Health Blog

[Traumatic Brain Injury (TBI) is all too commonly associated with modern warfare, particularly the War on Terror.  Many veterans suffer from these injuries without realizing it, until serious problems develop. Through awareness, we can help our military friends and family members avoid the serious implications of a traumatic brain injury.]

Military men and women are continually involved in situations where risk of injury is high. One silent war wound that often goes unnoticed is a traumatic brain injury (TBI). A TBI affects the function of the brain and can often cause life-altering damage ranging from personality and behavioral changes to complete loss of brain function and the ability to communicate. Therefore, some of the affects are not just life-altering, but also life threatening, and wind up requiring, long-term, specialized traumatic brain injury rehabilitation.

According to the Veterans Health Initiative, active male members of the military were hospitalized due to TBI related injuries at a rate of 231 per 100,000. The rate for female members of the military was 150 per 100,000. Based on these statistics, over 4,000 military personnel are hospitalized on average each year for traumatic brain injuries. Some are diagnosed as a mild TBI (aka concussions), while others result in moderate to severe TBI.

Mild TBI refers to loss of consciousness, confusion and/or disorientation for a duration less than 30 minutes. They are often overlooked at the time of injury but in at least 15% of cases can still have effects that last longer than 1 year. Symptoms associated with a mild TBI are fatigue, headaches, impaired vision, memory loss, inability to focus or pay attention, impaired sleep, dizziness, emotional impairment, depression and seizures.  They are not always experienced right away and behavior changes are usually noticed by friends and family members before the victim realizes there is a problem.  Therefore, it is important that any soldier suffering a physical blow to the head get examined immediately even though they might feel fine at the time of the injury.

The spouse of a veteran returning home from war can play an instrumental role in preventing long term damage stemming from a mild TBI by recognizing the difference between the “normal behavior” of their significant other and the occurrence of the abnormal symptoms listed above.  Since spouses often spend the most amount of time together, they are the first line of defense against long term damage. They can encourage their husband/wife to seek treatment immediately.  Likewise, soldiers returning home should not dismiss any concerns pointed out to them by those closest to them.  Early treatment of a mild TBI will allow a patient to have the best chance at a full recovery and give the entire family an opportunity to maintain (or return to) a normal lifestyle as it was prior to the victim suffering the injury.

Moderate TBI refers to loss of consciousness, confusion and/or disorientation between a range of 30 minutes and 6 hours with a Glasgow Coma Scale (GCS) of 9 to 12 (15 being the least severe). Severe TBI refers to a brain injury resulting in loss of consciousness, confusion, and/or disorientation for a duration longer than 6 hours and a GCS of 3-8 (1 being the most severe but 3 being the lowest score achievable without being considered vegetative).  The GCS is a cumulative point system that combines three different scores determined by a patient’s eye, verbal and motor responses.

In cases of severe TBI, patients suffer cognitive damage including all of the symptoms of a mild TBI with the additional difficulty with impulsiveness, language processing and executive functions.  Severe TBI patients may have difficulty speaking, understanding words, reading or writing and may alter the speed at which they try to communicate.  Impairments to their sense of sight, touch, hearing, smell, and taste are likely.  Seizures can ensue and damage to the individuals’ physical and emotional health can be devastating, including physical paralysis, chronic pain, bowel disorders, malnutrition, menstrual difficulties, anti-social behavior, lack of motivation, aggression, depression and denial.

With all of the short and long term effects resulting from traumatic brain injuries, the patient is not the only person to suffer, especially in severe TBI cases. Prior to seeking medical treatment, as the condition worsens, unexpected changes in behavior from a soldier returning home to their family can create a lot of stress, pain and suffering for everyone else around them.  It’s difficult for family members to be separated from their loved one while they are off fighting a war.  Usually a spouse anxiously awaits the safe return of their military husband/wife wanting nothing more than to spend time with them and to move forward with their relationship and their lives.  Unfortunately, the reunion may be troublesome if a soldier returns home with a TBI that they are unaware of.

If the injury is not recognized, the increase in irritability that the soldier experiences could spark constant feuds, thus creating distance between them and their family members. An inability of a TBI victim to control their motor functions would further divide them.  Whether the victim has trouble speaking, reading, processing words or connecting with their loved one physically, the change in the relationship would be devastating.  Showing affection simply by holding hands or sharing a relaxing meal together would be exponentially harder to physically execute by a patient suffering a severe TBI and could promote frustration.  The inability for a victim to return to work or be an active member of the household could cause emotional, physical and financial burdens down the road.  For spouses trying to manage a full time job and/or care for children and maintain a home while their loved one experiences these changes, the tasks may be overwhelming.

Even if the injury is recognized, during the treatment phase a spouse or other family member/friend would likely need to provide constant emotional and physical support to the patient, possibly leading them to overextend themselves and/or ignore their own health and well-being.  Ultimately, those that support the victim may find themselves emotionally and physically drained, struggling to keep up with day to day tasks – regardless of their desire to do anything it takes to get their loved one on the road to recovery.  The ability of a spouse to perform everyday duties while their husband/wife recovers may be impossible without further assistance from other family members, friends, or the long term care of a subacute care facility.  The spouse, children and other family members/friends of a patient who does not recover will be affected by the completely different role or absence that their mom/dad, brother/sister, child, etc has in their life.

A patient and the friends/family members of a patient suffering (and/or unable to recover) from a TBI will undoubtedly experience significant changes to their lifestyle.  The best way to prevent TBI is through awareness. Recognizing and responding to the early symptoms of a TBI can often aid in preventing further damage caused by the injury.  So it is vital that serviceman and their families are aware of TBI so that they can recognize the symptoms and help the victim seek medical treatment if symptoms are present.

Written by Chelsea Travers

Chelsea is a communications representative for CareMeridian, a well-known skilled nursing facility located throughout the western United States for patients suffering from traumatic brain injury, spinal cord injury, or medical complexities such as neuromuscular or congenital anomalies.