Traumatic Brain Injury is a big deal. It has affected 266,810 service members between 2000 and 2010 alone. When you think about this injury, it’s easy to focus on those types of TBI associated with major trauma or death. In all actuality – according to the Defense and Veterans Brain Injury Center – penetrating, severe, and even moderate TBI only represent 11% of the TBI cases among service members. The largest incidence is those classified as mild (82%). 6.8% of TBI is not classifiable.
While the more intense forms of TBI are obvious and require off-site medical treatment, mild TBI is often ignored and frequently goes under-reported or untreated. Just because this type of injury is classified as mild and does not always register as worthy of a hospital visit doesn’t mean it isn’t still serious. Minor symptoms can linger unbeknownst to the sufferer, thus having adverse effects on his or her work performance and unit readiness. Thankfully, DVBIC and the Defense Department are on the case.
Katherine Helmick, the DVBIC’s acting director, discussed the hurdles in detecting mild TBI, it’s often ignored symptoms and its effects on unit readiness at the Maryland Nurses’ Association 2013 Neuroscience Nursing Symposium on June 24. Her presentation’s silver lining is that both DVBIC and the DoD are aware of this issue and are taking steps to standardize diagnoses and treatment.
According to the DoD, TBI is defined as traumatically-induced structural injury or physiological disruption of brain function, as a result of external force to the head. Symptoms include new or worsening of at least one of the following clinical signs:
- loss of consciousness
- loss of memory immediately before or after injury
- alteration in mental status (e.g. confusion, disorientation, slow thinking)
- neurological deficits
- intracranial lesions
Drilling down to mild TBI, the symptoms – according to Ms. Helmick – range from the obvious:
- dizziness/balance problems
- ringing in ears
- slowed thinking
- difficulty finding words
To the less obvious:
- memory problems
- mood swings
The less obvious symptoms are often overlooked because they are not necessarily thought to be connected with mild TBI. It’s much easier to pass off fatigue or moodiness as the result of a bad night’s sleep than the after effect of a bump on the head that happened days or weeks ago.
The good news is in all of this is that mild TBI is easily treated. Often, rest is all the body needs to correct the injury. However, if left untreated the symptoms have serious impacts on service member performance and unit readiness. They can lead to poor marksmanship, decreased situational awareness and difficulty multitasking for the affected service member.
So what is DVBIC doing to address mild TBI?
Until now, according to Ms. Helmick, diagnosis for mild TBI depended on the service member or their commanding officer recognizing and reporting symptoms. This is going to change. In order to ensure that all mild TBI cases are caught and caught early, DVBIC is shifting from a symptom dependent, self-reporting system to one that treats all service members that have been part of a possible TBI-inducing event.
Ms. Helmick explained that exposure to the following events mandates prompt command and medical concussion evaluation with a 24-hour rest period:
- riding in a vehicle associated with a blast event
- riding in a vehicle that sustains a collision or rollover
- being within 50 meters of a blast (inside or outside)
- sustaining a direct blow to the head
- experiencing multiple blasts exposures
If a service member has experienced any of the above events, his or her commander will be required to direct a medical evaluation.
Evaluation techniques have also undergone shift in recent years. The current algorithms were updated in 2012 and now include a three step evaluation process . This process assesses the physical and mental state of a possible TBI-sufferer both immediately after the incident and after a prolonged period of time to determine if immediate and/or latent TBI symptoms are present. The overall intent of these evaluations is to assist commanders with return to duty decisions and provide the best possible support to service members with TBI.
If you are looking for resources on TBI, the DVBIC has you covered. They have brain injury centers located around the United States. They provide mobile apps – available on both iTunes and Android markets – that provide clinical guidance on your mobile devices and TBI-related pocket guides. The Defense Centers of Excellence also offers a wealth of knowledge and educational resources dedicated to TBI and its treatment.