The challenge today that the military is addressing
with regard to TBI is really quite significant.
With the emergence of these new conflicts that we are now involved in
Iraq and of course now Afghanistan
the military in a sense has been exposed to a new kind of warfare.
That involves a lot of blast and IED - the public reads about these IEDs
which is an improvised explosive device, and RPG, which is a rocket-propelled grenade.
So it's not the traditional bullets and mortars in a sense of blast conflicts
and what's emerged because of this type of weaponry
and because of the way our enemy is using it
is a tremendously high incidence of traumatic brain injury
particularly what's referred to as the mild traumatic brain injury
or the concussive-type brain injury.
Prior to these conflicts, historically, when we thought of the military problem
of traumatic brain injury was gunshot wounds to the head and to the upper torso.
Or high-velocity fragments from grenades, for example.
And that still persists. There has been close to 3500 severe TBIs so far
from these two conflicts caused by gunshot wounds.
But the mild TBI caused by blast is a real issue.
And it's a real issue because it's hard to diagnose, it's very difficult to identify.
Unlike in sports, football for example, you see the impact, you see the event.
You can assess the athlete's condition immediately.
We don't have that ability in theater with that level of sophistication to really do that
so a lot of the diagnosis is taking place days, weeks, months after
and so there may be a lot of under-diagnosed, misdiagnosed issues
but the numbers are enormous.
It has been estimated that there have been 300,000 mild TBIs already.
The confirmed diagnoses through the first 10 years, 9 years, of the conflict
borders on the order of about 155,000 diagnosed mild TBIs.
But again, the caveat is, how strong are those diagnoses?
Because there is a lot of symptomatology that you see with mild TBI
that also is seen with other conditions, like just depression
the stress of the environment, the stress of combat
post-traumatic stress disorder, PTSD, which, again, has been published
and printed quite prolifically in the press.
This problem facing the military is, particularly in terms of -
not mortality, not killed in actions, not post-conflict mortality
but in terms of what we call the morbidity, the post-injury quality of life for the soldier.
In terms of that, TBI is probably now our biggest combat casualty care issue.
And by combat casualty care, I'm specifically referring to
injuries that occur as a result of combat or involvement in combat.
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The changes in weaponry during the recent conflicts compared with weaponry in previous wars have made TBI, especially mTBI, a common and complex injury among returning service members.
Produced by Brian King and Noel Guther, BrainLine.
Frank C. Tortella, ST, PhD, Frank Tortella, ST, PhD serves as the U.S. Army’s Medical Research and Material Command’s subject matter expert on neurotrauma and neuroprotection research for a diverse range of insults to include traumatic brain injury, concussions, and the neurological effects of blast exposure.
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