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Tuesday, August 08, 2006

Protecting Our Troops from Traumatic Brain Injury

General Wesley Clark's Clark Community Network has just unveiled a new Troops and Vets issues blog, kicking things off today in fine form with the first in a series of articles on the signature injury of the Iraq War: traumatic brain injury (TBI).

You'll learn about one Marine's sister and the inspiring summer project she's taken up, advocating for Operation Helmet and for keeping all of our troops as safe as they can be.

In educational interest, article(s) quoted from extensively.

From the National Institute of Neurological Disorders and Stroke:

What is Traumatic Brain Injury?

Traumatic brain injury (TBI), also called acquired brain injury or simply head injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.

A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.

A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Traumatic brain injury can have a secreted, but cozy, relationship with post-traumatic stress disorder. Some TBI events lead to PTSD, but not all. It depends upon the specifics of the trauma.

When it does co-occur, PTSD and TBI together can be especially difficult to spot. The problem lies in the overlapping symptoms (increased anxiety, short attention span, limited concentration, problems with memory). This overlap muddies things up. The result? Detecting is difficult, making treatment and healing harder, too.

There's a great discussion of the TBI/PTSD relationship in an online chat with Dr. Catherine Mindolovich, Psychologist, Jamaica [New York] Hospital Medical Center. A few highlights:

TBI would be distinguished by such symptoms as increased processing time, problems with abstract thinking, muscle fatigue, loss of coordination, and problems with speech, hearing, vision etc. On the other hand PTSD would have associated cognitive problems but be marked by specific symptom profile. ... [For PTSD, following a traumatic] event, an individual may experience symptoms from three symptoms categories: 1 Re-experiencing; 2 Arousal; 3 Avoidance.

So, similar to TBI, an individual may become anxious, agitated, startle easily, be irritable... but also express symptoms such as avoidance of situations where the TBI was acquired. For example, it's not hard to imagine someone who was injured in a car accident avoiding driving. But that person may also avoiding walking along busy streets, or be hypervigilent when crossing a street. So, agitated arousal itself would not result in a diagnosis of PTSD, but that in combination with other symptoms might.

Are patients with a TBI more susceptible to PTSD symptoms?
It can go either way. If you have experienced a traumatic event in the past, you may be more vulnerable to experiencing PTSD after the TBI related event. By the same token, if you have TBI related PTSD, another, even less severe event may trigger a PTSD response, even if the event is not directly related. For instance, I often work with war veterans who have unresolved PTSD from the war, and who then experience an assault or accident and now have two life threatening events impacting on their well-being and functioning.

Read the rest of the interview here.

The Human and Financial Costs
So, why is preventing TBI important to all of us -- and not just the individual soldier or Marine who comes home with it? Although the human cost is obvious and by far gives reason enough to do what we can to prevent such violent and life-changing injuries, there are financial considerations as well for every American taxpayer.

From a Jan. 2006 paper, The Economic Costs of the Iraq War: An Appraisal Three Years After the Beginning of Conflict [pdf] by Linda Bilmes and Nobel Prize-winning economist Prof. Joseph E. Stiglitz:

"There is a special category of health care expenditures that go beyond those included in the above calculation -- for those with brain injuries. To date, 3213 people - 20% of those injured in Iraq - have suffered head/brain injuries that require lifetime continual care at a cost of $600,000 to $5 million. The government will be required to commit resources through intensive care facilities, round-the-clock home or institutional care, rehabilitation and assisted living for these veterans.

For the conservative estimate, we have used a midpoint estimate of a net present value of $2.7 million over a 20 year expected survival rate for this group, which is about $135,000 per year, yielding a cost of $14 billion. This amount seems low for brain-injured individuals who will require round-the-clock care in feeding, dressing and daily functioning. For the moderate estimate, we use a higher cost estimate ($4m) and assume a longer life duration for a total cost of $35 billion. In both cases we assume that the number injured will rise in a manner consistent with the duration of the conflict."

Here's What You Can Do
To help protect our troops in the field, Operation Helmet sprang into action because the DoD has been deathly slow in providing the very best head protection equipment available. A $100 upgrade of our current helmets is all that stands in the way of better protection. Here's a bit on how Operation Helmet came to be:

March, 2004: My grandson, Justin, was in a convoy-escort training program as a combat engineer student at Camp Pendleton and learned from a Marine gunny just back from Iraq of the benefits of installing a protective upgrade kit to his helmet. We sent Justin a couple for his rifle team. They tried them and loved 'em, but called an said that they couldn't keep them unless his entire Company of 100 could get them too. We researched the upgrade kit at Oregon Aero's Website and found it to be a very worthwhile product, capable of converting fatal impacts to ones that might daze a body, but would leave them alive and fighting.

We also spoke to Navy Explosive Research docs, demining professionals in the US, Sweden and France, and to a group of doctors in France doing helmet studies. Once we were satisfied the solution was viable and worthwhile, we started Operation Helmet, initially to outfit Justin's Company. From a start of 100, we have shipped over 9,000 as of June, 2006.

The helmets currently in use by the Marines as well as those projected for the future are engineered to protect against 'ballistics' (bullets) and have only fair protection from blast forces and fragment impacts from IED's and other types of newly appreciated combat dangers. Both the old PASGT and new Marine helmets depend on a strap suspension system to 'float' the helmet over the head to maintain helmet/cranium separation. A shock-absorbing pad suspension system is far superior in providing helmet/cranium separation ('standoff') and protection from blast waves and fragments. The shock-absorbing pad systems area available commercially for just under $100.00 each!

The Marine Combat Equipment Team tells me they have a limited budget and can't afford to retrofit all the existing PASGT helmets (cost $99.06 per kit), while at the same time purchasing the new LW helmets. It was my decision to act, rather than just write letters to Congressmen. The troops need this protection right now, not when the rather cumbersome Governmental process deems.

Please consider pitching in a couple of nickels in the Operation Helmet bucket. And if you're a service member currently deployed, be sure to request your free helmet upgrade kit.

CCN's Troops and Vets
Future articles in the TBI series are in the pipeline (I've seen two upcoming installments, and they'll make for a good primer on the issue). PTSD will then take over with a series of its own; and I've been humbled to have been invited to contribute to them as the newest member of the Clark Community Network's Troops and Vets team.

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