I am a neurologist (retired) with 50 years training and practice (1968 -2018). Head injury terms are very imprecise and as such cause confusion. Also, there is lack of agreement on very important items (e.g. Permanency, true structural injury, role of non-physical aspects) that compromise the term Traumatic Brain Injury. There are many non-scientific opinions which make their way into legal, political and other venues. Concussion clinics have opened all over the country, as money makers. A very muddy scene at present. Serious research is needed.
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My father, a WWII infantry combat veteran, firmly refused to recount the events that qualified him for his Combat Infantry Badge or the Bronze Star with V (for valor). Only after he passed away did we find the paperwork and letters from his buddies that described some of his experiences. His unit (Company G, 242nd Regiment, 42nd Infantry Division) was engaged defending against the 21st Panzer Division, part of Operation North Wind (last phase of the Battle of the Buldge). During the bitter infantry defense at Hatten on January 4th, several elements of Task Force Linden were attacked by a Panzer unit, including a formation of Panther V tanks. Armed with an M1919
30cal. machine gun, my dad had the most powerful weapon in his platoon, but still of no value against the Panther V. Forced to take cover from the fire of the Panthers 75mm main gun, all surviving infantry sought cover in the basement of a small stone house. As last man into the intensely packed basement, my dad had to crouch at the top of the stairs, just below floor-level, as the Stone structure was pounded by the Panthers. His Sergeant estimated 40 tank rounds struck that house or adjacent structures before the German tanks were driven away by artillery fire. He was left unconscious but unmarked by the rounds impacting that stone wall just above him. We never understood the injuries he suffered or fully appreciated what he accomplished despite those injuries. Hopefully we can do better for troops today.
2
Despite a total of 36 years, 7 months active duty and Army Reserve service and retiring as a Lieutenant Colonel, my dad refused to wear the Purple Heart that he was awarded due to his injury and evacuation. He returned to his unit in late February 1945.
2
Chapter 3 of the story about the 19 year old Pfc. recounted above. Both machine gun crews in Weapons Platoon, G Company in which my dad served as a gunner on an M1919A5 .30 cal Browning machine gun were nominated for Silver Stars. Their guns were decisive in stopping an advance by elements of the 6th SS Mountain Division after they had crossed the Rhine River north of Strausburg on the night of December 31st - January 1st. Every member from both gun crew was ultimately awarded that Silver Star. Except my dad. His Company Commander downgraded his citation to the Bronze Star after he was evacuated (at his platoon leader's initiative)from Hatten due to the head injury described above. The Captain justified the downgrade in his award as appropriate given his evacuation in the absence of an actual "blood wound"! The fact that he was unconscious when taken to the aid station and was obviously unable to return to his unit for several weeks somehow made the heroism that occurred 5 days earlier less worthy! Ironically, a Sergeant with whom the Company Commander apparently had a closer personal relationship had his name substituted into the after action report as the gunner in my dad's crew. According to other crew members, the Sergeant was not present during the action appearing in the report. In fact, members of the platoon did not see that soldier at any time during the defense at Gambsheim.
2
I was a speech-language pathologist for 35 years, a COO of a pediatric rehabilitation hospital, and the executive director of a state rehabilitation organization for five years.
There are subtle and sophisticated ways that a speech-language pathologist (as part of a multi-disciplinary team) can test for even mild TBI and treat it.
Most such teams are found in larger cities - and I believe there are such teams in the Washington, DC, area, that are part of the military.
Any one who has suffered a blow to the head might want to consider checking it out. Remediation may be slow or fast, but some to a lot of the damage can be remediated over time.
3
The president heard that some troops had headaches which he did not consider serious compared to other injuries he had see. Like those bone spurs he endured back in the 60’s.
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Greatest military in the world though, right? Right?
Just a reminder that the ANNUAL pentagon budget is around $750 billion.
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@Maple Surple the VA is not the Dept of Defense. They are a complete separate entity, and have their own budget. VA is requesting a total of $243.3 billion in fiscal year (FY) 2021 for the U.S. Department of Veterans Affairs (VA), a 10.2 percent increase above fiscal 2020 enacted levels.
1
@Maple Surple and it’s not spent on taking care of the troops.
1
@Maple Surple what does this have to do with diagnosing TBI's? TBI's happen to civilians too and is to exclusively a military issue.
Trump's definition of not getting into wars/conflicts which he demagogued to victory.
Don't get into wars unless it is with countries that are bankrolling his de facto bankrupt empire like Russia, Saudia Arabia, Israel etc.
22
The solution is: bring the troops home.
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@John Perry
Even simpler solution, don't get involved in foreign wars in the first place. Reduce your standing military and weapons. Plan to use your men and weapons only within your own country. What business do you really have in Vietnam, Afghanistan, Syria and other countries too numerous to mention?
Troops are exposed to bullets and missiles, and they are worried about a little radiation from a brain scan? Are they crazy?
Every brain injury is unique and requires experienced subspecialists to diagnose, treat and follow for short and long term prognosis. Are neurosurgeons; neuropsychologists, neurologists specializing in closed head trauma and neurorehab specialists evaluating the personnel affected by the blasts? I am a permanently disabled severe brain injury survivor . You need the finest possible medical intervention to move forward. I assumed our military was providing the optimum care for our serving personnel, but this article i suggests otherwise. Please keep following this important story.
2
If these injuries were being caused by football, we'd have people calling for it to be banned.
This is an excellent article on a very timely topic, but it omits what is clearly the real source of the problem. Why, in the 21st century, are countries firing missiles at solidiers from other countries?
I hate the fact that the leaders of these same countries then wear nice suits and meet in expensive hotels and talk about things like strategy and proportional responses and find euphemisms to avoid saying that basically they try to kill people, and even when they fail, they cause serious harm.
And no, this isn't about Trump, or Obama, or even Iran. It's about the normalisation of violence. It's about the way bodybags are never shown on TV, mangled corpses are taboo, casualty numbers are compared with the enemy's numbers to make it seem like we're winning.
The more we learn, the more we realise that no soldier comes back from a military deployment to a war-torn area without some mental or physical damage. And it's even worse for soldiers from other countries.
We just need to put an end to all this. Let's stop being patient, and accepting the explanations and justifications and "political realities" ...
3
More than any of his other insults, lies and evasions that Trump has expressed over these last, awful years, his quote, "I hear they had headaches," leaves me reeling. Having a child who sustained a TBI after being hit by a truck, I am hypersensitive to the insidious effects of those injuries. Certainly even this man would have recognized my daughter's injury, it was bloody, messy and visually apparent. What cannot be seen are the lasting and devastating impacts that can result. Attitudes such as expressed by the draft dodging president are another roadblock to understanding and treating our vets who have survived the war with "invisible" injurys. It shocks me that Trump still has the capacity to take my breath away in pain and anger.
3
I've had two TBIs. One was not treated, the other resulted in an ER visit. The latter was a diagnosed concussion and a negative CT scan (for bleeding), but it resulted in years of headaches. The other was not recognized, but resulted in a severe clinical depression that lifted years later in one day.
The brain is pretty much unexplored territory when it is teamed with personality. Personalities can be damaged by TBIs.
The question is how many cases of PTSD are caused by brain injury from concussive injuries?
We need to develop a protocol of behavioral signs of TBI. My undiagnosed TBI could have been noted had someone recorded a strange behavioral symptom the day after. We have a lot to learn. While waiting for blood tests, we can develop fairly good diagnostic criteria from a detailed questionaire.
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I am an osteopathic physician ( DO) who for over 30 years has treated hundreds of close head injuries. I had previously done a residency in Physical Medicine and Rehabilitation where I spent time on the brain injury unit at our hospital. This unit was staffed by four MD neurologists.
None of them ever put their hands on the patients during examination for closed head injury besides the standard neurologic testing. They lacked the training to palpate the musculoskeletal and neurological changes which characterize a concussion nor to determine its severity. This training is customary in all osteopathic medical schools.
It enables me to determine the specific trauma pattern in the body of the patient and to use gentle osteopathic treatment to address and eliminate them.
I do not believe that the standard approach I witnessed during my residency is capable of providing the diagnostic feedback which must support the subsequent ongoing treatment for this disorder.
Closed head injuries specifically involve strain patterns in the dural membranes in the cranium among other findings. These must be identified by palpation and then treated with osteopathic manipulation. None of these findings show up on imaging studies such as MRI and CT scans. They can only be found on palpation.
Only then will patients not only recover but make a full recovery.
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@Simon Sez So phrenology is making a comeback in America. TBI affects the brain itself and such injuries may be detected by newer MRI modalities not available earlier. True a standard neurologic exam may not detect the subtle parenchymal injuries caused by concussive forces, but neither will external "palpation".
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@Simon Sez
Please explain how you "palpate the musculoskeletal and neurological changes which characterize a concussions."
I must admit that as a pain management physician myself I have never ever seen such a thing done other than if someone had head trauma and an observable wound and I don't think that's what you are talking about. Nor do I recall any of the neurologists nor physiatrists (physical and rehabilitation medicine specialists) I've ever worked with claiming being able to do what you say.
1
@Simon Sez You palpate the dura???
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I had a TBI in 1995 as the result if an assault that nearly killed me. Two operations that saved my life, but I couldn’t speak properly, read, or use my right side for a few weeks. The doctors, at the UK’s leading neurological hospital, couldn’t predict what the long-term consequences would be, and I was assessed using the same type of questionnaire as described in the article. Over 3 years I slowly recovered, although not entirely, for I still have trouble concentrating and am easily distracted. The main things I learned from my experience is how little is known about the effects of TBIs and that I was very, very lucky to have recovered as much as I did, given the severity of my injuries. Not a lot seems to have changed in the past 25 years, except that TBI is being taken more seriously.
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Reading this leaves me heartbroken.
It is now 5am in the morning, and I am too tired to be truly coherent, unable to find the words for what I really want to say.
Before being in a car accident in 1998 I rarely experienced sleep problems. Since that day, I have rarely experienced a night without them. And this is the least of it. I was not in war; it was up to the doctors to determine whether or not I had a TBI. They did, and I do. I knew it: I couldn't find my own backyard, I couldn't figure out how to boil water for tea. But it was up to the judge to say that I didn't.
My TBI nightmare is NOTHING compared to what these soldiers are experiencing. I wish I were innocent enough to think that, even with decent testing, it would make much of a difference, but any innocence I had regarding "the system" before 1998 evaporated along with those neural connections in my brain.
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@Dancer's Mom Similar feelings here. My TBI was a result of a pharmacy error. That was 20 years ago and my life has never been the same. After a long while I did make it to a Traumatic Brain Injury group in Fairfax VA the only one of its kind. I am a veteran and in our groups are the other members who have suffered strokes, heart attacks, car wrecks, etc. We also have veterans who after leaving the military end up in a group with me. One of the veterans has three young sons that he cannot remember their names. Its heartbreaking. We still need better diagnostics and treatment.
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@Dancer's Mom Just to clarify: Despite numerous medical reports that had determined that I did have a TBI, the judge decided that I did not.
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@Dancer's Mom
Please, don't minimize your own experience and the strength it takes to live with the damage you had, whatever the cause. Thank you for sharing your story.
5
My father, 96 in two months, suffered TBI during WWII. The first injury was during Marine basic training at Parris Island. He remembers the "tremendous" headache and blacking out. There was a second head injury a year later. He has no memory of what happened only of leaving a hospital and then being told he was being honorably discharged with a service connected disability. He had severe seizures, (epilepsy), for years after, received his medication from the VA and over a period of many years the seizures gradually ended.
The TBI greatly impacted his life, not the least in that he joined the Marines because he wanted to be one of the toughest guys and this invisible injury embarrassed him always. Employers in the 1940's and forward were reluctant to hire epileptics. He couldn't get a driver's license till he was seizure free for a number of years and we walked everywhere when I was young.
In essence, the impact of these injuries reverberate deep in one's life. Being able to quickly diagnose and treat these types of injuries would be a tremendous tool.
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I went through this somewhat when I nearly died from heat stroke, (then) South Vietnam, July 1968, while in the Marines.
It took weeks of care in hospitals back in the Philippines and Okinawa to recover enough to function. My brain kept on freezing, just shutting down to the extend I had trouble remembering how to return to my quarters.
It is my experience that damage to the deep brain can be overcome, by retraining ourselves, at least in that one can wear a uniform and follow orders. But something significant changes, one loses the ability to conceive thoughts independently, to be aware of one's feelings and certainly one loses an ability to connect with others empathically.
The military is invested in results, and so buries hard to diagnose brain injuries, and the VA, at least during my time, never, absolutely never, made the effort with significant studies, to see if long term disability results from life threatening heat stroke.
So I see little has changed, blast injuries will cause veterans to have major problems in civilian life, and if one is poor, and cannot hold a job...
Hugh
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@Hugh Massengill n
Me too.. Tet, 1968
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My big brother, age 20, tet offensive '68, now on disability for severe hearing loss. also to my perspective, a sweet guy who came back with anger/emotional/authority issues that have never resolved, in fact have only gotten worse. we love him but are somewhat helpless in the face of his basic distrust of the "system". at least the local VA is on his side. good folks.
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@John Perry
My brother. River rat, 1968-69.
6
if the medical community really wants to know the after effects of traumatic brain injury it should really ask all of us survivors. they would probably find out a lot in studying the ways that we have all adapted workarounds to continue functioning,years later. relate blast trauma to pounds of pressure, per square inch, times speed, of impact. reverberation injuries are caused from being hit with the weight and speed of blast impact. and that's even before the physical trauma begins from getting hit with everything else that got thrown in the blast
1
Having recovered from a concussion I know how hard it is to diagnose. CT scans are useless as they can only detect physical trauma. If the trauma is a blockage to the free flow of energy to or within the brain that is not detected. Whether the trauma is the result of a blow to the head or shock-waves, if the damage causes the free flow of energy to be blocked the results are the same. There is confusion, vertigo, vision problems and frequent exhaustion. The medical profession is not good at understand problems caused by blocked energy. It takes a professional who has a degree in kinetic energy to understand and cure the problem. It takes alignment of the head to the trunk when the injury is due to physical contact. With a shock-wave it may be different but that would have to be checked out.
This is a cynical comment and not meant to cast aspersions of on people who are truly suffering from the effects for TBI. Treatment is critical but the current VA compensation system based on awarding a percentage to the disability is flawed.
The Bureau of Labor Statistics indicates that 41% of service members in the Iraq War era (2004 and later) have a VA disability rating with half of those at 60% or greater. Is it merely a coincidence that in 2004 Congress changed the VA compensation system to allow for two separate retirement checks: one from the Service and one tax free from the VA. The reported and delayed the nature of reported TBI cases in the missile attack suggests that the word got out that you could easily claim a combat related disability for TBI if it was document in your medical record.
In 2004 the VA budget was $63.9B, the 2021 request is for $243.3B and speaks to the power of the Veteran’s lobby. Interestingly, you can be on active duty ready to deploy with 30 years’ service on the Friday when you retire and 100% VA disabled on the following Monday --- The Military/Industrial/Political complex at its best.
1
Adding to the problem are individual thresholds of injury and cumulative there was, and may still be, a feeling in sprots medicine that 'concussions' (TBI) were cumulative, and the unanswered question, cumulative of what?
Any psychological assessment for TBI which relies on self-reporting is basically flawed and unreliable.
Self-assessment is always unreliable - we are trapped in our own minds and cannot step outside them to judge the normalcy of our feelings and responses.
Relying solely on a questionnaire is medical malpractice and a disservice to those who suffer.
CT is an is a first level imaging exam for concussion. It only shows skull fracture or bleed. The contemporary concussion protocol includes very high field MRI for soft tissue structural abnormalities, MRI diffusion tensor imaging for axonal (neurofiber) damage, MRI spectroscopy for brain chemistry shifts and functional MRI for cognitive assessment. Repetitive exams during the first month post concussion are used to assess recovery progress. Authors should review the mTBI literature on the NIH Pubmed website. Please note that there is a growing literature on MRI imaging of neuropsychiatric disorders evidenced by chemical shift analysis.
1
A paper questionnaire may be inadequate, CTs may miss TBI- so why not expand the clinical assessment? Yes- some self-reports could be obfuscating, exaggerated, minimizing--but it is actually hard to fully fool a thorough Mental Status Exam, visual spatial testing, neuropsych subtests, clinical interviews that evaluate thought processing and organization, prosody, abstracting, fluency, et al.
The greater contaminant is the military or POTUS trying to cover up injuries - reducing the VA's responsibility to provide services.
3
Bio markers. Interesting. I’m no neuropsychologist by any stretch of the imagination, but I recall when I was a post doc attending neuroimaging rounds how dubious it was to infer function from mere images. Sometimes people with cortical parenchyma that looked all shot up none the less had excellent function. Never a 1 to 1 correspondence. And, executive function neuropsych measures never felt all that sure to me. However, how can powerful shockwaves from these blasts not cause diffuse axonal shearing - like the pounding of a meat tenderizing mallet. How unfortunate we are forced to cede the care of our military to a commander in chief who apparently was born without mirror neurons that might afford him the possibility of basic human empathy!
1
A month has gone by since the attack. We have done nothing. Americans may be wounded, some severely, without consequences.
Are we supposed to turn the other cheek, accepting aggression without resistance or response? Where is our leadership? Where is our pride? Where is our resolve to defend ourselves?
The military apparently also doesn't have anti-missile weapons to protect the troops, or they don't work very well.
I was a passenger and survived a car crash that instantly killed all four other passengers, including my only brother. I was 16; I am now 70. I sustained broken limbs, multiple facial fractures and lacerations. I was in coma for five days, followed by permanent amnesia surrounding the crash. I suffered migraines for about forty years, and have battled depression my entire life.
Is it possible that I sustained TBI? If so, is it possible that my ongoing depression is a result of TBI? And if so, what would you recommend as treatment (I have sought psychiatric care since my teens; various meds have given no positive outcome; current daily dose of 40 mg Prozac has me addled).
Real worn out by living this way.
1
Traumatic brain injury is the most complex disease in nature. It should come as no surprise that the diagnosis of mild or moderate TBI is difficult and that available diagnostic methods are inherently prone for over or under-calling the degree of injury.
There are approximately 16 000 000 000 neurons in the typical human male brain, each forming around 7000 synapses, giving around 15 quadrillion (synapses) connections vulnerable to injury... is it any wonder that an injury that can affect any of these 15 quadrillion connections is difficult to predict. Loss of one neuron leads to loss of 7000 connections. We have no way of measuring how many connections are lost, let alone the function of those connections. Until better tools are available to ascertain the function and number of neurons and synapses lost, and the degree of redundancy present in the affected system, we will continue to be groping around in the dark.
I hate to break it to you, but this state of affairs holds true for all of psychiatry; i.e., we can only diagnose by asking questions about symptoms. Perhaps TBI is to be considered a neurological condition rather than a psychiatric one. The lines between the two continue to blur since it is now popular to view mental illness as a brain disease.
1
There are other solutions that don’t require blood or saliva to test, and one that specifically doesn’t require a baseline to test against.
Oculogica.com is new tech that tracks eye movements to determine tbi or icp or concussion! They are the only objective fda authorized aid in concussion diagnosis.
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The enormous defense budget our country has needs to use a large part of that budget to care for our veterans. In a war that is over 20 years old, the military still is trying to figure out TBI. I resent that Army, Navy and Marine recruiters try to entice young people to join the military. Do these young recruits know the physical and emotional scars they will bear for their service? Inadequate VA care for PTSD is something we’ve all heard about with 22 veterans killing themselves daily. These people all volunteer to serve but they should know what kind of nightmare they volunteered for.
1
if one could combine this study with one looking into TBI in sports, particularly football.. it would be a useful step,, and to further examine the effects: abusive men,, abuse of pain killers,, societal need to have armies,, military like sports,, love of weapons,,, males shooting people.. and loving their guns.. all a web of ongoing masculine sickness.. circle upon circle that needs to end.. enough already.
"The concrete bunkers scattered around bases like Ain al Assad protect from flying shrapnel and debris, but the small quarters can amplify shock waves and lead to head trauma."
Why can't they figure out how to build bunkers that would not amplify the shock waves that lead to head trauma?
If expensive tech was available and used the article would be about for profit medicine.
When effective and low cost tools are used this article still finds faults.
"Mr. Trump seemed to dismiss the injuries at a news conference in Davos, Switzerland, last month. “I heard they had headaches,” he said. “I don’t consider them very serious injuries relative to other injuries I have seen.”
A normal president would not recklessly throw out his uneducated opinion about serious medical conditions in public. This is irresponsible and dangerous. Trump has no concept of the position he occupies.
The United states has spent over $3 billion in research and development (NIH, DOD, DARPA, Dept. of Veterans Affairs, NSF) in DTI (diffusion tensor imaging) - an advanced type of MRI that accurately diagnoses head injury with very early appearance of Fractional anisotropy and tractographic abnormalities. There are over 20,000 peer reviewed publications about this. These are done along with SWI (susceptibility weighted imaging) which can detect microhemorrages early on. I am also a former US Army Lieutenant Colonel - and former commander of the 1466th Med Team Neurosurgery - we had 24 hour deployment orders for any action in the world (declared or undeclared, public or not) and had quite a bit of equipment. The obvious issue with this is that 3T scanners cannot be deployed - and would pose a risk if affected by a detonation nearby. With Med-evac, a DTI scan can be completed and read in 30 minutes. These are available forward in Kuwait, but most suspected of brain injury would be evacuated to Ramstein. Other than removal from the field of battle - there aren't too many acute interventions that help for minor to moderate TBI at this time. Most people have little difficulty detecting their own symptoms of brain injury (in events not severe enough to produce loss of consciousness) but soldiers may hesitate to report if they feel that the symptoms may clear. This issue is not appropriately summarized as some sort of problem with President Trump.
The existing bunkers succeeded in protecting the troops from shrapnel and direct blast injury as they were designed to do, but it's time for designing bunkers to better protect them from overpressure/concussive injuries as well such as with a prefab soft insulation layer between hard walls and blast doors.
The major advance in field diagnosis is in the area of accelerometers worn on the skin on the mastoid process behind the ear, or embedded in helmets which record and transmit in real time or when querried electronically.
These can identify immediately which soldiers have actually experienced abrupt acceleration, rotation and vibration at levels and in directions likely to cause brain injury. Other than those with symptoms - those with accelerometer data above a threshold can be identified for screening. These individuals can immediately get 3T MRI with diffusion tensor imaging (DTI) and fractional anisotropy analysis. This is a solved problem - but the standard use of helmet accelerometers in combat settings is still pending.
There is a calmest. I saw his name. He made comments in this newspaper.
When he was riding his bike, he was hit by a car. Eventually his wife asked if someone could walk with him. I had a program. I said I would use it with him. It was apparent he had brain damage. He could not recognize the designs. He was a reporter for a local newspaper. He Was hyperkinetic. Insured because he was hyperkinetic he could not sit long and head short attention span‘s. Because he was a reporter. I screamed him with the alphabet. He barely could recognize one letter or two. Therefore he could not be a reporter or a columnist.
As I screened him with visual designs. I then incorporated the alphabet. He recalled the alphabet. And shortly after the 12 hours he went to work. He nor his wife ever reported it to anyone. Yet it would have taken up to three years for rehab.
Kent Jackson hearing this road rewiring the brain. When I worked with a 78-year-old, a seven-year and a 23-year-old. The first 78-year-old could not write. The seven year old had two exams The third thought he was dyslexic. You may read the results. As I read in the newspaper. All improved in nine hours of work.
Modern diagnostics for brain injury is based substantially on Diffusion Tensor Imaging (DTI) which is an advanced type of MRI. There are 20,000 peer reviewed publications. The United States (DARPA, NIH, Dept. of Veterans Affairs, and DOD) have spent about $3 billion developing this technology. It is widely available. As a former Lieutenant Colonel in the Army (commander of the 1466th Med Team - Neurosurgery) I can tell you that the problem is substantially a matter of forward deployment of 3T MRI scanners. Once transported to Ramstein by air - evac - there is precise diagnosis and recovery tracking possible by tractography and fractional anisotropy analysis. The issue is really who needs to be evacuated and can we field advanced scanners - or access local MRI scanners safely in host countries.
This would appear to be an unresolvable quagmire there’s a very large incentive for people to cheat the system both knowingly and unknowingly
Traumatic brain injury (TBI) has only recently been scientifically studied and needs many more years of research before it can be fully understood. Only very stable geniuses like Donald Trump can make determinations of who is really suffering from TBI and who is just malingering. And what's really amazing is how Trump can diagnose the disease or lack thereof without even having to examine the patient. We are so lucky to nave this chosen one as our Commander in Chief!
Trump says that the soldiers at Ayn Al Assad experienced “headaches”. He didn’t think those were very serious compared to injuries he had seen. Was that during his secret, extensive combat experience in Vietnam?
$738 BILLION for the Pentagon and this is the best we can do? Hey, it's the best, most beautiful healthcare you've ever seen.
As a physician with 40+ years experience working with Traumatic Brain Injury (TBI), and also having worked for the VA doing disability evaluations, I can tell you that both in the civilian and military worlds, diagnosing TBI, particularly early on, is like nailing jello to a wall.
I'm not trolling here, but if you haven't worked with TBI, or had a family member who has experienced it, you really don't know what you are talking about.
Think of it this way. It is largely the impact of the concussion wave, which is nothing more than compressed air, that takes down large buildings, flips tanks, etc.. It is not hard to duplicate getting hit in the head with a sledgehammer.
The fact that a TBI doesn't have the visual impact of an eye hanging out of its socket should not lull you into thinking there is no problem. Also, a concussive TBI is frequently associated with a direct impact related injury as well. When you get launched into the air by an explosion, you have to return to Earth somehow
Of course, you have to take the psychiatric/psychological function of the victim into consideration as well. A child handles a TBI differently than a 20 year Seal.
We realized long ago that "concussion" was a horribly inadequate term to describe TBI.
I'm sure that President Trump has no more ability to knowledgeably discuss TBI than he can use calculus to program the re-entry of a space shuttle returning to Earth. The "World's smartest Person" would be much better off to say nothing.
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My son's humvee was blown up near Fallujah Iraq by an IED that just missed and 'only' shattered their armor glass and knocked them out. They were sent back into combat the next day and no record made of any injury. When he returned after that deployment for a while, before heading out on another, I noticed he winced when sun hit his eyes, had obvious symptoms of concussion and he still has difficulty with remembering words and has to use the definition instead. No purple heart nor tracking of his health by VA. They don't have records of his medical care in Kabul while deployed at all, despite serious non-combat injuries from a vehicle accident on patrol.
6
I hope these soldiers and airmen are given the benefit of the doubt and are given purple hearts. We don't have to see blood. The same goes for veterans benefits after discharge.
Terrific reporting!
It was widely reported that Iran gave a six-hour warning of their attack. Certainly, the many TBIs was predictable. Apparently, an anti-missile system wasn't available. Would it not have been better to evacuate the base during the attack? Being ten miles from the site in the open would seem to be better than hunkering down in a concrete bunker at the site. There's probably a reason why this wasn't done... perhaps one of my fellow Times readers can explain this.
1
I really wish the American military would stop whining about brain injuries. What a bunch of whimps. Brain injury? No, it’s just some headaches. Even our President, Donald Trump, the Commander-in-Chief, said so. And he’s seen a lot worse. He has a lot of respect for the military. We should all follow his admirable leadership.
1
How no one would be affected by missiles raining down on them is unrealistic and absurd. Of course, we are living in absurd times.
Regarding shock-induced brain injuries, friend of mine had a skiing accident ... hit a tree and broke five ribs. That healed in due course but few months later he started having incessant headaches. Turns out he had a subdural hematoma (brain bleed). He was lucky, caught it, got treated. The long term effects are still uncertain.
Trump’s typically uncaring concern for others also once again shows how he sociopathically must lie about everything. It also shows his lack of caring about our troops and his complete lack of understanding of what it’s like to be under fire.
Maybe if Iran’s missiles had caused them to get bone spurs he would express some empathy. Once again he’s proved his unfitness for the office. In that regard, he never disappoints.
2
Although there are some errors of reporting in this piece, it is in an objective sense reasonably accurate. The failure of this piece is in its slanted presentation. Journalists reporting on war injuries, and the diagnostic and treatment approaches of military medicine, lead the reader to think that military medicine is populated by incompetent clinicians. The article is a classic and shameful case of “if it bleeds it leeds.” God forbid anyone one of us ever finds ourselves in the trauma care unit of a hospital here in the US, but In the event, there is a good chance that survival and recovery is due to the experience the surgeons and support staff had treating wounded warriors in dire combat situation.
This reminds me of the same nonsense that goes on with the diagnosis of that ridiculously over-diagnosed and overly-medicated brain condition-- adhd. These so called "doctors" also use questionnaires.
This idea of adversarial medicine of the assumption of guilt approach is an effect of the greed based republican takeover of our government and removal of regulations.
Honest people know that the truth always comes out. Liars don't thus can never trust anything as they think they get away with their lies or do not properly internalise it when they get caught lying.
The military has many tools available. Hard to tell if this reporting is accurate. And btw there is no FDA device for “diagnosing” an actual TBI except for brain bleeds that can also have other causes. There are numerous neuropsychological tools to assist. It would be tragic if they were not used.
I have heard a lot about TBI recently. Last several years it was PTSD. Concussions damaged neurons etc. what no one ever talks about or I should say very little press time has been given over to hearing loss. I am a sufferer I have tinnitus, the constant ringing in my ears. These soldiers must have some kind of hearing damage. Believe me when I tell you mine was caused by gunfire then fire crackers then rock concerts then construction sites. I now wear hear protection like I use deodorant. But I cannot hear anyone at parties or Resturant’s so I have unconsciously begun to read their lips. But ever so slowly my social life is being strangled. My hearing aid is not too great. I have the best money can buy. How much attention is being paid to the hearing loss of our men and women in uniform. Logic tells me it is shockingly underreported. How good is their hearing protection. I know that 3M is being sued but is that enough? Enough information? Do we tell our boots or cadets or plebes that you cannot only be killed or maimed but also you can get brain injuries and loss of hearing that will not make its self known for decades to come.
Everyone knows, the military's first response is to cover up any failure and deny any injury.
In the hours after this incident, Trump reported what he was told from the front lines. He was told there were no American deaths and no serious injuries. He was told that a few people had headaches. This was accurate and, relative to what could have happened, it was "good news."
In the subsequent days and weeks, after the dust settled, it became apparent that several of those headaches were more serious than headaches and were in fact concussions.
There is nothing unreasonable with Trump characterizing these injuries, in the initial hours, as having been "luckily, no deaths" and "a few headaches." It was important to report "no deaths." People wanted/needed to know. And yes, that was good news!
In the subsequent weeks, many headache symptoms did not disappear and it became apparent that several of those headaches were more serious, as concussions.
That's not Trump's "fault." He did not "lie" in his initial report. He simply stated what was known at that point in time, in the immediate hours after attack.
From article: A week after the blast...Two weeks after the blast...By the end of January...This week..."
And, truthfully, given the job description of "soldier" and how many soldiers are in the middle east, a bunch of concussions is "not that bad."
This article, like many each and every day in the New York Times, is yet another one of our daily doses of anti-Trump propaganda from the left.
Most of my similar posts do not get published. I wonder if this one will be.
1
Since his cowardly dishonorable unpatriotic grandfather fled Bavaria/Germany for America to avoid criminal prosecution for dodging the military draft no member of the Donald Trump,Sr. family has ever been drafted nor volunteered to serve in the military uniform of any American armed force they have never faced nor risked no battlefield brain or any other kind of injury.
Since 9/11/01 a mere 0.75% of Americans have volunteered to wear the military uniform of any American armed force. And they have been ground to emotional, mental and physical dust by repeated deployments in ethnic sectarian foreign civil wars that have no military solution.
While the rest of us pretend to be brave honorable patriots by rising to sing the national anthem and saluting the flag at sporting events.
1
“ I heard they had headaches “. Yes, and we have a long-standing, involuntary, 300 pound headache that has been completely unresponsive to treatment. So far.
As a proud Veteran, from a Family of Veterans, this is the single most obnoxious facet of the Creatures Regime. How dare Cadet Bone Spurs question or denigrate the Military, in any fashion?
Fake President, Fake Patriot, Fake Human.
NOVEMBER.
The only valid test in a Trump administration is loyalty.
It's like trying to find a blood test for schizophrenia. Good idea but we aren't there yet. In the interim, the military should focus on sorting the hiders and cheaters from the truly sick. Outcome data will help. You can model the results of misdiagnosed patients statistically.
Take the entire population. Look for the percentage of people who legitimately display psychological dementia later in life. Compare your inaccurate diagnosis to the chronically ill. You'll have a baseline on which to form future expectations.
The question is not who is sick. The question is: How wrong are we? You can determine the error rate from past results. That gives you a pretty good guess how off you are in the present.
Trump's attitude is typical of Republicans - the military men and women, especially enlisted are only cannon fodder for the military-industrial complex's wars. The rich kids don't go to war, except for true heroes like John Kerry. As John Fogerty sang (a Vietnam vet): "I ain't no Senator's son...".
What a cheap shot at the president. TBI is a term for the entire range of injuries, from the mildest of concussions to those that cause severe, permanent brain damage. No, the military doesn't have a CT machine and NFL sized medical team at every small outpost. Instead, they take a very conservative approach with a high false positive rate at screening to ensure, in order to ensure correct treatment. So yes, the president's statement was correct. Nice hit piece.
1
The Department of Defense says far 109 U.S. service members were diagnosed been with "mild traumatic brain injury." A small percent of military persons who experience mild traumatic brain injuries may experience symptoms that last several months or longer, but for most the symptoms disappear within hours, days or weeks.
Service members diagnosed with mild traumatic brain injuries qualify for Purple Hearts if they are treated with pain medication such as aspirin or ibuprofen for a headache. So anytime a missile impacts a base camp, rear-echelon personnel line up for aspirin and a Purple Heart.
https://www.army.mil/article/55850/army_clarifies_award_of_purple_heart_for_concussion
"just a headache" and then sent back into combat.
Unlike, of course, Trump's debilitating imaginary "bone spurs", which kept him out of the military until he was in a position to puff up his chest and to play tough guy Commander in Chief on TV
This is a related story from CNN, featuring the daughter of a friend.
https://www.cnn.com/2020/02/14/politics/home-front-traumatic-brain-injuries/index.html
What a tragic tale, especially prefaced by Trump's lies.
I keep going back to the Edwin Starr record from the Viet Nam era: "War - what is it good for? Absolutely nothing." The details may have changed, the message hasn't.
Situation is worse than depicted...
While working with some neuroscientists regarding TBI several years ago, learned that the majority of TBI actually caused by extended riding in tanks or armored carriers with brutally stiff suspensions...
It's not so much that folks don't know how to diagnose...
Like some violent professional sports, they don't want to diagnose...
PS
High-velocity IED's and production-level anti-personnel devices raised this sort of hidden mayhem to art form...
That's why Trump's remark dismissing the severity of this sort of injury in the recent incident was so tone-deaf and all-around dumb...
Further, it gives our enemy license to inflict this sort of injury – at the rate of a couple of dozen – every couple of months...
While giving us plausible deniability, if we choose to be that feckless...
What the military needs is to clone that unique DNA that makes Trump able to perfectly assess a soldier's condition by merely looking at them and seeing what his gut tells him. Then all field doctors will have to do is check Dirty DJ's chirp-feed. Call it a cutting edge example of AI (Artificial Ignorance).
Unfortunately you have just given Trump and his supporters a way out of his lie that no one was injured...”see, it can not be proven!”
I know a number of people that have, or have had, TBI and it is quite obvious when you know the person.
I am not sure what this article was attempting to achieve. It seems to undermine those with TBI or as the authors may say “claim” to have TBI.
This article really missed the elephant in the room -- Abbott has been making progress on a TBI test and is far beyond any of the other blood-based test players. Alissa, gotta do your research better!
https://abbott.mediaroom.com/2019-04-30-Abbott-the-U-S-Department-of-Defense-and-TRACK-TBI-Partner-to-Study-Point-of-Care-Blood-Test-for-Concussions
" . . . troops on the ground are still being assessed with the same blunt tools that have been in use for generations."
Incorrect. This article was not thoroughly researched. The army has developed ANAM in association with Vista Life Sciences.
http://vistalifesciences.com/anam-intro
Everyone is looking to get the disabled veteran check.
1
America needs to admit the devastation they caused and injurues they brought on innocent Iraqi's. A house was obliterated and neighborhood buildings remained intact. .... US declared no collateral damage. What about all Iraqi citizens who had "Shock and Awe" inflicted on them? Men, woman, children with likely with traumatic brain injury from high explosive detonating in their neighborhood.
I find it amusing these soldiers were prepared, hunkered down in reinforced bunker yet they complained of concussion, headaches .... why doesn't US pay for medical for these Iraqi's who had to face trauma because of little Bush attempting to impress his father?
Traumatic Brain injuries (TBI) in this century have been more common in battles of this century than the last. IEDs, missiles and long range artillery can cause severe TBI. I cannot believe that the Ayn al Asa base in Iraq failed to protect the 100 service members from being hit by Iranian missile attack. Should they not have gone underground or moved to safer locations? Did the army military intelligence (an oxymoron) not have the common sense or estimate the potential of Iranian missile attack which has proved to be so damaging? If Iran can knock down a 160 million $s US drone with a missile fired under the orders of Gen. Suleimani. What should that have told any general overseeing the base so close of Iran? Heads should roll of whoever designed the base and whoever let these head injuries occur. Did these soldiers not have hard helmets on when the attack took place?
As far as why head injuries sometimes take a long time for experiencing symptoms associated with TBI. Those of us who have researched TBI in animal models know that there are primary effects due to the actual physical injury and/or concussion that can be evaluated within 96 hours of the injury and then there are subsequently progressive neurodegenerative effects that are long term due to neuroinflammation that can progress slowly but surely for years and result in other conditions such as Alzheimer's and PTSD. I disclose that I had applied to DOD for controlling neuroinflammation but never received a cent.
3
Look up CENC. https://www.limbic-cenc.org/
Look up TRACK-TBI. https://tracktbinet.ucsf.edu/
Needs more money for diagnostic projects. There's the need for immediate diagnosis, and then there's the need for a more accurate and specific diagnosis. I recommend advanced diffusion MRI for the latter, such as DSI or HDFT. Problem is that it needs work and validation in clinical trial, and the money to support this research has been less than what I would consider ideal given the need. The research benefits active duty and veteran service members, but also spills over into the civilian population.
“...no objective way of diagnosing it in the field...”
And if we did.
A diagnosis, disrobed of the mysteries of medicine, is but a way of collecting relevant data, transmuted into
useful, generalizable, needed information
which enables understanding. Insight(s).
Sometimes, rarely, wisdom.
In order to make a needed decision.
Diagnose to DO; or not to.
Consider, what is-was the objective diagnosis of the decision to assassinate
a...?
What implications and outcome were weighed by The weighed-DOWN, chronically -Personally Unaccountable
Commander-in-Chief and his “spurred”
MAGA mantrafying semantic missiles.
Which keep on missing the point.
The Chosen One’s daily target(s).
Just “a few headaches.” For whom?
For a lifetime?
For some. Who enlisted to protect...
As the predator twitterly-prognosticated;
selecting and labeling enemies of...
And missiles maneuvered into PTSD.
Diagnoses? Objective? Wellbeing? Whose
I grew up in a Third World country during a military dictatorship despised by millions. People joked there was a new measure of intelligence - the Tary. Geniuses were megatary. Very intelligent people were kilotary. The stupid were the military.
Of course it was a joke, but that’s how we coped with the day to day of the military dictatorship. However, it’s not too far from America spending trillions of dollars in taxpayer money and all they come up with is a questionnaire.
The Department of Defense says 109 U.S. service members were diagnosed with mild traumatic brain injuries following the Iranian missile attack. According to DOD, “a small percent of military persons who experience mild traumatic brain injuries may experience symptoms that last several months or longer, but for most the symptoms disappear within hours, days or weeks.”
Service members diagnosed with mild traumatic brain injuries qualify for Purple Hearts if they are treated with pain medication such as aspirin or ibuprofen for a headache. So anytime a missile impacts a basecamp, rear-echelon personnel will line up for aspirin and Purple Hearts.
https://www.army.mil/article/55850/army_clarifies_award_of_purple_heart_for_concussion
My father died at the age of 56 from the TBI he got on D-Day.
https://en.wikipedia.org/wiki/USS_Glennon_(DD-620)#/media/File:USS_Glennon_(DD-620)_and_USS_Rich_(DE-695)_mined_off_Normandy_in_June_1944.jpg
Billions continue to be spent trying to define TBI/PTSD/Concussion. The $$ are in research, not treatment and healing. Fact is, an active treatment does exist, irrespective of the "diagnosis": Hyperbaric Oxygen Therapy (HBOT). The TreatNOW Coalition have peer-reviewed positive scientific and clinical evidence, along with over 7,200 cases that HBOT helps heal wounded brains and returns patients to a life denied them by DOD/VA/Army ; veterans are not even told that the treatment might help them, even as they are given drugs that have NEVER been approved for brain wounds.
Reports released by the military paint a dismal picture. https://bit.ly/2oef1UT In 2018, active duty Army suicides reached a five-year high; suicide among active-duty Marines reached an almost 10-year high; active-duty Navy suicides hit a record high; USAF suicides will be the highest ever. Sexual assault in the military also reached a four-year high in 2018. And female service member suicides are “staggering” and “obscenely high” at six times the rate of other women. https://lat.ms/2p2x0xL The epidemic of active duty and reserve service members shows 541 took their own lives in 2018; DoD also reports that 186 military spouses and dependents took their own lives in 2017. https://bit.ly/2ounxza We know the rules for confronting epidemics. HBOT exists, is proven safe and effective in 14 FDA-approved indications, and has never killed anyone. It is available today in over 100 private clinics in the US alone.
So many words written in this report, yet it's frustrating to find nowhere a clear and concise definition what is "truamatic brain injury".
Concussions in battle are traumatic brain injuries. Our ignorant president dismissed our troops' 100+ brain injuries in Iran's shelling of Ayn al Asad Air Base in Iraq as "just a headache". Donald Trump is just America's headache.
Sounds like a good reason to withdraw from wars of choice. Massive brain damage is one heck of a price to pay for cheap gas.
I am contractually bound by a non-disclosure agreement, but there's an app for that.
I do not mean to sound glib, but if you own a smartphone, you own a device with a digital accelerometer. A tiny chip that senses the device's orientation to gravity, and records relative motion in real time.
Mounted in a soldier or football player's helmet, digital accelerometers can record the exact nature of any type of impact that could affect the brain. These devices can record the severity of the force a person endures. They can record detailed data about the direction the blow came from, and then record exactly what happens to the person after the injury. Did they fall to the ground? Remain motionless? Once upright, do they exhibit changes in they way they walk?
Tie this sensor to a smartphone application that logs this data in realtime, and then provides a set of cognitive tests that the injured can use to record baseline data and then continue to track the effects of their injury.
"Yo Sgt. Joe, your helmet indicates you took a tough blow, it's time to play brainball and report your high score. Please take five minutes to play the game every day."
Well maybe the military can use some of the trillions of dollars they blow on the military-welfare contraption to come up with something better. A budget/benefit cut would do them done good.
Just one more example of Trump having no clue what the situation is; or worse lying through his teeth about what really happened to these men; after declaring no harm resulted from assassinating the Iranian general. Putting men and women in harms way is the most sensitive thing any leader can do. Of course being safe and sound in the White House means never being in danger of these injuries. When even the experts are struggling to assess such battlefield injuries; listening to the idiot who set this whole series of engagements in motion saying no one suffered injuries is beyond lies; it is an insult to those who clearly are suffering as a result of Trump wanting his pathetic headlines.
1
Why worry? Our President said they were just headaches.
Here is a link to recent presentations from our group to the 2019 Military Health System Research Symposium.
http://stash.osgconnect.net/+krieger/M_1430_MHSRS_19-01099_Krieger.pdf
We describe and document the effectiveness of neuroelectric measures in distinguishing patients with chronic symptoms of concussion. These measures, which are acquired from a 10-minute recording in an entirely safe, silent, and non-invasive magnetoencephalographic (MEG) scanner, localize regions of abnormally elevated or reduced activity with much greater reliability and sensitivity than previously available.
The military is funding many groups' work on this problem, and there is real hope for substantive advances in the near future. Our work carries the additional hope that it will be useful in improving understanding, diagnosis, and treatment of not only concussion, so-called mild TBI, but also psychiatric illness, particularly depression and anxiety disorders.
Best - Don
Don Krieger, Ph.D.
Research Scientist
Department of Neurological Surgery
University of Pittsburgh
The Department of Defense says 109 U.S. service members were diagnosed with mild traumatic brain injuries following the Iranian missile attack. According to DOD, “a small percent of military persons who experience mild traumatic brain injuries may experience symptoms that last several months or longer, but for most the symptoms disappear within hours, days or weeks.”However service members diagnosed with mild traumatic brain injuries qualify for Purple Hearts if they are treated with pain medication such as aspirin or ibuprofen for a headache. So anytime a missile impacts a basecamp, rear-echelon personnel will line up for aspirin and a Purple Heart.
https://www.army.mil/article/55850/army_clarifies_award_of_purple_heart_for_concussion
I wonder how many Iraqi children and civilians have brain trauma. The MSM is too narcissistically focussed on Americans.
1
Trump and military don’t belong in the same paragraph, the same room or the same country. Certainly not ours.
I’m reading “ A Very Stable Genius,” by Pulitzer Prize winning authors Philip Rucker and Carol Leonnig.
I have to put the book down at intervals not believing what I had just read, but it is true. A vomit bag may be necessary at your side.
During a meeting with all four start generals, the Joint Chiefs, the president in one of his uncontrollable rages called these men of honor and life long service to their country, he called out, “You’re a bunch of dopes and babies.” The same person who played football in school and was in excellent physical condition, when alleged bone spurs negated his service. The coward in chief was name calling the Joint Chiefs dopes and babies.
So, when it come to brain injuries...
God, how is this country going to survive.
Hey, all you Vets that voted for him, consider yourselves hosed.
1
So this begs the question. Why has the NYT made front page news of this when explosives have been used for hundred of years?
Whatever our means of diagnosing TBIs, the President's egregious dismissal of injuries suffered by our troops is not just damning, it's indicative of that old school 'suck it up' mentality that quarantees these problems will remain unresolved due to the stigma he is perpetuating.
There is still an obvious disconnect between science and the prejudical bias of like minded Neanderthals so that such injuries will be forever be underreported and untreated; the military, which has been guilty since time immemorial of fostering this mentality 'for the good of the unit', producing like-minded field commanders in positions of power over others, has a duty to put an end to this and obviously they've failed. Or perhaps they're just guilty of 'a failure to communicate'.
The means of enabling an atitude adjustment has much to do with how it pertains to our egos, and to be most effective the impetus for change is most effective from the top down.
Unfortunately it remains a scare commodity as military commanders will attest, to find those in positions of power without its corrupting influence, without rampant egoism.
Surely is hasn't gone unnoticed by those august bodies that their current Commander in Chief has unwittingly schooled us all with examples of that scarcity.
Having a cranial osteopath evaluate soldiers would be a boon to identifying and treating PTSD.
Not sure the military wants to remove standing, breathing soldiers any more than the NFL wants to sideline million dollar quarterbacks. There's too much incentive to keep highly trained expendables on the field of play as it were.
6
Diagnosis is difficult in civilian facilities as well. I had a probable TBI when I fainted and hit my head in the bathroom. At the ER, they put a bandage on a cut on my face, but couldn't diagnose a concussion, which was diagnosed by the PA in my doctor's office a few days later. I have trouble concentrating but I can't say for sure whether this and a similar event a few years later are the cause.
3
I would like to see more research and funding into understanding brain illnesses and brain trauma, period. Just about most tools to evaluate a brain condition relies on primitive questionnaires. For many brain illnesses, it seems the best an MRI can do is detect a tumor in your brain to see if that is what is causing your symptoms. Even for people that for example, are experiencing major depression, which to remind people is also a physical illness, relies on self filled scorecard questionnaires which is really about self perception that is often inaccurately gauged. I suppose having something is better than nothing, but if you see science as a candle in the dark, when it comes to the brain, the light is still ten extremely dim and experts are still often without sight.
1
Response to magicisnotreal
Perception is not objective - clinicians must objectively evaluate in a meaningful validated data driven approach
@Mark - Neurological
Of course that is the premise of modern medicine.
My question (how does one overcome the assumption of guilt most medical professionals start with) is aking how one deals with the simple fact that most medical professionals are not doing that.
On Veterans Day, our soldiers are routinely feted as the best of the men and women serving their country. Yet, the VA has been in disarray since the Vietnam Nam war and too many veterans are homeless, addicted and dead from suicide. There is one simple path we can take to honor those who place their lives in danger for our defense.
Stop treating wounded soldiers returning home as criminal suspects in some scam to steal undeserved disability and benefits. We see insurance companies brag about how quickly they pay auto and home repair claims, including one that targets military families. We should do the same.
So here's the plan. Pay all disability claims within 30 days of receiving the paperwork. Begin paying 100% of the claim immediately and then take as long as the government needs to decide if the claim was valid or not. If the claim was valid, we have done those soldiers and their families a service in return for the service they have provided us. In the case of TBI, because of the lack of valid testing, our soldiers will be free to return to service or leave with their claims paid.
2
I'm almost relieved that there's no "magic biomarker".... use of clinical interactions and the "tincture of time" are undervalued currently and likely what clarifies the diagnosis here.
1
There are blast detection devices available. Most are for research. However the Military had developed one, yet cancelled the project. It was a small wearable device. It did work, but the Mil said it produced too many false readings. Wonder what the actual numbers were. NPR did a story on this.
1
It's not mentioned anywhere that brain injuries or bad blows to the head can actually put a person in danger of developing ALS. The blows damage the muscle movement neurons, this also happens during sports, all the ones where the head goes unprotected by a helmet. Lou Gehrig was the first famous case, as far as I know. Neither do I know whether he had a brain injury, but rugby players are the most affected. I don't understand why they don't protect their heads. My son played rugby and died of ALS aged 29 years.
3
Assuming that a person is "inventing symptoms" or "malingering" is a big problem in diagnosing TBI. Military service personnel need to understand that not all behavior is intentional. Lack of self-care, continual repetition of phrases, lack of short term memory or loss of executive functions can all be signs of TBI and not a bid for sympathy or bid for a Purple Heart.
2
Current questionnaires used to screen for brain injury seem intentionally inadequate. There are far better paper and pencil cognitive tests that could be used to measure cognitive processing. Yet they might be influenced by mood and environment. Expensive brain scans show structure or damage but not overall brian function. Unused are Event Related Potentials (ERP). They are cheap, simple to record, and a good indicator of overall brain function before and after an injury without distraction of confounding psychological variables such as depression. Changes in brain function before and after a football season or before and after a tour of duty could be easily demonstrated. My impression is that ERPs are ignored because institutions such as the military, parents of kids who play football, or the NFL want the appearance of concern but do not want information that would force change. The vague results of current ‘testing’ questionnaires and brain scans provide only speculative diagnoses and allow current practices to continue.
2
I am a TBI survivor. I suffered my brain injury on April 29, 2007, when a car driven by an elderly woman struck the bicycle I was riding in Pennsylvania. I ask the media to not forget that many, many Americans live with brain injury, injury sustained not in combat but when victimized in car vs. bicycle crashes.
2
"Some troops try to hide symptoms so they can stay on duty, or avoid being perceived as weak. "
“Battlefield injuries are complex,” he said. “We still haven’t found the magic biomarker.”
Blows to the brain, including via electrical current, shock waves, or shaking can damage the brain. "Brain damaged" is a term used as much as a slur as a description. I read about brain function because, as an adult, I came to remember that, and how, authorities damaged my brain when I was 11. The brain rewires itself continually, bathing itself in increased cerebrospinal fluid to flush out toxins while REM sleep is believed to consolidate needed memories and eliminate unneeded information. My brain injury did not affect my ability to answer questionnaires or learn information for school and work. I lived my life, however, physically and emotionally clumsy and somewhat stunted and unaware of some of my affect. My thinking became more connected when I took up X-country skiing in my 30's. An MRI of my brain done in my 50's shows physical damage. In my early 60's, I took "outdoor women" lessons that included shooting at clay pigeons with a shotgun. I fired a few times, hit a moving target once, and following that, felt light headed and dizzy for the rest of the day. That day made me greatly appreciate the daily challenges soldiers face.
Could our POTUS's minimizing head injuries be rooted in lack of information? Could it be tough guy talk or whistling in the dark?
Very little in life is purely objective. If Medicine had no need of subjective judgements, we wouldn't need doctors. Doctors do their best using the current information they have, which is almost invaribly incomplete in diagnosing and treating injuries in the short term.
Just because the NFL uses a protocol, doesn't mean it is an accurate predictor. At most it means that using the protocol is likely less risky (to the NFL) than not using it. The NFL is trying to assess players quickly on the sidelines to clear them to go back into the game. Arbitrary time limits are unnecessary on medical assessments.
1
How are we supposed to take care of our veterans in the long-term if we cannot take care of soldiers when they are at war? How are we supposed to send our young people to war, when we cannot guarantee they will receive proper treatment? It is a broad issue, but we need to address these injustices immediately. If we are going to increase "military spending," we need to ensure that those we are asking to join our military receive proper treatment while they are literally taking the hit. If there is no treatment, then there is no deployment.
10
@Aimee So, if we don't know how to treat brain injury, then we should withdraw our military and allow any enemy to overrun us?
There are tools out there that are utilized daily in clinical practice and on the sidelines of high school football games. A few mini mental exercises and neurological exam looking for abnormalities can provide clues to who we should worry about. Still does not predict recovery time, but to make it sound like we have no idea who is affected is a bit of a stretch.
19
@Amber Morgan
Thank you Dr. Amber for your informative insight.
Your Medal of Freedom will go out in Monday's mail.
The NYT has an article recently on the total diagnostic failure of those tests. They lack a baseline from which to judge if something has gone wrong.
@Amber Morgan And what evidence do you have that your techniques are accurate? Just because you do them doesn't mean they work as intended.
Dr. Bazarian makes it sound like this is the only illness treated based on patient reports.
As a physician myself, I'm curious as to how he manages patients with headaches. The overwhelming majority have no identifiable underlying disorder causing the headaches. Guidelines have been established to determine whether patients need further workup so that every patient isn't sent for unnecessary testing.
The same is true for neck and back pain where there is no identifiable etiology in over 85% of cases.
And obviously we have no objective testing for most mental disorders including the most common ones including depression, schizophrenia, or bipolar disorder.
I just wanted to point out that TBI is not the only disorder for which a great deal of doctor's decisions regarding the diagnosis and treatment is based largely on patient self report.
49
@Steve Great point. The headaches may last months or years if there is nerve damage. It doesn't make it any less severe as it drains the patient of energy and can cause
non-stop discomfort. To everyone, except of course, the President.
19
@Steve
This article did suggest to a lot of readers that questionnaires are a primitive, backward method, and the medical system is somehow negligent in not developing a simple high-tech test to tell whether you have TBI, like a saliva dipstick to tell whether you're pregnant.
Just because you saw it on Star Trek doesn't mean it's possible.
The NFL has a screening for concussion which would be a good place to start looking at TBI. My, relatively mild, TBI (sustained in a bicycle fall) included sub-arachnoid bleeding which was visualized using a CAT scan which makes a secondary assessment when the initial one is positive. This is SOP for hospital Emergency Departments (or so I'm told).
16
@Don What are the odds that the military doesn't know what the NFL is doing?
Most people call it a concussion.
Then, define it according to severity.
“Traumatic brain injury” is just word to trigger people. Very vague, yet dramatic.
13
@Randy L.
Again, I am a physician with decades of experience in TBI and no trolling is intended.
"Traumatic Brain Injury" is currently the preferred term amongst medical professionals who work with this condition to provide a label for what has been called "closed head injury", "Concussion", etc., over the years.
Medically, it is intended to be purely descriptive and to NOT evoke any emotional response.
Given the characteristics of the problem, it is a pretty good label that says no more, and no less, about traumatic brian injury than it should. It is a single label that describes a large number of different conditions.
I would say that there is no "conspiracy" regarding TBI other than that which arises from ignorance in our leaders.
64
@Randy L. I had a bad accident where I hit my head five years ago. Initially the hospital asked if I had passed out (I hadn’t) and concluded I had just broken my nose. Two months later, at the pressing of a friend, I saw a neurologist. The CT scan showed 11 places in my grey/white matter boundary with severe injuries, and I ended up on disability for years until retirement age. I’m still recovering my short-term memory, focus, and energy levels of pre-accident.
I assure you, a TBI is not a trigger phrase. It’s what we in the community call an invisible disability.
28
@Randy L. It's chosen to be dramatic for a very good reason- a long history people like you who underestimate the possible seriousness of a concussion. We now know that there can be long-term effects.
1
Traumatic brain injury is not common and also not a headache. It is scary how this has been reduced to something trivial.
37
@jaye fromjersey
TBIs are very common. My wife sustained 2. One year she was cleaning the floor and the top freezer drawer was open.
She stood up and hit her head. A week later she was still having headaches. She recovered completely in a couple of more weeks. Then years later she did a similar thing hitting head on a branch of a tree and that one took 3 months to heal. 2 TBIs in just an average person's life. Yet I dropped my motorcycle in a gravel patch and hit my head at 45 MPH and came away with nothing because I had an expensive full face helmet.
@jaye fromjersey
No trolling intended, but it is actually pretty common.
Sequela of brain injury and many neurological disorders are manifest as cognitive and psychiatric problems. Clinical assessments with traditional examination techniques are not only insensitive and often inaccurate but clinician perception (eg misperception) adversely impacts both recognition and initiation as well as utilization of more relevant and sensitive performance based metrics. Unless you are a stable genius, the rest of us use digital objective multidimensional performance based metrics to assess for such impact. Our patients and soldiers deserve better. We can and must do better. - mg
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@Mark - Neurological
So how does one overcome the assumption of guilt most medical professionals approach patients with?
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Why a Space Force when we still can’t properly protect, diagnose and treat our ground forces?
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@Greg Tutunjian More funding for the NIH !
@Greg Tutunjian think of the $billions to be made in outfitting a Space Force- there’s no money in treating Vets, especially at the VA! PTSD is just a headache, and anyway, there might be oil in space, or on the Moon or Mars; we’ve got to get there first to claim it!
This is a difficult clinical problem which is being addressed by resarch. Medicine has numerous conditions in which we do not have clear answers as to etiology or therapy.
I believe the tone and headline of the article are inappropriate, as they clearly imply that the military is derlict in its diagnosis and treatment of TBI. As it does correctly state, this is a rather complex clinical issue necessitating further research. We do not need to imply blame.
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@Daniel Karsch
The military and the VA ARE derelict. Duh!
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@Daniel Karsch We should be spending more on research. The NIH or even he US Army should fund more university research. . Curious I don't even see a category for Brain Injury on the US Army funding site : https://cdmrp.army.mil/pubs/press/2020/funding_press_release20
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@Daniel Karsch
I'm commenting here as a TBI Physician because the context is best.
We should not condemn the military here. The VA actually takes TBI quite seriously. This is not a political issue at its core. The civilian world is not that far ahead of the military in managing TBI, if we are ahead at all.
This is a very difficult problem to work with. A lot of intensive effort is going into treating it.
In the Brain Injury Medicine world, many very smart people have many very "spirited discussions" about how to deal with this.
If anyone is guilty of an error, it is minimizing the effects of TBI secondary to pure ignorance and pretending that TBI doesn't exist because the patient isn't dripping blood.
I'm not even going to get into the complexities of mild, moderate, and severe TBI.
It is no surprise that a simple questionnaire is inadequate to evaluate this. In fact, the questionnaire that they used in the last year or two to "prove" President Trump was cognitively intact was the same one used by the VA for TBI, and is generally abnormal only if you are fairly severely impaired.
I will bet Dr. Jeff is not so great at diagnosing back injuries either. Unless you have a better way don’t denigrate the questionnaire. Having been thrown from a horse onto my head I think I know what a concussion feels like: black out, dizziness, foggy thinking, then it slowly goes away. How many heart attack patients has he sent home with a diagnosis of heartburn. A relative called about her mother, she had all the stroke symptoms we laymen are supposed to recognize and I said get to the ER. They sent her home, by the next day her right side was unusable and it stayed so for the next twenty years until her death. When my appendicitis started I thought it was too many mashed potatoes for supper. The Times article every week proves how hard it is to diagnose ailments. Only the bone sticking out is easy.
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@Richard , in 2000, I was injured in a car accident and had a TBI. It was incredibly difficult to find someone who could diagnose my injury. No bleeding, no broken bones, severe whiplash, back, neck etc pain. I finally got a diagnosis and did 6 months of brain therapy, an additional 15 months of PT. I cannot see several types of movies, because my injury involved damaged to my inner ear balance. All ‘concussions are different.
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@Meme Maine what kind of brain therapy and how did you find out about it? Where do people get more info about treatments and help? great article and great comments-would also be wonderful if some resources were referenced. thanks
Current research on MTBI shows there are multiple areas of function that can be affected, including issues with balance, visual tracking, headaches, sleep disruption, mood, and memory/concentration. Any or all of these may be present to some degree. Some can be objectively assessed, some by definition must be self-report. Most MTBIs will show a normal MRI and CT. Self-report questionnaires of symptoms can, as the article says, have both false positive and false negative issues. The best approach is to treat the patient's report as legitimate and educate them, that the vast majority of MTBIs resolve completely within a few months. It is crucial to not overstress the healing brain and let the patient work to tolerance and progress at their own pace, which is often not possible in an active duty setting. Malingering is rare and it is far better to be liberal in the diagnosis so as to not miss legitimate cases.
David P. Schwartz, Ph.D.
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@drdave39 Wish I had found you five years ago! Instead I faced a steady stream of docs who suggested that a woman at my age just needs an antidepressant. It took 22 months of having to be both patient and advocate before I got confirmation of what I knew all along through some of the sorts of testing you mention above. Just this past spring, which was the 5th anniversary of the injury, I could finally read for pleasure again. I’m still unable to meditate (had a robust daily practice prior to the injury), have memory issues and embarrassing recall issues (both facts and also recognizing peoples’ faces, despite meeting them on a couple of occasions). I’m told I’m still experiencing a chronic inflammatory cascade (i don’t know if that’s considered a glutamate storm this far out) which affects both my brain and my gut. And, yeah, I have trauma around this all. Most people would. I’m reading with interest about research with brain-injured soldiers and HBOT, as well as exploring the polyvagal approach on my own.
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Over-pressure from a rocket can be totally debilitating beyond the damage caused to the brain. The blast wave does not only cause damage to your brain but other organs as well. I have experienced it first hand in Iraq. Let's say that a rocket lands within a few meters on the other side of the sandbag blast wall. There is some protection from fragmentation wounds, but the blast wave hits one like a fast moving truck. Blood pours from ones nose and ears. The retina become damaged with holes caused by the pressure and small blood vessels in the whites of ones eyes burst. There may be brief unconsciousness and the perception of white dots floating around your vision. Severe headache and pain in the gut and surrounding areas of the torso. Years later the effects of that blast are authoritatively diagnosed by doctors as organ disease attributable to alcohol or drug use -- not the heaping loads of prescription drugs, of course. These ancillary medical issues are not being looked at by doctors except for the specialists who are unable to connect blast injury to the underlying damage of the particular organ of their specialty. And they will not consider it because they did not learn anything about blast wave injuries in medical school or residency. The government has a vested interest in keeping these diagnosis numbers low because the wounds cost money. Like Trump, the medical world doesn't associate combat injury with non visible wounds of our internal organs. Maybe they should.
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@John OBrienj I’m really sorry for what you are going through. Yes, the current western medical approach doesn’t look at our body as a system and doesn’t look for root causes, but tends to just treat symptoms. I’ve had much more luck in the care of “functional medicine doctors,” who, to me, with their knowledge of bodily systems, biochemistry, the ability to recognize nutritional and gut deficiencies, are the “Sherlock Holmes’” of the medical world and, I hope, the direction into which the profession is moving. May you find support and healing.
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@John OBrienj
Overpressure doesn't go through sandbags. It goes up and over them and loses more than 50% of it's intensity so long as the sandbag extends higher than your head.
Losing 50% of intensity doesn't help you if what landed on the other side of the sandbag is a 2,000lb bomb or an ICBM. But it sure does save you from mortar fire and small rockets. Let's get our facts right if we're gonna comment on the science of this please. Thanks.
@John OBrienj thank you for your service and for sharing your story here. I work everyday to try to address injustice in health care and politics— your voice matters!
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The problem of using these “paper tests” such as the Glasgow Outcome Scale or Glasgow Coma Scale, has not only been a problem for diagnosing patients with mild to moderate TBI, but it has also, to a large extent, contributed to the failure of many industry and NIH-funded clinical trials trying to find effective treatments to repair the damaged brain. This is especially the case when these paper tests are used as the primary outcome measure for testing new drugs or other therapies for TBI. Yet, because it is short and relatively easy to administer, it continues to be used...as this NYT article points out. Very often clinical trials cost millions of dollars and result in so much variability in the patient’s response (as indicated in the article) that nothing can be concluded about the efficacy of the agents being tested. And the trial is considered a failure. Knowing all this, the persistence of using these tests in the medical community working with TBI victims, is hard to fathom. But then again, when one thinks of how long it took physicians to start washing their hands between seeing patients, or sterilizing instruments and their clothing between surgeries, there may still be hope that a proper solution to this really very critical problem will be found before the end of this century.
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Wouldn't the extent of concussion data in the NFL be of use to the military in coming up with an operational case definition? Are CT scans and MRI are deemed too expensive as a screening exam for the military? Further, there must be a continuum of damage from mild to major that could be identified so that brain injury to lead to treatment. It is stunning that in this digital age, we are assessing warriors with a paper questionnaire.
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Two thoughts come to mind. First, these are not contact injuries but rather blast effects. Second, the protocols that are used/created must be immediately available in the field, far from such diagnostic equipment.
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@Rosemary Galette CT scans miss some of the hallmark injuries like diffuse axonal injury and MRIs will sometimes show alterations in mild TBI but often not. The expense of MRIs means that studies are often too small to find generalizable effects. Severity is usually measured by the GCS but that's a blunt measure, and two people can have the same GCS and have very different outcomes
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@Rosemary Galette CT scans can only show brain bleeds, not the type of injuries sustained by blasts. There currently aren’t brain scans in clinical use that can diagnose these injuries. Hence the questionnaires and research into bio markers. The military is working with the NFL BTW. But even sports concussions are similar with regard to diagnosis.
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