veterans and TBI

The Primary Causes of Traumatic Brain Injury (TBI) are:

• Blasts (IED's, RPG's, Land Mines)
• Penetrating Injuries (Wounds to the head neck and face)
• Acceleration / Deceleration (Vehicular)
• Impact (Falls / Assaults)

What is Traumatic Brain Injury(TBI) and Post-Concussive Syndrome?

A traumatic brain injury occurs when a person's brain is physically injured, usually by a sudden force. With military members, this is often the result of a concussive blast or explosion. It can also be caused by falls, motor vehicle accidents, assaults, or any sudden blow to the head. Because the damage is internal, there may be no visible head wound. Most mild injuries to the brain improve to baseline within 3 months of injury, but in some individuals, there can be lasting impairments which should be evaluated. A traumatic brain injury event resulting in lasting impairment(s) is referred to as “Post-concussive Syndrome”.

Are There Different Levels of TBI?

Yes, there is a wide range in severity depending on the circumstances of the injury. Most people who experience a TBI can recover completely without medical intervention. On the other end of the scale, some people will have permanent and even total disability. Any brain injury, whether mild, moderate, or severe, can temporarily or permanently diminish a person's physical abilities, impair cognitive skills, and interfere with emotional and behavioral well being. Because of this, anyone who feels there is a possibility they may have had a TBI with lasting impairments should be seen by a doctor.

What are the Symptoms of TBI?

Every brain injury is unique and symptoms can vary widely. Damage to different parts of the brain will result in different symptoms. TBI shares symptoms with other physical and mental health conditions, such as Post Traumatic Stress Disorder, which complicates diagnosis. Below are some of the symptoms. Having some of them, however, does not necessarily mean a person has Post-Concussive Syndrome. Only a doctor can definitively identify and diagnose a TBI.

Common Symptoms Immediately After Injury

• Being Dazed, confused, or "seeing stars"
• Not remembering the injury
• Losing consciousness (being knocked out)

Common Symptoms Later On

• Persistent headache or neck pain
• Sensitivity to light and noise
• Loss of balance
• Changes in sleep patterns
• Feeling tired all the time, lacking energy
• Ringing in the ears
• Loss of sense of smell and taste
• Slowness in thinking, acting, speaking or reading
  • Symptoms that may appear to be mental health conditions
  • Sudden mood changes for little or no reason
  • Difficulty managing relationships
  • Chronic anxiety, depression, apathy
• Short term memory loss
• Getting lost or easily confused
• Having more trouble than usual with
  • Paying attention or concentrating
  • Organizing daily tasks
  • Making decisions

PTSD vs. TBI

Post-Traumatic Stress Disorder (PTSD) can occur as the result of exposure to events that involve actual or threatened death, intense fear, extreme stress or violence, or feeling helpless. You may have been exposed to these events daily. There are similarities and differences between PTSD and TBI. Common symptoms of PTSD include irritability, depression, sleep problems, feeling jumpy, difficulty concentrating, inability to recall details of the trauma, reliving the trauma, avoiding close contact with family or friends, flashbacks, and feeling detached or disconnected from emotions.

These symptoms could also be indicative of a Post-concussive Syndrome. It is not unusual for people to experience both diagnoses. The differences are often subtle. Common symptoms of a Post-Concussive Syndrome include insomnia, anxiety, mood changes, feeling like you are losing it, problems remembering or concentrating, depression, irritability, and avoiding close contact with family or friends. Certain physical symptoms may differentiate a traumatic brain injury from PTSD. If you are experiencing any of these symptoms, it is important to talk to a professional who can help you understand what is happening.

How Do I Find out if I Have had a TBI and am experiencing Post-Concussion Syndrome?

1. TBI Screening through the VA

The first step is screening to find out if you if you have experiences or symptoms that indicate you may have had an injury event causing traumatic brain injury. The screener will ask a series of ‚"Yes‚" or ‚"No‚" questions, which usually takes about 5 minutes to complete and can be done by your VAMC primary care and other clinics. There are two possible outcomes of the screening: ‚"I have not had a TBI" or ‚"I should be evaluated by a doctor to determine if I have symptoms of post-concussive syndrome‚" When you are referred to a doctor, it does not mean you have post-concussive syndrome. It only means that you are in a higher risk based on your military exposures and subsequent symptoms.

Who Should Be Screened For TBI?

Veterans should be screened for TBI if they experienced any of the following during their service:

• Close proximity to a blast or explosion (IED, RPG, Land Mine, Grenade, etc.)
• Fragment wound or bullet wound above the shoulders
• Vehicular accident or crash (including aircraft, tank, personnel carrier, etc.)
• Fall
• Assault / Blow to the head

2. Further Work up

Following your screening evaluations, your doctor may refer you to the VA Polytrauma System of Care. This program helps veterans and returning service members who have experienced injuries to the brain and other body parts, sustained in the same incident, resulting in physical, cognitive, psychological or psychosocial impairments and functional disabilities. There are Polytrauma clinics throughout the US, providing care to patients with a range of medical severity- from  acute inpatient to outpatient clinical  care.

For more on the Portland VA outpatient Polytrauma program- please see tab under Oregon VA.

For more about the Polytrauma System of Care  www.polytrauma.va.gov

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I Already Know I have a TBI, Who Can Help Me?

As you can see from above, there are a variety of programs in the state that can help you. If you have a diagnosis from a medical doctor that you have TBI, you should take advantage of whatever programs are best suited for your particular situation. Regardless of who you choose to provide care, Veterans with a TBI should make contact with the VA Polytrauma Clinic and the Brain Injury Association of Oregon. That way they will stay informed of the resources available and will have a broader support network. Because every TBI is unique, there is no one-size-fits-all approach for treatment.

The Brain Injury Association of Oregon has over 40 Brain Injury Support Groups and Veterans and their family members are encouraged to attend. We also have a Toll-free Helpline Veterans and their family members can call to get information, referral and support (800) 544-5243. Professionals are also encouraged to call us!

How Can I Learn More About TBI?

In addition to the programs mentioned above, other resources are available to learn more. Here are a few helpful links:

• Defense and Veterans Brain Injury Center
  The Defense and Veterans Brain Injury Center (DVBIC) serves active duty military, their dependents and veterans with TBI through medical care, clinical research initiatives and educational programs. They are a collaboration of the Department of Defense, the VA, and civilian partners. Their website has considerable information about TBI, to include TBI screening tools.

• BIANYS Documentary; Beyond the Invisible: Living with Brain Injury
  This 30-minute documentary focuses on three veterans who sustained a brain injury in combat during Operation Iraqi Freedom. The film is designed to educate the public, professionals, and advocates about what it means to live with a brain injury. Although the documentary portrays the challenges of brain injury in a military context, many of the struggles these veterans discuss are shared by all who experience a brain injury. Please note: The film contains explosion scenes. An edited version of the film is available by contacting the Brain Injury Association of NYS.

View the Documentary: Understanding Traumatic Brain Injury. This 29-minute video, introduced by General Colin L. Powell, USA (Ret.), offers an introduction to TBI, a health issue affecting at least 1.4 million Americans each year. It features the recovery journeys of several service personnel and their families. Please note: The film contains explosion scenes.