Thoughts on Traumatic Brain Injury
In October 2006, some 30 hours after departing Andrews Air Force Base in Washington, D.C., I stepped off a C-130 troop transport plane and on to the tarmac of Iraq's Al Asad Air Base to fulfill a long-planned visit with our troops. If I had any doubts that I was now in a war zone, they were quickly dispelled when I was ordered to put on a helmet and armored vest and invited to join my military hosts as they headed to the base field hospital to visit two Marines who had just been dispatched there, victims of a suicide-bomber attack that had demolished their tank.
As a former airman first class in the United States Air Force, past spokesperson for the U.S. Veterans Administration and honorary member of the United States Marine Corps, I have more than passing interest in the recent news that 34 U.S. service members are said to have suffered traumatic brain injuries in Iran's missile strike this month on the same airfield I visited more than a decade earlier.
Though much of the discussion of this report has taken a political turn, my hope is that it will also bring to light more examination of what science has learned of traumatic brain injury, which is now referred to as TBI. Back in 2006, little was known by doctors or scientists about what happens to a brain as a result of a powerful bomb blast as opposed to a car crash on a highway or a blow to the head on the football field. This has changed in recent years, as medical science has improved its understanding of TBI's effects on brain function. Medical science has made significant advances in its understanding of head trauma and how to treat it.
When faced with these situations, it is important to acknowledge that our military leaders are diagnosing and quickly acting on treatment. Commanders took the proper steps in assessing military personnel exposed to the blast. It also must be noted that of those examined and treated, many stayed in Iraq and have since returned to duty there.
Dr. David Cifu of Virginia Commonwealth University is head of a nationwide research group studying the effects of combat-related traumatic brain injuries. He recently told NPR News that, while all concussions and brain injuries are serious, "95% to 98% of people with concussions who are diagnosed early on, who are managed in a comprehensive way, which the military knows how to do, are going to do well, are going to have wonderful short- and long-term outcomes." Concussions refer to mild to moderate forms of TBIs.
As I reported in 2016, the Department of Defense reported 15,530 cases of traumatic brain injury in 2005 among service members, primarily caused by blast exposure. By 2011, that number had increased to 32,907. The Defense Department recently reported more than 375,000 incidents of TBIs occurred in the military between the years 2000 and 2018.
"If we look at the total numbers of folks that were in Iraq and Afghanistan, we're looking at well over 300,000 individuals just from this conflict alone had one or more of these concussive events," says Cifu.
"There is huge variability across individuals," said Jefferson Kinney, a neuroscience researcher at the University of Nevada at Las Vegas and chair of the department of brain health. "Some people will undergo a trauma that they seem to recover from very quickly, and others seem to be much more impacted by it for a longer duration." A problem in diagnosis is that symptoms from some brain injuries are not immediately apparent. Also, the consequences of even seemingly small concussions can be far-reaching, leading to financial problems, job losses, divorce and mental health issues. These ramifications often go unseen by the military because symptoms often worsen once one leaves the structure of military service for the unpredictability of civilian life.
Beyond military service, traumatic brain injury remains a major cause of death and disability within the United States. According to the Centers for Disease Control and Prevention, most TBIs each year are mild concussions. In 2014, an estimated 2.87 million TBI-related emergency department visits, hospitalizations and deaths occurred in the United States, with over 837,000 of them being among children. Falls were the leading cause of the injuries, followed by motor vehicle crashes.
As reported by Everyday Health, football is clearly a brain trauma subject, as mounting research confirms the short- and long-term damage caused by sometimes preventable injuries. It is the sports world's leading cause of traumatic brain injury in teens. According to the UPMC Sports Medicine Concussion Program, around 20% of high school athletes who play contact sports suffer from concussions each year. The effect these injuries have largely depends on severity and early intervention.
TBI education has come a long way in recent years, yet the clinical management of concussive brain injuries remains a challenge and needs more money and attention spent on diagnosis and rehabilitation.
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