Traumatic Brain Injury (TBI) is the fourth leading cause of death in the U.S. Treatment is very expensive; $25 billion per year is spent for social and medical management of people with TBI.
And there are a lot of these people: Two percent of the U.S. population live with TBI, including military members. This translates into 5.3 million Americans.
Types of TBI:
Diffuse Axonal Injury is caused by a shake to the head. The resulting tearing of nerve tissue can cause brain chemicals to be released causing additional injury; full swelling can actually shut down the central nervous system.
Concussion (the most common) can be caused by whiplash and can take up to six months to recover. It can cause attentional problems, memory loss, and difficulty concentrating. Everything may check out fine in the hospital so people may not be aware they have a concussion.
Military members, due to multiple deployments and/or explosions, may have many concussions. Even with just mild shaking (i.e. driving around in their humvee), there is a cumulative affect, and if there have been enough of them the next one could cause death.
There is a difference in the severity of TBI, and they cannot all be treated the same. However, sometimes the symptoms can appear similar, so it may be difficult to tease out the severity. Besides determining treatment, the military makes decisions based on the categorization. Therefore, proper diagnosis of TBI is critical.
The frontal lobe of the brain is 99% impacted when there’s a brain injury- attention, impulse control, executive functioning, problem solving, coping. This is the CEO of the brain. It is interesting to note that memory is closely tied to attention. Therefore if they are having memory problems it’s really not their memory, it’s their attention, because if they can’t pay attention they can’t consolidate their experiences into memory. Therefore an injury to the frontal lobe can affect memory because it affects the ability to focus.
TBI and PTSD symptoms are very similar:
sleep disturbances
fatigue
depressed mood
attention & concentration problems
memory problems
reduced cognitive processing speed
reduced reflexes
Most common symptoms:
dreams/nightmares
hyperarousal- they will remember incident, they lose impulse control and inhibition
irritability
Treatment:
The treatment with the strongest evidence is cognitive behavioral. In addition, we know from the research base that psychotherapy combined with medication is the most effective. Psychoeducation about the course of treatment and recovery soon after the injury can be very helpful, particularly for vets since they are accostomed to structure; they need to know what is going to happen.
Additional resources:
Yours in the Joy of Knowledge,
Dr. Barbara LoFrisco
*Personal communication from Dr. Tobi Gilbert, a clinical neuropsychologist who works with a lot of veterans, August 1, 2014
