March is Brain Injury Awareness Month, and I wanted to share some facts that I have learned as it relates to military service. As many of us know, TBI (Traumatic Brain Injury) and PTSD (Post-Traumatic Stress Disorder) are the “signature injuries” of the wars in Afghanistan and Iraq. However, because they are also invisible, they are the least understood, it is easy for the average person to write a soldier off as being “fine” even if they are suffering from one or both wounds. Because of this fact, these injuries present a unique challenge.
For an interesting video overview to TBI, click this link: Survive, Thrive, and Alive: Understanding TBI.
There are 3 types of TBI: 1) Penetrating Brain Injury, which means an object (such as shrapnel) penetrates the skull; 2) Closed Brain Injury, which can be mild, moderate, or severe. It can also be focal or generalized and characterized by the severity of symptoms and the length of time the soldier was unconscious. This type can be caused from events such as a explosion or blast. 3) Diffuse Axonal Brain Injury, which often happens during whip-lash caused by a car accident. This type of brain injury twists or tears axons and leads to generalized swelling. (Source: “Survive, Thrive, and Alive” video)
TBIs cause a range of cognitive and physical problems, such as difficulty with memory, emotions, and basic motor functions. Problems with comprehension and understanding can occur, as well as personality change, headaches, dizziness, fatigue, concentration problems, and irritability. With a closed brain injury, there is a distinction between one classified as “mild” and those classified as “moderate” or “severe.” Mild injuries are referred to as mTBIs, also known as a concussion and usually brain scans look normal after this type of injury. Another helpful resource that I found is the book by Charles W. Hoge, MD (Ret. U.S. Army Colonel), Once a Warrior, Always a Warrior: Navigating the Transition from Combat to Home. On page 38 he writes: “Although concussions can occasionally lead to long-term health effects–such as headaches, irritability, sleep disturbance, memory problems, or fatigue–most warriors who experience concussions recover quickly. Concussions/mTBIs are clearly not the same as moderate and severe TBIs…”
Colonel Hoge also writes (p. 43) that “Concussion/mTBI is not the same thing as PTSD, and having an either/or perspective isn’t helpful. Concussion is the injury itself. PTSD…refers to a specific set of reactions or symptoms after trauma…persisting for at least one month, and usually much longer…If you experienced a concussion during deployment, you may be at higher risk for PTSD because of the context in which the concussion occurred. If you were knocked out or temporarily disoriented from a blast on the battlefield, this was a very close call on your life…It’s understandable to experience PTSD symptoms after these types of experiences.”
It is important to get screened for TBI as soon as possible after a traumatic event, because the more time that goes by, the harder it will be to give an official diagnosis. The brain has an amazing ability to heal itself through “plasticity,” but since some mTBI symptoms (such as headaches, anger, and sleep troubles) overlap with other causes (like PTSD or environmental factors) it’s important to see a doctor right away. The military has gotten better at testing servicemembers right away in the war zone and this is greatly helping with more effective treatment. However, soldiers still don’t want to complain about being wounded and want to keep pushing on and performing their duties. Warriors are trained to be strong and resilient, and admitting you have a “problem” is still often perceived as a sign of weakness. Spouses are often the first to notice that there is something amiss, especially with changes in personality or irritability. So since loved ones play a crucial role in helping our warriors heal, it is important for us to be educated, aware, and compassionate.
OnceaWarrior.com – More info about Once a Warrior, Always a Warrior. I just got done reading this for the second time and there is so much valuable information in here!
U.S. Army Ready and Resilient – a new site run by the Army
After the War Zone: A Practical Guide for Returning Troops and Their Families by Matthew Friedman and Laurie Sloane (both Ph.D.) – This is another book I read before The Warrior returned (and also shared with his mom) and I found it to be helpful as well.