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Deployment-Related Traumatic Brain Injury and Co-Occurring Conditions

A Course for Civilian Health Care Providers from BrainLineMilitary.org

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Introduction

VIDEO: Course II: Deployment-Related TBI and Co-Occurring Conditions Intro

Begin this course by watching this video.

"You just really have to sit down, get to know your patient and then treat them symptom by symptom…"

About This Course

This course is for civilian health care workers who will be seeing military service members — veterans or members of the National Guard or Reserve — who had a mild traumatic brain injury (mTBI or concussion) and now have ongoing related symptoms. More than 200,000 American men and women have incurred a concussion during their service in Iraq or Afghanistan, and a significant number of these men and women will experience other medical concerns in addition to their mTBI. For people who have ongoing symptoms, experts are now treating traumatic brain injury as a chronic health condition. A small but significant percentage of people will have problems that persist beyond the immediate time frame of the injury.

Watch this video segment from Capt. J.L. Hancock, who sustained a concussion/mTBI in Afghanistan:

VIDEO: Capt. J.L. Hancock Shares His Story and His Questions

Capt. J.L. Hancock Shares His Story and His Questions

Capt. J.L. Hancock discusses his persistent symptoms after sustaining a deployment-related traumatic brain injury.

 

During this course, if you have any questions, please email info@dvbic.org and a TBI expert will respond promptly.

This course will help you identify and treat the co-occurring conditions that are common in deployment-related concussion.

Family nurse practitioner Helen Coronel describes the important role of primary health care providers in treating both the acute symptoms of concussion and the co-occurring conditions that may continue to cause problems after the resolution of the concussion injury itself.

VIDEO: Treating Concussion at the Primary Care Level

Treating Concussion at the Primary Care Level

Oftentimes, though in a civilian population, what you're dealing with isn't an acute concussion. You're dealing with these co-occurring conditions which have been brewing for a long time…

What You'll Learn

Here you'll find information about:

  • The most common co-occurring conditions associated with concussion
  • Recommended treatments for these conditions
  • Prognosis when conditions are identified and treated
  • Related resources for service members and their families

This course includes an introduction and six sections:

At the end is a post-test that provides a score and feedback on incorrect answers.

How the Course Works

You can follow the course from start to finish by using the "next" button at the bottom of each page. Arrows on the right and left of each page allow you to move back and forth between pages. You can jump to any section by clicking on the section titles across the top of the course. You can keep track of your progress by checking the progress bar at the top of each page. Links to additional resources are listed on the last page of each section.

Need a refresher on concussion/mTBI?

If you would like to take a step back and review the basics of concussion/mTBI, please take the first course in our series, Identifying and Treating Concussion/mTBI in Service Members and Veterans.

What Is Traumatic Brain Injury?

In order to understand the persistent symptoms that can accompany a concussion or mild TBI, it is important to first understand the general characteristics of the broader condition of traumatic brain injury or TBI.

A traumatic brain injury (TBI) is a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as: mild, moderate or severe.

A concussion, or mild traumatic brain injury is the most common type of TBI. CDC

To learn more about concussion in a military context, please view our web course: Identifying and Treating Military Traumatic Brain Injury.

Five Guiding Principles

Before diving into the details of treating the symptoms or co-occurring conditions that may accompany concussion, here are a few principles to guide you.

First Guiding Principle: Take a Thorough Clinical History

This is probably the single most important thing you can do. Here is a checklist that asks about previous brain injuries with some questions you can ask.

  • What was the service member's health like before this concussion? For example, was this her first ever (military or civilian) concussion?
  • Did he have headaches before the trauma?
  • Did the service member have a history of substance abuse or psychological issues including stress before the injury?
  • Does the service member have a history of learning disabilities or attention deficit disorder?

If the service member had headaches or psychological issues prior to this concussion, he or she has a greater likelihood of having persistent problems after the injury. While it's helpful to understand which symptoms are likely related to one or more recent concussions, it's even more important to treat the presenting symptoms because if untreated, these symptoms can become significant problems.

Nurse practitioner Helen Coronel explains why it's so important to understand which symptoms are new versus pre-existing:

VIDEO: Getting a Thorough History Is the Necessary Starting Point for Patients with TBI

Getting a Thorough History Is the Necessary Starting Point for Patients with TBI

"Oftentimes, it's been months — even years — from the time that this person has suffered the injury to the time that you're going to see them in your practice…"

 

Sometimes, problems don't seem obvious until the service member is back home. Changing routines and environments can highlight symptoms that might have been overlooked in the deployed setting.

Adam Anicich talks about going back to work and realizing that something was different:

VIDEO: When Problems Linger Past the Normal Readjustment Period

When Problems Linger Past the Normal Readjustment Period

"I was having troubles remembering the names of the customers or what I'd helped them with … there was just a huge difference in my personality, a huge difference in my temperament."

Second Guiding Principle: Be Optimistic

Be optimistic about the likelihood of recovery. Most people who have persistent symptoms after a concussion do in fact recover well, and an upbeat outlook demonstrably aids recovery. Neuropsychologist Cynthia Boyd emphasizes the importance of positivity:

VIDEO: I Tell My Patients: "TBI Is a Temporary Condition"

I Tell My Patients: "TBI Is a Temporary Condition"

"You are young. You have the whole future ahead of you. We need to get you well right now, so you can prepare for it."

Third Guiding Principle: Have Patience

Realize that the longer the symptoms have been present, the more challenging and complex it may be to treat them. It may help service members to understand that it could take some time to see improvement but you will work with them to find an effective treatment.

VIDEO: Healing From TBI Is Often Not Something People Can Do on Their Own

Healing From TBI Is Often Not Something People Can Do on Their Own

"This wasn't something I was going to be able to fix on my own. It was really something that was going to require pretty advanced cognitive therapy …"

Fourth Guiding Principle: Family Involvement

Remember family support can have a big impact on recovery. Physical therapist Katie Stout urges families to get involved. Additional resources for families can be found at the end of this section.

VIDEO: Involving the Family in Tailoring a Service Member's Long-Term Treatment Program

Involving the Family

"Involving the family with the service member's treatment plan is really imperative to helping them through long-term recovery…"

 

The love and support of family and friends can also have an enormous impact on the recovery process. Helping families understand their crucial role can go a long way to achieving positive outcomes.

VIDEO: Educating Families and Children

Educating Families and Children

Capt. J.L. Hancock discusses the importance of education and family involvement as part of the treatment protocol for service members with mTBI.

Fifth Guiding Principle: Non-pharmacological Interventions

Try to use non-pharmacological interventions whenever they are indicated and appropriate. That's because medications that help one condition can worsen another. For example, prescriptions for pain can aggravate cognitive problems, anxiety medications (e.g., benzodiazepines) can increase balance problems, and SSRIs for depression can contribute to sexual dysfunction. Consider starting with a low dose and increase as necessary. Minimizing the number of pharmaceuticals an individual takes has the added benefit of reducing the risk of dangerous drug interactions.



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