US Army,
FORT DETRICK: The Defense and Veterans Brain Injury Center treats and researches traumatic brain injuries, signature wounds of Operation Iraqi Freedom.
Headquartered at Walter Reed Army Medical Center, the DVBIC operates nine sites across the country that treat patients with mild, moderate and severe TBI, develop guidelines for care, study the prevalence of TBI, and conduct research to help future patients. It also frequently addresses the difference between TBI and Post Traumatic Stress Disorder.
“It's impossible not to be changed by going to war,” said Dr. Deborah Warden, DVBIC national director. “Parsing out what parts are a stress reaction and what parts have to do with a previous concussion is difficult.”
TBIs and PTSD share such common symptoms as difficulty concentrating, memory problems and irritability, but TBI symptoms can also include headaches, dizziness and balance problems. A person with PTSD may have nightmares, re-experience traumatic events and have anxiety that worsens.
According to Kathy Helmick, acting deputy director of Clinical and Educational Affairs at DVBIC, another difference is that diagnosis of a TBI is usually made when the person is first injured. But treatments for the two are the same, she said, and include sleep, good nutrition and support. “Those are the three top things you do for both,” she said.
Dr. Warden explained that Soldiers with a mild TBI must also avoid risking a second head injury while their brains are healing. In most cases, the brain can recover from one mild TBI, she said, but two in quick succession have a cumulative effect that's not as easily treated with rest.
While the Army's high operational tempo can make getting adequate rest difficult for TBI patients, Ms. Helmick said servicemembers may have an advantage when recovering.
“The older you are and the more medical conditions you have, the more this will impact recovery,” she said. “Because the military is young with few medical conditions, they have better outcomes than the general population.”
More than 35,000 servicemembers have been screened for TBIs. Roughly 11 percent of those screened had a mild TBI, while half had no symptoms.
According to a message the Army's Surgeon General sent to all Army commanders last July, mild TBI – also commonly referred to as a concussion – can effect operational effectiveness through poor marksmanship, delayed reaction time, decreased ability to concentrate and inappropriate behavior that lasts for several days or longer.
To find Soldiers who may have sustained but “shook off” mild TBIs, the DVBIC created a three-question screening tool asking Soldiers if they were injured, had a mental-status change as a result and what symptoms they experienced, said Dr. Warden. The Department of Veterans Affairs has requested the tool for their patients.
Both a similar screening tool and the Military Acute Concussion Evaluation tool, a standardized mental status exam, are used to evaluate concussions in theater. The military also plans to include TBI screening questions on the post-deployment health assessment all servicemembers complete.
A study proposed in Congress as part of the Heroes at Home Act would follow servicemembers with mild, moderate and severe TBIs for 15 years to determine the long-term effects of brain injuries. Researchers are also studying anxiety and hyperactivity medications to see if they can benefit TBI patients, according to Dr. David Moore, DVBIC's director of research.
“Nobody thought that blast was going to be a problem until two or three years into the conflict,” Dr. Moore said. “The discomfort about the whole situation is that you know that people are suffering and you want to get on and do the work as quickly as possible.”
Dr. Warden said she believes mechanisms are in place to identify Soldiers with a TBI, and that help is on the way to those in recovery.
“I think there are people who had concussions in theater and may have recovered completely, and others who have not recovered completely,” she said. “I'd like to think that the processes we are putting into place are going to make it easier to address the needs of a lot of those people.”
(Karen Fleming-Michael is a public affairs officer for the U.S. Army Medical Materiel & Research Command.)
