Brain Injury Center treats new affliction for war on terrorism

  • Published
  • By Donna Miles
  • American Forces Press Service
WASHINGTON (AFPN) --  Land mines, rocket-propelled grenades and improvised explosive devices are taking their toll on deployed U.S. troops’ bodies. What is not as easily recognizable is the damage these weapons are doing to servicemembers’ brains.

Traumatic brain injury, or TBI, is becoming an increasingly common affliction of the war on terrorism. It is affecting servicemembers with injuries ranging from mild concussions to unconsciousness or coma, said doctors at the Defense and Veterans Brain Injury Center here at Walter Reed Army Medical Center here.

Improved body armor “is doing a wonderful job of saving lives” and reducing the rate of internal injuries on the battlefield, said Dr. Louis French, a neuropsychologist at the center.

But even with Kevlar helmets, there is a critical organ this protective gear does not adequately protect: the gelatin-like brain material that can shift violently inside the skull when confronted by explosions, sudden jolts or shock waves from blasts.

This movement, which also typically occurs during vehicle accidents and falls, can stretch and tear nerve fibers or bruise the inside of the brain, said Dr. Deborah Warden, Defense and Veterans Brain Injury Center director.

“It’s like what happens when a quarterback gets sacked and sees stars, or when someone hits the windshield in a car,” she said.

Often there is no visible sign of an injury, and even magnetic resonance imagery does not pick it up. “But you see it on a microscopic level,” Dr. French said.

TBI symptoms run the gamut, from slower reaction times to severe emotional and cognitive problems. Affected servicemembers often report headaches, sensitivity to light or noise, dizziness or nausea. But many also experience the less-obvious symptoms of depression, irritability, insomnia, loss of memory or problem-solving abilities, the doctors said. In more severe cases, victims can lose their eyesight and their ability to walk and talk.

The good news, the doctors said, is that if the injury is detected and treated early, most victims can recover full brain function, or at least return to relatively normal lives.

Field hospitals are doing “a remarkable job” of offering sophisticated medical care close to the point of injury, Dr. French said, including conducting initial screenings for brain injury when possible.

Doctors at these hospitals initially focus on saving lives and evacuating patients for more advanced care if necessary, but they have become increasingly aware of the symptoms of traumatic brain injury and the value of early battlefield intervention, Dr. French said.

Often this intervention begins with simple questioning: What happened? Was there any period of time that you do not remember what happened?

Such questions help identify whether the patient has experienced a concussion or mild form of traumatic brain injury. With a short period of rest, ideally away from the front lines, these patients often recover within a few hours or days, they said.

The Walter Reed center helps identify undiagnosed cases of brain injury and treats patients with more severe cases.

Walter Reed serves as the headquarters for other centers focused specifically on treating traumatic brain injuries, all overseen by Dr. Warden. They are at Wilford Hall Medical Center at Lackland Air Force Base, Texas; Naval Medical Center San Diego; and Department of Veterans Affairs facilities in Richmond, Va.; Tampa, Fla.; Minneapolis, Minn.; and Palo Alta, Calif. A civilian re-entry program in Charlottesville, Va., is also part of the program.

At the Walter Reed brain center, doctors screen each new casualty list to determine who has been injured from explosions, vehicle accidents or falls and may have developed a brain injury. They arrange personal interviews with high-risk patients and prescribe treatments that frequently include physical and psychological therapy to heal the brain.

Research shows it is also effective to treat the symptoms, such as prescribing drugs to help affected servicemembers deal with insomnia or depression, Dr. Warden said.

While medication and other therapies help, there is no “magic bullet” that cures brain injuries, she said.

Patients with severe cases undergo a long healing process, sometimes requiring speech and occupational therapy to relearn basic skills. Some may find that while they are able to return to work, they can no longer do the same job, Dr. Warden said.

Even patients who appear to recover fully may experience some long-term symptoms, the doctors said. At work, they may find they are not as capable of taking on extra projects or demands. Some find that the reserve they once drew on to meet these challenges is no longer there, Dr. Warden said.

This spills over to their personal lives as well, she said. People who have experienced brain injuries may take longer to do simple things such as coming up with the correct change in the checkout line at the grocery store.

“Many people do well, but they may find that they need to make modifications in their lives,” she said. “(Traumatic brain injury) can be a life-altering experience.”

Navy Chief Petty Officer James Miner knows firsthand just how life-altering brain injuries can be. A severe sandstorm blew him off a Conex container in Iraq in June 2003. The fall put him into a coma. When he gained consciousness, he could no longer walk or talk, had lost much of his vision and no longer knew Phon Miner, his wife of 12 years.

He has since made strong progress, but said it was not easy or fast.

“It took me a long time on parallel bars to be able to walk again,” Chief Petty Officer Miner said. Recently, he skied for the first time since his injury, wearing a “blind skier” bib and getting coached by the sighted instructor at his side during the 19th National Disabled Veterans Winter Sports Clinic at Snowmass Village, Colo.

The gratification of treating servicemembers like him “is enormous,” Dr. Warden said, and their cases are providing insights that will help future victims of traumatic brain injuries -- both military and civilian.

“It feels like a very important thing that we’re doing,” Dr. French said. “These people have made tremendous sacrifices and deserve the best care. Ensuring that they get what they need means a lot. It’s a remarkable feeling.”