Fall 2011 - Jewish War Veterans of the United States

Treatment for Traumatic Brain InjuryBy Jacob M. Romo, Ph.D.,Department Commander, MATraumatic Brain Injury (TBI), often called thesignature wound of the Iraq and Afghanistanwars, occurs when a sudden trauma or head injurydisrupts the function of the brain. Commoncauses of TBI include damage caused by explosivedevices, falls, and vehicle or motorcycleaccidents. Most reported TBI among OperationEnduring Freedom and Operation Iraqi Freedomservice members and veterans has been tracedback to Improvised Explosive Devices, or IEDs,used extensively against Coalition Forces.Not all blows or jolts to the head result in aTBI. The severity of such an injury may rangefrom “mild” (i.e., a brief change in mental statusor consciousness) to “severe”, (i.e., an extendedperiod of unconsciousness or amnesia after theinjury). Each of the three forms of TraumaticBrain Injury display different symptoms.Mild TBI, otherwise known as concussion,is more difficult to diagnose both in civilian lifeand on the military battlefield. With mild TBIpatients, full recovery can be within minutes tohours; small percentages have symptoms thatmay persist months or years.Moderate TBI patients have the most variabilityin the clinical presentation picture. Thereis usually a loss of consciousness, from an hourto a day; there can be confusion for days toweeks; and mental or physical deficits that canlast months or be permanent. The vast majorityof these service members are identified andevaluated at theater-level medical facilities, andare evacuated back to the United States for furtherevaluation.Severe TBI usually results from a significantclosed head injury, as in an automobileaccident or most open or penetrating injuries,where there may be considerable residual deficitsof brain function. Depending on the injury,a severe TBI could impact speech, sensory, visionand cause cognitive deficits including difficultieswith attention, memory, concentration,and impulsiveness. There is an aggressive initialtreatment program in the theater with neurosurgicalexpertise.Initial focus of treating a TBI is to stabilizethe injured person in order to minimize secondarycomplications. After individuals with TBIhave been stabilized, the treatment plan generallyinvolves rehabilitation efforts to teachpatients how to cope with their specific injuryrelatedsymptoms.After a TBI, the body often begins a remarkablerepair process. Unlike the skin, the braindoes not heal by forming new cells. Instead, existingcells will change to make up for the lostcells. In most cases, brain swelling subsideswithin a few weeks and the pressure inside theskull stabilizes. This is the time when recoveryis most rapid. The brain’s chemical balancereturns to normal within several months. Andwhile the damaged connections between nervecells will not grow back, research has shownthat some new connections may develop betweenthese cells over an extended period oftime.Rehabilitation services are needed by individualswith TBI who continue to have medicaland functional problems following injury andinitial treatment. The need for rehabilitationcrosses all age groups, but the type, intensity,and goals differ from person to person.Early intervention is important to speedrecovery and maximize functional outcome.Rehabilitation is begun as soon as individualswith TBI are medically stable. The degreeand rate of recovery are difficult to accuratelypredict because TBI is experienced differentlyby each person depending upon several uniquecharacteristics, such as the type of injury andan individual’s personal health and resilience.Where rehabilitation takes place depends on theperson’s needs. Individuals with severe TBI’smay need inpatient care at a Military TreatmentFacility (MTF), a VA Polytrauma hospital, or acivilian rehabilitation center. Individuals with amild TBI (mTBI)/concussion may be treated atoutpatient facilities.Rehabilitation is most commonly providedby a team approach that may include a numberof different therapies such as physical therapy,occupational therapy, speech therapy, nursingcare, psychologists, social workers/case managersand other health care practitioners. Membersof the team create a program based on each individual’sneeds. For example:• Occupational therapy is intended toenhance a person’s ability to do activitiesof daily living (ADLs), job-relatedtasks, improve fine motor coordinationand maximize participation in leisureactivities.• Physical therapy involves exercising andmoving the body to preserve, enhanceor restore movement and impaired functionutilizing therapeutic exercises, assistivedevices and individual educationand training.• Speech and Cognitive therapies workwith individuals with TBI who mayhave problems with attention and concentration,learning, problem solving,memory, and speech. The goals are toretrain the brain.• Many other therapies may be used in TBIrehabilitation such as Vestibular (balance)therapy, Art therapy, TherapeuticRecreation, and Driver Rehabilitation.• Cognitive Rehabilitation Therapyshows some promise in helping patientswith traumatic brain injury regain lostbrain function, but there is not enoughevidence to decide which types of thesetherapies work and which do not.A report released by an Institute of MedicineCommittee concluded there is “limited evidence”that some types of cognitive therapy– exercises and strategies taught to patients torecover brain function – work in the long term,especially therapies addressing deficits in memory,attention and communications.Currently there are over 220,000 servicemembers diagnosed with mild and severe braininjuries since 2001.Traumatic Brain Injury Resources• America’s Heroes at Work A US Departmentof Labor project that addresses the employmentchallenges of veterans with TBI and PTSD.www.americasheroesatwork.gov• Defense Centers of Excellence for PsychologicalHealth and Traumatic Brain Injury Providesinformation and resources including a 24 houroutreach line at 1-866-966-1020.www.dcoe.health.mil/24-7help.aspx• Vet Success Contains information on the servicesthe Vocational Rehabilitation and Employment(VRE) program provides to veterans with serviceconnecteddisabilities.www.vetsuccess.gov• Wounded Warrior Project Provides programsand services to help severely injured servicemembers. www.woundedwarriorproject.org10 The Jewish Veteran Fall • 2011 www.jwv.org