Filed under: TBI
Two-a-day practices have started for teens in fall sports. One big issue is concussion education: learning the signs of a concussion and then what to do if you actually have one—or if someone you know does. Several dietary supplement manufacturers have promoted products to help with recovery from concussions and traumatic brain injuries (TBIs), but there isn’t enough scientific evidence to support these claims. If you suffer from a concussion or TBI, make sure you follow your doctor’s orders for recovery. And if you have children involved in sports, watch them for possible signs.
FDA warns consumers to avoid using products that claim to prevent or treat a concussion or TBI. For more information, read FDA’s Consumer Update on dietary supplements and concussions.
Between 2000 and 2015, more than 339,000 service members sustained a traumatic brain injury (TBI) in the Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF) conflicts. The first step to care is being able to recognize symptoms, especially for less obvious TBIs. While service members are at greater risk than their civilian counterparts, TBI is not just a military injury. Over 2.2 million American civilians are treated each year for TBI. Leading causes include falls and automobile accidents. In theater, blasts account for most TBIs. Each injury is unique, and each person’s road to recovery is different.
TBI involves alteration of brain function caused by an external physical force. A penetrating TBI is usually obvious, such as a bullet or stab wound to the head. Closed injuries sometimes aren’t so apparent: These include blast injuries, falls, vehicle crashes, and head-to-head collisions (such as on an athletic field).
Severity depends on the amount of brain tissue injured and ranges from mild to severe. Impairment can be physical, cognitive, sensory, and/or emotional.
About 82% of TBIs sustained in OIF/OEF conflicts were labeled mild (mTBI, also referred to as concussion). The most common symptom is headache. Other symptoms include dizziness, sleep disturbances, fatigue, attention and memory problems, irritability, and changes in vision, balance, and mood. However, symptoms can be subtle, and patients often don’t seek medical help for weeks or months after the injury occurred.
Most mTBI patients recover fully. The Defense and Veterans Brain Injury Center (DVBIC) “Blast Injuries” web page offers good advice for recovering from blast-induced mTBI.
Recovery from moderate-to-severe TBI usually requires treatment at a rehabilitation hospital. The goals are to improve function and promote independence and re-integration into the community. Progress can be slow, but change and improvement can continue for years.
Health.mil offers resources for both patients and clinicians. DVBIC’s A Head for the Future website provides educational materials to encourage prevention and promote recognition and treatment of TBI in the military.
Since 2000, around 350,000 service members have been affected by traumatic brain injuries. TBI often impacts memory, especially short-term memory. Think of long-term memory and short-term memory as “holding bins” for information. Your long-term memory can hold information from several days to decades, while your short-term memory retains information for just a few seconds. And short-term memory is closely associated with working memory (your ability to manipulate information in your head) and sustained attention (your ability to maintain focus).
When memory problems strike, short-term memory, working memory, and sustained attention tend to suffer before long-term memory does. Regardless of cause, memory of a remote event stands out more than newer events because your mind has “rehearsed” the older event repeatedly, essentially embedding it in your brain through repetition. By comparison, your mind hasn’t yet “learned” the newer event. For example, you might recall every detail of combat stories but have difficulty remembering what you ate for lunch. In this case, brain connections that rehearsed the combat story have become solidified, while connections responsible for learning this new information haven’t formed yet.
Depending on the location and nature of the injury, your brain might work differently than it did in the past. This could happen because brain cells that used to “communicate” with each other easily are now being rerouted.
Short-term memory, working memory, and sustained attention also can be affected by other factors such as stress, distraction, poor sleep, depression, anxiety, and/or body toxins. The cause isn’t always obvious. Your doctor can help sort it out, answer questions about your condition, treatment, and prognosis, and refer you to a neuropsychologist for further evaluation. In the meantime, you might find HPRC’s TBI resources useful too.
Many service members exposed to bomb blasts in the field walk away unscathed—or so it would seem. However, there could be some damage they’re not “seeing.”
High-pressure shockwaves from explosive blasts can cause serious eye trauma. In fact, up to 10% of all blast survivors experience significant eye injuries from projectiles thrown into their eyes, eye perforations caused by the high-pressure blast waves, or effects on the eyes associated with traumatic brain injury (TBI). If you were exposed to a blast while in the field but weren’t otherwise injured, don’t wait to set up an appointment with your eye doctor. Prompt medical attention could prevent permanent injury.
Most eye injuries are preventable if you wear protective eyewear on-duty and off-duty. There are many options to choose from the Department of Defense’s (DoD) approved Authorized Protective Eyewear List (APEL). Your vision is extremely important! For more information on protecting your eyesight, visit the Vision Center of Excellence.
Returning to duty after a mild traumatic brain injury (mTBI; also referred to as acute concussion) requires a special recovery process. Until now, procedures used by military healthcare professionals were largely based on sports-related mTBI practices, which are not always appropriate for returning Warfighters to military activities and demands. Medical and military experts worked together to develop new recommendations for returning service members to military activity after mild traumatic brain injury. The six-step process includes progressing from rest through light to moderate activity and exercise and eventually to unrestricted activity. Patients cannot progress until they are symptom free at any given stage in the process. Almost 84% of military brain injuries in 2014 were from mTBI/concussions. Some of the most common causes of concussions occur in non-deployed setting. While not all mTBI/concussions are preventable, there are things that you can do to reduce your risk in your day-to-day life:
- Always wear a seat belt when driving or riding in a vehicle.
- Wear a helmet when suitable (for example, on a bicycle or motorcycle).
- Create safe living spaces to reduce falls. Remove or secure potentially hazardous items from floors and overhead.
- Be aware of your surroundings. Try these Mind Tactics Performance Strategies to improve your ability to control your attention.
Walk into the new facility of the National Intrepid Center of Excellence (NICoE) on the campus of Naval Support Activity Bethesda, and one of the first things you will see is a sign commemorating the center’s origins, including the fact that the $65 million facility itself was donated by the Intrepid Fallen Heroes Fund. NICoE is committed to the interdisciplinary diagnosis, treatment, and long-term healing of Warfighters, and educational support for their families, from all branches of service.
Unlike many military environments, the facility is curved, spacious, quiet, and pleasant. Some notable features are the high ceilings, artwork, and state-of-the-art treatment rooms.
Patients at NICoE typically are active-duty service members with mild traumatic brain injuries (mTBI) combined with other psychological health conditions such as post-traumatic stress (PTS), anxiety, and depression. Most have already begun treatment elsewhere, often with many medications. The tranquil environment of NICoE instantly helps put them at ease and often leads to more effective treatment with fewer medications.
Recognizing that traditional therapies can’t heal all wounds, NICoE has rooms dedicated to art therapy, virtual reality, and meditation. Beautiful masks line the entrance to the art therapy room, providing a small glimpse into Warfighters’ individual and unique roads to recovery. The virtual reality room allows Warfighters to face traumatic scenarios at a pace that makes sense, an incredibly lifelike setting full of sound, movement, scents, and images. The spirituality room lets in natural light to a space with a beautiful wood floor surrounded by natural plants and a speaker system that plays sounds of nature.
An interdisciplinary approach, combining traditional and integrative medicine, contributes to NICoE’s 99% satisfaction rate, with more than 600 patients from all different services having completed their four-week program. There is no one-size-fits-all approach to healing, and the interdisciplinary makeup of the clinical team enables patients to pursue various treatment options. Providers can collaborate regularly and have cutting edge equipment at their disposal.
Patients usually bring a non-medical attendant, often a spouse or parent. Children also are welcome at NICoE. A private family room with frosted glass includes a children’s play area, and a playground is located behind the facility.
NICoE also focuses on research to help ensure long-term treatment success. There has been discussion of opening their doors to a wider range of Warfighter patients (treating more conditions) and opening more NICoE satellite centers. Referred to as Intrepid Spirits, such centers are open already at Fort Belvoir and Camp Lejeune. The Intrepid Spirit at Fort Campbell will open this summer, and ground was broken recently for one at Fort Bragg. Other bases that may receive an Intrepid Spirit include Forts Hood, Bliss, and Carson, along with Joint Base Lewis-McCord and Camp Pendleton.