Putting the pieces back together: TF Duke treats mTBI with rest, games
March 16, 2011
- MTBI is a common but potentially sever injury, prevalent on the battlefield
- With proper treatment, most Soldiers affect by mTBI get better quickly
- The most important treatment for mTBI is rest
KHOWST PROVINCE, Afghanistan (March 14, 2011) Aca,!" Anyone whoAca,!a,,cs been paying attention to sporting news knows that over the last few years there has been an exponentially increasing interest in the effects of concussions on players, especially in hockey and football. Indeed, the main subject of the NHL General ManagersAca,!a,,c annual meetings, going on this week in Boca Raton, Fla., will be concussions and checks targeting playersAca,!a,,c heads.
But the issue of concussions, also known as mild traumatic brain injuries, is not one that only affects sports stars. Anyone that has had any sort of head injury is at risk of being affected, particularly Soldiers who have been struck by improvised explosive devices or other attacks.
But these Soldiers have help in their recovery from this common but potentially severe injury. Task Force DukeAca,!a,,cs mTBI reconditioning center at Forward Operating Base Salerno is just one facility of many operating in Afghanistan here to help the Soldiers affected by mTBI in their recovery.
According to the Defense and Veterans Brain Injury Center, mTBI is any Aca,!A"disruption of brain functioning from a blow or jolt to the head or a penetrating head injury.Aca,!A?
While that may sound fairly simple and direct, what can actually go on inside a personAca,!a,,cs head, and the ensuing injuries, can be very severe.
The physiological aspect of the injury, that is, the physical effects on the personAca,!a,,cs brain itself from being bounced or twisted inside the skull, or even penetrated by an object like a bullet or bone fragment, is only one factor that physicians need to consider when working with an mTBI patient, said U.S. Army Maj. Thomas Hair, a board-certified family care physician, and department chief for warrior care at Ireland Army Community Hospital in Fort Knox, Ky.
Hair deployed to Afghanistan with the Fort Knox-based 3rd Brigade Combat Team, 1st Infantry Division, Task Force Duke, and is currently serving as the Battalion Surgeon for the 201st Brigade Support Battalion, 3rd BCT, 1st ID, TF Duke.
In addition to the physical injury to the brain, the affected Soldier may also have to deal with the emotional trauma that can result from such an injury, said Hair.
During an injury resulting in a loss of consciousness, the rational part of the brain can be damaged and stop working properly, sending the emotional center into a frenzy, which often results in varying degrees of post-traumatic stress disorder, he said.
The symptoms exhibited by Soldiers affected by mTBI vary, and can often be subtle, or may not even appear until later, Hair said.
Aca,!A"A lot of times guys will come in and they Aca,!Eoejust ainAca,!a,,ct rightAca,!a,,c,Aca,!A? he said.
Aca,!A"You canAca,!a,,ct find any one thing wrong with them. But everything they do is two or three percent slower than they used to be. They can remember things, but it takes five seconds longer than it used to,Aca,!A? he said.
There are more physical symptoms to watch out for as well, though.
Spc. Chamai Shahim of Portland, Ore., a CH-47 Chinook mechanic with Company B, 1st Battalion, 168th Infantry Regiment, 3rd BCT, 1st ID, TF Duke, was playing basketball when another playerAca,!a,,cs jaw came down hard on the top of her head.
Aca,!A"I was vomiting and slurring my words,Aca,!A? she said, but she didnAca,!a,,ct realize it had to do with the hit on her head until she happened to meet with Capt. Emily McGinty, an occupational therapist from Brooke Army Medical Center in San Antonio, Texas, and currently the Officer in Charge of the TF Duke mTBI reconditioning center.
Shahim explained her symptoms to McGinty, who advised her to get a professional examination from a doctor. She was diagnosed with a concussion and referred to the center as an out-patient for treatment.
Another Soldier, Pfc. Jeremiah Mullins, a military policeman from Richmond, Va., attached to 1st Battalion, 26th Infantry Regiment, 3rd BCT, 1st ID, TF Duke, was standing guard on a tower at Combat Outpost Bak when a mortar shell exploded within five meters of where he was standing.
Aca,!A"The blast knocked me out,Aca,!A? he said, and since then heAca,!a,,cs had bad headaches, trouble sleeping, bad dreams, and difficulty getting the incident off his mind.
This was the second time Mullins had been in an incident like this Aca,!" he had been struck by an IED previously Aca,!" so he was referred to the center by his commander to ensure he got a thorough examination for any sign of mTBI, and any treatment he needed.
One of the keys to treating mTBI, as is the case with any injury or illness, is early diagnosis from a physician and the proper medication and treatment.
As long as Soldiers seek help from medical personnel, Hair said, almost all of those with head injuries are able to recover just fine.
Aca,!A"The most important treatment is time, reassurance, realistic expectations and rest,Aca,!A? said Hair.
Affected Soldiers are first examined by their unit medics. If they show signs of concussion, they are ordered to get at least 24 hours of rest.
If they continue to show symptoms after that period, they are sent to see a doctor who will decide whether to refer the Soldier to the mTBI center for further treatment.
Rest is the first treatment Hair recommends; ideally the affected Soldier will get 72 hours of real rest, if the mission allows it.
Aca,!A"Most Soldiers in a combat zone are sleep-deprived to begin with,Aca,!A? he said, Aca,!A"and the reality is that someone who is sleep-deprived looks just like someone whoAca,!a,,cs had a concussion.Aca,!A?
He also added that sleep is one of the best ways for the brain to heal itself.
But that doesnAca,!a,,ct mean the Soldier gets to go take three days off to do whatever he wants.
In order to get good rest, the Soldiers must avoid as much stimulation as possible, said Hair, so that means no video games, caffeine or cigarettes, to name a few.
Aca,!A"Soldiers need to go to bed at night, instead of staying up late watching TV or talking on the phone,Aca,!A? he said. Aca,!A"This is actual rest.Aca,!A?
Aca,!A"I was told to stay in a dark room and get as much sleep as I could for the first couple of days,Aca,!A? said Shahim. Aca,!A"I try not to do anything mentally exhausting or stimulating.Aca,!A?
Shahim said that sheAca,!a,,cd had insomnia since before the injury, which complicated her healing process since she couldnAca,!a,,ct get proper sleep on her own.
She was prescribed medication to help her sleep by a health-care provider, which has lead to a noticeable improvement.
She said she isnAca,!a,,ct bothered by slurring words or nausea anymore, but she still gets headaches when she exerts herself.
When she no longer shows any symptoms, Shahim will move on to the next step, known as the exertional period of her recovery, where she will conduct some basic physical training, like riding a stationary bike.
If she is able to get her heart rate up without a recurrence of her symptoms, sheAca,!a,,cll be cleared to return to her normal duties, said McGinty.
Mullins, on the other hand, is scheduled to leave the facility Wednesday and return to duty, which heAca,!a,,cs looking forward to.
Aca,!A"I feel a lot better now,Aca,!A? he said. Aca,!A"The memory building exercises and the brain game I played on the Wii really helped out a lot.Aca,!A?
Aca,!A"NintendoAca,!a,,cs Wii gaming system is used by the center as a training tool for visual, perceptual, balance and cognitive rehabilitation,Aca,!A? said McGinty. Aca,!A"ItAca,!a,,cs become a standard practice tool in all four established mTBI reconditioning centers in Regional Command Aca,!" East.Aca,!A?
Aca,!A"The Wii Fit game focuses on improving balance and coordination through games that require the service member to challenge his vestibular system,Aca,!A? said McGinty. A personAca,!a,,cs vestibular system is located in their inner ear and contributes mostly to their movement and balance.
The Wii also allows occupational therapists like McGinty to identify a patientAca,!a,,cs improvements by providing feedback regarding the patients speed and accuracy; and furthermore adapts to patientsAca,!a,,c progress by increasing the challenges as they improve, she added.
Using a guided recovery process with graded intervention; the TF Duke mTBI reconditioning center treats Soldiers affected by mTBI with care, and challenges them to get better.
The center has treated 33 patients since October, said McGinty, and only one had to be sent on for level III treatment, which is conducted by a 5-person team at Bagram Airfield, Afghanistan.
That Soldier was eventually able to fully recover and return to normal duty as well.
While the center only has four patients currently, McGinty expects to be filled to capacity in the future, with the expected increase of activity during the summer.
In anticipation of this, a construction project has been started to increase their capacity from four to nine beds, to better serve the TF Duke personnel that will need it.
Aca,!A"[mTBI] is not new,Aca,!A? said Hair. Aca,!A"Discussion of brain injury dates back to the beginnings of medical literature, and even the ancient Greek dramas. We know how to deal with it as doctors. The Army knows how to deal with it as an Army. We just need to treat it, and be intelligent about it.Aca,!A?