DEW Hot War Series:
Module 1: Assessment and Diagnosis of Victims
February 25, 2022
Content taken from Government, Military, and Academia Experts Transcripts and Testimonies from Softwerx Conference 2018
How Does this New Weaponry Impact Your Body?
MODULE 1: ASSESSMENT OF VICTIMS
Content taken from Government, Military, and Academia Experts Transcripts and Testimonies from Softwerx Conference 2018
Motivation, vision, and treasure can create amazing results associated with disruptive technology.
From “Risk Takers”
Transcript of Dr. Michael Hoffer
University of Miami
In February of 2017, I literally got this call this is the State Department we have a problem so what happened was individuals began experiencing symptoms late in 2016 of ear pain, tinnitus, dizziness, and cognitive issues. The profiles were all experienced a loud noise or pressure phenomenon before and during the symptoms all were members or family members of individuals stationed with the U.S. diplomatic mission in Havana Cuba.
The sound was localized and followed the individuals in fact if they opened the door to the outside the sound immediately went off
Thirty-five individuals who were symptomatic or at risk were evaluated at our facility
University of Miami twenty-five who were exposed and have symptoms had symptoms,and ten who were not exposed but were but lived with the individuals who were exposed, and were in the houses when the individuals were exposed, we also saw a hundred and five unaffected embassy members who we evaluated those people in Havana. They were largely selected by the embassy to see us, however we did ask to see all the Marines who are assigned to the embassy details ourselves.
All the all the individuals at University of Miami underwent a standard history and physical with an additional targeted neurological history and physical. They all had eye movement tests that included tests for:
- Nystagmus [Nystagmus is a condition where the eyes move] rapidly and uncontrollably.
- Smooth pursuit, and
- Anti-saccade [An (often voluntary) movement of the eye away from a point of stimulus. The anti-saccade (AS) task is a gross estimation of injury or dysfunction of the frontal lobe, by assessing the brain's ability to inhibit the reflexive saccade. Saccadic eye movement is primarily controlled by the frontal cortex.
- Optokinetic response in vergence responses. [Vergence is a learned response. It appears at about the third month of life and is readily modified by placing prisms in front of the eyes. ]
- They all had standard audiometry
- A subset of individuals had additional vestibular testing and
Additional neuropsychological testing.
We were seeing these individuals as patient only; clinically relevant data were collected and all testing that we did had to be justified and approved by insurance the event. New individuals we saw were acute, and unaffected by the influences of time variable pretreatment modalities compensation. They weren't seeing us for workers comp and media attention.
When we saw the individuals, they did not know what they were supposed to be presenting with because at that time the media had not publicized what the effects were. So they came to us without the ability to know what they should say for symptoms.
The prevalence of the symptoms in the unaffected groups and the effective group for analyze was a two-tailed Fischer Exact test this is going to explain this to be used in the following slides. Due to the non-Gaussian distribution, we use the lower fifth percentile in the lower one percentile of performance to judge abnormalities and this is up there because there's been a criticism that some of the tests that we're going to present people that have anxiety or people that have other disorders have these abnormalities but not to this degree. This counters that argument this is a population study in 140 total, 100 and 105 in Cuba, and 35 in Miami distributed.
As I reported earlier this so here is the presenting symptoms of the groups so the affected group you can see they had a lot of a great number of them reported.
When they saw us in Miami their symptoms included:
- Cognitive disorders
- About half hearing loss,
- One-third tinnitus,
- One-third hear pain in 20%
None of the ten individuals who were in the houses at the same time, but were not affected, had any of those symptoms.
In fact, except for headache, which is a common symptom in many individuals, the affected group had statistically more symptoms than the unaffected group.
- 96% of the affected group had at least two symptoms, and
64% had at least three symptoms, again being- dizziness, cognitive disorders, hearing loss, ringing in the ears, or headache.
This is the data by group of the 25 affected individuals. Now we're not talking about the ten.
- 88 % of them, had an abnormal subjective visual vertical testing.
- 52 % of them had abnormal anti-saccade testing,
- 83% percent had chair impulse testing.
At least one had VAMP abnormality.
Let me explain. The subjective visual vertical is a test where individuals are told to take an object that's off-center and make it point straight up. Vestibular hook myogenic potentials are tests that explore how the organs of gravity of perception, either the utricle and saccule -how they respond to sound if you have an abnormal event. Or an abnormal subjective visual vertical is telling us that the organs of gravity perception have been affected.
What we're seeing is that if you take the subjective total data and the VEHM data:
Every one of the affected individuals all 25 of them had at least one test that was abnormal telling us that their utricle or their saccule, in least one, were affected.
These organs that tell you whether you're that you're up and down were affected.
Universally, in this population, the set of organs is extremely important because that gives you a perception of where you are in space. Not where your heads turning, but how your body is oriented to gravity. When these organs are affected when, when these organs are abnormal in this population and in other vestibular populations individuals are severely affected, because you don't know which way up and down is. You are not really good for anything else [this results in comprehensive cognitive and biological disruption].
These are the definitions again. You can read them.
What we want to point out is that we are talking about abnormalities that are extreme.
- Subjective visual vertical abnormalities in the lab are 1.5 to 2.5 degrees.
Accepting over 3.2 degrees on down cervical VAMP errors, abnormal, if amplitude is less than 100 microvolts or greater than 35 percent amplitude.
Asymmetry between the sides are much stricter criteria than the standard vestibular lab uses. If you see arguments that, well people have these abnormalities with other disorders, not to this extent, and not to these that we are reporting. And again, that's important because there was a recent article in JAMA where someone said, “Well lots of people have these abnormalities,” but not to this extent.
There were also some cognitive and neuropsychological symptoms that Bonnie Levine did this data. I’m reporting her data:
- Cognitive fog in attention
- Problems retrieving information, and
When you did the testing, they were:
- Below the expected level for verbal fluency
- Below working memory
Below for sustained attention.
They had difficulty with:
- Auditory processing and
Difficulty with increased levels of cognitive load.
Now, while this pattern of abnormalities can be seen in other populations, at least according to our neuropsychological colleagues, this unique constellation pattern is seen here, is unique to this group. Therefore, we have a unique set of vestibular findings, and we have a unique set of neurocognitive or neuropsychological findings. That combination is not that that is not seen in any other group of patients.
The exposure is unknown.
It could be ultrasonic energy or millimeter, or microwave energy. It could be one of a variety of things. Dr. Balaban is going to talk a lot about how directed energy can be produced by cavitation bubbles. Dr. Giordano is going to speak about this as well.
Cavitation of the Brain
Cavitation is bubble formation and bubble bursting that can produce damage in any hollow space. The candidate’s spaces exist right around your temple. I use the term utricle and saccule. I think Dr. O'Donnell's got a picture of those in his presentation and those organs are, right next to areas where cavitation can occur. It makes sense, that if I'm getting a sound in, and it cavitates in that area, it's going to affect those to gravity.
The organs-utricle and the saccule, and the area of mild traumatic brain injury. I use this term because if you really break down the term mild traumatic brain injury- it's simply injury to the brain that is mild, and that occurred from trauma, and it's synonymous with concussion, nothing more. If you say you sprained an ankle, your sprained ankle is what you say you have.
If you say, MTI, all of a sudden, you're some mystical creature who crawled out of the lagoon. It doesn't make any sense. Because, medically, it's just traumatic damage to the brain that's mild, just like a traumatic jolt.
One important question we're always asked we were asked by the State Department, we were asked by DoD, we were asked by CDC, and we were asked by NIH, is this what you saw in these Cuba patients? Is this traumatic brain injury.
The definition of traumatic brain injury as determined by the DoD back in 2005, reaffirmed in 2009, and finally reaffirmed most recently in 2017: individuals suffer a blow to the head. The individual has altered by a period of altered or loss of consciousness of less than 30 minutes.
Some groups, not the DoD, but some groups, will accept less than 60 minutes. The individual has a sequalae. They have a finding after that, and the same individual does not have inter-cranial bleeding, does not require surgery for the injury, or acquiring an intensive-care state. It is synonymous with a concussion. I will say that the blow to the head could be either a natural physical contact with the head or could be a pressure sensation. It does not have to be physical contact. That is what the DoD said a year ago and still stands by as their definition for mild traumatic brain injury. Now, it doesn't need to be our definition, but it's their definition, and it's one that we use in a lot of our work because I was in military for 21 before this, so I'm a good soldier or good sailor.
This is what mild traumatic brain injury looks like, if you look at people that were injured in the in a war, these this is group this is data from when I was in San Diego. There is a group that was collected [information] acutely when I was deployed in Iraq. These individuals were all within three days or having had an injury in the in theater, usually a blast injury, subacute. The group was collected in San Diego when I was there and the chronic group, also at San Diego, to give you some idea about how much traumatic brain injury was produced.
The number of individuals in the acute group is 88 the number of individuals. Not shown here is the subacute group, but this is all published data. Already seventy and there's about sixty in the chronic group and that was collected, subacute. It is a product in San Diego over a two-month period of time, at the height of the war in Iraq. A lot of individuals were coming back with brain injury, so notice, that dizziness is the most common symptom, at the time acutely. Sub acutely in chronically. The different groups of people present very similar presentations. Notice that dizziness is there 98 % of the time. Almost universally in the acute group, and it falls off, but not very much. Headache is the next most common symptom seen in 72 %- 82 % of patients long-term. Then, you can see vertigo and hearing loss. For those who do receive dizziness, in this case, was on steadiness, being off balance. Vertigo is actually room spinning phenomenon. There was a lot of off-balance, and it's not as much room spinning, and not as much hearing loss. Notice the high prevalence of headache. This is the ROC curve published data that from Kari Balaban and I on our group. We will we take a pair of goggles, the same pair of goggles that we applied to the Cuba individuals. Kerry's going to talk about these a little bit later. These are the key factors for the anti-saccade error rates that predict difference saccade error rates, and it had even post-testing error rates. Notice, through visual vertical VAMP testing, there are not the key indicators for the group in Cuba.
This traumatic brain injury, the definitions don't match, the findings don't match and predictive saccade and head tests that are used for MTI, whereas odorless findings are seen in those with this syndrome. Different findings, there is a much higher incidence of headache in the Mayo traumatic brain injuries. I showed you anywhere from 76 to 82 % versus the low incidence in this group of 32%, and there's a difference in neuropsychological testing outcome as well, with Bonnie Levine.
We are not saying this is not MTB, this does not fit the military definition of mTBI, as subscribed a year ago.
What is clear is:
- Neurosensory dysfunction
- Essentially universal otolithic disorders,
- Some additional vestibular findings,
A unique pattern of cognitive findings.
I described for you that otolithic abnormalities that huge cones actually mean that the individual has an abnormal gravity sense. Now the site of injury could be limited to the inner ear, with secondary cognitive dysfunction, because when you don't know what upright is- essentially like when you're being chased by a tiger in the jungle, and you fall, you become dinner. For the tiger, it really doesn't matter if you can balance your checkbook or do or function cognitively.
It's quite possible we have data in our lab, with Carrie and Bonnie as well, that shows that:
If you have a mission dysfunction of what's up and down, you are not going to have a lot of mental energy left.
For cognitive tasks, the injury could be limited to the inner ear and the cognitive effects may be secondary. It is simply the inability to know what up and down is, or there could be injury in multiple parts of the system. That remains to be determined.
We are working on that now because if you don't know what up and down is, you can't do much cognitively. Moore importantly, this is a real physical injury. Those truly affected, the individuals we saw, had objective findings of a disorder that came acutely from what happened in Cuba.
I'm not talking about the worried-well. I am not talking about people who presented later somewhere else. I am talking about people who came to Miami. They didn't know what they should report, and they had objective findings. You can't fake a VAMP test. You can't fake a subjective visual vertical. You can fake it, but it will be apparent to us that you're that you're faking it. Therefore, the tests were real, and they were objective and that's important, because the 25 most affected individuals. We are not sure if anyone else got affected elsewhere in the world until we do this kind of testing on them. But the 25 affected individuals are often accused of malingering or exaggerating. I can tell you those 25 are not. This is an important message for most of us.
Importantly, these findings suggest the ability to screen potential cases. Otolithic tests, the test for whether you were up and down, are easy to transport and quick to perform, and a quick cognitive screen could be easily designed.
These screening techniques are critically important for distinguishing the worried-well. We already have at least 25 documented cases from the truly affected, and the fact that these findings are known means, it's going to call out groups. They should be applied to anybody else who complain of this. We feel we can design a fairly easy screen, and Kari is going to show you an additional part of that screen in his talk, to really determine who's affected and who's well.
- Because now that it's out,
- There are now people who know what they should complain,
- They know what the symptoms are, and
That is a minus given all lay media attention.
They can fake this stuff easily. We have had 25 people trying to fake it. Come to us, and we have been able to rule them out.
In in any current or future evaluation of this case, you should include at least this short battery as a screening.
We know this is the real story of at least the acute individuals. Thank you very much.
PDF: Module One Assessment
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