“Traumatic Brain Injury and the Military”

"Traumatic brain injury (TBI) is becoming a common wound of modern warfare. It has even been coined the “signature wound” of the War on Terror. While TBI is becoming more prevalent in wartime activity, many service men and women continue to go undiagnosed. Institutions, like the US Department of Veterans Affairs, are working to make quick and accurate diagnoses in order to prescribe appropriate and effective treatment.

TBI is caused by forced trauma to the head, either by being shaken or hit. The severity of a TBI varies from case to case, but symptoms range from mild concussions to a debilitating state. The majority of TBI’s acquired by military personnel are classified as mild traumatic brain injuries (MTBI). Initial symptoms of MTBI consist of loss of consciousness, disorientation, loss of memory, headache, and temporary loss of hearing and vision. They are often partnered with anxiety, irritability, difficulties processing information, limited concentration amongst other problems experienced down the road. While MTBI is most common amongst the men and women of the armed forces, more severe cases of TBI are happening much more frequently and often require the victim to attended specialty rehabilitative nursing centers, like CareMeridian.

The most common cause of a TBI in the military is due to blasts. There are three degrees of blast injuries where a TBI is common; Primary (due to blast itself), Secondary (due to objects being propelled by a blast) and Tertiary (due to a collision with a third party object). According to the Veterans Health Initiative, active male members of the military from the ages 18-24 are hospitalized with a TBI at a rate of 231 per 100,000 and females 150 per 100,000. Based on military force projections this would mean that 4,141 military personnel are hospitalized on average each year with a TBI, and these numbers often rise during wartimes. "

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9 Responses to “Traumatic Brain Injury and the Military”

  1. alnval says:

    Col. Lang:
    Glad to see your post. TBI needs as much public visibility as it can get.

  2. Eliot says:

    TBI is awful injury, the healing is slow and recoveries are all over the place.
    – You can’t retrain the mind. Flash cards and memory exercises do nothing to aid a patient’s recovery.
    – Concentration is repairable though and that should be one of the focuses of any TBI rehabilitation program.
    – Ultimately, the best options are coping strategies. Memory is usually the first thing to go and some of the most seriously injured are left with only the most limited recall. You can side step this by training patients physical memory. Have them write down their schedule in a notebook and habituate it. Make sure they refer to it a dozen times a day and then they start to become self sufficient.
    TBI is more than cognitive impairment though. Depending on how the neurons shear in the brain anything and everything can go out the door. Personality change is not uncommon. A man without a temper can become violent and prone to angry outbursts. The converse can be true as well though.
    It’s a strange, awful, injury.

  3. curious says:

    Read it somewhere that the new helmet is good at stopping bullet, but transfer too much blast shockwave into cranium. Basically, poor little brain in the middle is shaken like a bowl of jello when hit with shockwave.
    I guess somebody has to go back to the drawing board and tweak that helmet.
    Maybe should look around for lesson from nature. There got to be an animal with cranium design that can sustain heavy blast.

  4. PeterHug says:

    That’s not an easy thing to do – there’s a nontrivial amount of kinetic energy in the bullet, and it’s got to go somewhere…
    I wonder if there are two components to the current epidemic of TBI being seen: first, in previous conflicts, many of these people would have been dead instead of injured (thanks to improved body armor as well as a better medical response); and second, this may also be something that we’re getting better at diagnosing, and these injuries previously would just have been ignored.
    Still, you can’t address a problem until you see it – and now that this is recognized I expect there to be rapid progress in understanding, and then developing therapies, for the TBI.

  5. Brian Hart says:

    Col., I think the article referenced may understate the problem. Last time I checked which was about a year ago 2/3rd of those with wounds at Walter Reed also had TBI. As IEDs were the main reason they were at Walter Reed in the first place, it is not hard to understand the correlation. It also didn’t help that the marine corp had skimped on helmet padding and the army allowed a key native american subcontactor to skimp on helmet kevlar content. Also recent studies suggest the use of mouth guards may prevent concussions from blasts and jarring in a vehicle not unlike boxing and professional football injuries. Lest people snicker at the suggestion it should be remembered that in 1914 it was thought that helmets were unnecessary in trench warfare because they were uncomfortable and reduced perception – but then WWI shrapnel and Iraq war IEDs have a way of influencing the discussion. Look to professional sports, especially NFL players unions, for major advances in equipment. It was no coincidence that WWII tanker helmets looked a lot like football gear.

  6. different clue says:

    PeterHug, I wonder whether some of these injuries aren’t due to the blast-front pressure-wave from the IED explosion hitting the head AS a pressure wave; quite apart from any bullet or shrapnel or not. This makes me wonder whether the helmet wouldn’t have to have some kind of whole-helmet internal squeezable-material layer which could absorb some of the moving wave-front energy within itself withIN the helmet and turn some of that motion
    into heat-of-friction within the layer.
    Then too, perhaps the vehicles which soldiers ride
    in should have such a pressure-wave absorption layer between its layers of armor. A vehicle could probably be better pressure-wave padded than a helmet could.
    Curious, in nature the woodpecker is subjecting its cranium to tens of thousands of jackhammer shocks per day as it spends it life jackhammering wood.
    Perhaps the woodpecker’s whole head and neck system could be studied for force absorption and dispersion.

  7. Amir says:

    As a person interested in this subject because of professional and personal reasons, I would like to post the following link as a primary source of reliable information on the subject of Traumatic Brain Injury (TBI):

  8. In the advancement of war comes the advancement of injuries. In the second world war more people were shot than any other injury, In todays wars the need for gunfight is decreasing whilst the enemy uses IEDs and rockets, once the military overcomes this issue they are almost exclusively left with Post-Traumatic disorders and mental anguish, however no matter how advanced war gets, this will always be a problem as you cant take away human nature.

  9. there will always be TBI in any war, but if the MOD can take measures to protect their soldiers from this- such as helmets and adjustments to deployment- then they really should do everything they can.

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