The month of March is dedicated to brain injury awareness and prevention. Mild Traumatic Brain Injury (mTBI), more commonly to as a concussion, is a very common injury for both civilians and Servicemembers.
At the Landstuhl Regional Medical Center Traumatic Brain Injury Clinic, we want everyone in the local military community to be aware that concussive events can happen to anyone, and we want people to think ahead toward injury prevention and brain health.
TBI is referred to as the signature injury of the wars in Afghanistan and Iraq because many our Servicemembers experienced blast or vehicle accidents that resulted in a concussive event. But, mTBI can occur due to a multitude of other types of accidents and injuries such as slip and fall accidents, bicycle accidents, sports injuries, motor vehicle accidents or combative training. So during the month of March we're launching a full-court press to spread awareness and help people think ahead about what mTBI is, how to educate themselves and how to seek care.
TBI occurs across a spectrum of severity from mild to severe. mTBI is defined by the Defense and Veterans Brain Injury Center as "a blow or jolt to the head that disrupts the normal function of the brain. It may knock you out briefly or for an extended period of time, or make you feel confused or "see stars" (alteration of consciousness)." Not all blows to the head cause a concussion, but sometimes that blow to the head can be more than a concussion as well. Going to the emergency room or seeing your primary care physician following a potentially concussive event is important so that you receive the evaluation and the education needed to for a quick recovery.
Part of the problem we face is that diagnoses of mTBI can often be overlooked because they often occur with other significant injuries. While moderate, severe and penetrating head injuries are identified due to external trauma, mTBI is often missed. In a study done in 1991, up to 25 percent of those with a concussion do not seek medical attention. In a second study it was found that many of those who receive medical attention do not have a TBI diagnosis recorded, especially if they have multiple traumas. We want to encourage people to contact their primary care provider or to self-refer to the TBI Clinic at Landstuhl should they have any questions about mTBI so that they are evaluated appropriately and appreciate the necessary steps in recovering from a concussive event.
Our primary care clinics here in Europe have local TBI champions that can assist Servicemembers, veterans, and family members with mTBI screening, evaluation and treatment. Getting care for mTBI and understanding how to manager recovery is important. Rest is a vital part of treatment, but helping symptoms to resolve and gradually adding activity is important. Your primary care physician can assist you in understanding this and helping you get back to resuming your duties and activities.
Why is it so important to highlight brain injury awareness and prevention? Well, there are over 1.4 million TBIs that are reported annually with the majority - between 75 percent and 90 percent - being mTBI. It is one of the most common neurological disorders. It occurs when an impact or forceful motion of the head results in a brief alteration of mental status, such as confusion or disorientation, brief loss of memory, or loss of consciousness.
However, even such brief alterations in mental status can inflict profound and persistent impairment of physical, cognitive and psychosocial functioning. mTBI is often referred to as a "silent epidemic" because its symptoms are non-specific and commonly occur in the general population. Many sufferers and healthcare providers fail to recognize the potential severity of a brief loss of consciousness. Often, individuals with mTBI do not receive medical care at the time of injury, but present to their primary care physician days, weeks, or even months after the injury with complaints of persistent symptoms.
Seeking care for mTBI soon after the injury directly optimizes the potential for recovery. Delaying care increases medical costs. Total annual costs associated with TBI have been estimated at $56 billion, of which $16.7 billion was for mTBI. These estimates do not include costs of lost productivity or lost quality of life. Therefore, having primary care providers that are well trained to support individuals with mTBI can contribute invaluably to the needs of the general population, and specifically, our military Servicemembers and their health concerns.
mTBI can be very difficult to diagnose as it can produce a number of imprecise perceptual symptoms without diagnosable objective structural brain alterations.
Current methods used to assess the presence and severity of brain injury, based on imaging techniques such as CT scanning and neurologic examinations, are expensive, not consistently reliable or universally available, are slow to produce results, and are insensitive to mild injuries. Physicians treating less severe injuries have little, if any, objective diagnostic information with which to evaluate injury severity and to guide treatment.
Furthermore, diagnosis of mild brain injury may be missed in the face of more dramatic physical injuries. Many patients may appear unimpaired and be discharged, only to appreciate the extent of their symptoms once they attempt to return to normal functioning. Training and educating primary care providers on the most current clinical practice guidelines, and providing educational support is a vital part of ensuring our Servicemembers and civilians receive the support and care that they need to recover. We want our families and Servicemembers to recovery quickly to sustain military readiness and be able to maximize their quality of life.
If you or a family member experience what you may think was a concussive event, seek care. Ask questions of your physician and follow your physician's guidance in slowly returning to duty to ensure that the symptoms don't recur. Think ahead toward prevention of accidents and use the appropriate protective gear to help protect your head. Helmets may not be sexy but they are smart. You've only got one noggin, so please use it!
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