TBI Awareness

Former news anchor Bob Woodruff was injured by an improvised explosive device (IED) in Iraq while embedded with troops. Miraculously, he lived to tell the tale during prime time on ABC. He, like thousands of others, suffered injuries to the brain, the signature injury of the war in Iraq and Afghanistan. Woodruff looks well, but he will suffer lifelong challenges with sight, speech, and thinking.

Brain injured soldiers and thousands of others who have suffered traumatic brain injuries (TBI) as a result of falls, motor vehicle accidents, and assaults applauded Woodruff's report. They could identify with the loss of sensation, slurred speech, and interrupted thought processes. They were elated that long overdue recognition was being given to the complicated and frustrating disabilities that result from this unseen injury.

Woodruff discovered what TBI sufferers have known for too long: that diffuse TBI symptoms are often misdiagnosed as mental illness, nervous disorders, and ill-defined conditions of the muscular-skeletal system.

"We are very excited to see him talking frankly about brain injury," said Lorraine Justice, a Brain Injury Association of Virginia (BIAV) regional resource coordinator. "We know there is a great need for understanding symptoms, teaching coping skills, and rehabilitating the brain injured."

Brain injuries can be closed or open. In a closed head injury, the skull is not broken. For example, a football player who receives a blow to the head may experience brain damage even though the skull is not damaged. An open injury occurs when the skull is broken, as was the case with Woodruff. Shrapnel or a bullet wound causes damage to the skull as well as to the brain. In either case, those with mild TBI may have mood and various cognitive difficulties and those with moderate to severe brain injury will have multiple deficiencies.

The exceedingly complex brain is an organ that governs the senses, speech, and movement. Recovery relies on the brain's plasticity-the ability for other areas of the brain to take over the functions of the damaged areas. Progress requires hard work from the patient and a rehabilitation team to help strengthen remaining abilities.

According to the Centers for Disease Control and Prevention, each year, at least 1.4 million Americans sustain a traumatic brain injury. Since the Bob Woodruff story broke, it has been estimated that 10 percent of the soldiers deployed to Iraq and Afghanistan could have some form of TBI. Sadly, many do not receive suitable care. They do not understand what is wrong with them.

"My son was so frustrated and people would think he wasn't trying," said Patricia Haldeman of Williamsburg, Virginia. Her son, who was hit hard by a swing when he was a child, committed suicide as a young adult. "I knew that he wasn't the same person after the accident, but I couldn't convince doctors and didn't know how to help him." He would have behavioral outbursts driven by agitation, a common side effect of brain injury. It was only in the last few years of his life that she was able to find a doctor who believed his symptoms indicated a mild to moderate TBI.

In Haldeman's case, the wound was a closed head injury that was unacknowledged. In the case of open head injuries like Woodruff's, individuals are surviving because of access to quick and high-quality care that keeps them living after injuries that would have resulted in loss of life several years ago. In both cases, physical and cognitive impairments interfere with the ability to function effectively in school and at work. Cognitive impairments, or thinking problems, interfere with safety, productivity, independence and interpersonal relationships. The brain injured may have drinking problems as result of finding alcohol to be the only means to soothe irritation, burning sensations, and ringing ears.

Neuropsychologist can test brain-injured patients to determine cognitive deficits. Therapists who are skilled in cognitive rehabilitation can help patients recognize deficits and teach strengthening skills and coping mechanisms. Systematically applied medical and therapeutic services reduce dysfunction and assist individuals in compensating for cognitive function in their daily living.

"The BIAV works to coordinate these services in the brain-injured community," said Justice. "We believe that cognitive rehabilitation can help people regain their independence."

Unfortunately, many insurance companies deny coverage claims and public health agencies limit the scope, duration and timing of treatment. "The brain-injured and their families and caregivers lack access to important treatment," continued Justice. The BIAV also helps individuals find free or low-cost services and alternative means to afford services.

Services for the brain injured also include therapy to help individuals accept that they will have to deal with their injury for a lifetime. Meditation is sometimes taught to those who need help relieving anger. The brain injured are helped by involvement in jobs that are comfortable and work that allows them to feel useful.

"Society must understand that brain-injury is real," said Justice. "If the injury can't be seen, that doesn't mean that it is not there."

Visit Bob Woodruff's Web site (http://www.bobwoodrufffamilyfund.org) to learn more about the fund established to assist servicemen and women and their families affected by the war in Iraq and Afghanistan.

In Virginia, visit the Community Futures Web site (http://www.communityfuturesva.org) to learn about their successful Clubhouse concept for brain injury rehabilitation.