Brain Injury Center Treats New Affliction of Terror War
By Donna Miles
American Forces Press Service
WASHINGTON, April 13, 2005 Land mines, rocket-propelled grenades and improvised explosive devices are taking their toll on deployed U.S. troops' bodies. What's not as easily recognizable is the damage these weapons are doing to servicemembers' brains.
Traumatic brain injury, or TBI, is becoming an increasingly common affliction of the war on terror. It's affecting troops with injuries ranging from mild concussions to unconsciousness or coma, doctors at the Defense and Veterans Brain Injury Center here at Walter Reed Army Medical Center told the American Forces Press Service.
Dr. Louis French, a neuropsychologist at the center, said improved body armor "is doing a wonderful job of saving lives" and reducing the rate of internal injuries on the battlefield.
But even with Kevlar helmets, there's a critical organ this protective gear simply doesn't adequately protect: the gelatin-like brain material that can shift violently inside the skull when confronted by explosions, sudden jolts or shock waves from blasts.
This movement, which also typically occurs during vehicle accidents and falls, can stretch and tear nerve fibers or bruise the inside of the brain, explained Dr. Deborah Warden, director of the Defense and Veterans Brain Injury Center.
"It's like what happens when a quarterback gets sacked and sees stars, or when someone hits the windshield in a car," she said. Often there's no visible sign of an injury, and even magnetic resonance imagery doesn't pick it up. "But you see it on a microscopic level," French said.
TBI symptoms run the gamut, from slower reaction times to severe emotional and cognitive problems. Affected troops often report headaches, sensitivity to light or noise, dizziness or nausea. But many also experience the less-obvious symptoms of depression, irritability, insomnia or loss of memory or problem-solving abilities, the doctors said. In more severe cases, victims can lose their eyesight and their ability to walk and talk.
The good news, the doctors said, is that if the injury is detected and treated early, most victims can recover full brain function, or at least return to relatively normal lives.
Field hospitals are doing "a remarkable job" of offering sophisticated medical care close to the point of injury, French said, including conducting initial screenings for brain injury when possible.
Doctors at these hospitals initially focus is on saving lives and evacuating patients for more advanced care if necessary, but they've become increasingly aware of the symptoms of traumatic brain injury and the value of early battlefield intervention, French said.
Often this intervention begins with simple questioning: What happened? Was there any period of time that you don't remember what happened?
Such questions help identify whether the patient has experienced a concussion or mild form of traumatic brain injury, the doctors explained. With a short period of rest, ideally away from the frontlines, these patients often recover within a few hours or days, they said.
The Walter Reed Center helps identify undiagnosed cases of brain injury and treats patients with more severe cases.
The center serves as the headquarters for other centers focused specifically on treating traumatic brain injuries, all overseen by Warden. They are at Wilford Hall Medical Center at Lackland Air Force Base, Texas; Naval Medical Center San Diego; and Department of Veterans Affairs facilities in Richmond, Va.; Tampa, Fla.; Minneapolis, Minn.; and Palo Alta, Calif. A civilian re-entry program in Charlottesville, Va., is also part of the program.
At the Walter Reed brain center, doctors screen each new casualty list to determine who's been injured due to explosions, vehicle accidents or falls and may have developed a brain injury. They arrange personal interviews with high-risk patients and prescribe treatments that frequently include physical and psychological therapy to heal the brain.
Research shows it's also effective to treat the symptoms, such as prescribing drugs to help affected troops deal with insomnia or depression, Warden said.
While medication and other therapies help, there's "no magic bullet" that cures brain injuries, she said.
Patients with severe cases undergo a long healing process, sometimes requiring speech and occupational therapy to relearn basic skills. Some may find that while they're able to return to work, they can no longer do the same job, Warden said.
Even patients who appear to recover fully may experience some long-term symptoms, the doctors explained. At work, they may find they're not as capable of taking on extra projects or demands. Some find that the reserve they once drew on to meet these challenges is no longer there, Warden said.
This spills over to their personal lives, as well, she said. People who have experienced brain injuries may take longer to do simple things such as coming up with the correct change in the checkout line at the grocery store.
"Many people do well, but they may find that they need to make modifications in their lives," she said. "(Traumatic brain injury) can be a life-altering experience."
Navy Chief Petty Officer James Miner knows firsthand just how life-altering brain injuries can be. A severe sandstorm blew him off a Conex container in Iraq in June 2003, the fall putting the Seabee into a coma. When he gained consciousness, he could no longer walk or talk, had lost much of his vision and no longer knew Phon Miner, his wife of 12 years.
He's since made strong progress, but said it wasn't easy or fast. "It took me a long time on parallel bars to be able to walk again," said Miner. Last week, he skied for the first time since his injury, wearing a "blind skier" bib and getting coached by the sighted instructor at his side during the 19th National Disabled Veterans Winter Sports Clinic at Snowmass Village, Colo.
"I'm so proud of him," Phon said of her husband's progress. "He had to relearn everything, and he's gone through so much. This is a really big step forward for him."
Miner joins the ranks of other victims of traumatic brain injury who are making steady progress.
They include 1st Sgt. Colin Rich, a soldier in the 504th Parachute Infantry Regiment who was shot in the head while serving in Afghanistan in December 2001. The round went through Rich's Kevlar helmet, which slowed its momentum, then ricocheted, shattering part of his skull.
Rich arrived at a Hamburg, Germany, hospital within 15 hours of being shot and arrived at Walter Reed's brain center for follow-on treatment. He was released from the hospital in early 2002 for 30 days of convalescent leave, still suffering headaches, ringing in his ears and impaired eyesight, but eventually was able to return to active duty.
The gratification of treating troops like Miner and Rich "is enormous," Warden said, and their cases are providing insights that will help future victims of traumatic brain injuries - both military and civilian.
"It feels like a very important thing that we're doing," agreed French. "These people have made tremendous sacrifices and deserve the best care. Ensuring that they get what they need means a lot. It's a remarkable feeling."