The following is a guest post by Linda Dailey Paulson, a medical and technology journalist for Providian Medical Equipment. 

Brain injury is commonly referred to as “the signature injury” for the Iraq and Afghanistan wars. Symptoms may not appear immediately and even then, detection is extremely difficult, making it possible for a soldier to have multiple, undetected, and untreated trauma incidents.

The Defense and Veterans Brain Injury Center (DVBIC) shows that the Department of Defense reports that a cumulative total of 212,742 incidents of traumatic brain injury (TBI) have been reported since 2000. Some head injuries may go unreported or undetected, making an exact tally nearly impossible.

“With IEDs, the insurgents have by dumb luck developed a weapon system that targets our medical weakness: treating brain injury,” Kevin “Kit” Parker, a U.S. Army Reserve captain and assistant professor of biomedical engineering at Harvard University who served in southern Afghanistan, told Technology Review in 2008.

These types of injuries can include concussions or mild traumatic brain injury (mTBI), which is defined as “any incident that produces unconsciousness lasting for up to a half hour or creates an altered state consciousness.” Pressure waves from blasts can also cause injury. Standard CAT scans and MRIs do not detect these so-called “mild” brain injuries, but newer imaging approaches may be able to detect injuries, which is why research into possible technologies and treatments continues — $300 million in funding for TBI research was authorized in 2008.

“I don’t know what makes it ‘mild,’ because it can evolve into anxiety disorders, personality changes, and depression,” said David Hovda, director of the Brain Injury Research Center at the University of California in Los Angeles, and recipient of the U.S. Army’s  “Strength of the Nation” award for his work on developing military protocols for caring for those with traumatic brain injury.

Although most soldiers reportedly recover from mTBI, an estimated 5-15% do not. There is also concern that the reported number of cases is actually very low.

“People just get blasted and blasted and blasted,” Maj. Connie Johnmeyer with the U.S. Air Force’s 332nd Medical Group said. Estimates are that of the two million troops who have served in Iraq and Afghanistan, more than 800,000 soldiers have had multiple deployments — some as many as or more than five tours. Those in the field can typically encounter multiple blasts while on patrol.

Possible disabilities resulting from head injuries include chronic pain, sexual dysfunction, subtle changes in personality, and insomnia. mTBI has also been linked with suicide, increased domestic violence, depression, and obsessive-compulsive disorders. It is also a risk factor for Alzheimer’s disease.

Concussions are reportedly the greatest traumatic brain injury experienced by ground troops in Iraq and Afghanistan who encounter roadside bombs. The Army estimates that, since 2000, its soldiers have had more than 91,000 concussions — the highest number among the armed forces in the U.S. Military leaders continue looking for better helmet designs and concussion-detection tools.

Many of these technologies as well as treatment protocols originated in sports, including a portable, radar-based system developed by Georgia Tech Research Institute engineers that measures and compares an individual’s gait to determine whether it is safe for the individual — soldier or athlete — to resume activities.

The Canadian military also has reportedly found that “‘invisible wounds,’ such as mild traumatic brain injuries” are challenging its health system as well. “Brain injuries are hardly new to combat, but it’s now becoming clear that mild injuries can result from being close to an explosion, and these injuries can sometimes lead to ongoing problems — everything from chronic headaches to behaviour changes.”

“The brain is the most complicated organ that we have, and trauma is the most complicated type of an injury,” Hodva said. “The trick is to understand what has occurred from a blast and to just allow the brain to go through its natural course of recovery before you expose it to another blow…It’s so important to protect the individual as soon as possible after concussion with rest, sleep and non-stimulation.”

Linda Dailey Paulson has over 20 years experience as a medical and technology journalist. She writes for Providian Medical Equipment, a leading provider of new and refurbished ultrasound machines to hospitals and clinics all over the world.

Image by DVIDSHUB, used under its Creative Commons license.