During the March National Brain Injury Awareness month observance, the importance of Traumatic Brain Injury education, diagnosis and treatment is being emphasized by Lt. Gen. Eric Schoomaker, Surgeon General/commander, U. S. Army Medical Command, and Brig. Gen. Donald Bradshaw, commander, Southeast Regional Medical Command and Dwight D. Eisenhower Army Medical Center.

Traumatic brain injury is known as "the invisible injury" since many times the damage is not as readily apparent as many other types of physical injuries. A traumatic brain injury results from a no degenerative, noncongenital insult to the brain from an external mechanical force such as a sudden blow to the head or an improvised explosive device blast, which causes the brain to violently collide with the inside of the skull.

In combat zones, shock wave blasts from improvised explosive devices, rocket propelled grenades, and land mines are a leading cause of traumatic brain injury for our active duty military personnel. In other instances, an object, such as a bullet, may penetrate brain tissue and cause significant injury. In the civilian world, a traumatic brain injury can result from a fall, an assault, a car accident or other incidents in which a blow to the head has occurred. These events destroy nerve cells and their connections throughout the brain, which damages and disrupts normal brain function possibly leading to permanent or temporary impairments.

Traumatic brain injuries can be diagnosed as mild, moderate or severe. Other symptoms of traumatic brain injury may include seizures, fatigue, headaches, and endocrine dysfunction.

The human brain controls physical, behavioral and cognitive functions. A TBI may result in impairments to the following: 1) cognition, including concentration or attention issues, memory loss, learning problems, difficulties with judgment, planning, or reasoning, 2) physical/motor skills such as balance and normal ambulation, 3) sensory deficits including vision, hearing and sense of smell, and 4) psychosocial/behavioral issues including emotional disturbances, depression, anxiety, impulsiveness, aggression, stress disorders, and thoughts of suicide

No two brains are alike and therefore, no two brain injuries are alike. The same force applied to the brains of different individuals will result in different injury severities. Impairments caused by traumatic brain injury are heterogeneous and not predictable. Because of this factor, traumatic brain injury is unlike other medical diagnoses and some symptoms or impairments may emerge soon after the injury while others manifest after weeks or months.

Maximum recovery and long term health maintenance for traumatic brain injury patients can only be achieved through a coordinated, comprehensive, multidisciplinary neurotrauma management system providing immediate treatment, rehabilitation and supportive services. Treatment by a multidisciplinary team including a physician, neuropsychologist, clinical psychologist, occupational therapist, physical therapist, speech language pathologist, recreational therapist, counselor, and case manager will result in maximizing recovery. Additional input from a neurologist and psychiatrist may be necessary.

Significant efforts are being made by the U.S. Army to ensure that its service members are screened and receive the appropriate treatment for their injuries. At DDEAMC, Bradshaw has been actively involved on a national level to include serving as the Chair of the Army Medical Department Task Force for Traumatic Brain Injury in order to ensure that our Soldiers receive the best treatment.

"Our TBI clinic is part of the Neuroscience and Rehabilitation Center, said Dr. John Rigg, MD, Traumatic Brain Injury Program director. They treat those who have mild TBIs secondary to concussion injuries typically sustained as a result of exposure to an IED blast."

"A characteristic mild TBI patient/post-concussive patient will present with significant headaches, short term memory loss, insomnia, and mood problems, continued Rigg. They will undergo an initial evaluation and then be placed into a multidisciplinary program that may include a neuropsychological evaluation, treatment by a neurologist specializing in headache management, cognitive therapy provided by an occupational therapist or speech language pathologist, counseling, and recreational therapy."

Psychiatric services are available from Eisenhower Behavioral Health and the TBI team will acquire their own dedicated Psychiatrist this month, according to Rigg. Other medical services such as Endocrinology and the Sleep Clinic are also available as determined by the extent of the patient's injury.

Sources: U. S. Army Medical Department and Brain Injury Association of America