Diagnosing & Treating Brain Injury
It's called the "invisible injury" for a reason: brain injury is notoriously difficult to diagnose and treat. Brain injury has also become known as the signature wound of the wars in Iraq and Afghanistan. As of 2011, more than 212,000 service members sustained a TBI, many of which from blast injuries — the primary cause of TBI in combat. And symptoms of post-traumatic stress disorder and TBI often overlap, making diagnosis and treatment more challenging.
Brain injuries in Iraq or Afghanistan have triggered the most advanced medical trauma response in history. Scores of medical professionals collaborate to provide sophisticated care that involves helicopter evacuation, battlefield wound care, flying intensive care units, and state-of-the-art hospital care and rehabilitation. Because of the highly advanced care, survival rates are higher than in any previous wars.
Once diagnosed, TBI is treated by a complex plan of medical rehabilitation, which can include one or a combination of rest, physical and occupational therapy, psychotherapy, and medication. Long- and short-term treatment can involve the combined efforts of neurologists, psychiatrists, physiatrists, an array of rehabilitation therapists, case managers, and social workers, along with a person's network of friends and family.
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January 26, 2016
Retired Navy Senior Chief Petty Officer Ed Rasmussen experienced multiple concussions and now tells others who may have experienced a TBI to “talk to somebody you know who has one — because we’re out there.”
November 24, 2015
A new system that has been shown to record for the first time how brain tissue deforms when subjected to the kind of shock that causes blast-induced trauma commonly seen in combat veterans.
July 15, 2014
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…
Col. Sidney Hinds, MD talks about guidelines and systems used in the combat setting to help diagnose concussion — from the MACE card to the incidence-based reporting system.
Col. Sidney Hinds, MD talks about why an incident-reporting system of concussions in combat is more effective than a patient- or symptom-reporting system.
Col. Sidney Hinds, MD talks about TBI care in military concussion care centers, concussion specialists, and evacuation, depending on the severity of injury.
Col. Sidney Hinds, MD talks about the importance of having standardized care for traumatic brain injury in combat and back at home.
Col. Sidney Hinds, MD talks about how doctors and researchers are looking at why some people recover more easily than others from TBI, and how treatment could vary.
Col. Sidney Hinds, MD talks how, after a concussion, service members need supervised rest and then step-by-step return to daily activities.
Col. Sidney Hinds, MD talks his goals as national director of DVBIC — from standardized care across all platforms to emphasizing patient-focused care.
Col. Sidney Hinds, MD talks about current research for diagnosing and treating brain injury — from neurocognitive assessment tools to the role of complex neuroimaging.
June 2, 2014
A study looks at the difference in post-concussive symptoms depending on the cause of combat-related mild TBI.
Dr. Jack Tsao talks about the debate around computerized baseline testing: is it useful, is it comprehensive, and when is the appropriate time for retesting.
Dr. Jack Tsao talks about research on military-related CTE and what questions are being asked — from who is most susceptible to can it develop from blast injuries rather than direct hits to the head.
February 3, 2014
TBI? PTSD? Both? No matter your diagnosis, Adam says that taking the first steps to get help is what will matter most for a successful recovery.
December 9, 2013
Adam says that like drill and ceremony and calling cadence, which start with a first step, so does recovery from a brain injury and/or PTSD.
Lt. Col Jeffrey Yarvis, PhD talks about Eye Movement Desensitization and Reprocessing therapy, which has been established by extensive scientific and clinical research as an effective treatment for PTSD.
Dr. Heechin Chae recommends that primary care physicians realize they can't take care of TBI, PTSD, and other co-morbid problems in a military patient during one appointment.
Dr. Heechin Chae talks about understanding what a person truly wants to focus on during his recovery and building an individualized treatment plan with those goals in the forefront.
Dr. Heechin Chae says he feels like a conductor in an orchestra -- each patient is a different symphony and he has to understand that music and then come up with the exact right "instruments" and "musicians."
Dr. Heechin Chae explains that for neurogenesis to occur after an injury, the brain needs to be in a relaxed and restful state.
Dr. Anand Veeravagu talks about the efficacy of coordinated care among a patient's entire medical care staff and how it ties into patient-centered care and successful outcome.
Dr. Anand Veeravagu discusses how being at or near home, close to family and "regular" life contributes greatly to the healing process of service members and veterans with TBI and other injuries.
Dr. Anand Veeravagu outlines the cognitive and physical symptoms that can result from a blast injury as well as the general timeline for recovery.
Dr. Heechin Chae says that civilian providers treating military patients with TBI should always be sensitive to the fact that there may be emotional scars involved.
Dr. Heechin Chae says he feels like a detective when treating a patient with TBI; you have to ask the right questions so as to develop an individual treatment plan.
Dr. Heechin Chae explains how a person's spirituality, in whatever form, can play an important role in recovery from brain injury.
Dr. Anand Veeravagu describes this life-saving neurosurgical procedure, performed to prevent brain damage resulting from uncontrollable swelling in the brain.
Dr. Anand Veeravagu explains how a blast causes a swift change in pressure that generates a wave of wind, sound, and/or debris that, in turn, can damage a person's brain through a microtrauma or microbleed.
Dr. Anand Veeravagu talks about how Obama's BRAIN initiative will further advancements in research for TBI, stroke, Alzheimer's and other neurological conditions to the arena of clinical care.
With more than 266,000 diagnoses of TBI from the wars in the last decade, researchers are trying to create a "common data dictionary" that better differentiates among mild, moderate, and severe injury.
Dr. Anand Veeravagu talks about how the military's ability to deliver high-end acute care on the battlefield can benefit paramedics and EMTs handling acute care in the civilian world.
June 14, 2013
The last thing Samuel Console, a retired Pennsylvania Army National Guard lieutenant, remembers after the explosion in Iraq was an orange flash of light. It wasn't until six years later he was diagnosed with brain injury.
Despite the pre-conceived ideas people may have about hypnotherapy, it is actually more about awareness and control than the lack thereof ... and can help people with TBI and PTSD.
"Individualized" is the operative word when it comes to creating a treatment plan for someone with
Symptoms of TBI and PTSD can overlap, says Lt. Col. Jeffrey Yarvis, PhD, but sometimes treating the psychological ones first makes treating the neurological ones from there more effective.
Using animal models in the lab to study the mechanisms of blast-related brain injury, researchers like Dr. Lee Goldstein are feeling optimistic that their findings will lead to viable treatments.
Dr. Jordan Grafman talks about the Vietnam vets in a longevity study who were able to create stable, good lives for themselves and their families without much systemized rehab like there is today.
In recent wars, there has been more programmatic effort to treat and evaluate soldiers with TBI and PTSD. But are these issues any better resolved than they were 30, 50, 100 years ago?
Dr. Geoffrey Ling talks about the military's success in creating a standard, system of care for TBI — from immediate assessment to admittance into a concussion restoration center.
Although other treatments for second impact syndrome are being studied, the two hallmark treatments now are rest and removal from play. They should not be underestimated.
Dr. Geoffrey Ling describes PREVENT, an initiative to better understand the spectrum of injury — from the more inflammation-driven injury of mild TBI to the tissue destruction of severe TBI.
As a researcher and clinician, Dr. Geoffrey Ling knows that research needs to be fast and efficient because patients are waiting now!
Dr. Geoffrey Ling talks about the use of the Military Acute Concussion Exam — a simple, standardized tool for first providers.
With the burgeoning understanding of the cellular and biochemical effects of brain injury, pharmacologists can successfully intercede with more promising standardized treatment.
Dr. Geoffrey Ling talks about what it would take to duplicate the military's top-notch standard of care for TBI in the civilian sector.
Dr. Geoffrey Ling shares his work on the Revolutionizing Prosthetics Program, especially on the mechanical arm that allows a soldier to open a door, feed himself, even pick up an M&M.
Dr. Geoffrey Ling talks about DARPA's tiny blast gauge, which worn now by 11,000 soldiers, can quantify who is at risk for brain injury so that they can get screened and treated more quickly.
November 19, 2012
Accepting changes in oneself after a brain injury can be difficult. But denying the changes, over the long run, will be more painful — for the injured person and those he loves. Adam shares his experience.
The VA is dedicated to not only providing the care that veterans need today, but also what they will need in the future.
Dr. Shane McNamee talks about helping each veteran transform from a patient with complex injuries back to an individual with many roles — Marine, father, husband, son, athlete, artist ...
The MRI machine at the National Intrepid Center of Excellence generates far more information and images than do standard MRI machines.
Neuroradiologist Gerard Riedy talks about the variety of ways the PET scan can be used to image injuries to the brain.
Ironically, people with TBI and their families are relieved when neuroimaging shows a problem. Those images can give answers that can lead to more individually tailored treatment.
Many experts collaborated on the plan for the National Intrepid Center of Excellence with the goal of creating an objective measure to better characterize brain injury, and then treat it.
Neuroimaging the brain with a MEG can show, in real time, how damage to the brain can interrupt, slow, or stop communication from one part of the brain to other parts.
Neuroimaging the brains of service members with blast-related TBI are showing patterns of variable damage, perhaps most notably in the cerebellum.
Researchers talked to more than 600 people in the military who might know anything about TBI and psychological health to learn more about available programs.
Soldiers with TBI and their families should not stop looking for help and guidance; recovery will not happen if people isolate themselves.
Blast injuries are a complex form of injury — from the effects of pressure waves on the body's tissue to the psychological trauma that can come with physical injury.
August 13, 2012
Adam shares his experiences of having to push through the frustrating periods during his recovery from brain injury and continue to make progress.
August 7, 2012
Overwhelming fatigue post-injury can be due to disrupted sleep patterns — and there are strategies to help.
July 30, 2012
For veterans and service members with TBI, getting help anonymously is available. But Adam encourages taking the courageous step to reach out for help.
Biomarkers are anything that can measure acutely and then identify the prognosis or future development of a person's brain injury.
Service members need to share their injury history, symptoms, and any diagnosis or treatment done in theater to help their stateside doctors better tailor care.
Concussion Recovery Centers, located near service members' units, are quiet, comfortable environments conducive for rest and recovery after a brain injury.
July 6, 2012
The eight levels of the Rancho Los Amigos is an evaluation tool used by the rehabilitation team to describe the pattern or stages of cognitive recovery typically seen after a brain injury.
July 6, 2012
This module is about the ways that a moderate to severe traumatic brain injury (TBI) may change a person’s body, thinking, acting, and feelings.
Realizing you are not the only one with a brain injury gives you the ability to get insight into the injury-related challenges, get help, make a plan, and carry on from there. Navy veteran Derek McGinnis shares his experience.
Focus on what you can do after injury, give it 110% effort, and the other abilities will come. Navy veteran Derek McGinnis shares his experience.
Vets and service members need help after injury not only to build on the strengths they once had but also to realize how to grow and change from there. Navy veteran Derek McGinnis shares his experience.
Derek McGinnis, an Iraq veteran, tells the story of his deployment, his combat injuries (brain, leg, hand, and more), and the road back to recovery.
"There have been people who didn't leave me even when I told them to, who gave me chances, who listened even during my darkest times post-injury. I couldn't have made it without them." Navy veteran Derek McGinnis shares his experience.
We know that blast waves alone can damage the human brain. But more research is needed to learn how exactly blast waves alone damage the brain's cells, blood vessels, and structure as a whole.
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.
Research on the use of blood biomarkers for diagnosing brain injuries — in theater and in the civilian world — is getting closer. The hope is to be able to use it as a standard diagnostic tool.
Neurometabolite is a chemical within cells in the brain that reflects function or dysfunction within those cells.
An IED explosion can not only cause a blast injury from the shock waves themselves, but can also cause concussion or a penetrating injury at the same time.
Despite grievous wounds, including brain injury, survival rates are at an all-time high because of improved body protection and medical care from theater to hospital.
COL Hack talks about the Army's thousands of Combat Casualty Care projects, including 450-500 just for brain injury research and care.
Diagnosing a mild TBI often has to rely on subjective evaluations. A standard, objective screening tool like a blood biomarker would help with diagnosis and with tracking recovery.
Every service member transitioning from the DoD to the VA is screened for TBI. If detected, a comprehensive evaluation is performed.
Increased awareness of the short- and long-term issues of TBI has helped improve programs for comprehensive TBI screenings and evaluations. But many treatments are still in the research phase.
Special Forces are being studied during breacher training in which they experience real explosive events in hopes of answering more questions about the effects of blasts on the brain.
December 30, 2011
Questions about childhood, habits pre- and post-TBI, and how relationships can change are all part of taking a full case history.
December 16, 2011
Taking a detailed case history is crucial for tailoring a recovery plan for service members or vets with TBI.
Blood biomarkers could enormously change the way TBI — from severe to mild — is diagnosed and then treated.
Surgical and non-surgical interventions for TBI, especially those that are more severe, hinge on accurate diagnosis. More research is needed to fine-tune how TBIs are diagnosed, in ERs and in theater.
Army COL Dallas Hack, MD, talks about the challenges in diagnosing and treating TBI — from the dearth of research to the lack of definitive treatments.
November 18, 2011
Ten years of combat in Iraq and Afghanistan have created an epidemic of PTSD and TBI in service members, sailors, and airmen. Treatments run the gamut from yoga to drugs. Learn more.
November 15, 2011
"The blast was deafening and created a concussion that sucked the oxygen from the air ..."
Research in TBI can seem slow. But even small steps can make an incredible difference in the quality of life of people with TBI.
Progress in research and treatment for brain injury may seem slow, but a closer look will show otherwise.
Today versus 20 years ago, the standards of care for TBI across the US have vastly improved. However, these standards could certainly be higher and more consistent across all medical centers.
Researcher David Hovda, PhD is less interested in aptosis — or cell death — after TBI than what the cells that survive are doing to compensate for what is lost.
"I try to teach my TBI research students to get rid of scientific tenets, to let the door open to other possibilities."
There is always more to learn, but certain changes — from monitoring cranial pressure to having patients lie at an incline instead of flat — have increased recovery in patients post-injury.
The human brain is a wonderful organ with amazing flexibility. Learn more about recovery.
The research into the hows and whys of blast injuries continues — from the impact of pressure waves to the push and pull of air blasts.
"War is now an intermingled mess of insurgencies ... making injuries different from previous wars."
Learn how new procedures and new treatment facilities are greatly benefiting service members with brain injury.
There is a paucity of research on stem cell therapy and TBI compared with Parkinson's, stroke, and Alzheimer's. Continued research might reveal more.
Researchers still need to discover the underlying "why" when looking at stem cell therapy for people with severe traumatic brain injury.
Brain Injury researchers are making steady steps — from studying the use of progesterone for treatment to biomarkers for diagnosis.
Stem cell research and brain injury started to take off in the late 1990s. Learn about progress being made in the field.
Stem cell transplantion is irreversible, so more research is needed to reveal how stem cells actually promote functional recovery in the brain.
April 12, 2011
Learn why professionals need to treat TBIs in service members and veterans differently from those in civilians ... and how the VA can help.
April 9, 2011
Learn how a Tele-TBI Clinic at Walter Reed is helping many service members and veterans with TBI ... even if they states away from Washington, DC.
March 8, 2011
For service members, vets, families, and providers, this DVBIC PSA features Captain James Hancock, MD who shares his perspective as a shock trauma platoon doctor and a person with a TBI.
March 8, 2011
Dirigida los miembros del servicio militar, los veteranos, las familias y los proveedores, este anuncio de servicio público de DVBIC presenta al Commander Hancock, MD, quien comparte su punto de vista en su calidad de médico de pelotón de choque traumático y persona que sufrió una lesión cerebral.
January 24, 2011
The mechanics of a blast injury are complicated and still being researched. See more.
December 13, 2010
A blast injury feels like being hit by a wave and then being pulled back into the ocean — all in intensely rapid succession.
Military experts are working to define what baseline testing for TBI would be most effective for pre- and post-deployment comparison, as well as for use in theater.
To date, there is no distinctive rating system for blast-induced concussions.
October 20, 2010
The definition is the same as in the civilian world, but different precautions are taken before a soldier is released back to combat.
Screening all service members who've had a risk of a concussion is a big step forward.
Symptoms of PTSD and post-concussive syndrome can overlap significantly. Should they be treated the same way?
Find out about research on TBI in the military setting.
BrainLine talks with Dr. Maria Mouratidis about her experiences working with military families.
January 1, 2006
Explosions can produce unique patterns of brain and other injuries seldom seen outside combat. Learn more.
August 26, 2013
From taking notes on a laptop during class to using a voice recorder to tape a lecture to review later, technology can help veterans with brain injury succeed in college. Adam shares his first-hand knowledge.
March 27, 2012
New appliances, like Adam's microwave, come with all sorts of buttons, displays, and settings. Heating up rice for the first time is not always easy.
March 6, 2012
After his brain injury, Adam Anicich needed help getting organized, remembering appointments and people, and finding places. His Smartphone -- with its proactive calendar and GPS function -- has as helped him remedy his "sloppiness."
July 29, 2011
Military smartphone apps for service members and veterans, their families, and professionals.
June 15, 2011
A new military telehealth application — mCare — is poised to help wounded active duty, Reserve, and Guard get the daily help they need to recover.
September 23, 2016
Today, like all families… we have our good days and bad days
And we’re facing them together.
"Being in the hospital after a TBI — tubes and machines attached everywhere — is scary and frustrating. Only the Marines were able to calm me down." Navy veteran Derek McGinnis shares his experience.
BrainLine got the chance to catch up with Michael Paul Mason about his trip to Iraq to visit the primary trauma care at the Air Force hospital in Balad.
Seniors & Brain Injury
Dr. Jordan Grafman discusses the research around aging with a TBI — from the importance of regular social interaction to the strategies for reducing tissue damage as the brain ages.
Glenn Parkinson, MSW talks about how alcohol and drug use after a TBI can significantly impact a person's sexual function, his or her feelings about sex and intimacy, and the ability to connect and build a relationship.
February 25, 2013
Studies show that binge drinking after a TBI, especially for active duty and veterans, could be a significant risk
November 20, 2012
Cognitive and mental issues arising from combat exposure can also contribute to drug abuse. With so many contributing factors, the rate of substance abuse is high in returning service members who have had a concussion.
November 29, 2011
The military is offering stronger services for service members and vets who have TBI and substance abuse issues, such as the availability of regional care coordinators for Guard and Reserve.
November 29, 2011
For service members with mild TBI and substance abuse issues, their job is to get better. Their command works with them to get them better and back to their units.
"For veterans and non-veterans with TBI, the only amount of drugs and alcohol that is safe is none."