Page 64 - Journal of Special Operations Medicine - Summer 2015

Potential of Visual Sensory Screening,
Diagnostic Evaluation, and Training for Treatment of
Postconcussive Symptoms and Performance Enhancement

for Special Forces Qualified Personnel

Sean T. Suttles, PT, DPT, OCS, CSCS

ABSTRACT

Mild traumatic brain injury (mTBI) or concussive inju- Keywords: traumatic brain injury, mild; concussion; sensory
ries remain a challenge for both athletes and clinicians, station; rehabilitation; visual skills; return to duty; Special
given high incidence rates and heterogeneous clinical Operations; human performance
trajectories. Moreover, exposure to blast in combat is
compounded by chronic, frequent exposure to a variety
of subclinical impacts and overpressure, in some cases Background
annually over many years. Subsequent injuries are often
more severe than the original and lead to higher inci- According to the Fourth International Conference on
dence of chronic symptoms in combat units, particularly Concussion in Sport Consensus Statement, concussion
Special Operations Forces (SOF), which is compounded is defined as: “A complex pathophysiological process
by a propensity to underreport or avoid Army medical affecting the brain, induced by traumatic biomechani-
systems altogether. The unique nature and psychologi- cal forces . . . may be caused either by a direct blow to
cal makeup of SOF Soldiers suggest that new guidelines the head, face, neck or elsewhere on the body with an
for progressive return-to-activity and return-to-duty ‘impulsive’ force transmitted to the head . . . typically
decision-making within the traditional medical setting results in the rapid onset of short lived impairment of
may not be generalizable to this population. Further, the neurologic function that resolves spontaneously . . . may
traditional criteria for return to duty and return to play result in neuropathological changes but the acute clini-
in sport may be insensitive to persistent deficits, result- cal symptoms largely reflect a functional disturbance
ing in premature return. There is presidential and De- rather than a structural injury . . . results in a graded set
partment of Defense mandates for continued research in of clinical symptoms that may or may not involve loss of
the areas of diagnostics, treatment, and assessments for consciousness. Resolution of the clinical and cognitive
return to duty. With recent shift toward understanding symptoms typically follows a sequential course however
clinical trajectories, particularly visual and vestibular it is important to note that in a small percentage of cases
trajectories, promising new technology from the field of however, postconcussive symptoms may be prolonged.
sports vision may prove useful toward that endeavor. . . . No abnormality on standard structural neuroimag-
Since the advent of performance programs within SOF ing studies is seen.” 1
units, these Soldiers build trust with performance per-
sonnel, which include rehabilitative personnel, through More than 287,000 service members sustained a trau-
consistent and regular shared experience. Implementa- matic brain injury (TBI) between 2000 and the third
tion of comprehensive vision and visual performance quarter of 2013. The majority of these (83.3%) were
screening in conjunction with the study of sports vision classified as mild TBI (mTBI), also known as concus-
technology within the performance setting, in conjunc- sion. It is estimated that between 11.2% and 22.8% of
tion with unit medical personnel, may yield important returning personnel screened positive for mTBI during
findings for diagnosis and treatment of mTBI; to include their deployment. 2–4
the chronically symptomatic postconcussive Soldiers.
Last, with a wealth of literature supporting visual skills In the military, acute and/or penetrating TBI is typically
training for athlete populations, to include competitive identified and cared for immediately. However, closed
shooters, the implementation of visual skills training head injuries, including mTBI, may be missed in the pres-
will likely be a useful adjunct to performance training ence of other more obvious life-threatening injuries or
of SOF personnel. complicated by comorbidities such as combat stress (e.g.,

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