Definition of Concussion and its Causes
Based on the APA formatting style, I have aligned the first line of the executive summary which was previously indented in the unrevised paper. The new test involves attachment of impact sensor on the headgear of the recruits who are the subjects for the experiment. The impact sensor will then detect and record the forces transmitted to the brain during collisions. Relevant people responsible for coordinating the process will be a task with the role of excluding those soldiers with the higher impact of concussion. The technology is much useful in preventing injuries as it measures the intensity and number of hits that are transmitted to the brain with the consideration of time factor.
I have centered the title of the paper, “Effects of concussion in military deployment” according to the standards outlined in the APA formatting style. To avoid many definitions of the term concussion, I decided to use only one that provided a more summarized, complete, and easy to understand the meaning. Shock refers to a complex pathophysiological process that affects the brain through induction by traumatic biomechanical forces.
In the first paragraph of page four, I have broken down the sentence due to the length that makes it much easier to be understood. Commas and punctuations have been correctly and the abbreviated words placed in the bracket. Alphabetical order has been successfully applied in providing citations.
The sentence which was individualized has been generalized by the use of the word person instead of athletes which is more specific. I have also made the discussion more of military content through changing the terms used such as sports medication for military medication which still makes sense since medication practices in both the profession are similar. The subsequent headings in APA format should be centered and in italics which I have corrected. The sentence that starts with the word, this, has been adjusted to make it more understandable to the reader of what the writer is referring to.
Unnecessary words such as investigation can be replaced with another similar word to avoid repetition in the sentences. The alternative word to be used can be, test, which makes it easy for the reader to understand. Instead of using additional in the sentence, I linked it with the previous line by using the term, “as previously discussed.”
I have formatted the level 2 headings which should be bold and not in italic. I have presented an explanation of what the control subject is. It includes the individuals that voluntarily give up themselves to be used in the experiment, and they are used to compare the results in the test with placebo which represents those who are forced into the trial. The pretest measures include ensuring the test equipment are safe and has no harm to the subjects and identifying uncertainties that may interfere with the test results.
Symptoms of Concussion
In answering what is done to control the subject, the measure of the velocity and number of hits is taken to act as valuable data that will help in the prevention of concussion progressing to full-blown brain damage. Moreover, I have removed the dots in the hypothesis as per the requirement. The third point doesn’t make clear sense; thus I have decided to remove it.
In my rationale of the new technology, impact sensor can be used as an alternative technology to measure concussion in the brain hence helping to prevent further injuries from occurring during training or deployment of soldiers.
Scientists are still trying to link the enduring effects of mild brain injury to relate chronic or neurodegenerative problems. Despite the advancement in technology regarding weapons and body armor, the brain remains vulnerable to non-penetrating injuries such as extreme impacts on the head and explosions during combat. The major challenge of diagnosing a concussion with technology is that there is no specific subsystem of the brain that is universally affected by the shock. Early diagnosis of a concussion remains a priority to prescribe the proper therapeutic management and deterrence of premature deployment to battle zones. The new test involves attachment of impact sensor on the headgear of the recruits who are the subjects for test. The impact sensor will then detect and record the forces transmitted to the brain during collisions. Relevant people responsible for coordinating the process will be task with the role of excluding those soldiers with higher impact of concussion. The technology is much effective in preventing injuries as it measures the intensity and number of hits that are transmitted to the brain with the consideration of time factor. Dingemans et al. (2014) argue that the test is more effective and accurate since it provides both general and specific information of the current ranges of cognitive performance in patients.
The Committee on Head Injury Nomenclature of the Congress of Neurological Surgeons (1966) explains concussion as, “a clinical syndrome characterized by the immediate and transient post-traumatic impairment of neural function such as alteration of consciousness, disturbance of vision or equilibrium, etc. due to brain stem involvement”. Later the American Academy in Neurology (AAN) (1997) referred to a concussion as “any trauma-induced alteration in the mental status that may or may not include the loss of consciousness.” The First International Symposium on Concussion in Sports in Vienna described the concussion as a “complex pathophysiological process affecting the brain, induced by traumatic biomechanical forces (2001)”.
Impact of Concussion on Cognitive Functionality, Stability, and Other Post-Concussion Symptoms
Concussion may be as a result of a direct hit by a blunt object to the skull, neck, or face, or any other part of the physique that in turns conveys an irresistible force to the brain. The concussion leads to neuropathological changes in the brain. However, the impact is mainly manifested in the functional capacity of the mind other than any structural changes in the head. There may not necessarily be a loss of consciousness registered after the concussion as the clinical and cognitive symptoms will resolve sequentially (Giza and Hovda, 2001)
Barr et al. (2008) states the effects of concussion as having compromised cognitive functionality, reduced stability, and subjective post-concussive symptoms According to the research by Duhaime et al., 2012, p. 559 on college footballers, 85.2% complained of headaches, 77% had balance problems, and 69.4% reported feeling of reduced cognitive function at the time of the accident. The evidence from the research suggested that players suffering from subjective post-concussion had specific characteristics. Their empirically evaluated cognitive function impairment and stability related issues tend to recover fast from the injury, balance issues are sorted within five days, and full cognitive functions resume functionality within a week of the damage.
Research by the Defense and Veterans Brain Injury Center (DVBIC) indicates that 220 to 430 soldiers had suffered from Traumatic Brain Injury (TBI) of which 169 and209 of these cases were classified as concussions making the US prevalent of Traumatic Brain Injury. However, just like in civilians, the shock might be problematic to detect and can be perplexing to manage. This is because during standard imaging it shows no abnormalities, moreover, both signs and symptoms of concussion are subtle (Iverson, Langlois, McCrea, and Kelly, 2009; Ling, Bandak, Armonda, Grant, and Ecklund, 2009).
As of 2003, there were approximately 300,000 cases of concussion-related to sports reported. This number, however, is believed to be an understatement as many of the cases go unreported or due to the lack of awareness of the constituents of concussive symptoms. However, the cognitive functions of the athletes after a concussion are what are employed to determine the suitability to return to play and the various rehabilitation strategies (Aubry et al., 2002). The usual procedure or established protocol of evaluating the cognitive functions of the brain after a concussion is the short battery of Neuropsychological Tests which compares the performance of the athlete pre-concussion period and post-concussion period. The scores between the two periods are what are used to speak of the mental status during the post-concussion period. Nevertheless, this method has gained considerable attention with many raising issues regarding the methodology itself. Matters raised involve the setting in which the test occurs, and the potential effect of other factors such as age and learning difficulty has on the results of the (NP) analysis (Barr, McCrea, and Randolph, 2008; Duhaime, et al., 2012; Giza & Hovda, 2001).
Testing and Diagnosis of Concussion in Athletes
Early diagnosis of a concussion remains a priority to prescribe the suitable remedy and instituting management practices and avoid the premature deployment to battle zones. A medical practitioner makes the presence of cognitive impairment following an accident leading up to the concussion. Moreover, where the practitioner has no access to any baseline date, the judgment rendered is based on a person’s performance relative to normative data (Aubry et al., 2002). It is relatively more comfortable where the practitioner has access to baseline data as it becomes easier to compare the possible changes in cognitive functions based on the scores. The method has gained prominence and is advocated for by neuropsychologists and neurologists involved in military medication. Neuropsychological testing has been successfully deployed in brain trauma injuries as a clinical measure for identifying the initial effect and track the recovery progress. The results are often used to make a critical decision regarding whether a militant should be deployed or allowed to train (Aubry et al., 2002; Barr, McCrea, & Randolph, 2008).
Increased evidence sourced from medical practice (Guskiewicz et al., 2003; McCrea, Guskiewicz, & Randolph, 2009) proves that potential cases of concussion risk increased the possibility of a repeat scenario of the concussion within the first ten days of receiving the shock. Injuries sustained during training are often mild, and trainees usually go unchecked due to failure to report and in real combat situations and those with mild concussions quickly resume full duty. It is therefore essential to understand the impact of mild concussion on the cognitive and the physical functions of the brain which is associated with the increased chances of subsequent reoccurrence (Schartz and Sandel, 2013).
Neuropsychological tests are essential in the identification, management, and evaluation of concussion cases and assist in giving the green light for normal functioning of the patients. However, the neuropsychological tests are prone to the human aspect (McCrea, Guskiewicz, & Randoplh, 2009). Factors such as depression, stress, fatigue, sleep deprivation, malingering, fear, increased pressure, environment and an understatement of the symptoms to avoid appearing weak may influence the results of the tests. One of the critical challenges in adequately responding to concussion is in recognition of the fact that a recruit may have sustained a head injury and should be taken off practice until further investigation are carried out (Barr, McCrea, & Randolph, 2008). The presence of a skilled medic, senior officer, or a certified health care provider on the battlefront facilitates health evaluation of the injured soldier. However, their presence is not always guaranteed due to inaccessibility of the soldiers, failed rescue missions, or KIA or MIA soldiers. The decision to have a trainee excused from training comes from the high above. Additional obstruction to the diagnosis of concussion is that the symptoms may not manifest for some hours following the injury, and as a result, a severe manifestation of the symptoms may occur up to 24hours after the impact occurred (Duhaim et al., 2012).
Managing Concussions – Rehabilitation and Recovery
Science has over the years shown diversity in the manner in which concussions manifest itself in the brain making it impossible to rely on a single assessment tool focusing on single subsystem with the aim of establishing inconsistency in the functioning of the brain. This necessitates a blended assessment approach taking into consideration cognition and emotive aspects of the mind, balance, and oculomotor functions (Giza and Hovda, 2001)
The technology I am proposing involves attaching impact sensors on the headgear of recruits. The impact sensors are expected to record the forces transmitted to the head during a collision. They can help detect linear and rotational forces applied to the skull. The sensors will record and send in real time the number and severity of hits on the head over time. The relevant people will be alerted once the singles reach a certain threshold. Several side-line assessments are accessible to help with the recognition of concussion symptoms during training, influencing the decision on whether the trainee will resume training or not (Aubry et al., 2002)
I propose using the recruits being recruited for training. The procedure will be two-faced whereby some of the candidates will participate voluntarily whereas for some it will be involuntary. The Neuropsychological test will be carried out as it has already proved its value in diagnosing concussions.
The test will be a longitudinal study where the data collected for the subjects will be observed through the training period and once after they have left training and in active duty. The controlled subjects will be exposed to stressful conditions, sleep deprivation, and strenuous activities to factor in how such affects the results. Control subject includes the individuals that voluntarily give up themselves to be used in the experiment. Pre-test measures will have been conducted on the army team and those already in active combat situations. These may include ensuring the test equipment are safe and has no harm to the subjects and identifying uncertainties that may interfere with the test results.
Besides having a professional diagnose the concussion using a Neuropsychological test, I will need impact sensors such as the Force tracker, i1 Biometrics, BlackBox Biometrics, and X2 Biosystems’ xPatch. In collaboration with neurologists, we will identify the appropriate threshold level of force. The impact sensors will report remotely to a reporting software so we will need handheld mobile devices and computers.
The impact sensors will be attached to the helmet or the patches placed on the neck or behind the year. While calibrating the threshold of impact, the age of the recruit must be put into consideration.
Conclusion
By counting and measuring the velocity of the hits suffered in the head, we will gain valuable data that will help in the prevention of concussion progressing to full-blown brain damage. If the test is reliable, I expect to see a high correlation between the data collected from the impact sensors and the conventional neuropsychological tests. The higher the impact recorded the same will reflect in the sideline measures of psychomotor functions, working memory, cognitive, and decision-making process. The same results are expected to be observed during the test-retest reliability having factored in the human aspect of the test established by the control group. The results should resonate with those of the pre-tests.
If the test is valid, I predict that:
(1) Recruits who will have transmitted higher numbers and severity to the head will have a slower response in their cognitive functions
(2) Soldier in real combat situations will be conveying higher numbers and severity especially those in volatile areas such as Afghanistan and Iraq than those in training.
Conclusion
Impact sensor can be used as an alternative technology to measure concussion in the brain hence helping to prevent further injuries from occurring during training or deployment of soldiers. Despite the advancement in technology regarding weapons and body armor, the mind remains prone to non-penetrating injuries such as collisions and explosions during combat (Orcutt, 2016). Practically, the scores from the neuropsychological tests potentially reflect on the general status of the patient. The tests are designed to capture and evaluate the functioning of the brain making the inclusion of the system related errors in the analysis scores an impediment in the psychometric accuracy of the test (Barr, McCrea, and Randolph, 2008; National Research Council, 2014; Schatz & Sandel, 2013). The major challenge of diagnosing a concussion with technology is that there is no specific subsystem of the brain that is universally affected by the shock. Different cases have different impacts with some complaining of severe headaches, deregulated sleep, cognitive or emotional issues, and balance and equilibrium (Giza and Hovda, 2001)
Reference
Aubry, M., Cantu, R., Dvorak, J., Baumann, T. G., Johnston, K., Kelly, J., & al., e. (2002). Summary and agreement statement of the ?rst International Conference, Vienna. British Journal of Sports Medicine , 3(6), 6-10.
Barr, W., McCrea, M., & Randolph, &. C. (2008). Neuropsychology of sports related injuries. In J. Morgan, & &. J. Ricker, Textbook of clinical neuropsychology (pp. 660-678). New York: Oxford University Press
Duhaime, A., Beckwith, J., Maerlender, A., McAllister, T., Crisco, J., Duma, S., . . . Greenwald, &. R. (2012). Spectrum of acute clinical characteristics of diagnosed concussions in college athletes wearing instrumented helmets. Journal of Neurosurgery, 12(5), 547-559.
Giza, C., & Hovda, &. D. (2001). The neurometabolic cascade of concussion. Journal of Athletic Training, 36, 228-235.
Guskiewicz, K., Mcrea, M., Marshall, S., Cantu, R., Randolph, C., Barr, W., & al, e. (2003). Cumulative effects associated ith recurrent concussion in collegiate football players. Journal of the American Medical Association, 290(19), 2549-2555.
Iverson, G., Langlois, J., McCrea, M., & Kelly, J. (2009). Challenges associated with post-deployment screening for mild traumatic brain injury in military personnel. The Clinical Neuropsychologist, 23, 1299–1314.
Ling, G., Bandak, F., Armonda, R., Grant, G., & Ecklund, J. (2009). Explosive blast neurotrauma. Journal of Neurotrauma, 26, 815–825.
McCrea, M., Guskiewicz, K., & Randoplh, &. C. (2009). Effects of symptom free waiting period on clinical outcome and risk of reinjury after sport-related concussion. Neurosurgery, 65(5), 876-883.
National Research Council. (2014). Sports-Related Concussions in Youth: Improving the Science, Changing the Culture. In R. Graham, F. Rivara, & M. F. al, Institute of Medicine. Washington DC: National Academic Press.
Orcutt, M. (2016, June 9). Is This the Diagnostic Tool We’ve Been Waiting for in Concussion Testing? Retrieved from MIT Technology Review : https://www.technologyreview.com/s/601619/is-this-the-diagnostic-tool-weve-been-waiting-for-in-concussion-testing/
Schatz, P., & Sandel, &. N. (2013). Sensitivity and specificity of the online version of ImPACT in high school and collegiate athletes. American Journal of Sports Medicine, 41(2), 321-326
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