Traumatic Brain Injury and the Military

Traumatic brain injury, or TBI, has been called "the signature wound of the Iraq war". With the introduction of improvised explosive devices as a tool of war, American troops are being exposed to many more blasts and the resultant injuries than in any previous war. While serious TBI has been a medical topic for many years, mild TBI is only now being seen as a concern.

TBI is not just an injury suffered by soldiers in war. Both civilian and military medical researchers are looking in to the causes and effects of this injury. The CDC estimates that 1.7 million Americans suffer a traumatic brain injury annually.

In an article in the New England Journal of Medicine, January 31, 2008, a study concludes:

"Mild traumatic brain injury (i.e., concussion) occurring among soldiers deployed in Iraq is strongly associated with PTSD and physical health problems 3 to 4 months after the soldiers return home. PTSD and depression are important mediators of the relationship between mild traumatic brain injury and physical health problems."

The United States military has created a Defense Center where TBI can be studied. Kathy Helmick, Interim Senior Executive Director, Traumatic Brain Injury, Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, spoke with me and other bloggers recently about the activities at the Center.

One of the areas she highlighted was the working relationship between the Center and the National Football League. The Center is an ad-hoc member of the NFL's committee on mild traumatic brain injury. Eagles' quarterback Ron Jaworski suffered more than thirty concussions in his career and Cowboys' quarterback Roger Staubach was forced to retire after suffering over 20, according to Sports Illustrated and CNN. The NFL takes TBI seriously.

Helmick addressed the differences that are being discovered in the mild TBI's that troops suffer versus a football player. Military TBI's tend to be caused by a blast or blasts. New imaging techniques show inflammation of the brain after a blast injury that does not appear with a contact injury, like a football tackle.

Blasts introduce overpressure as a factor in the injury. How that affects the injured soldier is one of the areas the Center is exploring, according to Helmick.

Another area where a difference is being found is in the body chemistry of the injured. The nerve chemistry in a running back about to be tackled is different from a soldier in combat. Helmick told us that it is not clear why those differences exist or how they affect the potential injury.

The Center and the military are experimenting with a variety of new treatments for TBI. KTRK in Houston reported on a VA Medical Center using botox to relieve the muscle spasms caused by TBI. Marines at Camp Pendleton in California are being treating with hyperbaric oxygen as described in a North Country Times article.

Helmick told us that mild TBI is a fully recoverable injury, with the keys to recovery being early detection and treatment. The military is changing its protocols in the field from a system where troops are medically assessed if they report symptoms to one where entire units are assessed if they were exposed to an action that could cause TBI, whether or not individuals have symptoms at that time.