Understanding Traumatic Brain Injuries
20,250 of the 1.7 million Americans that experienced a Traumatic Brain Injury (TBI) last year served in the U.S. Military. If you or a loved one has experienced a TBI while serving there are some basic things you need to understand.
Anyone exposed to or involved in a blast, fall, vehicle crash, or direct impact who becomes dazed, confused or loses consciousness, even momentarily, should be further evaluated for a brain injury.
During the course of the current conflicts in Afghanistan and Iraq, traumatic brain injury (TBI) has emerged as a significant cause of morbidity. Although penetrating TBI is typically identified and cared for immediately, mild TBI (mTBI) may be missed, particularly in the presence of other more obvious injuries. Due to numerous deployments and the nature of enemy tactics, troops are at risk for sustaining more than one mild brain injury or concussion in a short timeframe. The sports literature, which is highly relevant to the combat blast injury model, has published consensus documents on the assessment and management of sports related concussion (McCrory, 2005). However, due to tactical, logistical and resource considerations, it is challenging to directly apply these findings in a combat setting.
There are two types of TBIs, Mild TBI (mTBI), also referred to as a concussion and Severe TBI which can be classified as Closed or Penetrating.
A mild TBI/concussion can be caused by blasts or explosions, vehicle collisions, falls, blows to the head or other common battlefield injuries. A Severe Closed TBI is caused when there is movement by the brain within the skull. This can occur when being struck by an object, being involved in a motor crash or during falls. A Severe Penetrating TBI is caused when a foreign object enters the skull such as in firearm injuries or when the skull is struck with a sharp object.
Generally, during an mTBI, the person remains conscious but may notice symptoms after the injury. These types of head injuries are usually not life threatening but knowing the signs and getting proper treatment quickly is important. Symptoms include headache, dizziness, fatigue, difficulty concentrating and memory problems.
A Severe TBI usually results in a period of unconsciousness of 30 minutes or more. Symptoms can be the same as with a mTBI but the long term problems can effect cognitive and motor function, emotion and behavior and sensation.
Diagnosis should be made quickly after recognizing you or a loved one has had any type of TBI. A medical professional may perform an MRI or CT scan or perform a series of neuropsychological and neurocognitive tests that help to access your learning and memory skills as well as your ability to concentrate. A medical professional will decide what the best options for treatment are but things to keep in mind, especially immediately following a TBI are to get plenty of sleep and rest during the day, proper nutrition, and to make sure you are taking the proper medication. Avoid alcohol, contact sports, returning to work/service and other activities too quickly, and sustained computer/video game use. Overall, make sure that you or your loved one is comfortable and well taken care of. Encourage them to write down things they have a hard time remembering and take the time to help tell them about memories they might have.
Long term care may include behavior and physical therapy, drug treatment and other treatments as deemed necessary by your medical professional. Healing takes time and some things may never go back to what you used to consider normal. You are not alone. There are resources to help you and your family.
Neurocognitive assessment in the mild TBI patient is an important part of a comprehensive approach to care. After providing evidence outlined above as to the neurocognitive sequelae after mild TBI, utilizing neurocognitive assessment procedures can be helpful in determining cognitive deficits as well as recovery from transient cognitive deficits often associated with mTBI. The Military Acute Concussion Evaluation (MACE) tool developed by the Defense and Veterans Brain Injury Center has a history and evaluation component. The history component can confirm the diagnosis of mTBI and provide further assessment data by utilizing the Standardized Assessment of Concussion (SAC) (McCrea, 2000) to preliminarily document neurocognitive deficits. This tool can be easily used by medics and corpsmen to confirm a suspected diagnosis of concussion and can be administered within 5 minutes. The four cognitive domains tested are: orientation, immediate memory, concentration and delayed recall.
The MACE is the recommended tool for use in theater at Level I and II and III.
Beyond the use of the MACE, other neurocognitive measures should be used at Level III to comprehensively assess the cognitive state of the injured service member. Consensus was reached on areas to assess and the following neurocognitive domains should be assessed and documented in troops sustaining mTBI in theater:
- Processing Speed
- Reaction Time
- Executive Function
From the Defense and Veterans Brain Injury Center Working Group. www.dvbic.org.
CDC website on TBI: http://www.cdc.gov/TraumaticBrainInjury/index.html
US Army Website, which also has comprehensive information and resources for veterans and their families regarding TBI and it’s treatment: http://www.army.mil/tbi