The invisible wounds of war: traumatic brain injury and veterans

With the approach of Veterans Day this year, it’s important to think of our military personnel – not only for the service they’ve provided but also for the medical care they may still need – especially if they have incurred injuries while deployed overseas. One such injury is traumatic brain injury (TBI) which occurs from a violent hit to the head – often caused by vehicle crashes, falls, and explosions, or other military-related impacts. More than 430,000 U.S. service members were diagnosed with a TBI from 2000 to 2021, with 15% of those classified as ‘severe’. In this blog, we’ll explain TBI, how it affects our veterans, and what types of treatment are available.

What is traumatic brain injury (TBI)?

Traumatic Brain Injury can occur after any significant, physical damage to the head. This can come in the form of:

• an explosion
• objects being knocked into the head
• the impact of slamming a head into an object
• a foreign body penetrating the brain.

When these kinds of head injuries occur, the brain is violently moved back and forth within the skull causing damage to brain tissue. Common symptoms identifying traumatic brain injury at time of injury include:

• Lost or decreased level of consciousness
• Loss of memory for events immediately before or after the injury
• Altered mental state at the time of injury (such as being confused, dazed, disoriented, etc.)

Over time, and especially if a head injury is undiagnosed or untreated, the language and cognitive effects of brain injury on veterans can be significant. The American Speech-Language and Hearing Association summarizes the long-lasting symptoms of TBI as:

• Physical: headache, nausea, vomiting, dizziness, blurred vision, sleep disturbance, weakness, paresis/plegia, sensory loss, spasticity, aphasia, dysphagia, dysarthria, apraxia, balance disorders, disorders of coordination, or seizure disorder.
• Cognitive: problems with attention, concentration, memory, speed of processing, new learning, planning, reasoning, judgment, executive control, self-awareness, language, or abstract thinking.
• Behavioral/emotional: depression, anxiety, agitation, irritability, impulsivity, or aggression.

TBI is often called an “invisible” injury – especially in veterans

A big issue with TBI is that not everyone realizes how badly they have been hurt until symptoms become chronic and impact their daily lives. TBI can ‘hide in plain sight’ – those with traumatic brain injuries may seem to look, walk, talk and act “normally”.

With military veterans, traumatic brain injury may also be accompanied and complicated by PTSD (post-traumatic stress disorder) and depression, making it difficult to tease apart which symptoms are secondary to TBI and which are secondary to PTSD. 

Additionally, the symptoms for these three disorders often overlap. In fact, in a study published in the New England Journal of Medicine, Dr. Hoge and colleagues surveyed 2,525 US Army infantry soldiers returning from Iraq. They found that mild TBI in soldiers returning was strongly associated with PTSD and physical and mental health problems for 3 to 4 months after returning home. The group also found that PTSD and depression play a key role in the association between mild TBI and physical health problems.

Speech, language and cognitive therapy can help

What can be done? We owe our armed forces the best of care and support, especially when they have returned home as wounded warriors. Speech-Language Pathologists, and apps like Constant Therapy, can assist in the improvement of cognitive and language skills affected by TBI. Clinicians and tools like our app can help with reading comprehension, attention, focus, speech, and many other everyday skills. Many VA clinics around the country treat veterans for the effects of TBI using tools like Constant Therapy. If you are a veteran or a clinician working with vets, reach out to us to get started with Constant Therapy at your VA clinic. Treatment for brain injury has come a long way and can be life-changing for our vets suffering from the long-term effects of TBI.