By Jasmine Morales (Carl R. Darnall Army Medical Center)March 16, 2009
FORT HOOD, Texas - Working in a combat zone while in theater can sometimes lead to events that cause Traumatic Brain Injury, or TBI. A roadside explosion or hard falls are two of the most common incidents that cause injury to the brain.
Better known as a concussion, a mild case of TBI can cause various physical and mental problems for an individual. Mild traumatic brain injury affects from 10 to 20 percent of service members returning from combat deployment in Iraq or Afghanistan.
Concussions can result from a blow to the head causing ringing in the ears, headaches, dizziness, memory gaps, disorientation, balance difficulties, and blurred vision.
"Traumatic brain injury results in problems that weren't there before and are due to some sort of damage to the brain," said Maj. Alan Hopewell, chief, and officer in charge of Carl R. Darnall Army Medical Center's Traumatic Brain Injury complex at Fort Hood. Hopewell, a native of Richardson, Texas, received the Bronze Star medal while consulting and conducting research on brain injuries in Iraq.
Providers as the TBI complex, located in building 42005 on Battalion Avenue on Fort Hood, treat active duty and reserve service members with brain injuries. Services include outpatient psychological, medical, and consultation services.
The TBI team began services in 2007 from various buildings and offices on the installation, making it difficult to treat service members effectively. In November 2008, the first building in the complex opened with consolidated services.
"In addition to treatment, our current mission is to develop the complex into an integrated team and continue to build on the progress that has been made; We're developing a fully functional rehabilitation program and expanding on what we are able to do for the Soldiers," Hopewell said..
The ultimate goal is improve the health of personnel who have experienced a brain injury and to ensure the Soldier returns to duty in good physical and mental shape, Hopewell added.
The center is comprised of a professional military and civilian staff that includes; one psychiatrist, two psychiatric nurse practitioners, three neuron-psychologists, six licensed clinical social workers care managers, two physician assistants, an occupational therapist, and three registered nurse case managers.
"We are a team dedicated to the rehabilitation of service members who have suffered a TBI and have persistent symptoms," Hopewell said. Emergency evaluations, medication assessment and management, individual and group counseling are just a few services available at the TBI Complex.
When a service member is referred to the TBI center, the first assessment is to determine the intensity of the patient's condition.
Hopewell said many Soldiers do not seek help for fear of appearing week, or that there is somehow a stigma in getting healthcare.
"Many times they deny the injury or think it's not as bad or they are afraid that someone will think that they have mental problems," said Hopewell. "The truth is people suffering from a TBI don't understand how the injury affects them.
In much the same way bullet invades your body causing bleeding and pain, an injury to the head causes reactions in the brain. It is not something that you caused, it is something that happened to you, Hopewell said.
"In addition to treating TBI as an injury, we want to emphasize to Soldiers that because it involves the brain, you can have emotional and psychological reactions. We want to emphasize this is not a psychiatric illness. It's an injury that affects the body and affects the nervous system," said Hopewell.
"The overwhelming primary symptom is headache. Other symptoms that seem much more prevalent are sleep disruptions, feeling tired, and having trouble concentrating," he said.
Other frequent symptoms caused by TBI include loss of coordination and trouble processing or retaining information. Anyone that has experienced a concussion can suffer from an alteration of his or her mental status. Other symptoms such as confusion, dizziness, or physical disabilities are also signs of a possible brain injury.
A factor not normally associated with TBI is heat. While deployed to Iraq, Soldiers experience extreme heat. Hauling around an additional 60 pounds of gear can always increases the chances of heat fatigue. With temperatures many times reaching 100 degrees, heat can be a Soldier's enemy.
"In Iraq, heat exhaustion can also lead to a trauma effect better known as heat injury to the brain," said Hopewell.
Any of these symptoms should trigger medical personnel or even commanders to refer the service member to the TBI complex for further evaluation.
After the initial assessment, clinic staff identifies the level of injury a Soldier is suffering. The symptoms are divided into three categories: physical symptoms, cognitive symptoms, and emotional effects.
"Level one is primarily supporting the soldier to management symptoms: Level two is referral to CRDAMC for more extensive examinations such as CAT scans, MRIs, ear, nose, and throat exams and balance exams; Level three is helping a service member with medical board separation for medical disabilities," said Hopewell.
When required, patients may be referred to physicians at CRDAMC for additional healthcare. Neurology services, the Resilience and Restoration Center, Chaplin services, garrison BATTLEMIND, and command consultation are just a few of the services available at Fort Hood. The TBI Complex coordinates with CRDAMC and garrison services to ensure all patients receive the entire spectrum of care needed to assist with their injury.
Married service members undergoing treatment at the TBI complex are encouraged to invite their spouse for a weekly evening discussion at the complex.
"We have a program for the spouses that helps explain the symptoms. It's an educational support system to help spouses understand what the Soldier is going through after an injury and during treatment," said Hopewell.
The TBI complex is still growing to meet the healthcare needs of Fort Hood Soldiers. A brand new state of the art facility under construction across from the TBI Complex will help reintegrate Soldiers back to their units.
"The new facility will include a living apartment where we can teach people who are having trouble cooking for example," said Hopewell. They are also working on a car and motorcycle simulator that will help evaluate patients' driving ability after suffering a TBI. Other amenities include a whirlpool and more physical therapy equipment.
"If you are experiencing a lot head aches and other symptoms, don't be afraid to share it with your battalion aid station or primary physician, let us help you," said Hopewell.