANAM was selected. The report released by ProPublica and NPR identified that the individuals who invented ANAM and could profit from its use by the military were involved in the decision making process. No other tests received serious consideration. A 2010 report by the Army’s top neuropsychologist released to key members of Congress raised concerns with the selection process and with the ability of the ANAM to screen or diagnose traumatic brain injury. The military has also not administered the test as recommended and has rarely used the results. The Army has issued an order that soldiers whose scores indicated cognitive problems should be sent for further medical evaluation. Those further assessments have been rarely conducted. To make matters worse the military has not conducted the promised head-to-head study of the ANAM with other assessments to make sure that it is the best instrument available to detect brain injuries. There is evidence to suggest that the ANAM does detect injuries when used immediately after exposure to a blast and a yet-to-be published study shows that the instrument can detect certain cognitive problems months after the initial injury. Yet the true objective qualification of the ANAM remains clouded in relationships between the test’s patent holders and trademark owners and the members of the military board who evaluated the instrument. Critics of the ANAM claim that the National Hockey League conducted a better assessment of tests to detect brain injury than the military. The NHL evaluated five tests, looking for accuracy supported by research and ease of use by trainers and players. A test known as ImPact was selected, a 20-minute computerized test requiring the athlete to remember and then reconstruct a series of designs and patterns. By 2007 every NHL player had taken a baseline test. Army Special Forces have also selected ImPact which they say was based on a review of the research.
Our soldiers in Iraq and Afghanistan face the possibility of brain injury every day. Over 1 million have been tested at a pre-deployment level but only 11,000 have had comparative studies since 2008. Fewer than 3,000 requests for ANAM results have come from the war zones. To make the situation more difficult there is no computer data base that stores ANAM results or integrates them with the military’s medical records. A request from the war zone for pre-deployment scores requires a manual data search and conversion to a scrubbed PDF file which is then sent. The military reports 90,000 traumatic brain injuries and civilian data bases report much higher numbers. Does the delay in accessing data expose soldier’s to the possibility for a return to duty without the benefit of a thorough evaluation and create the additional risk of a second, possibly more serious brain injury?
As we are experiencing a winding down of the wars and a return home for the troops will we be finding that there are more returning vets with brain injuries than we imagined? Why has the military pushed what may be an untested instrument to detect brain injury into use and then further complicated the use of that instrument and access to the data? And, what resources will be made available for the rehabilitation of veterans with traumatic brain injury once they are home?