Recognizing traumatic brain injuries

by Jerry Harben

A roadside explosion throws a Soldier against the side of his vehicle with a force that shakes his brain inside his skull. Another Soldier is in a traffic accident, and her head is thrown forward into the windshield.

These are different situations, but they often have the same result – a mild traumatic brain injury, better known as a concussion.

A concussion is an injury that causes an alteration of the person’s mental status. More serious brain injuries that cause unconsciousness for 30 minutes or more are usually quickly recognized, but concussions may be dismissed and go untreated.
Most people recover from concussions in a short time as long as they do not repeat the injury, said Lt. Col. Lynne Lowe, TBI program director in the Office of The Surgeon General of the Army.

“If someone has a concussion, we want them to be evaluated. It is very important that we protect them from getting another concussion before their brain heals,” Colonel Lowe said.

Symptoms of a concussion include confusion, headaches, dizziness, ringing in the ears or nausea. These symptoms usually resolve within hours or a few days. Some people do have more persistent symptoms, which can include trouble sleeping,
irritability or blurred vision.

“We teach (providers) about what it means to have a concussion, and some of the warning signs of a worsening condition. If symptoms last longer, more formal testing can be done and, if needed, rehabilitation,” Colonel Lowe said. “It’s a step care model; give them what they need while always using our best judgment and
available guidance.”

The military has developed two tools to help medical professionals diagnose concussions. The Mild Acute Concussive Evaluation is part of treatment protocols used in the Department of Defense for injuries less than seven days old. A doctor or medic will ask about the subject’s medical history and test memory and thinking ability. The subject may be asked to repeat a sequence of words or count backwards.

The Automated Neuropsychological Assessment Metric is a computer-based test. From the full 45-minute test battery, the military has extracted several tests associated with brain injury that take about 15 minutes to complete. Soldiers complete this test before deploying. If there is an incident that might produce a concussion, medical personnel on site can e-mail for the baseline results and compare them to a post-injury test.

The Army has conducted a well-publicized campaign to convince Soldiers who may have suffered a concussion in combat to seek treatment.

But this is not an injury limited to combat; it can result from sports, vehicle accidents or everyday activities.

“Whether you’re going down a snow ramp on a tube, riding a bicycle or playing contact sports, it’s a good idea to wear a helmet,” said Larry Whisenant, chief of the safety office at Army Medical Command Headquarters. “Even children on a  bicycle carrier should have helmets. It’s such an easy thing to do and it can prevent a lot of grief.”