Understanding ANAM: What’s that computer test at the MTF? Published Jan. 31, 2012 By 1st Lt. Ian S. Anderson 55th Medical Group Public Health OFFUTT AIR FORCE BASE, Neb. -- Traumatic brain injuries and concussions, also known as mild traumatic brain injuries, have recently become hot topics in both medicine and sports. A mild Tramatic Brain Injury, or TBI, is a disturbance of brain function because of injury to the connections between the brain cells that happens after a blow to the head or violent shaking of the head. Symptoms for a mild TBI can include headache, difficulty with memory and concentration, trouble with decision making, dizziness, and fatigue. The National Football League is one organization trying to protect players from TBIs by increasing the number of penalties, fines and suspensions on defensive players for helmet-to-helmet hits. The NFL has also started to diagnose players on the sideline for concussion symptoms and keep them out of the games to prevent further damage that can happen if somebody continues to play with a brain injury. Players are routinely tested before an injury in order to get baseline data so that doctors can measure the effects of a mild TBI after it occurs. The way they collect baseline data is by using computer-based neuro cognitive assessment tools. The assessment is a 20 minute screening test that measures a variety of general brain functions by having the test-taker answer questions about their current sleepiness and mood, then to perform tests that measure reaction time, basic math, learning and memory. If somebody suffers a brain injury later, the test is repeated and the results help doctors identify how the injury affected the victim. Anybody who has recently deployed or had a preventive health assessment may remember going through a similar test at public health. That is because the number of TBIs for military personnel has increased substantially to those deployed in the recent wars in Afghanistan and Iraq. In 2008, Congress mandated baseline testing for all Defense Department personnel within 12 months of deploying to Operation Iraqi Freedom / Operation Enduring Freedom for at least 30 days and receiving hazardous duty pay. The assessment tool used by the Air Force was developed by the Army and is called the Automated Neuropsychological Assessment Metric. In 2009, Offutt Air Force Base became a test base and was one of the first bases in the Air Force to roll-out the assessment metric. The assessment is used to aid post-injury assessment and return-to-duty decisions, but is not used to diagnose medical injuries or mental health. The ANAM is also used to screen for other neurological problems not associated with TBI or mTBI. When the ANAM is given, the test-taker has up to two attempts to achieve a normal score before a referral is made to a provider for further evaluation. But keep in mind that it is not a test a person can fail, because it's just an assessment of how well the brain is functioning. Scoring below the normal level means that there is a possibility a problem needs further investigation. In fact, during the initial roll-out phase, 3,393 people took the assessment, 145 had to retest, but only four scored below the normal level after two attempts. This means 96 percent of test-takers passed on the first try and nearly all of those who had to retest simply did not understand or follow the directions the first time. Being sleepy or sick can also affect test scores. If a person still scores below the normal level after a retest, their test is flagged and they are referred to the mental health clinic for a face-to-face evaluation. It's important to remember that the assessment is a screening test and doesn't mean the person who scores below the normal level has a medical or mental condition caused by a brain injury. Scoring below normal indicates a person is showing symptoms similar to those caused by a brain injury. Only a credentialed mental-health provider can determine the exact cause of the symptoms and whether a condition is present.