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.
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. Lt. Col. Jeffrey Yarvis, PhD talks about how effectively it can work for people with TBI and PTSD.
"Individualized" is the operaltive word when it comes to creating a treatment plan for someone with TBI and PTSD since symptoms can overlap and some may be psychological while others neurological.
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 effetive.
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 define and better understand the spectrum of injury — from the more inflamation-driven injury of mild TBI to the tissue destruction of severe TBI.
Dr. Geoffery Ling talks about the use of the Miliatary Acute Concussion Exam (MACE) — a simple, standardized tool for first providers. "It's better to have an 80 percent solution now than a 100 percent solution that you never see."
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 shares his work on the Revolutionizing Prosthetics Program, especially on the mechanical arm that allows a soldier or veteran to open a door, feed himself, even pick up an M&M and place it in his mouth.
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.
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.
Dr. Shane McNamee of the Richmond VAMC 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 ...
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.
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.
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.
For veterans and service members with TBI, getting help anonymously is available. But Adam encourages taking the courageous step to reach out for help.
Service members who sustained a TBI in theater need to seek professional care once they are home. Sharing their injury history, symptoms, and any diagnosis or treatment done in theater will help the 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.
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.
Realizing you are not the only one with a brain injury gives you the abiity 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.
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.
"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 a blast wave alone damages 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.
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.
Diagosing 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.
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.
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.
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.
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.
There is always more to learn, but certain changes — from monitoring cranial pressure in the brain to having patients lie at an incline instead of flat — have increased recovery in patients post-injury.
Is a subconcussive event a concussive event that only affects one part of the brain? Learn more about what research is showing, and hopes to show in the future.
For service members, vets, families, and providers, this DVBIC PSA features Commander Hancock, MD who shares his perspective as a shock trauma platoon doctor and a person with a TBI.
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.
"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.
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.
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.
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.
