Traumatic brain injury (TBI) is being called the “signature wound” of the Iraq and Afghanistan wars – much like Agent Orange-related illness was the signature wound of the Vietnam War. The reasons TBI is so prevalent among our Iraq and Afghanistan War veterans is three-fold:
- In earlier wars, many soldiers receiving head injuries did not survive because of wounds to other parts of their bodies. Today, modern body armor allows more soldiers with head injuries to survive.
- Better field hospitals and faster trauma treatment also improve survival rates for severely injured soldiers, allowing more of those with brain injuries to return home.
- Explosive devices are the enemy’s favorite weapon and the most common cause of concussive brain injuries. Injury occurs not only from the blast itself, but also from flying objects striking the head, and from the impact of the head striking something after the body is flung through the air by the blast.
Types of TBI
Traumatic brain injuries generally fall into either of two categories.
- Closed head injury. In a closed head injury, there is no physical sign of injury to the head other than possibly a bump or bruise.
- Open or penetrating head injury. A visible head wound clearly identifies an open or penetrating head injury.
TBI is also classified according to severity.
- Mild TBI. Someone with a mild TBI will typically recover fully within one year.
- Moderate TBI. Those suffering moderate TBIs will recover to some degree but have lingering mental and/or emotional deficits, usually for the remainder of their lives. Nonetheless, they may seem normal to others who do not know them well.
- Severe TBI. A severe TBI is accompanied by noticeable mental and/or emotional disability, and sometimes physical disability as well.
How War TBI Goes Undiagnosed
TBI is always suspected when there is a visible head wound. Soldiers with obvious head wounds are routinely screened for the effects of brain injury.
But those who have experienced a TBI from a closed head injury may not be diagnosed. This type of injury can be caused by whiplash or any similar sudden movement of the head that causes the brain to violently strike the inside of the skull. A closed head injury can occur not only in an explosive blast, but also from a fall or a vehicle accident, or from a flying object striking the helmet.
TBI symptoms vary depending on the part of the brain that is affected and the type and severity of the injury. Symptoms can be a mixture of difficulties related to:
· Cognitive impairment – Reduction in intellect, memory, reasoning, math or language skills
· Behavioral issues – Anger, self-centeredness, aggressiveness, inappropriate behaviors
· Emotional problems – Depression, apathy, low self-esteem, social withdrawal, irritability
Complicating the diagnosis of TBI is the fact that some of these symptoms can be attributed to post-traumatic stress disorder (PTSD), effectively masking the existence of the brain injury.
A mild or moderate TBI is especially likely to go undiagnosed if the victim suffers no other physical wounds that would lead to being seen or evaluated by a doctor.
With so many Iraqi War and Afghan War veterans suffering catastrophic injuries and amputations, it is difficult for a veteran with a closed head TBI to compete for government medical services. In fact, even those veterans who suffered devastating open head injuries with obvious TBI are having a difficult time obtaining rehabilitation services through the Veterans Administration. Some seriously wounded have waited up to six months, and others are still waiting.
What to Do
If you are experiencing problems with thinking or memory, or emotional or behavioral problems after serving in Iraq or Afghanistan, read the following two articles to see how those problems compare to the symptoms of TBI.
If the symptoms seem to indicate the possibility of a TBI, try to recall when you may have received a blow to the head or experienced a violent head motion. Be aware, however, that it is not uncommon for someone who received a closed head injury to be unable to remember the event that caused it. If you don’t recall an event that may have caused an injury to your head, do you recall a time when you felt confused or suffered from a headache and were unable to remember what happened immediately beforehand? Any such recollection can help substantiate the possible existense of a TBI.
If your symptoms are mild, you’ll probably recover fully after several months to a year following the injury.
For more bothersome symptoms, however, you should see a physician. Sometimes, the signs of a TBI can be seen on an MRI or CT scan, but not always. Doctors also have ways to test for thinking or memory problems or evaluate psychological and behavioral problems to arrive at a diagnosis of TBI.
If you have a TBI, it’s important to acknowledge it and obtain assistance. Various types of therapies can help you learn how to compensate for many of the effects of TBI and resuming leading a productive and happy life.