Traumatic brain injury has been called the “signature wound” of America’s current wars. The rate of combat-related brain injuries in service members returning from war is higher than in previous conflicts. The U.S. military estimates 144,000-plus service members in the last decade have suffered from some type of TBI, either as a result of combat operations or by accidents in training.
The medical definition of TBI is a disruption in brain function caused by a blow or jolt to the head, or an injury that penetrates the lining of the brain. Not all blows to the head result in injury.
A Department of Defense study reports more than 30,000 service members have been diagnosed with TBI since 2000; of these more than 25,000 were diagnosed with mild TBI or concussion.
The TBI Specialty Clinic at Martin Army Community Hospital has screened and treated more than 1,700 patients for TBI since May 2008.
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March is designated National Brain Injury Awareness Month.
“TBI is described by many as one of the leading invisible scars of war,” said Col. Timothy Lamb, Fort Benning’s MEDDAC commander, “and we have made great progress, but there is still much to do in this area of care. We must be persistent with an aggressive focus of awareness though concussion identification, evaluation, education, treatment and continued research.
“We must continue to develop resilience along with coping skills and encourage help-seeking behavior for our Soldiers and Families.
TBI is classified along a spectrum from mild to severe. Mild TBI, the most common type, is more commonly known as a concussion. A concussion is like having your “bell rung” or being knocked out for a few minutes. A concussion or mild TBI can be difficult to detect, but if identified early is easily treatable and recovery is quick. More severe types of TBI can lead to coma and death.
While explosions are a leading cause of TBI for active-duty military personnel in combat environments, the majority of these are concussions and most Soldiers do not suffer long-term effects. The leading causes of TBI in noncombat environments are falls, motor vehicle crashes, being struck by an object and assault. Doctors note that the Fort Benning population is especially prone to TBI because of its training mission that includes Modern Army Combatives and parachute training. Just as in a deployed environment, seeking prompt care early is essential to making a full recovery.
Treating a TBI patient is challenging, said a clinical neuropsychologist.
“Each patient presents a study in and of themselves,” said Dr. Marlin Wolf. “It’s like peeling back the layers of an onion, treating symptoms.” Soldiers injured in a blast while in combat are likely to have other conditions. For example, the patient may also have combat stress or depression associated with a return from deployment. “It is very challenging, in these situations, to determine what symptoms are due to the concussion and which symptoms are due to the combat stress or depression.”
TBI can also be caused by multiple traumas, rather than just a single event. In years past, a typical Soldier would drive on with the mission after a mild concussion. The Soldier would continue to sustain further injuries until they presented for treatment.
Today, specific training is being provided to all Soldiers for awareness, and to ensure that we have an educated, trained force to provide early recognition, treatment and tracking of concussive injuries in order to protect warrior health.
MACH’s TBI clinic is designed to address mild to moderate TBI. The symptoms it encounters include disorientation, headaches, dizziness, balance difficulties, ringing in the ears, blurred vision, nausea, vomiting, irritability, gaps in memory, sleep problems, or attention and concentration problems.
“The key to success,” Wolf said, “is the integrated approach. Our clinic is a team, dedicated to getting a Soldier back into the fight.”
The TBI clinic employs specialists in pain management, neurology, speech, behavioral health, occupational and physical therapists, to name a few. Care is coordinated by an experienced nurse case manager who follows a patient throughout his or her care. Soldiers generally stay in their unit while they attend their appointments and therapy.
Soldiers are sometimes afraid to seek treatment because they fear being stigmatized or of being found “unfit” for duty.
At Fort Benning’s TBI Clinic, 85 percent of Soldiers treated are fully returned to duty within 90 days. “Other issues, such as PTSD, depression or Family issues present a more complicated problem,” said Dr. Peter Szostak of the TBI Clinic, “and it’s sometimes difficult to determine what is causing what.” Symptoms closely mirror those of post-traumatic stress disorder and the two conditions often occur at the same time.
Most traumatic brain injuries are mild and, if treated promptly, result in full recovery with no long-term physical or mental effects. Seeking prompt medical care is important to recovery.
Soldiers and family members should talk with their primary care physician for evaluation or a referral to the TBI specialty clinic.
For more detailed information, visit the Defense and Veterans Brain Injury Center website at www.dvbic.org.org.”