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Q1. What is brain injury awareness month?
A1. March is the month set aside each year by medical professionals to increase awareness about brain injuries to include prevention, diagnosis, and treatment.

Q2. What is a TBI?

A2. Traumatic brain injury refers specifically to a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. The severity of TBI may range from mild - a brief change in mental status or consciousness - to severe - an extended period of unconsciousness or amnesia after the injury. It can also be defined as any direct or indirect force to the head that temporarily (or permanently) disrupts brain function. This can be caused by a direct blow to the head (boxing, a bean ball), an indirect force (whiplash sitting in a car hit from the rear), a penetrating injury (shrapnel from an explosion). It can range from an injury so mild and transient that it is completely missed, to a severe injury that causes profound coma just short of, or including, death.

In plain language, it is a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain. Not all blows or jolts to the head result in a TBI.

Traumatic Brain Injury

• Severe traumatic brain injury is obvious. It is treated in standard ways in theater by neurosurgeons. The Joint Theater Trauma System, an in-theater trauma care regulating system, helps to insure that those casualties with severe head injury go to a theater medical facility with neurosurgical capability. These injured service members have immediate emergency surgical treatment as required, including decompressive surgery, and then have ongoing treatment in the United States either at a military medical center, or at one of four Department of Veterans Affairs polytrauma centers.
  
  
• Moderate traumatic brain injury is also clearly recognized, with an event-related period of loss of consciousness and clearly observable deficits such as ongoing confusion for days to weeks. The great majority of these service members are identified and evaluated at theater level medical facilities, and are evacuated back to the United States for further evaluation and care.
  
  
• A concussion, clinically known as a mild traumatic brain injury is as difficult to detect in the military sector as it is in civilian life. Equivalent situations might be a concussion in a hockey rink, on the football field, or in the boxing ring.
  
  These events, not necessarily associated with loss of consciousness, can be more subtle to detect, and the index of suspicion must be high to ensure that those who have suffered concussion are appropriately evaluated, treated, protected, and sent for further evaluation and treatment if their condition deteriorates.
  
  In addition, it is well known that multiple concussions within a short period, before the brain has had time to recover from the last injury, can provoke a more severe deterioration than might be warranted by the last injury suffered alone.
  
  
• Penetrating is not mild, moderate or severe. Services members who sustain a open head injury which penetrates the dura of the brain via a bullet or fragments from a blast.

Q3. Why do clinicians use the word traumatic when talking about a concussion?

A3. The word, "traumatic," is a term to indicate certain causal factors that result in clinically describing a brain injury condition. "Traumatic brain injury" refers specifically to a blow or jolt to the head or a penetrating head injury that disrupts the function of the brain.

Q4. Why is this brain injury awareness important to Soldiers and their Families?

A4. It is important for all service members and Families to understand potential causes of brain injuries, what to do in the event one occurs and what to expect. The military health system identifies resources that can help in care and treatment.

Q5. Describe the different types of brain injuries; how they occur; how they are diagnosed and treated; and how they can be prevented.

A5. Mild TBI (concussion) is difficult to diagnose on the battlefield, as is true in civilian life. The equivalent situation might be a concussion on the football field. These events, not necessarily associated with loss of consciousness, can be more difficult to detect.

Moderate TBI is usually clearly recognizable, with an event-related period of loss of consciousness and clearly observable deficits, such as ongoing confusion for days to a week. Most of the service members identified with moderate TBI are evaluated at theater-level medical facilities, and evacuated back to the United States for further evaluation and care. It is possible, however, for some with moderate TBI to be missed.

Severe TBI is obvious. It is treated in standard ways in-theater by neurosurgeons. The Joint Theater Trauma System, an in-theater trauma care regulating system, helps to insure that casualties with severe head injury are treated at a theater medical facility with neurosurgical capability. These injured Service members are given immediate emergency surgical treatment as required. They then receive ongoing treatment in the United States either at a military medical center, or at one of four Department of Veterans Affairs Polytrauma Centers.

Penetrating is not mild, moderate or severe. Services members who sustain a open head injury which penetrates the dura of the brain via a bullet or fragments from a blast.

Prevention is based on education, training and advances in protective gear and operational techniques when in high-risk situations/locales.

Q6. How many Soldiers suffer brain injuries as a result of combat? Is it really the signature injury of the current wars?

A6. According to data from the Defense and Veterans Brain Injury Center (DVBIC), 33% of patients who needed medical evaluation for battle-related injuries from theater to Walter Reed Army Medical Center in 2008 had traumatic brain injury. Cumulatively, DVBIC sites have seen 9,100 patients with TBI. Some patients are seen at a military treatment facility and later referred to a Veterans Affairs site and/or the DVBIC community reentry program. It is neither objective nor official to place a label such as "signature injury" on the current wars.

The percentage breakdown for the Army is:

Conucssion-89%
Moderate-5%
Severe-3%
Penetrating-3%

Q7. What is the treatment for brain injuries?

A7. The primary treatment for concussion is reassurance, education about what concussion is and what to expect during recovery, and protection from sustaining a second injury before the brain heals.

For patients who have persistent symptoms after a concussion, treatment may include evaluations and possibly treatment by specialists such as neuropsychologists, speech and language pathologists, neurologists, occupational therapists, physical therapists, ophthalmologists, optometrists, and audiologists. These specialists evaluate impairments and develop individualized interventions. They introduce patients to cognitive, behavioral, and learning strategies that prepare them to successfully engage in daily living activities at home, at work, or in a classroom environment.

For patients who have a moderate, severe or penetrating injury, treatment will involve a diverse team of specialists including case managers, nurses, doctors, surgeons, social workers, and rehabilitation experts. Treatment typically starts during acute hospitalization and depending on the severity of the injury can continue for months or even years after the injury in various settings such as inpatient rehabilitation, outpatient rehabilitation, home care, and long term care.

For patients who have persistent symptoms after a concussion and for those who sustain moderate, severe or penetrating injuries, Family members and significant others are included in the treatment programs. This external support is encouraged to support return to successful daily living through consultation and participation in learning self-care/coping, life-skills, and community reintegration strategies.

Q8. What is the difference between a traumatic brain injury and a concussion? Do Soldiers with concussions need medical treatment? Are they evacuated from theater?

A8. A concussion is the same as a mild TBI. Yes, concussions should receive medical treatment although in the long term there is almost always recovery through the brain's natural healing process. If it is a concussion, or mild TBI, it would usually not be necessary to evacuate the patient from theater.

Q9. What lessons have been learned during OIF/OEF about brain injuries?

A9. OIF/OEF is bringing important screening processes and tools to better identify the needs of service members who may require further evaluation for mild TBI.

Also, it is clear that blasts are a leading cause of TBI for active duty military personnel in war zones. Led by DVBIC, the conflicts have brought clinical practice guidelines for mild TBI.

Q10. What happens if a Soldier is exposed to a blast in theater but has no visible injuries? Can a brain injury show up later?

A10. It is possible to be exposed to blast and have no injury. Service members who are exposed to blasts, or any possible mechanism for concussion, should seek care as soon as possible after the injury because that is the best time to make an accurate diagnosis and initiate intervention.

When care is sought long after the injury event, the provider must rely on the Service member's recall of the event to determine if an injury and alteration of consciousness occurred to make the diagnosis of concussion. The more difficult task long after the injury is determining if the symptoms the Service member is experiencing are as a result of the concussion or are more appropriately attributed to another condition. The key is early identification.

Q11. If you have a brain injury does that mean that you are brain damaged and will not fully recover? If not, how long does recovery take?

A11. No, having a brain injury may or may not indicate long-term health ramifications. Length of recovery will depend on many factors including severity of the brain injury, time unconscious, timeliness of treatment, health of the individual at the time of injury, and more. People who sustain concussion almost always recover within hours to days. Those who sustain moderate, severe and penetrating brain injuries tend to have a more prolonged recovery, months to years.

Q12. What are the degrees of TBI?

A12. Concussion, clinically known as Mild TBI is similar to a concussion in football or hockey, and can range from mild enough that a person can go back into the game after a short rest, to being out for the rest of the game or even season. Mild TBI is when a concussion occurs when loss of consciousness is brief - a few seconds or minutes. It is sometimes characterized as getting your bell rung, seeing stars or feeling dazed. It is not always clinically evident and if unrecognized may result in adverse outcomes. Concussions are seldom life threatening, thus the term mild is used when the person is only dazed, confused or loses consciousness for a short time.

With mild TBI patients, full recovery can be within minutes to hours; small percentages have symptoms that may persist for months or years.

Severe TBI usually results from a significant closed head injury, as in an automobile accident, or most open or penetrating injuries, where there may be considerable residual deficits of brain function.

Casualties with severe TBI may never return to normal, though this can be difficult to predict. There is an aggressive program in theater with neurosurgical expertise available.

Moderate TBI, not well defined, is in between. There is usually loss of consciousness, from minutes to hours; there can be confusion for days to weeks; and mental or physical deficits that can last months or be permanent.

TBI can be closed or penetrating in nature. Severity of closed TBI is graded upon a continuum from mild, moderate and severe. Penetrating brain injury is also another classification of TBI in which the integrity of the skull is compromised by a penetrating fragment or object. The causes of closed and penetrating brain injury include but are not limited to blast/explosion injury (especially in our combat injured), motor vehicle crashes, falls, GSW to head, neck and face as well as any fragmentation/stab wound to the head.

Q13. What are some common symptoms of brain injury?

A13. Difficulty organizing daily tasks; blurred vision or eyes tire easily; headaches or ringing in the ears; feeling sad, anxious or listless, easily irritated or angered, feeling tired all the time, trouble with memory, attention or concentration, more sensitive to sounds, lights or distractions; impaired decision making or problem solving; difficulty inhibit behavior; slowed thinking, moving, speaking, reading; easily confused feeling easily overwhelmed; change in sexual interest or behavior.

Q14. Discuss recovery from TBI.

A14. Speed of recovery varies. Most people with mild TBI recover fully, but it can take time. Soldiers with a previous brain injury may find that it takes longer to recover from their current injury. Some symptoms can last for days, weeks or longer.

Q15. What helps with TBI?

A15. Getting plenty of rest and sleep; increasing activity slowly; carrying a notebook and writing things down if you have trouble remembering; establishing a regular daily routine to structure activities; doing only one thing at a time if you are easily distracted such as turning off the television or radio while you work; check with someone you trust when making decisions; avoid actives that can lead to additional brain injury such as contact sports, motorcycles, skiing, etc.; avoid alcohol as it may slow healing; avoid caffeine or energy enhancing products as they may increase symptoms; and avoid excessive use of over the counter sleeping aids - they can slow thinking and memory.

Q16. Do people with TBI recover—if so, how does it change their lives?

A16. Yes, the vast majority of patients with TBI recover. Recovery is based upon the severity of the initial injury and varies. There are many ways that having a traumatic brain injury can change a person's life.

There can be physical consequences, such as limb weakness or paralysis, headaches, etc as well as cognitive and neuropsychiatric consequences such as irritability, memory loss and problems, difficulty concentrating, sleep disturbances, anxiety and depression.