CRCC - COMPREHENSIVE WARRIOR CARE" APRIL 30, 2011

Concussion Restoration Care Center

Mind Over Matter In this Issue

Mental Health in the Concussion Continuum
• Psychiatry and
Concussions
LETTER FROM THE OIC
• Psychology and
Hello all! April has flown by and we As always we will have my favorite Concussion
have gone through many changes.  section, “ Stories from our Heroes”. 
LCDR Vath, our physical therapist, has followed by some exciting research in • Stories from our Heroes
returned home and his replacement, the areas of reaction times and their
LCDR Rachel Oden (pictured to the use in the military setting. Please enjoy • By the Numbers -
right) has arrived picking up right this month’s edition.
CRCC data - The
where her predecessor left off.
This issue will highlight our ANAM Test
CDR Earl Frantz, DO, USN
Mental Health team. The CRCC
employs a clinical psychologist who
helps our patients with the
psychological trauma that often
accompanies a concussion and provides
supportive care to our caregivers.  
The CRCC also has a psychiatrist
working in the Camp Bastion hospital
not only offering caregiver support to
their staff, but evaluating concussion
patients in the emergency room. He
and his psychiatric technician are often
the first CRCC face our patients see
and they are a vital part of the CRCC
team. 

LCDR Rachel Oden

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 CRCC - COMPREHENSIVE WARRIOR CARE" APRIL 30, 2011

THE PSYCHOLOGICAL IMPACT

Not surprisingly, for many of the concussed psychological just as the psychological impacts
warriors, there is a strong psychological the cognitive.
component to their injury. As our OIC, CDR
By incorporating an experienced psychologist
Frantz, has told many a visiting dignitary, “unlike
into the multidisciplinary team, the CRCC is able
Aaron Rodgers (quarterback, Green Bay Packers),
to address those non-physical issues that may be
when these guys get concussed, it’s because
inhibiting the healing of our warriors and
somebody just tried to kill them , and that’s why
preventing them from returning to the fight.
we have our clinical psychologist, CDR LaBrie.”
- CDR Walt LaBrie, MSC, USN
Because many of the symptoms associated
with a concussion are the same symptoms
associated with acute psychological injuries,
sorting out the cognitive and psychological is a
challenge for the entire treatment team. For
example many symptoms, such as difficulty with
sleep, are associated with both concussion and
psychological injury. Rather than trying to
determine which injury is causing a symptom we
recognized that the cognitive impacts the

SPOTLIGHT - PSYCHIATRY: BEFORE THE CRCC

The Concussion Restoration
Care Center has its primary
location in Leatherneck,
providing patients comprehensive
medical and mental health care.  Concussion Restoration Care
" However, the Bastion Role 3
Hospital plays a key role in
identifying individuals that suffer
a concussion. The primary team
in the Camp Bastion hospital is a
psychiatrist and psychiatric
technician who evaluate
individuals with suspected
concussions.
Patients are screened for
neurologic symptoms with
recommendations that can
include hospitalization for
neurologic observation, admission
to a unit that minimizes risk of coalition service members
injury (providing assistance with working at Bastion to facilitate
activities of daily living), or positive morale in a high stress
clearing individuals to return to community. Psychiatry in the high
their unit with follow up at the operation tempo of a Role 3
facility like Bastion hospital
Center. provides no end of experiences
Although evaluating and opportunities to care for our
concussions is a primary goal, the US and allied service members.
Bastion team is also consulted for - LT Mike Okasinski, MC,
acute psychiatric cases, evaluating USN
patients for personal safety or
serious mental health issues.  
The team also screens US military
patients for mental health issues
and provides information on
coordinating care with the
outpatient mental health clinic,
the Combat Stress Team.
The team is also available for

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 CRCC - COMPREHENSIVE WARRIOR CARE"
STORIES FROM OUR
HEROES
“When can I go back?”
The anxious but also not
quite focused eyes looked at
me from a face scarred by
shrapnel. “Soon”, I said to
the young corporal and
marveled again at the bravery
and esprit de corps of our
Marines.
This Marine’s concussion
story started the second
week of April. He was
dismounted at the time of
the blast on a foot patrol. He
felt that something was out
of the ordinary the first time
he saw the wall they had to
pass on their hump. As he
passed it the second time, on
the way to the pickup point,
his misgivings became reality
as an 82 mm mortar was
detonated about 3 meters
from his position. He was
thrown to the side,
concussed and suffered
shrapnel wounds to the face
and side. Through the haze
of his altered consciousness,
his first thoughts were for his
fellow Marines. He called out
to them from the tall grass
and was reassured as each
one answered.
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APRIL 30, 2011
His care at the straightened his shoulders
Concussion Restoration Care and stepped out the door.
Center concentrated on He is another hero-one we
relieving his headache, are proud to serve.
helping him sleep and
- Judy R. Schauer
addressing balance problems. CAPT,MC,USN
He progressed with each of
his visits. One day, the
underlying concern about
going back outside the wire
surfaced. I let the young
“We believe in
man talk as this seemed to shared suffering -
settle him. After going over one unit, one
his fears and concerns, he fight.”
came to the bottom line. “I
am a Marine. Our culture is
that we support each other.
We believe in shared
suffering-one unit, one fight.”
I didn’t have to give any
counseling. He basically
walked himself through the
process and came to the
conclusion that he needed to
be with his platoon.
Today, I released him to
full duty-his headache gone,
his wounds healing, his sleep
restored. I told him we care
for him and if he needs
anything, he can come back
to see us. He politely said he
would but I suspect this is
the last time I will see him.
He will go back to his unit,
resume his duties and be
renewed in his vigilance in
looking for IEDs. He smiled
at me (a little boyishly),
 CRCC - COMPREHENSIVE WARRIOR CARE" APRIL 30, 2011

BY THE NUMBERS - THE levels and have recovered from the

ANAM TEST concussion. Mailing Address
CRCC
One CRCC goal is to generate The ANAM itself is being
2nd MAINT BN FWD
new knowledge through research studied by the CRCC for its use as
with the intent of improving care. an appropriate measurement for ATTN: SURG CO
concussion. While components of UNIT 73615
Prior to deployment, most all
the test have existed for years, its FPO AE 09510-3615
Marines and Sailors take an
Autonomic Neuropsychological use for battlefield evaluations is
Assessment Metric 4 TBI battery, fairly new. Clinical application is DSN Phone:
or ANAM test. The purpose of still being refined. Preliminary 318-357-3900
this test is to establish baseline evidence and clinical opinion
cognitive functioning prior to indicates the part of the test that
measures simple reaction time We’re on Sharepoint!
suffering injuries in the field.
(SRT) may be a powerful, In the RC(SW) homepage - search CRCC
When Marines and Sailors enter
care at the CRCC following a blast objective predictor of a member’s
or concussive injury, they take the time to heal from injury. THE CRCC TEAM
test again, which is then compared More work is forthcoming,
to the original score. The member but refining the clinical use of the • CDR Earl Frantz - Officer in
continues with the ANAM at ANAM is one of nearly a dozen Charge, Sports Medicine and
subsequent visits; the idea being on-going or emerging research and Family Medicine Physician
that the physician can track the process improvement efforts by • CAPT Judy Schauer - Sports
member’s cognitive functioning as CRCC staff. Because the CRCC is Medicine and Family Medicine
they recover from the injury. at the forefront of treating combat Physician
When the scores improve and related concussion in the acute • CDR Richard Sams - Family
return to the baseline, it’s thought phase, many of the efforts here Medicine Physician
that the member’s cognitive may have far reaching application • CDR Walter LaBrie - Clinical
abilities have returned to normal in concussion management. Psychologist
• LCDR Daniel Clark - Clinical
Manager
• LCDR Kathleen Ditto -
Occupational Therapist
• LCDR Rachel Oden - Physical
Therapist
• LT Michael Okasinski -
Psychiatrist
• LT Jacob Norris - Research
Psychologist
• HM1 Jason McGee- Leading Petty
Officer
• HM2 Jonathan Huffman - General
Duty Corpsmen
• HM2 Alvin Jules - psychiatric
technician
• HM3 John Tissier - General Duty
Corpsmen
• HN Stephen Roach - General
LT Jake Norris (right) works with HM2 Huffman on perfecting the CRCC’s clinic Duty Corpsmen
registry. The registry is crucial to data retrieval for process improvement and research into • HA Josiah Garcia - General Duty
concussion and musculoskeletal injuries. Corpsmen

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