Traumatic Brain Injury (TBI) is a mechanical insult to the brain from an external mechanical force which may lead to temporary or permanent impairment in cognitive, behavioral, or physical functions. This may or may not be associated with an alteration of consciousness.
Few conditions in medicine today are associated with more varying definitions or confusing inclusion criteria than TBI. This is due, in a large part, to the most recent technological advances in brain imaging, which are defining the brain pathologies associated with trauma and expanding the clinician’s ability to diagnose and accurately treat TBI. For the nearly 400,000 Veterans of the Iraq and Afghanistan conflicts who currently suffer from TBI, advances cannot occur quickly enough for them or their family members. Mild Traumatic Brain Injury (mTBI) rarely has associated physical abnormalities and is therefore described as the “invisible signature injury” of the Iraq and Afghanistan conflicts.
Moderate or severe traumatic brain injuries, as opposed to milder injuries, are usually associated with other signs of trauma and require evacuation and immediate treatment at a military hospital, usually Landstuhl Regional Medical Center in Germany. The recovery process progresses to Army or Naval facilities in the United States, and recovery is slow and requires many months to years of rehabilitation. These injuries will be discussed in the future.
Currently, the medical communities, both military and civilian, need to address the nearly 400,000 OIF (Operation Iraqi Freedom) and OEF (Operation Enduring Freedom) with mild traumatic brain injury. It is estimated that only 30-40% of our Veterans with TBI are currently being screened or receiving treatment through a local Veterans Administration Hospital or clinic. The workup requires a detailed history of exposure to any blast injury from an Improvised Explosive Device (IED), rocket propelled grenade (RPG) , mortar, or like explosive as well as any injury due to a motor vehicle accident (MVA), fall, or hitting one’s head on a wall or door as often happens during night combat. In addition, there are cases of global injury to the brain due to lack of oxygen, termed anoxic brain injury, from cases of near drowning. Bacterial infections and chemical exposures can also lead to brain insult, but are not considered traumatic injuries. Hallmark signs and symptoms of traumatic brain injury include headache, photophobia (difficulty with bright lights), increased hearing or ringing in the ears, sleep disturbance, dizziness, loss of mapping skills, and increased symptoms with crowds and large department or grocery stores.
The diagnosis of TBI is made by a thorough medical history, as noted above, as well as neurological testing to determine memory skills, mental processing skills and reaction times, among several other mental and balance skills. The typical tests to determine acute brain injury such as MRI’s or CT scans are normal in cases of mTBI. Only very updated technologies such as functional or diffusion tensor MRI’s, brain volumetrics, and PET and SPECT scans can determine injured areas of the brain.
The rehabilitation process for even mTBI requires a team approach consisting of the following members: physical medicine physician, psychologist, neurologist, a social worker, vocational rehab specialist and physical and occupational therapists. All veterans should be given the opportunity for cognitive retraining as well as assisting the patient with various electronic devices such as GPS systems and PDA devices such as the iPhone and iPad.
Please feel free to follow our web page as we network OIF/OEF Veterans with TBI to the resources in the community. In this new signature injury we need everyone’s cooperation with identifying and treating this invisible wound.
For more information about an article recently published describing those diagnosed with traumatic brain injury (TBI) continue to show symptoms after 5 years since their initial diagnosis, please read: TBI study