Bringing awareness to traumatic brain injury in veterans

November 11th is Veterans Day – a time to honor those who serve in our nation’s military. This year, we’re bringing awareness to a major issue faced by many returning veterans – Traumatic Brain Injury, or TBI.

The conflicts in Iraq and Afghanistan have resulted in increased numbers of veterans who have experienced traumatic brain injuries. The statistics are staggering – more than 410,000 vets have been diagnosed with TBI since 2001. Research on the topic has shown that there are differences between the way that brain injury is experienced by those in the military vs. those in civilian life. This article will explore those differences, and provide suggestions to help family members care for veterans with head injury.

The facts about head injury in combat are shocking

The impacts of TBI are felt within each branch of the service but are most likely to come from a blast or explosion, especially from improvised explosive devices (IEDs). The average age at the time of injury in the military is 26 years old, and 38% of those who experienced injury in combat, have experienced an astounding 2 or more head injuries.

According to Department of Defense collected statistics, the immediate results of head injury in the military can range from loss of consciousness (45%) to skull fracture (4%). Reported longer-term results include physical issues (headaches, sleep disturbances, dizziness, balance problems, nausea/vomiting and fatigue), cognitive issues (concentration problems, gaps in memory, attention problems, slowed thinking and difficulty finding words), and emotional issues (irritability, anxiety, depression and mood swings).

In the Veterans Administration, TBI has become a major focus, second only to recognition of the need for increased resources to provide health care and vocational retraining for individuals with a diagnosis of TBI, as they transition to veteran status.

Research highlights the differences between military and civilian cases of TBI

Civilian cases of TBI arise most often from motor vehicle crashes, sports injuries and falls, while military TBIs are more often associated with high-energy explosions, including blast waves, which may impact the brain in different ways, including more impact to the side or back of the head.

In addition, studies have found that the unique nature of combat situations presents potential obstacles to reporting, accessing care for, and documenting head injuries. In combat, brain and other injuries are frequently experienced as part of longer, continuous missions rather than occurring as discrete events like a motor vehicle accident, as is more often the case in civilian brain injury. Removing oneself from active combat to report with what may seem to be a mild injury or to access care may not occur. Military service members who experience TBIs are frequently sleep deprived and operating under high levels of stress, and that stress can also impede the ability to identify or recognize post-injury symptoms and can interfere with the encoding of injury details for recall later.

Due to the reasons above, service members with positive TBI screens in VA facilities are more likely than civilians to show concurrent psychiatric diagnoses. For example, almost 50% of service members with combat-related mild TBI or TBI meet criteria for post-traumatic stress disorder (PTSD), and over 30% show signs of depression and related alcohol misuse, binge drinking, or pain disorders.

What can be done to mitigate the effects of TBI in veterans

Regardless of how you or a loved one may have experienced your brain injury, there are steps you can take to help manage TBI symptoms.

During a TBI evaluation, you and your clinician will discuss what caused your injury, how to deal with its physical, cognitive, and behavioral symptoms and effects, and how these things affect your daily life. Your clinician may also recommend counseling to help you learn ways to manage the effects of TBI. 

Most clinicians agree that recovery is faster if you get enough rest and resume your responsibilities at your own pace. In addition, consider the following suggestions:

• Establish a regular daily routine.
• Check with someone you trust when making decisions.
• Recognize triggers. Keep a record to help identify situations that are more likely to make you feel worse.
• Talk to others to keep you from feeling isolated and to give friends and loved ones a chance to support you.
• Have a caregiver attend visits to your medical provider with you to help provide details about progress and challenges. Ask questions and take notes.
• Remember that your symptoms are a normal part of the recovery and that they will likely improve over time.
• For caregivers, be supportive and patient, but don’t forget to take care of yourself too –– you are doing the best you can and making a difference in your loved one’s life.

If you or your loved one’s symptoms are interfering with daily life or are not improving, be sure to talk to your medical provider. He or she may be able to suggest other options based on what you are experiencing.

Finally, Military.com suggests the following additional resources to help veterans and families manage TBI:

• Brain Injury Association of America
• Defense and Veterans Brain Injury Center
• Brainline.org
• National Institute of Neurological Disorders and Stroke, National Institutes of Health

References

• Chapman, J. and Diaz-Arrastia, R., 2014. Military traumatic brain injury: A review, Alzheimer’s and Dementia, Volume 10, Issue 3, Supplement, June 2014, Pages S97-S104.
• K.A. Schwab, and B. Ivins, et al., 2007. Screening for traumatic brain injury in troops returning from deployment in Afghanistan and Iraq: initial investigation of the usefulness of a short screening tool for traumatic brain injury, Journal Head Trauma Rehabilitation, 22 (2007), pp. 377-389
• Military.com, Traumatic Brain Injury Overview, 2017.
• Defense and Veterans Brain Injury Center (DVBIC), DoD Numbers Worldwide for TBI, 2018.