CAMP LEATHERNECK, Afghanistan -- A rehabilitation center opened here Monday aimed at treating service members with the number-one battle injury: concussions.
The Concussion Restoration Care Center is a first-of-its-kind facility in Helmand Province that was developed to aid in the treatment of concussions as well as musculo-skeletal injuries commonly caused by improvised explosive device blasts.
More than 3,200 Marines were diagnosed with mild traumatic brain injury in 2009, according to the Defense and Veterans Brain Injury Center Web site. A concussion is a form of mild TBI with symptoms that can include headaches, dizziness, sleeping problems and memory loss. Troops exposed to IED or rocket-propelled grenade blasts can also experience other injuries such as broken bones or muscle tears.
Never before has there been a single facility in Helmand Province with a medical staff capable of treating concussions and rehabilitating musculo-skeletal injuries.
"The United States Marine Corps is leading the way in caring for what has been a difficult and misunderstood pattern of injuries that can result from high-intensity blast effects," said Lt. Cmdr. George Cowan, a psychiatrist with Combat Logistics Regiment 15 (Forward), 1st Marine Logistics Group (Forward), who helped spearhead creation of the CRCC.
Prior to its construction, concussed service members in Helmand Province were treated at the Combat Stress Clinic aboard Camp Leatherneck, but as the summer months of intense fighting wore on and patients began to overflow the clinic, a need for a bigger, multi-disciplinary facility arose, said Cowan.
The 2,000 square-foot facility will be staffed with two family physicians, one of whom specializes in sports medicine; a physical therapist, occupational therapist, clinic nurse, neuropsychologist, psychiatrist and seven corpsmen. The center will consist of two office buildings and a rehabilitation tent, and will be able to accommodate up to 24 patients at a time.
The psychiatrist will aid with concussion management and combat stress; a neuropsychologist will assess whether patients are safe to return to duty. Patients recovering from musculo-skeletal injuries will meet with occupational and physical therapists, and a sports medicine physician, who will oversee their physical rehabilitation.
"We’re making sure we’re taking care of the whole warrior," said Lt. Cmdr. Gray Dawson, a family physician with CLR-15 (FWD) who oversaw construction of the concussion center.
"No other location has gotten this comprehensive in caring for concussed Marines this close to the fighting," added Cowan, who has helped treat concussed Marines since March. "This center provides a place to put into practice real and proven therapy strategies for concussions in a way that has never been available this far forward before."
The medical staff began seeing patients at the clinic a few days before its official opening. One patient, Sgt. Gorge Segura, artilleryman with India Battery, 1st Battalion, 11th Marine Regiment, suffered a grade-two concussion when a 100-pound roadside bomb exploded 30 meters away from him during a foot patrol in the Kajaki region of northern Helmand province.
"I still have nightmares," said Segura, 25, from San Angelo, Texas, of the blast that occurred just three days earlier. In addition to sleep disturbance, he suffers from light sensitivity and ringing in the ears.
Segura meets with a doctor at the center every few days to undergo neurological testing to monitor his progress. He hopes to return to his unit in a few days after completing treatment.
Oftentimes, troops who suffer from concussions are medically evacuated from theater if their symptoms don’t improve within a few days; most concussion symptoms resolve in a couple of weeks. The new center allows patients to remain in theater for treatment as long as their symptoms improve.
"By retaining Marines in theater we are able to maintain the fighting force levels and reduce unnecessary evacuation of Marines who often return to their units in full-duty status," said Cowan, 45, from Scranton, S.C. "We are actively preventing war-fighting gaps in a new and innovative fashion."
With the help of the Automated Neuropsychological Assessment Metrics, also known as ANAM, a computer-based system that tests neuro-cognitive skills such as reaction time, doctors can monitor patient recovery using baseline information gathered prior to the patient’s deployment, said Cowan.
"They are also very useful in helping to educate Marines on the nature of these ‘invisible’ wounds," said Cowan. "The results are shown to the Marine and explained so that the patient understands that even though their body feels fine the brain, or ‘computer’ that runs the body, is still going through a recovery or ‘re-set’ process that needs to finish before they go back to combat."
The doctors are able to witness first-hand, significant improvement in patients who come to them with mild to severe concussion symptoms. Dawson remembers a Marine whose speech was severely impaired after suffering a blast-related concussion; the Marine could only utter a single word every few seconds. Over the course of treatment, Dawson said, the Marine’s speech patterns slowly returned to normal and he became "a completely different person" than when he was first injured.
"It’s been really exciting," said Dawson, 36, from Port Orchard, Wash. "It’s really satisfying seeing a Marine who came in very impaired post-blast and very concerned, and a couple of weeks later seeing them return back to their unit fully-functional."