FORT SILL, Okla. -- March is Traumatic Brain Injury awareness month. TBI continues to be one of the ongoing medical issues of the Iraq and Afghanistan wars. Progress has been made with regards to diagnosing and treating this condition, often caused by concussions from blast events in the war zones. But recent studies have revealed that the majority of concussions happen in a most unlikely place -- on the garrison level.
"Most TBIs are mild in nature. A study by the Armed Forces Health Center has shown that 76 percent of most TBIs over the past decade occurred right here, on post. But there's still a definite percentage that happen down-range. The Army is examining where these events occurred, and what can be done to prevent these injuries," said Jason Albano, supervisory neuropsychologist at the Traumatic Brain Injury Clinic on Fort Sill.
Over the past decade the Army has improved the armor on vehicles and in many cases switched from Humvees to M-RAPS that are better armored and three feet above the ground to minimize concussions from improvised explosive devices (IEDs).
But, a concussion can also be sustained if a Soldier head-butts another player in a soccer game.
"So, is it the chicken, or the egg? What caused the headaches that a Soldier is currently having?" Albano asks.
Albano explained that a concussion is basically a type of bruise to the brain. The difference between a bruise to the body and one to the brain is that the brain remembers that bruise for a long time.
"When you get a bruise on your body, it will usually heal up and you won't feel the effects of the first bruise if you get another in the same place," he said. "But, the brain remembers all of the bruises. Once the bruise heals up it will be better, but it takes time, and if you receive a bruise in the same spot within three days or so, the effects multiply rather than just adding up. That's the dangerous part of concussions -- the cumulative part. They become much more significant, much quicker.
"In the civilian world, there's a term called dementia pugilistica, or boxer's dementia. The boxer becomes impaired by being hit in the head for so many years. So there is research to support the fact that multiple concussions are not something that should be ignored," Albano added.
"Combatives injuries, even a motor vehicle accident here on post, that's part of the cumulative effect. So why is it that a Soldier comes into the clinic, and their medical record is blank? They don't have a lot of medical contacts and they don't have a lot of appointments on their records," Albano said. "But then they sustain a combatives injury, or were playing basketball and got hit in the head and all of a sudden these symptoms show up. So you look back into their history and find out they had 22 blast exposures, but they are pointing to this latest event. So what is it about this event?
"That is the importance of educating someone about brain injuries. Just because it wasn't caused by an IED doesn't mean it wasn't a concussion, and it's important to get the information out there," he said.
"Sleep deprivation is probably the most significant difficulty that a Soldier struggles with. When they are in country they are always on edge, hyper-vigilant is the word. They have to watch for danger every minute. Adrenalin is a great drug for keeping alert in combat situations," Albano said.
"But hyper-vigilance is a fight-or-flight response to previous traumatic stressors. Once you have that response, guess what the symptoms that show up are? Everything that would look like a concussion attention memory deficit, headaches, irritability, dizziness, sometimes tinnitus (ringing in the ears associated with a change in blood pressure) and all of the other symptoms. If you go through the list of symptoms associated with a traumatic event, it will look like a concussion. The parallels are astounding."
Albano said if a Soldier is concerned something is wrong, the most appropriate first step is to go to their primary care provider at the hospital. Primary care providers have been treating concussions longer than any other discipline, and they know what symptoms need to be looked at first.
Then specialty clinics doctors, like the TBI clinic staff, can provide a more targeted assessment to help the Soldier know what is going on. The person who needs the most information is the Solider, so he or she can drive their care, he stated.
"A mild concussion is a hit you never forget. A moderate to severe head injury is a hit you never remember. That's a good way to separate a more severe head injury from a mild concussion," Albano said.
"TBI is an injury that is not going away, even with the withdrawal from Afghani-stan at the end of 2014," he added. ?"It's something that we very much need to be aware of, and educate Soldiers and their families about. When in doubt, check it out."
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