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Jack Sisson's TBI Blog

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We all know by now that Traumatic Brain Injury is the signature wound of the Iraq War. Explosions that would have killed soldiers in previous wars are now less often fatal, due to the improved protective qualities of military helmets. What happens, however, is that the brain is knocked around inside the skull, as the head forcibly hits the helmet during the explosion. The result is less fatalities, but more brain injuries. According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009. The military has planned clinical trials using pure oxygen in a pressurized chamber to determine if the technique can help brain-injury sufferers heal.

From The Associated Press:
The U.S. military plans clinical trials next year to see whether breathing pure oxygen in a pressurized chamber might help thousands of Iraq and Afghanistan war veterans suffering from traumatic brain injuries.

About 300 service members with mild to moderate damage will participate in the trials of hyperbaric oxygen therapy to help determine whether it can help them heal, or at least ease the headaches, mood swings or other symptoms linked to brain injury.

Some will spend a total of 40 hours over 10 weeks breathing pure oxygen in a hyperbaric chamber, where the atmospheric pressure is increased to a level similar to what they would experience about 20 feet under water.

According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009.

Read the story here.

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St. Petersburg Times, By William R. Levesque, Times Staff Writer, February 12, 2008 --

TAMPA - The James A. Haley VA Medical Center and the University of South Florida Photo credit: U.S. Dept. of Veterans Affairsannounced on Monday that they are entering into a partnership to research traumatic brain injury.

Traumatic brain injury is considered the signature wound of soldiers serving in Iraq who are often exposed to explosions. Up to 20 percent of all returning troops exhibited symptoms of the injury.

Congress last year set aside $450-million for research on the condition, which is still poorly understood by the medical community. [This is something Jack has complained about for years. The extremely poor care he received immediately following his own injury inspired a lifelong crusade to have doctors better informed about brain injury. He believes even psychologists, although they are not medical doctors, would benefit from learning more about brain injury. And he's convinced their patients would. How can they expect therapy to be successful if part of the patient's problem is a brain injury that the therapist either doesn't recognize or knows little about?]

At a news conference outside Haley, Rep. Kathy Castor, D-Tampa, said she recently inserted language in the National Defense Authorization Act that gives the Haley-USF partnership "a leg up" in getting some of that $450-million.

How soon or how much of the money will come to Tampa is not immediately clear.

"We have unique assets here," Castor said. "So we're going to use all that leverage to draw down as much of those research dollars that we can."

She said it was unique set of circumstances having a major veterans hospital sitting side by side with a major research university like USF. And both are a short drive from MacDill Air Force Base.

Also, Haley is home to a polytrauma center, one of just four in the nation where physicians treat some of the most severely wounded veterans.

Haley doctors said the partnership contains an education component that allows researchers to "export" their knowledge on treating traumatic brain injury to hospitals around the nation.

Continue reading.

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USA TODAY, January 18, 2008, WASHINGTON — An Army task force found major gaps in the care of traumatic brain injury last year, but officials say they are moving rapidly to correct the problems.

A task force study — completed last May but not made public until Thursday — found fault with several issues, including efforts to identify and treat soldiers suffering mild traumatic brain injury often resulting from exposure to roadside bomb blasts.

Although victims often show no outward sign of the injury, it can affect brain functions dealing with short-term memory, problem solving and sleep, and cause nausea, dizziness and headaches. Treatment often involves pulling a soldier out of combat temporarily or permanently, and treating the symptoms.

Screening efforts show 10% to 20% of Marines and soldiers returning from Afghanistan and Iraq may have suffered this wound, according to the Army. The task force last May found that "major gaps" in identifying and treating the injury "were created by a lack of coordination and policy-driven approaches."

This was despite the fact that researchers at the Defense and Veterans Brain Injury Center — the Pentagon's premier clinical research office for brain injury — had developed ways of identifying the wound in 2004, the study said.

USA TODAY reported in November that at least 20,000 U.S. service members returning from combat have been diagnosed with, or shown signs of, brain injury.

"There is clearly a problem when the most common injury of the war is the least understood," said Sen. Patty Murray, D-Wash. "This task force is a long-overdue step forward in diagnosing and understanding the signature wound of this war."

Continue reading.

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Savannah Morning News, Sunday, December 2, 2007 -- Laboran Pickens sits inside the busy Savannah coffeehouse.

He flinches every time the grinders whine so strangers can walk away with frothy, caffeinated beverages.

He looks nervous. He assures his company he's fine.

He's on medication from Georgia Regional Medical Center.

It helps, but not always.

The Iraq nightmares still come, medicine or not.

Sometimes the spell is prompted by a loud noise or errant thought. It makes him space out. He moves like he's in a dream. He often disappears from his Hinesville home, sometimes for hours.

His wife spends those hours frantic, wondering where he is. She worries each time will be his last. That he won't come back to her and their three children.

He returns, but remembers nothing.

At 30, he is a shell of the man he once was.

'Signature wounds'

It is estimated that up to 20 percent of the 1.5 million men and women who have served in Afghanistan and Iraq since America's War on Terror began may suffer from post-traumatic stress disorder or traumatic brain injuries, according to the Defense and Veteran Brain Injury Center, which is part of the Walter Reed Medical Center.

And a 22-month study by Veterans for America of all soldiers returning to Fort Carson, Colo., found more than 17 percent of all servicemen and women who had deployed from the installation had some form of traumatic brain injury.

Veterans organizations fear that thousands of soldiers are living undiagnosed.

Many have left the military. Or, like Pickens, were asked to leave.

They carry invisible scars.

These wounds take the form of honorable discharges, public disturbances, police reports, missing memories, sleepless nights.

And their numbers are only increasing.

Continue reading the article.

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USA TODAY, Gregg Zoroya, November 22, 2007 --Marine Lance Cpl. Gene Landrus was hurt in a roadside bomb attack outside Abu Ghraib, Iraq, on May 15, 2006, and faces medical separation from the Corps. He's also up for a Purple Heart.

Along with 20,000 other veterans, he's not included in the Pentagon's official count of U.S. troops wounded in Iraq and Afghanistan.

That's because Landrus' wound was to his brain and hidden from view. Landrus, 24, of Clarkston, Wash., says he did not realize the nausea, dizziness, memory loss and headaches he suffered after the blast were signs of a lasting brain injury.

Army medics who examined him in the field didn't find the wound either. "They wanted to know if we had any holes in us, or if we were bleeding. We were in and out of there (the aid station) in 10 to 15 minutes," Landrus remembers.

For the balance of his combat tour, he tried to shake off the blast's effects and keep going. Now, "my goal is to get back to a normal life," he says.

A USA TODAY survey of four military installations and the Department of Veterans Affairs, where combat veterans are routinely screened for brain injury, has found that about 20,000 people show signs of damage. They are not counted in the Pentagon's official tally of 30,000 war wounded.

The military lacks "a standardized definition of traumatic injury or a uniform process to report all TBI (traumatic brain injury) cases," Assistant Secretary of Defense Ellen Embrey wrote in a memo last month. As a result, it is hard to determine the scope of the problem, she wrote.

Continue reading article.

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In an article earlier this year, the magazine Discover asked, "What sort of future do brain-injured Iraq veterans face?" Read the following article to find out if they managed to answer that question:

Discover, 02.23.2007 -- In a flash, the blast incinerates air, sprays metal, burns flesh. Milliseconds after an improvised explosive device (IED) detonates, a blink after a mortar shell blows, an overpressurization wave engulfs the human body, and just as quickly, an underpressure wave follows and vanishes. Eardrums burst, bubbles appear in the bloodstream, the heart slows. A soldier—or a civilian—can survive the blast without a single penetrating wound and still receive the worst diagnosis: traumatic brain injury, or TBI, the signature injury of the Iraq War.

But in the same instant that the blast unleashes chaos, it also activates the most organized and sophisticated trauma care in history. Within a matter of hours, a soldier can be medevaced to a state-of-the-art field hospital, placed on a flying intensive care unit, and receive continuous critical care a sea away. (During Vietnam, it took an average of 15 days to receive that level of treatment. Today the military can deliver it in 13 hours.) Heroic measures may be yielding unprecedented survival rates, but they also carry a grim consequence: No other war has created so many seriously disabled veterans. Soldiers are surviving some brain injuries with only their brain stems unimpaired.

While the Pentagon has yet to release hard numbers on brain-injured troops, citing security issues, brain-injury professionals express concern about the range of numbers reported from other military-related sources like the Defense and Veterans Brain Injury Center, the Department of Defense, and the Department of Veterans Affairs (VA). One expert from the VA estimates the number of undiagnosed TBIs at over 7,500. Nearly 2,000 brain-injured soldiers have already received some level of care, but the TBIs—human beings reduced to an abbreviation—keep coming.

Keep reading this article.

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Washington Post

ROMNEY, W.VA., Sunday, October 14, 2007 -- Michelle Turner's husband sits in the recliner with the shades drawn. He washes down his Zoloft with Mountain Dew. On the phone in the other room, Michelle is pleading with the utility company to keep their power on.

"Can't you tell them I'm a veteran?" asks her husband, Troy, who served as an Army scout in Baghdad and came back with post-traumatic stress disorder.

"Troy, they don't care," Michelle says, her patience stretched.

The government's sweeping list of promises to make wounded Iraq war veterans whole, at least financially, has not reached this small house in the hills of rural West Virginia, where one vehicle has already been repossessed and the answering machine screens for bill collectors. The Turners have not been making it on an $860-a-month disability check from the Department of Veterans Affairs.

After revelations about the poor treatment of outpatient soldiers at Walter Reed Army Medical Center earlier this year, President Bush appointed a commission to study the care of the nation's war-wounded. The panel returned with bold recommendations, including the creation of a national cadre of caseworkers and a complete overhaul of the military's disability system that compensates wounded soldiers.

But so far, little has been done to sort out the mess of bureaucracy or put more money in the hands of newly disabled soldiers who are fending off evictions and foreclosures.

In the Turner house, that leaves an exhausted wife with chipped nail polish to hold up the family's collapsing world. "Stand Together," a banner at a local cafe reminds Michelle. But since Troy came back from Iraq in 2003, the burden of war is now hers.

Michelle has spent hundreds of hours at the library researching complicated VA policies and disability regulations. "You need two college degrees to understand any of it," she says, lacking both. She scavenges information where she can find it. A psychotic Vietnam vet she met in a VA hospital was the one who told her that Troy might be eligible for Social Security benefits.

Meanwhile, there are clothes to wash, meals to cook, kids to get ready for school and a husband who is placidly medicated or randomly explosive. Besides PTSD, Michelle suspects that Troy may have a brain injury, which could explain how a 38-year-old man who used to hunt and fish can lose himself in a three-day "Scooby-Doo" marathon on the Cartoon Network.

Keep reading this article.

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Earlier this week, Gregg Zoroya in USA TODAY wrote:
Scientists trying to understand traumatic brain injury from bomb blasts are finding the wound more insidious than they once thought.

They find that even when there are no outward signs of injury from the blast, cells deep within the brain can be altered, their metabolism changed, causing them to die, says Geoff Ling, an advance-research scientist with the Pentagon.

The new findings are the result of blast experiments in recent years on animals, followed by microscopic examination of brain tissue. The findings could mean that the number of brain-injured soldiers and Marines — many of whom appear unhurt after exposure to a blast — may be far greater than reported, says Ibolja Cernak, a scientist with the Johns Hopkins University Applied Physics Laboratory.

This cellular death leads to symptoms that may not surface for months or years, Cernak says. The symptoms can include memory deficit, headaches, vertigo, anxiety and apathy or lethargy. "These soldiers could have hidden injuries with long-term consequences," he says.

Physicians and scientists are calling TBI the "signature wound" of the Iraq war because of its increasing prevalence among troops.
Continue reading the article.

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On Friday, Sept. 28, 2007, The Brown Daily Herald published the following story about a Brown University alumnus who, after suffering a TBI in 2004, started a foundation for brain injury patients. From the article:

A month after his graduation, Charlie Maddock '04 was hit by a car and suffered an often-fatal traumatic brain injury. Two years later, in 2006, he founded the Charles Maddock Foundation, a nonprofit foundation that supports patients who have suffered brain trauma.

Maddock was crossing the street in New York City when he was hit by a taxi cab and crashed through its windshield. He received several severe physical injuries, including a fractured jaw and shattered pelvis. The most critical injury, however, was the trauma to his brain, which swelled due to the impact of hitting the cab.

Maddock was taken to New York Presbyterian Hospital, where he underwent surgery to reduce the intracranial pressure in his skull.

According to the National Center for Injury Prevention and Control, approximately 1.4 million people sustain a traumatic brain injury, or TBI, in the United States annually. Of that number, 50,000 die. Other long-term effects of TBI can include epilepsy and a greater risk of Alzheimer's and Parkinson's diseases.

"I was one of the lucky ones," Maddock told The Herald.

After leaving the hospital, Maddock still had the difficult task of rehabilitating from the physical and emotional pain of his TBI. The affliction is often called an "invisible epidemic," Maddock said, because people who survive a TBI are forever changed.
The story later notes:
TBI has recently received national media due to the increasing amount of head injuries for soldiers stationed in Iraq. About 10 to 20 percent of the 35,000 screened "health returnees" from Iraq and Afghanistan had "experienced a mild TBI during deployment," the New York Times reported in July.
And:
TBI has also made the national news FOX Newsbecause of the large number of NFL players with head trauma. In June 2007, late Pittsburgh Steelers offensive lineman Justin Strzelczyk was found to have signs of a condition associated with the elderly or boxers with dementia. Strzelczyk is the fourth NFL player to be found with this condition, which is thought to be caused by repeated concussions on the football field.

Read the article.

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Fighting Brain Injury in Iraq
The war in Iraq is bringing a well-documented but hardly understood battlefield injury into the limelight: traumatic brain injury (TBI). In an effort to learn more about the injury, the U.S. Army awarded Simbex, of Lebanon, NH, a million-dollar contract to develop sensor-studded helmets for combat soldiers. The army is currently testing the helmet technology, which could be deployed as early as December of this year.
Keep reading.

DOD, VA medical programs too complex for those with brain-damage

The bureaucracies that are supposed to help brain-injured war veterans are too complex for them to navigate, a panel of military and medical experts concluded at a meeting Tuesday.http://www.bcrc.com/

Specifically, the departments of Veterans Affairs and Defense need better coordination of their programs, according to the panel, which was part of a daylong Washington Defense Forum sponsored by the U.S. Naval Institute and the Military Officers Association of America.

The panel included two military officers, a doctor, a lobbyist and the chief executive officer of the Brain Injury Association of America.

"The systems in the VA and DOD seem to be against what brain injury can handle," said Susan Connor, chief executive officer the Brain Injury Association. "Because the frontal lobe controls memory, thinking, judgment and processing ... if you shove paperwork in front of someone with sustained brain injury or put them in a large group with scripted instructions, they can't follow it."
Keep reading.

Nonfatal TBIs From Sports and Recreation Activities
Each year in the United States, an estimated 38 million children and adolescents participate in organized sports,1 and approximately 170 million adults participate in some type of physical activity not related to work.2 The health benefits of these activities are tempered by the risk for injury, including traumatic brain injury (TBI). CDC estimates that 1.1 million persons with TBIs are treated and released from U.S. hospital emergency departments (EDs) each year, and an additional 235,000 are hospitalized for these injuries.3 TBIs can result in long-term, negative health effects (e.g., memory loss and behavioral changes).3 To characterize sports- and recreation-related (SR-related) TBIs among patients treated in U.S. hospital EDs, CDC analyzed data from the National Electronic Injury Surveillance System–All Injury Program (NEISS-AIP) for the period 2001-2005. This report summarizes the results of that analysis, which indicated that an estimated 207,830 patients with nonfatal SR-related TBIs were treated in EDs each year during this period. The highest rates of SR-related TBI ED visits for both males and females occurred among those aged 10-14 years. Increased awareness of TBI risks, prevention strategies, and the importance of timely identification and management is essential for reducing the incidence, severity, and long-term negative health effects of this type of injury.
Keep reading.

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U.S. Army Sgt. Frank Sandoval
It's hard to believe that, at this late date, certain people still accuse those of us opposed to the Iraq War of not supporting our troops. How in the world can they construe supporting our troops to mean sending them back into that escalating quagmire for repeated (and extended) tours of duty where over 3,700 have died and approximately 1,800 have suffered traumatic brain injuries (TBIs)?

According to the Washington Post, "...neurologists worry that hundreds of thousands more -- at least 30 percent of the troops who've engaged in active combat for four months or longer in Iraq and Afghanistan -- are at risk of potentially disabling neurological disorders from the blast waves of IEDs and mortars, all without suffering a scratch." A study by researchers at Harvard and Columbia predict that brain injuries from the Iraq war will cost the government at least $14 billion over the next 20 years.

Here's one more recent story:
CAMP WILLIAMS, Utah (ABC 4News)- A voluntary assignment to help the people of Afghanistan develop new agriculture skills turned into a life long sentence for a Utah man, who joins an increasing list of returning soldiers who suffer from traumatic brain injuries caused by roadside bombs.

"I remember leading up to it, the event, most of the explosion, no," said Highland resident Doyle Peterson.

A roadside bomb destroyed Peterson's vehicle in rural Afghanistan two years ago on August 21, 2006. He is recovering physically, but like many roadside bomb survivors Peterson sustained permanent damage to his brain.

"It's a blank spot. I do remember some of the things that happened when we were being evacuated to the field hospital," he said.

Brain injures are now the signature injury of the Iraq war according to former Secretary of Army, Martin R. Hoffman. Hoffman came to Utah to meet with members of the Community Based Health Organization (OBHCO) located at Camp Williams.
Continue reading.

The photo accompanying this post was honored in The Best of PhotoJournalism 2007. Go here to see this picture and other winners.

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More on TBI and the military...
  • The Army News Service reports that -- as announced a few weeks ago -- "The Army launched its Post Traumatic Stress Disorder and mild Traumatic Brain Injury chain-teaching program at the Pentagon last week." The program:
  • ...is mandatory for all active-duty and reserve-component Soldiers, from the highest to lowest levels in the chain of command.
    ...
    Lt. Gen. James L. Campbell, director of the Army Staff, opened the training by telling his peers that the biggest teaching point he wanted to get out to the Army's leaders involved a cultural shift in thought - that leaders shouldn't assume that because Soldiers have no visible injuries that all is well mentally.
  • Good news no matter how you look at it, or from what portion of the political spectrum.
  • And on the not-yet-dealt-with front, we have a report from NPR's KUOW (Seattle) of the experience of a local soldier, Staff Sgt. Richard Kellar, with the hell of TBI:
  • KELLAR: "Depression, anxiety and all the rest of that stuff. It's bad. They give you Zoloft and they try to monitor it. And all the rest of that."

    REPORTER: "Does it help?"

    KELLAR: "I don't know. I don't see a difference. I'm still depressed."
It's going to take years -- decades -- for the full impact of returning Iraq veterans' TBIs to be handled (well or at all) by US society, as Kellar's experience (and others like it) is already showing. But it's encouraging to see even the limited progress represented by the Army's joint PTSD/TBI educational program.

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The number of TBI's caused by injuries in the Iraq War continues to stretch the government's ability to treat them. As the following excellent article points out, no one was prepared for the high number of wounded, kept alive by improved body armor. And no one really knows exactly how many of those wounded are TBI survivors:
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.
Even with the continuing media coverage of the war's injured, and the recent flurry of interest by Congress, I still don't think the average American's knowledge (or even awareness) of TBI has increased by much. I hope I'm wrong. I know that Bob Woodruff got a lot of press, and that he made the rounds of television talk shows. I suppose we just need to be patient. Change takes time, and it will be a while before people's understanding of TBI increases appreciably. Here's an excerpt from the article:
Orangeburg Times Democrat, June 23,2007 -- These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.

More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.
Continue here to read the entire article.

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ABC30.com, 05/24/2007 - As many as 20% of service members returning from duty in Iraq and Afghanistan will have some level of traumatic brain injury.

This spring the Department of Defense acknowledged traumatic brain injury as a "significant health concern" and vowed to identify it among active duty troops. But many new cases are likely to emerge as troops transition to civilian life as veterans.

Military records show that 60% of the 25,000 war injuries to date resulted from explosive blasts like IED's or roadside bombs. And nearly 3,000 of the wounded are currently being treated for severe traumatic brain injury or TBI.

Fresno V.A. Hospital emergency room doctor James Lindsay says injuries in this war are different from other wars when bullets did the majority of the damage.

Dr. Lindsay, Fresno V.A. E.R. physician, says "there's less ballistic wounding from actual gunfire and more blast injuries and blast injuries typically produce traumatic brain injuries." And those blasts can leave an injury without ever breaking the skin.

Read the article here.

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News about brain injuries in Iraq doesn't stop:
Frontline combat troops in the Iraq war have at least a one in five chance of coming home with a brain injury, according to Chris Elia, a Veterans Affairs psychologist who spoke Friday about traumatic brain injuries in veterans at the second annual Black Hills Brain Injury Conference in Rapid City.

“And I suspect it’s a much higher chance than that,” Elia said, presenting an array of statistics about what has become the “signature wound” of the wars in Iraq and Afghanistan.

Of the 23,000 U.S. soldiers, marines and other military personnel who have been wounded in Iraq and Afghanistan since 2002, more than 6,500 have been diagnosed with traumatic brain injury, according to military figures. Elia said those numbers are probably low, given what today’s war is still teaching medical experts about blast injuries.
What a shame that it's literally taken a war to bring TBI front and center. Hardly a day goes by now that TBI is not in the news, and word of advances in TBI research hits the media with unusual frequency. Advocates for brain injury research have wanted this for a long time, but who could have forseen that a war would be necessary to accomplish it? The universe does indeed work in mysterious ways, but I can't imagine anyone who'd have chosen this route to brain-injury awareness.

Read the complete article here.

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'Red Tree Sky,' photo by Greg Olsen, copyright 2007
No matter your politics, I hope you'd agree that it's a strange world in which wars are said, dispassionately, to have "signature injuries." For the American Civil War, maybe this was battlefield amputations; for World War I, trench mouth or gas-attack symptoms; for Vietnam, I guess, post-traumatic stress; and for the original Gulf War, various Agent Orange-related afflictions.

Here at sossisson.com, we've noted before (recently, for example, here) that traumatic brain injury is widely regarded as the signature wound of the current war in Iraq. This sad state of affairs has at last received Federal attention, in the form of a Congressional ruling that soldiers must be tested for TBI before and after their Iraq deployments. This news came at the end of last week, in a report from USA Today. This comes roughly concurrently with a report from the Defense Department itself, per the Associated Press.

From USA Today:
The Pentagon must use computers to screen troops before and after they go to Iraq or Afghanistan to better determine whether they suffered traumatic brain damage in combat, according to a plan by a congressional brain-injury task force...

Congress has authorized a record $450 million for brain-injury treatment and research in the Iraq spending bill being negotiated by Congress and the White House. Legislators say the Pentagon acted slowly on this issue.

"The military was blindsided by the number of blast injury victims in Iraq and Afghanistan, and it is clear that the proper resources were never in place to care for them," says Rep. Bill Pascrell, D-N.J., co-chairman and founder of the 112-member Congressional Brain Injury Task Force.

And from the Associated Press:
Issuing an urgent warning, the Defense Department's Task Force on Mental Health chaired by Navy Surgeon General Donald Arthur said more than one-third of troops and veterans currently suffer from problems such as traumatic brain injury and post-traumatic stress disorder.

With an escalating Iraq war, those numbers are expected to worsen, and current staffing and money for military health care won't be able to meet the need, the group said in a preliminary report released Thursday.

"The system of care for psychological health that has evolved in recent decades is not sufficient to meet the needs of today's forces and their beneficiaries, and will not be sufficient to meet the needs in the future," the 14-member group says.
There have also been a couple of other recent news items on this issue:

As increasingly elaborate body armour protects the torso, and even the limbs, the brain is still vulnerable to shock waves that helmets cannot deter... And these "closed-head" injuries are harder to treat than even those commonly suffered by motorcyclists.
  • From the San Antonio Express-News, "Troops living with brain injury":
    ...untold thousands of U.S. troops [are] returning from the Middle East with a brain injury, the signature wound of the war in Iraq and a rising challenge stateside for everyone from doctors to lawmakers.

    Overtaxed military medical facilities have farmed out many cases [...] to private rehabilitation centers at an unprecedented pace, raising questions about oversight and quality of care and forcing the military to rethink preventing and screening for such injuries, many of which are hidden...

    In Iraq, modern body armor protects troops from bullets and shrapnel. Not even a padded helmet can keep a riveting blast from pounding the brain against the ridges inside the skull, causing bruising or swelling or stretching its nerve fibers. The injuries often aren't seen on CT scans or MRIs.

    But they can cause a loss of balance, memory or cognitive skills that might not appear until a year after deployment. Even civilians who don't live by the tough-and-ready ethos of the military are hesitant to seek help.

  • From Army Times, "Soldier says he was deployed with head injury":
An MRI later showed that Thurman had lesions on the right parietal lobe of his brain, a condition that led to a “don’t deploy” order — which the Army violated, according to Thurman. Worse, rather than providing compassionate understanding of the symptoms associated with traumatic brain injury, he said leaders at Fort Carson, Colo., have harassed him, refused him medication and pushed for an Article 15.

Thurman stepped forward Friday as one of the 18 soldiers whose cases were cited by six senators in a letter to the Government Accountability Office requesting a review of alleged improper handling of traumatic brain injuries, post-traumatic stress disorder and ungrounded personality disorder discharges.

The letter was sent after an Army surgeon general investigation into the cases said the soldiers were handled properly — but the soldiers involved said no one from the surgeon general’s office ever talked to them in the course of that investigation.
As an aside, if you -- like I -- were previously unfamiliar with the term "Article 15": It refers to a section of the Universal Code of Military Justice, or UCMJ. Generally, it's one of the UCMJ's "punitive articles." According to Rod Powers, about.com's "Guide to the US Military," Article 15 is one of several procedures
whereby the commanding officer or officer in charge may:
  • Make inquiry into the facts surrounding minor offenses allegedly committed by a member of his command;
  • afford the accused a hearing as to such offenses; and
  • dispose of such charges by dismissing the charges, imposing punishment under the provisions of Art. 15, UCMJ, or referring the case to a court-martial.
To initiate Article 15 action, a commander must have reason to believe that a member of his/her command committed an offense under the UCMJ. Article 15 gives a commanding officer power to punish individuals for minor offenses... The term "minor offense" ordinarily does not include misconduct which, if tried by general court-martial, could be punished by a dishonorable discharge or confinement for more than one year. The military services, however, have taken the position that the final determination as to whether an offense is "minor" is within the sound discretion of the commanding officer.
Note that the soldier whose case is covered in the Army Times piece claims about his post-TBI treatment that his superiors have "pushed for an Article 15." I understand that the military code of justice must be different than the civilian. But if this claim is at all true, I hope the military at least stops to reflect on ways in which Article 15 can be abused -- if not outright criminalizes the abuse.

[Updated 2007-05-09 7:56 pm]

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Assignments lengthened to 15 months.
The following seems a little "after the fact," because Traumatic Brain Injury was labeled the signature wound of the Iraq War last year. Still, even if the military has been slow to fully address this issue, the following AP article from the "Boston Herald" sounds promising (except for identifying TBI as "military parlance"):
AUGUSTA, Maine - Traumatic brain injuries are common among wounded soldiers returning from Iraq, but they’re also commonly misdiagnosed or undetected, according veterans’ activists and Maine’s congressional delegation.

For some soldiers, the injury is graphically obvious.

”They’re the ones with part of their skull missing,” Ron Brodeur, state inspector for the Maine Department of Disabled American Veterans, said during a forum Wednesday on soldiers’ health care.

For others, the traumatic brain injury, or TBI in military parlance, presents itself in subtle ways, said Jack Sims, director of the Togus Veterans Administration Medical Center.

”Our providers are now aware of TBI and are on the lookout for it. We’re trying to be much more proactive in recognizing these things than we were in past conflicts,” he said.
Read the entire article.


Here's more from the "IndyStar":
WASHINGTON -- Sens. Evan Bayh and Hillary Rodham Clinton said Wednesday that soldiers with traumatic brain injuries should get extended treatment through the Defense Department instead of the Veterans Affairs Department, which they argued is less capable of handling such injuries.

The Democrats, who serve on the Senate Armed Services Committee, said they would pursue legislation to make that change.
"The VA does a great job," Bayh said. "But they've simply been overwhelmed by the number of these types of injuries and are still in transition in terms of how best to treat them.
Read the article.

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Here's a link to a Fox News transcript of Greta Van Susteren interviewing Bob Woodruff. The interview took place last night.

Good article in the Detroit News about Woodruff's growing influence on good medical care for TBI injuries.

Yesterday ABC News reported receiving over 1000 emails from wounded veterans and their families. The emails resulted from ABC's documentary about Woodruff, "To Iraq and Back," "with many claiming they have had problems dealing with the Veteran's Benefits Administration as they seek rehabilitation from injuries sustained in Iraq and Afghanistan." Read the article (and talk to the Woodruff family) here.

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The NY Times cited Bob Woodruff's contribution to public awareness about traumatic brain injury (TBI), called the signature wound of the Iraq War. All those "Support Our Troops" bumper stickers aside, how many people really knew that a number of our wounded will never be the same because they suffered a TBI? There are so many ugly things about this war that have been suppressed or cleaned up for public consumption, but now here is someone whose story no one can question because its truth has been well documented by the media. Maybe some of those wounded veterans will now have a chance at better medical care because of Woodruff. And maybe TBI sufferers everywhere will see improved funding for research because the public is more aware of this epidemic.

Read the entire article.

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