Caring for TBI patients
June 27, 2008
They walk, talk and stand tall in uniform like other Soldiers at Fort Bragg, N.C., who wear the immediately recognizable combat patches so commonly seen at the post that's home to XVIIIth Airborne Corps and the 82nd Airborne Division, among other elite units. Outwardly, people wouldn't notice their injuries.
But for most Soldiers being treated for mild-to-moderate traumatic brain injury, or mTBI, short-term memory failure means forgetting something someone said 15 minutes earlier or getting lost on the way to a nearby store are common signs of mTBI.
"We screen every single soldier who comes back from theater," said Lt. Col. Benjamin E. Solomon, a medical doctor who heads the Traumatic Brain Injury and Neuro-Rehab Center at the post's Womack Army Medical Center. Over an eight-week period this spring, his staff evaluated approximately 250 redeploying Soldiers per day for possible signs of mTBI.
Solomon said about 10 percent of the Soldiers who are screened suffer from the injury that's often caused by direct exposure to an "over-pressurization wave" associated with a bomb explosion or blast.
"This is an injury that affects who you are," Solomon said. In many cases, the affected Soldiers don't want to talk about it. It's the airborne ethic to be tough as nails, and they are, plus they don't want to have to see lots of doctors repeatedly. "But it's really tough to say, 'Nope, I've never been injured,' when you're face-to-face with experienced, specialized, primary-care personnel and you're looking them right in the eyes."
TBI is also known as a concussion, and Soldiers with a TBI are dealing with post-concussion syndrome, he said.
"I want our redeploying Soldiers to convince me that they haven't been injured in this way," said Mary Susan Tolbert, medical director and certified physician assistant with the TBI center. She is also the clinical coordinator for the Defense and Veterans Brain Injury Center at Fort Bragg, which focuses on research.
"There is a huge gap between being able to dress yourself and being able to function properly," she added.
"Many are afraid to come forward to say, 'I've been injured,' because they think it's a psychiatric problem, and they don't want anything psych on their record," said Solomon.
Some Soldiers with this injury may function with an absent, blank stare or seem detached. Once diagnosed, Soldiers suffering from mTBI will receive an individualized treatment plan. Solomon said about half of the mTBI patients they see will one day return to duty.
"TBI patients may have difficulties with memory, problem solving, reasoning, processing information quickly, attention, and many other areas of cognition," said Solomon.
"I use a variety of materials, including workbooks, computers, board games, brain teasers, and even decks of cards. All of the activities I plan for therapy are designed to enhance any cognitive deficits a patient may have. For example, Scrabble can be used to target word finding. Puzzles address reasoning, and both [games] address attention," said speech pathologist Rebekah McLean.
It is the goal of the WAMC staff to treat the mTBI symptoms and return injured Soldiers to a pre-injury baseline status. Solomon said WAMC's treatment program for mTBI was the first of its kind in the Army. The Office of the Surgeon General recognized the WAMC program as a model for other military medical facilities to follow.
"They don't have a rushed attitude. It's more, 'We're here to work with you as long as [it takes],' and I think the positive approach is the best thing," said Sgt. Austin Honrath, an 82nd Abn. Div. infantryman who is being treated for mTBI at Fort Bragg.
Honrath sustained numerous injuries when his patrol base in Iraq was hit by a suicide truck bomb.
"I am honored to be working with these Soldiers. What I do for them doesn't even compare to what they do for our country. I will always be in debt to them, because they put their lives on the line. My patients are truly heroes, but above that, they're my friends," said McLean.
(For more information, see the July issue of Soldiers magazine.)