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Tonight is the Superbowl. I assume most people watch it because they want to see the commercials, or because they actually care about who wins. That’s not me. (Partly because I don’t actually watch it.) (Don’t get me wrong – I’m a New Orleans Girl at heart, and want to see Peyton win, but really, if the Saints aren’t playing, I don’t care.) I do think a lot about professional athletics, especially football, but not in the typical “care about sports way”.
OK, after last week’s post, you may be thinking that I focus on the head injuries and future cases of CTE. That’s reasonable, since I am working with a doctor who has healed brain injuries. But that’s not it either.
I think about the difference between #1 and #2. In professional sports, there is very little difference. Every one one field, whatever the sport, is one of the elite in the field. Why does one team win? Why does the other team lose? (Other than that, eventually, one will win and one will lose.) Everyone has good days, everyone has bad days. That’s part of it. The ability to work as a team is another part of it (training, interpersonal issues, etc).
But I think a big part of it is cognitive – and this is never really tested in professional sports. (Yes,th the combines use the Wonderlic. But teams, from what I understand, pretty much ignore the scores. They have not been predictive of a player’s performance.) What kind of cognitive skills does a professional athlete need? He (or she) needs the ability to read the field – the opposing team, their own teammates – and react. Quickly.
What cognitive function does this? Well, possibly several. But one of them is Working Memory Capacity (WMC).
WMC is a cognitive processing capacity system responsible for maintaining focus (attention control) on a given set of items (short-term memory), retrieving relevant information (long-term memory) related to those items, and manipulating the relevant information to apply to those items. It is correlated with intelligence, language comprehension, multitasking, attention control, situational awareness, problem-solving, impulse control and decision-making.
WMC very well may make the difference between #1 and #2 on the sports field.
It also may make an even bigger difference on the battlefield. Where all “players” are not elite, where US troops already have the advantage of training and materiel, using WMC as a characteristic will likely provide those troops an increased advantage over the opposing forces, who have the advantages of knowledge of the terrain and going home to their families each night.
More on WMC in the coming weeks.
Last spring, I took some time to try to understand why so many soldiers have PTSD, and what we can do about TBI. Mental health is hugely stigmatized in this country (and, I suspect, throughout the world) as being a sign of weakness. And brain injuries represent a totally separate, harder category for healing, because there’s still so much we don’t know about the brain.
And then I found out about CTE – chronic traumatic encephalopathy. Most people diagnosed with it are former athletes. And, unfortunately, at this time, the only way to diagnose it is postmortem, through an autopsy.
Most people who discuss CTE look at late stage symptoms, which mimic Alzheimer’s disease. Early stage symptoms are, too often, unrecognized or misdiagnosed. In fact, in speaking with several psychologists at the International Association of Chiefs of Police, the primary group for supporting law enforcement in the US, they did not acknowledge that there are symptoms earlier than the dementia. This does not seem to be uncommon: many people who work with CTE claim it is an aging disease, and there aren’t early symptoms.
And then there was this: a 27 year old former football player took his own life by overusing prescription medications, but was found to have CTE.
What does early-stage CTE look like? “Memory loss, confusion, impaired judgment, impulse control problems, aggression, depression, anxiety, (and) suicidality” are some of the symptoms according to Boston University’s CTE Center.
Several – if not all – of these symptoms are also associated with PTSD.
PTSD is treated with medications for mental illness – chemical changes in the brain. If someone who does not have the illness takes medications to alter their brain chemistry, it changes it for the worse, causing additional problems. It also causes additional emotional issues when the treatment does not work (because it is addressing the wrong problems).
It is my belief – and, as always, I acknowledge that I am not a doctor or psychologist or any other kind of medical professional – that part of the reason PTSD is so bad within the Army is that we are misdiagnosing and mistreating structural brain injuries as chemical imbalances. And this mistreatment leads to more problems, both from the brain chemistry issues and from frustration when treatment fails.
Luckily, the Army has options.
First, it must acknowledge that it, like professional sports, has a CTE problem.
Second, it must start to treat CTE.
Wait. There are CTE treatments? Then why aren’t the sports leagues using it? The first answer is easy: yes. The second is more complicated. Too much of this country and medical treatment is run by pharmaceutical companies. And big pharma does not have the solution. Hyperbaric chambers have been shown somewhat effective in treatment. Laser light therapy has been shown to be VERY effective.
In the next few months, we are hoping to show the Army just HOW effective laser light therapy can be.
If you know any soldiers/veterans who would be interested in participating in a two month trial of laser light therapy in healing brain injuries, please contact me to learn more.
I spent two days this week with the Army’s Brain Health Consortium. We meet a few times a year, different people show up, and it’s a very informal event. Among other things, this means we never quite know what we’ll focus as the conversation takes shape.
This month, it turned out to be sleep, and the importance thereof.
At the same time, GEN Milley spoke at AUSA’s Institute of Land Warfare, where he said that the Army’s plan from now through 2020 is to simply catch up technologically, and will make modest improvements in 2020 to 2025, with no new leap-ahead technologies available to the Army until after 2025.
And while I’m sure that’s true from a materiel standpoint, we could make some major leaps in readiness by focusing on brain health (NOT just brain illness, e.g., PTSD, depression, and TBI), starting with sleep. Based on our knowledge of brain health and sleep, two minor changes could increase readiness dramatically:
Of course, the Army prides itself on doing more by 9 AM than most people do all day – even if that slogan isn’t in use any more. And too many leaders brag about their lack of sleep. This would require a major cultural shift.
Materiel solutions are definitely easier to achieve. Even if they take a decade.
The first time I heard the phrase “cognitive overburden” was in 2011 or so, when Dr. Marilyn Freeman, then-DASA(R&T), introduced the 21 top Army S&T challenges. Because I was focused (perhaps hyper-focused) on my training system at the time, though I had never heard the phrase before, I instantly just “knew” that the answer to cognitive overburden was to train.
On and off for a few years, I would throw the phrase into my pitches, but it never really went anywhere. And I continued to know it was the answer without knowing (or, really, caring) why.
And then, one day, a well-meaning low level bureaucrat, upon listening to my pitch, looked at me and told me, with complete sincerity, that “the Army isn’t really interested in reducing cognitive load. We want to increase capacity. Do you have a way to make soldiers smarter?” I was a bit dumbfounded, but started researching and reading that day.
There really isn’t a lot written about cognitive load, certainly not using those terms. Mostly because it’s not something many people concern themselves with. Cognitive Load Theory is an educational design theory based on balancing intrinsic load (how difficult the material is) with extrinsic load (how the material is presented/designed) and germane load (effort expended by the student to understand). As a theory, it is boring and dry to read about, and complicated to implement.
There’s a lot of focus these days on UI (user interface) and UX (user experience) design, but these are both about maximizing enjoyment and increasing customer loyalty. Neither, even when used by educational companies, considers best education methods and balancing load.
Now, obviously, the Army does a lot of training, so cognitive load theory applies there. But does it apply anywhere else?
My contention is that it absolutely does. At the core of cognitive load theory is the understanding that learning is compromised when the sum of intrinsic, extraneous, and germane loads exceeds available working memory capacity. But it isn’t just learning that is compromised when working memory capacity (which I will address in detail at a later date) is exceeded; it’s all cognitive function. Everything a good soldier – a thinking soldier – does relies on cognitive function.
Given the amount of materiel all soldiers rely on to do their jobs, they are all, essentially, all systems-of-systems. And all of them can be overloaded, physically and mentally. Until all materiel solutions are designed with Cognitive Load Theory in mind, and an understanding that reducing extrinsic load of each one individually and of them all as a whole, soldiers will be in danger of shutting down mentally on the battlefield.
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