We know that combat exposure is not good for the human brain
and not good for the human mind.
With explosive munitions, there are significant amounts of individuals
who are getting blast-based concussions.
We also know that the rigors and the vigilance required
to be in a combat environment
produce really significant combat stress syndromes at the back end.
It is not uncommon for our patients that we see in the VA who are typically
2-3 years removed from the combat environment
and a year removed from their DOD activity once they're in our outpatient clinics
to have some combination of a history of a traumatic brain injury
as well as some pretty significant combat stress syndromes.
The teams that we have, and to do it really effectively,
you need to be aware of both of these things, both of these entities,
and they do appear to be relatively separate entities
from the penetrance of the problems.
The issues and the symptoms that the individuals are having at the back end
can be relatively similar, but it is incredibly important that when you treat
an individual with a traumatic brain injury that you recognize
and also effectively treat the other issues that someone is having.
For some reason, the medical community and the lay community
don't see what we term psychological injuries as being as important
and as weighty as physical injuries.
If we look at someone with a mild traumatic brain injury who has blindness,
we're obviously going to adjust the way that we treat that individual
and set up their care plan to try to, again, help them be people again.
It's the same thing with the "psychological injuries" of combat.
Without recognizing those things and treating those things,
there's no way that those individuals - let me put it a different way.
It's going to be a lot harder for those individuals to get better
and to rediscover their lives and flip the chapters over
and find out what's next if you can't direct your treatment
at exactly what the person is suffering from.
When we talk about trying to figure out what psychological burden somebody is carrying,
be it an anxiety-based disorder like combat stress syndrome
or be it depression, it's important where it comes from; i.e.,
is it from a TBI, is it from the PTSD, is it from substance abuse,
to help treat those things.
So when somebody has a TBI and they've got significant neurocognitive issues,
the pathways that you're going to use to treat the PTSD are going to be different.
The counseling-based sessions, the cognitive processing therapy,
the CBT, and the different things that we use to try to help them get better,
they don't have the cognitive skills necessary to fully engage in those things,
we need to build those pieces up over time.
We touched upon sleep a bit.
If there is one thing, there is one burden that this population seems to be carrying
that is just ultimately terribly destructive, it's anxiety with sleep,
an inability to get restful sleep over time.
we know that both traumatic brain injury and PTSD
can negatively impact our ability to get restorative sleep,
and as you talk to these young men and these young women
who have served our country in the outpatient clinics
months and years afterwards, their sleep patterns are just devastated.
Without an ability to kind of get in there and really help them get to sleep again
and to restore it's really challenging to help them.
Show transcript | Print transcript
Combat exposure can damage the brain physically and psychologically. Working to find the causes of these injuries will help with the nuances of treatment.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.
Shane McNamee, MD serves as chief of Physical Medicine and Rehabilitation at the Richmond VAMC and has worked extensively on the development and implementation of the Polytrauma System of Care in the Veterans Health Administration.
The contents of BrainLine Military (the “Web Site”), such as text, graphics, images, information obtained from the Web Site’s licensors and/or consultants, and other material contained on the Web Site (collectively, the “Content”) are for informational purposes only. The Content is not intended to be a substitute for medical, legal, or other professional advice, diagnosis, or treatment.
Specifically, with regards to medical issues, always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Web Site. If you think you may have a medical emergency, call your doctor or 911 immediately. The Web Site does not recommend or endorse any specific tests, physicians, products, procedures, opinions, or other information that may be mentioned on the Web Site. Reliance on any information provided by the Web Site or by employees, volunteers or contractors or others associated with the Web Site and/or other visitors to the Web Site is solely at your own risk.