By Shannon Carabajal, Army MedicineMarch 1, 2012
FORT SAM HOUSTON, Texas (March 1, 2012) -- According to the Centers for Disease Control and Prevention, nearly 1.7 million people suffer a traumatic brain injury, or TBI, each year.
Of those, 52,000 people die. TBI is also a contributing factor to a third of all injury-related deaths in the U.S.
During March, in recognition of Brain Injury Awareness Month, the Army is taking steps to increase awareness about brain injuries, including prevention, diagnosis, and treatment, while reducing the stigma for persons who seek care.
TBI is a disruption of function in the brain caused by an external force. The severity can range from mild, also known as concussion, to severe involving an extended period of unconsciousness or amnesia.
"Traumatic brain injuries result from an external force such as blow or jolt to the head. Concussions can occur in combat operations (such as during a blast event), in sports (particularly contact sports such as football, soccer, or martial arts), during recreational activities (such as skiing or biking accidents), and in vehicle collisions that have sufficient acceleration/deceleration movement.
A TBI can also be caused by a penetrating injury to the brain from a bullet or other object," said Maj. Sarah Goldman, TBI program director for the Office of the Surgeon General.
Goldman said concussions are common injuries that occur in many settings including combat operations, contact sports, recreational activities, and vehicle collisions. Because they are not as obvious as other physical injuries, leaders, medics, physicians, and even those injured may mistakenly overlook or underestimate the effects of concussions.
Symptoms of concussion can include confusion, headaches, dizziness, ringing in the ears or nausea. These symptoms usually resolve within hours or a few days. Some people do have more persistent symptoms, which can include trouble sleeping, irritability or visual disturbances.
"It is imperative to reduce the chance of a second head injury before the brain can recover. Soldiers should be taken out of the fight and athletes should be removed from the field to prevent repeated injury and promote healing," she said.
Col. Nikki Butler, director of the Rehabilitation and Reintegration Division at the Office of the Surgeon General, said TBI awareness is especially important for military personnel who, due to the nature of their work duties and lifestyle, are at a higher risk for TBI than the average citizen.
Since 2000, the Defense and Veterans Brain Injury Center has counted 229,106 cases of TBI among U.S. military personnel worldwide. Of those cases, 76.7 percent were determined to be mild, 16.7 percent were moderate, 1 percent were severe, and 1.6 percent were penetrating.
"Soldiers and leaders need to understand the subtle effects of concussion, because the Soldier often has very subtle or no outward signs of injury. Battle buddies need to be aware of any changes following a head injury and encourage Soldiers to seek medical attention as soon as possible after the injury, no matter how mild it may seem," she said.
Butler encourages Soldiers and their families to be proactive in preventing TBI by using protective equipment for sports and avoiding high-risk behaviors such as aggressive driving. She also said early identification and treatment is critical.
Brain injuries should be identified and treated as quickly as possible, Butler said. Current scientific evidence supports rest, education, and expectation of recovery as the cornerstones of treatment for concussion.
Statistics indicate that more than 90 percent of those who have suffered a TBI will fully recover; however, some patients may experience long-term symptoms, Butler said. The chances of long-term ramifications are increased if there have been multiple or repetitive injuries such as in the case of professional boxers.
"It takes time for the brain to heal and Soldiers do not all recover at the same rate even if they sustain a similar injury. It is absolutely essential to avoid getting a second concussion or insult before the brain has fully healed," Butler said.
Army Medicine has primary care and specialty providers throughout the continuum of care who are educated in brain injury identification and rehabilitation. On the front lines, medics are trained prior to deployment to screen for brain injuries using the Military Acute Concussion Evaluation developed by the Defense and Veterans Brain Injury Center.
Additionally, the DOD stood up a concussion system of care at the point of injury in theater to promptly identify and treat these injuries.
"Brain injury evaluation and treatment services extend throughout Army Medicine which has funded over 500 dedicated TBI providers located around the world since 2007. The Department of Defense also collaborates with the Defense Veterans Brain Injury Center and the Veterans Administration to provide ongoing support for patients and their families," Butler said.
In addition to support from medical professionals, Goldman said support from family members is very important during TBI treatment programs.
"Family members are an essential component to the Soldier's care and recovery. Our military treatment facilities ensure that family members have the opportunity to learn more about the effects of TBI, be involved in treatment planning, and are an essential aspect in a Soldier's rehabilitation," Goldman said.
The Army is also taking steps to protect Soldiers from injuries and better detect and treat brain injuries. According to Butler, the service has invested more than $800 million in research and development activities to better identify and treat brain injuries.
Army Medical Research and Materiel Command has funded hundreds of research studies devoted to advancing the science of TBI to include basic science research to better understand the pathophysiology of injury and recovery. The Army is improving detection and diagnostic capability such as neuroimaging, diagnostic biomarkers, and improved screening tools; and treatment techniques to maximize recovery after an injury.
For more information about brain injuries, visit the Defense and Veterans Brain Injury Center website, www.dvbic.org.
For more information about the Army TBI program, visit www.armymedicine.army.mil/prr/tbiprg.html.