A-State Faculty Helping Military Veterans Through Concussion Screening Tool

JONESBORO – One Arkansas State University professor is using a sports medicine assessment originally developed for student-athletes to help military veterans after returning from deployment.

Dr. Scott Bruce is a professor of athletic training and co-chair of the Veterans’ Suicide Prevention Program. He is using the Global Well-being Index® (GWBI), typically used to evaluate lingering symptoms after suffering a concussion and returning to activity. 

Bruce recognized that the index may also benefit veterans who sustained concussions years ago but continue experiencing effects that may or may not be related to those head injuries. The research shows that someone with a GWBI score of 40 or higher (out of 50) is likely experiencing depression and anxiety.

“It has been my belief since the beginning that many of these veterans have a history of not just one concussion, but of multiple concussions. What I didn’t expect to find was the number of veterans who are suffering from residual symptoms,” Bruce said.

Bruce had been studying the field long before the index was put into practice. Originally, student-athletes had to fill out several different health surveys before each sports season. Many of the questions asked the same things over and over. Researchers used statistical methods to determine which questions were the most useful, resulting in a shorter survey: the Global Well-being Index.

The GWBI is a survey that took 15 years to develop. The work began at the University of Tennessee at Chattanooga while Bruce was a faculty member. 

While researchers were studying concussions, they made several discoveries.

“One of the things they learned was that those with a history of concussion were more likely to become injured,” Bruce said.

“This led to examining some of the baseline concussion testing the athletes were required to do. They found a significant percentage of athletes were identifying concussion-related symptoms at baseline, which is when and where you would expect to see no symptoms reported or minimal symptoms. This led to the creation of the Sports Fitness Index, which evolved into the Overall Well-being Index, before becoming the GWBI,” he added. 

The index is designed to identify ongoing symptoms that may be related to past head injuries. There are four domains of concussion symptoms: physical and somatic, sleep, cognitive, and emotional and behavioral. Participants are asked five questions related to each of these areas and how they have felt during the past 12 months.

If a participant reports an issue in any of the five categories, they are then asked more specific questions about the frequency, recent occurrence, and severity of the problem. Each question awards points based on different degrees of severity, with a maximum of 10 points, and an overall total of 50. The higher the score, the more severe or more frequent symptoms.

Recognizing that the GWBI could also benefit people outside athletics, Bruce began exploring its use with military veterans. Many veterans struggling with mental health issues may have also experienced one or more concussions during military service. 

“For example, 89 out of 152 veterans reported having a history of concussion (58.6%) and 52 out of 152 reported having suffered multiple concussions (40.8%)," Bruce continued. "Only 12 of the veterans reported zero residual symptoms on the GWBI. When we compare it to the concussion symptoms they reported, 38 reported no concussion symptoms. Somehow, that does not make sense.”

This led Bruce to conclude that many veterans may still be experiencing problems without recognizing them as concussion-related.

He says the findings suggest that the GWBI may serve as a useful preliminary screening tool. Bruce continues to educate audiences and speak about the GWBI, including recently at the 77th National Athletic Trainers’ Association Clinical Symposia and AT Expo. 

“The results are extremely positive where the GWBI can be used as a screening tool for further mental health assessment. If a participant scores 40 or more points on the GWBI, they should then be assessed further for depression and anxiety,” Bruce said.