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Explaining Brain Injury to Your Child

Chapter Four, The Caregiver’s Journey on tbi.cemmlibrary.org

 

Having a parent with a TBI can be frightening for a child who looks to them to provide strength and safety.
A parent with TBI may no longer act the same as they did before the injury. They may be angry, depressed, or uncertain. They may not be able to speak or walk, and they may not be able to do all the same things they did before they were injured (for example, go to work, pick up the kids from school, play on the playground). You can help your children by explaining TBI in a way that they can understand, or you can ask a healthcare provider to talk with your children.

As a result of the changes caused by the injury, the special parent-child bond that existed previously has probably changed, at least to some degree.

Children may be confused and upset about what is going on. This could be due to worry about a parent’s condition or concerns about changes in their parents’ relationship. It could also be due to financial strains, or simply adjusting to the new “normal” (in other words, the new way of life following the TBI). Be sure to communicate with your child that they are not to blame for the TBI – many children will assume they somehow contributed to the injury and will carry some sense of responsibility for it. If your child appears to be anxious or depressed for a long time, or they begin taking on risky behaviors, seek professional help.

It is important to recognize that your children are grieving, just as you are – they are grieving the loss of the parent’s former “self” and the abrupt changes that have taken place. They may withdraw from social activities with peers, have mood swings, become withdrawn or disruptive, do poorly in school, and show other behavioral problems.

Children also need time and space to be kids. Allow them time to think, play, talk, or just hang out – don’t smother them with too much information or attention over the injury – but be sensitive to their questions and concerns. Build new family routines, and keep an eye out for signs that your child is not coping well.

Some children may need to take on some caregiving tasks for the parent or for younger children in the family. Children who care for parents or other relatives may experience conflict over the reversal of roles between parent and child. Others will find it helpful for them to play a supportive role.

Make sure any tasks that your child takes on to help around the house or with caregiving activities – household chores or meal preparation, for example – are suitable for their age. Strive as much as possible to find other adults to help you, rather than relying on your children to play a major caregiving role.


 
How Can I Tell My Child about TBI?

It is difficult to explain TBI to a child. Yet it is vital to tell your child what is going on. Some adults try to protect children from the truth because they think they are too young to understand. Children of almost any age are aware that something is wrong and they want to know what is happening.

Communicate in an age-appropriate way what has happened to the service member or veteran with TBI. Protecting your children by withholding information may backfire. Children have active imaginations that may create a scenario worse than reality.

How you tell your child about TBI depends on the age of the child. Here are some suggestions for how to explain TBI to a child:

  • Use Language a Child can Understand: The brain is similar to the command station of a spaceship. If a meteorite hit the command station, the crew would not be able to control what the spaceship does. If the brain is hurt, it may send out the wrong signals to the body or no signals at all. A person with TBI may have a hard time walking, talking, hearing, or seeing.
  • The brain is the body’s computer. When it gets injured, it doesn’t “boot up” properly, runs slower, has less memory, and may not perform all of its normal functions.
  • A cut may take a few days to heal, and a broken bone will usually heal and be as good as new in a few weeks or months. Getting better after a brain injury can take several months or even years, and sometimes the person may not get 100 percent better.
  • Even though the person with the injury may look the same, they may still be injured. These injuries might include having a hard time paying attention or remembering what you told them. They may get tired easily and need to sleep more than usual. They may say or do things that seem strange or embarrassing. They may get angry and shout for no apparent reason.
  • Explaining Anger Changes: Many people with a TBI develop anger as a direct effect of the damage to the brain. In other words, the parts of the brain that normally stop angry flare-ups and feelings have been damaged and don’t do their job as well. The parent with TBI may be mad because they can’t do the things they used to do. Their feelings may be hurt because others treat them differently than before the injury.
  •  
    Brain injury changes people. These changes can be confusing. Try to remember that the changes you see are caused by the brain injury. You can still love and care about the person regardless of the brain injury.
     

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    Ayn al Asad Air Base in western Iraq after an Iranian missile attack on Jan. 8. The number of service members experiencing symptoms associated with brain injuries has since topped 100. Photo Credit…Sergey Ponomarev for The New York Times

     

    Brain Injuries Are Common in Battle.
    The Military Has No Reliable Test for Them.

    Traumatic brain injury is a signature wound of the wars in Iraq and Afghanistan. But the military still has no objective way of diagnosing it in the field.

    By Dave Philipps and Thomas Gibbons-Neff for nytimes.com, February 15, 2020

     
    U.S. troops at Ayn al Asad Air Base in western Iraq hunkered down in concrete bunkers last month as Iranian missile strikes rocked the runway, destroying guard towers, hangars and buildings used to fly drones.
    When the dust settled, President Trump and military officials declared that no one had been killed or wounded during the attack. That would soon change.

    A week after the blast, Defense Department officials acknowledged that 11 service members had tested positive for traumatic brain injury, or TBI, and had been evacuated to Kuwait and Germany for more screening. Two weeks after the blast, the Pentagon announced that 34 service members were experiencing symptoms associated with brain injuries, and that an additional seven had been evacuated. By the end of January the number of potential brain injuries had climbed to 50. This week it grew to 109.

    The Defense Department says the numbers are driven by an abundance of caution. It noted that 70 percent of those who tested positive for a TBI had since returned to duty. But experts in the brain injury field said the delayed response and confusion were primarily caused by a problem both the military and civilian world have struggled with for more than a decade: There is no reliable way to determine who has a brain injury and who does not.

    Top military leaders have for years called traumatic brain injury one of the signature wounds of the wars in Iraq and Afghanistan; at the height of the Iraq war in 2008, they started pouring hundreds of millions of dollars into research on detection and treatment. But the military still has no objective tool for diagnosing brain injury in the field. Instead, medical personnel continue to use a paper questionnaire that relies on answers from patients — patients who may have reasons to hide or exaggerate symptoms, or who may be too shaken to answer questions accurately.

    The military has long struggled with how to address so-called invisible war wounds, including traumatic brain injury and post-traumatic stress disorder. Despite big investments in research that have yielded advances in the laboratory, troops on the ground are still being assessed with the same blunt tools that have been in use for generations.

    The problem is not unique to the military. Civilian doctors struggle to accurately assess brain injuries, and still rely on a process that grades the severity of a head injury in part by asking patients a series of questions: Did they black out? Do they have memory problems or dizziness? Are they experiencing irritability or difficulty concentrating?

    “It’s bad, bad, bad. You would never diagnose a heart attack or even a broken bone that way,” said Dr. Jeff Bazarian a professor of emergency medicine at the University of Rochester Medical Center. “And yet we are doing it for an injury to the most complex organ in the body. Here’s how crazy it gets: You are relying on people to report what happened. But the part of the brain most often affected by a traumatic brain injury is memory. We get a lot of false positives and false negatives.”

    Without a good diagnosis, he said, doctors often don’t know whether a patient has a minor concussion that might require a day’s rest, or a life-threatening brain bleed, let alone potential long-term effects like depression and personality disorder.

    At Ayn al Asad, personnel used the same paper questionnaires that field medics used in remote infantry platoons in 2010. Aaron Hepps, who was a Navy corpsman in a Marines infantry company in Afghanistan at that time, said it did not work well then for lesser cases, and the injuries of many Marines may have been missed. During and after his deployment, he counted brain injuries in roughly 350 Marines — about a third of the battalion.

    After the January missile attack, Maj. Robert Hales, one of the top medical providers at the air base, said that the initial tests were “a good start,” but that it took numerous screenings and awareness among the troops to realize that repeated exposure to blast waves during the hourlong missile strikes had affected dozens.

    Traumatic brain injuries are among the most common injuries of the wars in Iraq and Afghanistan, in part because armor to protect from bullet and shrapnel wounds has gotten better, but they offer little protection from the shock waves of explosions. More than 350,000 brain injuries have been reported in the military since 2001.

    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.

    The blasts on Jan. 8, one military official said, were hundreds of times more powerful than the rocket and mortar attacks regularly aimed at U.S. bases, causing at least one concrete wall to collapse atop a bunker with people inside.

    Capt. Geoff Hansen was in a Humvee at Ayn al Asad when the first missile hit, blowing open a door. Then a second missile hit.

    “That kind of blew me back in,” he said. “Blew debris in my face so I went and sat back down a little confused.”

    A tangle of factors make diagnosing head injuries in the military particularly tricky, experts say. Some troops try to hide symptoms so they can stay on duty, or avoid being perceived as weak. Others may play up or even invent symptoms that can make them eligible for the Purple Heart medal or valuable veteran’s education and medical benefits.

    And sometimes commanders suspect troops with legitimate injuries of malingering and force them to return to duty. Pentagon officials said privately this week that some of the injuries from the Jan. 8 incident had probably been exaggerated. 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.”

    In the early years of the war in Iraq, troops with concussions were often given little medical treatment and were not eligible for the Purple Heart. It was only after clearly wounded troops began complaining of poor treatment that Congress got involved and military leaders began pressing for better diagnostic technology.

    Damir Janigro, who directed cerebrovascular research at the Cleveland Clinic for more than a decade, said relying on the questionnaire makes accurate diagnosing extremely difficult.

    “You have the problem of the cheaters, and the problem of the ones who don’t want to be counted,” he said. “But you have a third problem, which is that even if people are being completely honest, you still don’t know who is really injured.”

    In civilian emergency rooms, the uncertainty leads doctors to approve unnecessary CT scans, which can detect bleeding and other damage to the brain, but are expensive and expose patients to radiation. At the same time doctors miss other patients who may need care. In a war zone, bad calls can endanger lives, as troops are either needlessly airlifted or kept in the field when they cannot think straight.

    Mr. Janigro is at work on a possible solution. He and his team have developed a test that uses proteins found in a patient’s saliva to diagnose brain injuries. Other groups are developing a blood test.

    Both tests work on a similar principle. When the brain is hit by a blast wave or a blow to the head, brain cells are stretched and damaged. Those cells then dispose of the damaged parts, which are composed of distinctive proteins. Abnormal levels of those proteins are dumped into the bloodstream, where for several hours they can be detected in both the blood and saliva. Both tests, and another test being developed that measures electrical activity in the brain, were funded in part by federal grants, and have shown strong results in clinical trials. Researchers say they could be approved for use by the F.D.A. in the next few years.

    The saliva test being developed by Mr. Janigro will look a bit like an over-the-counter pregnancy test. Patients with suspected brain injuries would put sensors in their mouths, and within minutes get a message that says that their brain protein levels are normal, or that they should see a doctor.

    But the new generation of testing tools may fall short, said Dr. Gerald Grant, a professor of neurosurgery at Stanford University and a former Air Force lieutenant colonel who frequently treated head injuries while deployed to Iraq in 2005.

    Even sophisticated devices had trouble picking up injuries from roadside bombs, he said.

    “You’d get kids coming in with blast injuries,” he said, “and they clearly had symptoms, but the CT scans would be negative.”

    He was part of an earlier effort to find a definitive blood test, which he said in an interview was “the holy grail.” But progress was slow. The grail was never found, he said, and the tests currently being developed are helpful for triaging cases, but too vague to be revolutionary.

    “Battlefield injuries are complex,” he said. “We still haven’t found the magic biomarker.”

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    Libby and Tom Bates // CBS News

    A brain disease best known for impacting football players who suffered concussions is now being found in soldiers

    By Sharyn Alfonsi, September 16, 2018, CBS News

    Until a few years ago, NFL players who struggled with severe depression, bouts of rage and memory loss in their retirement were often told they were just having a hard time adjusting to life away from the game. Doctors have since learned these changes can be symptoms of the degenerative brain disease CTE – chronic traumatic encephalopathy, caused by blows to the head.

    As we first reported in January, CTE isn’t just affecting athletes, but also showing up in our nation’s heroes. Since 9/11 over 300,000 soldiers have returned home with brain injuries. Researchers fear the impact of CTE could cripple a generation of warriors.

    When Joy Kieffer buried her 34-year old son this past summer, it was the end of a long goodbye.

    Kieffer’s son, Sgt. Kevin Ash, enlisted in the Army Reserves at the age of 18. Over three deployments, he was exposed to 12 combat blasts, many of them roadside bombs. He returned home in 2012 a different man.

    Joy Kieffer: His whole personality had changed. I thought it was exposure to all of the things that he had seen, and he had just become harder. You know, but he was — he was not happy.

    Sharyn Alfonsi: So at this point, you’re thinking this decline, this change in my child is just that he’s been in war and he’s seen too much.

    Joy Kieffer: Right.

    Sharyn Alfonsi: Did he tell you about blasts that he experienced during that time?

    Joy Kieffer: Uh-huh.

    Sharyn Alfonsi: What did he–tell you?

    Joy Kieffer: That they shook him. And he was having blackouts. And — it frightened him.

    Ash withdrew from family and friends. He was angry. Depressed. Doctors prescribed therapy and medication, but his health began to decline quickly. By his 34th birthday, Sgt. Kevin Ash was unable to speak, walk or eat on his own.

    Sharyn Alfonsi: Looking back on it now, was there anything you feel like he could’ve done?

    Joy Kieffer: Uh-uh.

    Sharyn Alfonsi: Because?

    Joy Kieffer: Because it was– it– it was his brain. The thing I didn’t know was that his brain was continuing to die. I mean, before he went into the service he said, “you know, I could come back with no legs, or no arms, or even blind, or I could be shot, I could die,” but nobody ever said that he could lose his mind one day at a time.

    His final wish was to serve his country one last time by donating his brain to science — a gesture he thought would bring better understanding to the invisible wounds of war.

    Joy reached out to the VA-Boston University-Concussion Legacy Foundation Brain Bank where neuropathologist Dr. Ann McKee is leading the charge in researching head trauma and the degenerative brain disease CTE.

    McKee has spent fourteen years looking at the postmortem brains of hundreds of athletes who suffered concussions while playing their sport.

    Last summer, her findings shook the football world when she discovered CTE in the brains of 110 out of 111 deceased NFL players — raising serious concerns for those in the game today.

    And when Dr. McKee autopsied Patriots tight-end Aaron Hernandez who killed himself after being convicted of murder, she found the most severe case of CTE ever, in someone under 30.

    Now she’s seeing similar patterns in deceased veterans who experienced a different kind of head trauma — combat blasts. Of the 125 veterans’ brains Dr. Mckee’s examined, 74 had CTE.

    Sharyn Alfonsi: I can understand a football player who keeps, you know, hitting his head, and having impact and concussions. But how is it that a combat veteran, who maybe just experienced a blast, has the same type of injury?

    Dr. Ann McKee: This blast injury causes a tremendous sort of– ricochet or– or– a whiplash injury to the brain inside the skull and that’s what gives rise to the same changes that we see in football players, as in military veterans.

    Blast trauma was first recognized back in World War I. Known as ‘shell shock,’ poorly protected soldiers often died immediately or went on to suffer physical and psychological symptoms. Today, sophisticated armor allows more soldiers to walk away from an explosion but exposure can still damage the brain — an injury that can worsen over time.

    Dr. Ann McKee: It’s not a new injury. But what’s been really stumping us, I think, as– as physicians is it’s not easily detectable, right? It’s– you’ve got a lot of psychiatric symptoms– and you can’t see it very well on images of the brain and so it didn’t occur to us. And I think that’s been the gap, really, that this has been what everyone calls an invisible injury.

    Dr. Ann McKee: This is the world’s largest CTE brain bank.

    The only foolproof way to diagnose CTE is by testing a post-mortem brain.

    Sharyn Alfonsi: So these are full of hundreds of brains…

    Dr. Ann McKee: Hundreds of brains, thousands really…

    Researchers carefully dissect sections of the brain where they look for changes in the folds of the frontal lobes – an area responsible for memory, judgement, emotions, impulse control and personality.

    Dr. Ann McKee: Do you see there’s a tiny little hole there? That is an abnormality. And it’s a clear abnormality.

    Sharyn Alfonsi: And what would that affect?

    Dr. Ann McKee: Well, it’s part of the memory circuit. You can see that clear hole there that shouldn’t be there. It’s connecting the important memory regions of the brain with other regions. So that is a sign of CTE.

    Thin slivers of the affected areas are then stained and viewed microscopically. It’s in these final stages where a diagnosis becomes clear as in the case of Sgt. Kevin Ash.

    Sharyn Alfonsi: So this is Sergeant Ash’s brain?

    Dr. Ann McKee: Right. This is– four sections of his brain. And what you can see is– these lesions. The, and those lesions are CTE And they’re in very characteristic parts of the brain. They’re at the bottom of the crevice. That’s a unique feature of CTE.

    Sharyn Alfonsi: And in a healthy brain, you wouldn’t see any of those kind of brown spots?

    Dr. Ann McKee: No, no, it would be completely clear. And then when you look microscopically, you can see that the tau, which is staining brown and is inside nerve cells is surrounding these little vessels.

    Sharyn Alfonsi: And explain, what is the tau?

    Dr. Ann McKee: So tau is a protein that’s normally in the nerve cell. It helps with structure and after trauma, it starts clumping up as a toxin inside the nerve cell. And over time, and even years, gradually that nerve cell dies.

    Dr. Lee Goldstein has been building on Dr. McKee’s work with testing on mice.

    Inside his Boston University lab, Dr. Goldstein built a 27-foot blast tube where a mouse – and in this demonstration, a model – is exposed to an explosion equivalent to the IEDs used in Iraq and Afghanistan.

    Dr. Lee Goldstein: When it reaches about 25 this thing is going to go.

    Dr. Goldstein’s model shows what’s going on inside the brain during a blast. The brightly colored waves illustrate stress on the soft tissues of the brain as it ricochets back and forth within the skull.

    Dr. Lee Goldstein: What we see after these blast exposures, the animals actually look fine. Which is shocking to us. So they come out of what is a near lethal blast exposure, just like our military service men and women do. And they appear to be fine. But what we know is that that brain is not the same after that exposure as it was microseconds before. And if there is a subsequent exposure, that change will be accelerated. And ultimately, this triggers a neurodegenerative disease. And, in fact, we can see that really after even one of these exposures.

    Sharyn Alfonsi: The Department of Defense estimates hundreds of thousands of soldiers have experienced a blast like this. What does that tell you?

    Dr. Lee Goldstein: This is a disease and a problem that we’re going to be dealing with for decades. And it’s a huge public health problem. It’s a huge problem for the Veterans Administration. It’s a huge moral responsibility for all of us.

    A responsibility owed to soldiers like 34-year-old Sgt. Tom Bates.

    Sgt. Tom Bates: We were struck with a large IED. It was a total devastation strike.

    Bates miraculously walked away from a mangled humvee — one of four IED blasts he survived during deployments in Iraq and Afghanistan.

    Sharyn Alfonsi: Do you remember feeling the impact in your body?

    Sgt. Tom Bates: Yes. Yeah.

    Sharyn Alfonsi: What does that feel like?

    Sgt. Tom Bates: Just basically like getting hit by a train.

    Sharyn Alfonsi: And you were put back on the frontlines.

    Sgt. Tom Bates: Yes.

    Sharyn Alfonsi: And that was it?

    Sgt. Tom Bates: Uh-huh

    When Bates returned home in 2009, his wife Libby immediately saw a dramatic change.

    Libby Bates: I thought, “Something is not absolutely right here. Something’s going on. For him to just lay there and to sob and be so sad. You know, what do you do for that? How do I– how do I help him? He would look at me and say, “If it wasn’t for you, I would end it all right now.” You know, I mean, like, what do you– what do you do– and what do you say to somebody who says that? You know I love this man so much. And —

    Sharyn Alfonsi: You’re going to the VA, you’re getting help, but did you feel like you weren’t getting answers?

    Sgt. Tom Bates: Yes.

    Sharyn Alfonsi: And so you took it into your own hands and started researching?

    Sgt. Tom Bates: I knew the way everything had gone and how quick a lot of my neurological issues had progressed that something was wrong. And I just– I wanted answers for it.

    That led him to New York’s Mount Sinai Hospital where neurologist Dr. Sam Gandy is trying to move beyond diagnosing CTE only in the dead by using scans that test for the disease in the living.

    Dr. Sam Gandy: By having this during life, this now gives us for the first time the possibility of estimating the true prevalence of the disease. It’s important to estimate prevalence so that people can have some sense of what the risk is.

    In the past year, 50 veterans and athletes have been tested for the disease here. Tom Bates asked to be a part of it.

    That radioactive tracer – known as t807 – clings to those dead clusters of protein known as tau, which are typical markers of the disease.

    Through the course of a 20 minute PET scan, high resolution images are taken of the brain and then combined with MRI results to get a 360 degree picture of whether there are potential signs of CTE.

    Scan results confirmed what Tom and Libby had long suspected.

    On the right, we see a normal brain scan with no signs of CTE next to Tom’s brain where tau deposits, possible markers of CTE, are bright orange.

    Dr. Sam Gandy: Here these could be responsible for some of the anxiety and depression he’s suffered and we’re concerned it will progress.

    Sgt. Tom Bates: My hope is that this study becomes more prominent, and gets to more veterans, and stuff like that so we can actually get, like, a reflection of what population might actually have this.

    There is no cure for CTE.

    Dr. Gandy hopes his trial will lead to drug therapies so he can offer some relief to patients like Tom.

    Dr. Ann McKee believes some people may be at higher risk of getting the disease than others.

    While examining NFL star Aaron Hernandez’s brain she identified a genetic bio-marker she believes may have predisposed him to CTE.

    A discovery that could have far-reaching implications on the football field and battlefield.

    Sharyn Alfonsi: Do you think you will ever be your old self again?

    Sgt. Tom Bates: I don’t ever see me being my old self again. I think it’s just too far gone.

    Sharyn Alfonsi: So what’s your hope then?

    Sgt. Tom Bates: Just to not become worse than I am now.

    Since our story first aired, over 100 veterans have contacted Dr. Gandy to enroll in ongoing trials to identify whether they are living with CTE. And more than 300 have reached out to Dr. Mckee about donating their brains to research.

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    The Intrepid Spirit traumatic brain injury treatment center is slated to open April 2 at Camp Pendleton. (Courtesy Naval Hospital Camp Pendleton) (Photo/iStock)

    Brain injury center to open at Marine base

    By Linda McIntosh, March 27, 2018, sandiegouniontribune.com

    A brain injury treatment center for military personnel will open its doors April 2 near the Naval Hospital Camp Pendleton.

    The $11.5 million Intrepid Spirit center is the seventh of nine such facilities at military bases across the country. It is funded by the New York-based nonprofit Intrepid Fallen Heroes Fund founded in 2000 by Zachary Fisher, who also started the Fisher House Foundation for military families.

    The center will operate as a part of Naval Hospital Camp Pendleton to treat active-duty military patients who suffer from the physical and psychological effects of brain injury. The center will also provide education and other resources on brain injury for veterans and the wider community.

    The center will expand the hospital’s existing program at the Concussion Care Clinic, which has served more than 2,000 patients since 2014. An estimated 550-600 new patients are expected to be referred to the center each year.

    “The facility will offer interdisciplinary, state-of-the-art evaluation of service members using clinical, laboratory and imaging resources to guide treatment,” said Cmdr. Paul Sargent, medical director of the Intrepid Spirit center, Naval Hospital Camp Pendleton.

    The center’s specialty rehabilitation and therapy programs will focus on providing service members strategies to improve recovery from physical, emotional and spiritual injuries.

    “We know that being able to be close to home, surrounded by loved ones, is a crucial part of the recovery process, so we are opening centers on the West Coast this spring at Camp Pendleton and also at Joint Base Lewis-McChord in Washington in order that service members who need treatment do not have to uproot themselves and their families to get it,” said David Winters, president of the Intrepid Fallen Heroes Fund.

    Two teams of clinicians will serve the clinic. Their specialties range from neurology, physical medicine and rehabilitation, psychiatry, trauma psychology, neuropsychology and pain psychology to physical and occupational therapy, creative arts therapy and neuro-optometry.

    “Our approach is a broadly collaborative center for preventing, treating and researching head trauma and injury to the brain,” Sargent said.

    The Intrepid Spirit center includes research, education and clinical staff from the Defense and Veterans Brain Injury Center, which is part of the Department of Defense’s Health Agency.

    “Teaching Marines, sailors and their commands about the risks of head injury, how to mitigate concussions and how to understand Traumatic Brain Injury signs and symptoms, along with how to improve readiness is a major goal of our TBI training,” said Regional Education Coordinator Clint Pearman, a certified brain injury specialist with the Defense and Veterans Brain Injury Center.

    Pearman provides outreach, education, training and resources for medical personnel, military commands, service members, veterans and family members and civilian community groups from the Camp Pendleton area up to northern California.

    The center’s design is based on the original National Intrepid Center of Excellence, which opened in 2010 at the Walter Reed National Military Medical Center in Bethesda, Md., operated by the Department of Defense.

    “There are hundreds of thousands of U.S. service members who continue to suffer from traumatic brian injury and other psychological health conditions,” Winters said. “The Intrepid Fallen Heroes Fund has tried to help these brave men and women get the best care available, so we made it our mission to build nine Intrepid Spirit centers that provide comprehensive, state-of-the-art treatment.”

    The clinic’s ground breaking was last May and a grand opening ceremony will be held at 11 a.m. April 4 at the Intrepid Spirit Center.

    For information about base access, visit pendleton.marines.mil/About/Base-Information/Base-Access.

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    The Cohen family partners with USC to serve families in Los Angeles.
     
    by Lynn Lipinski, tfm.USC.edu (Autumn 2016) — PEACE AFTER WAR can be elusive for combat veterans who fight painful memories long after they’ve left the battlefield. Of the more than 2.6 million men and women who have served in the U.S. military since 9/11, about 20 percent experience some form of post-traumatic stress or brain injury—but nearly half forego treatment, according to the Cohen Veterans Network.

    The Steven A. Cohen Military Family Clinic at USC, made possible by a $15.7 million gift from Steven Cohen and the Cohen Veterans Network, offers veterans and their family members free outpatient mental health services and case management. Recently opened in downtown Los Angeles, the Cohen Military Family Clinic at USC is part of a national network of clinics serving veterans and is a collaboration between the USC School of Social Work and the Keck School of Medicine of USC.

    Providers will also be stationed at locations throughout the county in areas that otherwise lack these types of services. The clinic will also serve veterans who are ineligible for Veterans’ Admnistration benefits, such as those who served in the National Guard or the Reserves.

    “The wounds of war are serious. It is not easy to serve your country in combat overseas and then come back into society seamlessly, especially if you are suffering,” says Cohen, chairman and CEO of Point72 Asset Management. “Veterans have paid an incredible price. It’s important that this country pays back that debt.”

    The Cohen Veterans Network plans to create a system of about two dozen centers across the country by 2020 as part of a $275 million initiative to improve access to behavioral health care for recent veterans. Cohen’s support of services for veterans began in part because of a personal connection: His son, Robert, deployed to Afghanistan with the Marines and is currently in the Reserves.

    USC’s strong programs for veterans made it a natural fit to host the clinic. The USC School of Social Work is home to the Center for Innovation and Research on Veterans and Military Families, where researchers conducted the first comprehensive study of veterans in L.A. County. Their findings are already helping to create effective services for veterans. The school has also earned national recognition for its pioneering master’s degree in military social work—the only program of its kind offered by a civilian research university.

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    By John Prybys, LAS VEGAS REVIEW-JOURNAL (August 22, 2016) — Randy Dexter and Captain are more than just dog owner and dog. That’s obvious from the way Captain looks for Dexter whenever the Army veteran leaves the room, and the way the Lab mix’s demeanor slips instantly from playful to dead serious once he’s wearing the jacket that denotes his status as a service animal.

    Dexter is a retired U.S. Army staff sergeant who did two tours of duty in Iraq. He was diagnosed with both post-traumatic stress disorder and a mild traumatic brain injury, and the story of Dexter and Captain is featured in a new awareness campaign urging veterans and military service people to seek help for traumatic brain injury if they need it.

    The campaign, “A Head for the Future,” is sponsored by the Defense and Veterans Brain Injury Center. In his video, Dexter shares the struggles he has experienced coping with his injuries and the reluctance he felt at first to seek help for it.

    But, he says, “I was lucky, because when I was in the Army and had my head injury, I was kind of forced to get help.”

    Dexter, 34, is a graduate of Green Valley High School who served in the Army for 11 years and had two tours of duty in Iraq. In 2005, Dexter, a combat medic, and his squad were hit by an IED, prompting a long, and continuing, struggle with post-traumatic stress disorder.

    Then, after returning home and while still being treated for PTSD and training soldiers bound for Iraq and Afghanistan, Dexter suffered a brain injury during a recreational football game. He’s not sure, even now, what happened. All he knows is that he lost the memory of about 24 hours’ time and, even, of going to the game at all.

    X-rays and imaging studies revealed no skull fractures or apparent injuries. But, afterward, Dexter experienced a worsening of already existing problems with his memory, concentration and equilibrium, and began to suffer migraines and severe, debilitating headaches that eventually compounded his PTSD and caused severe depression.

    Dr. Scott Livingston, director of education for the Defense and Veterans Brain Injury Center in Silver Springs, Maryland, says symptoms of PTSD and brain injury often can overlap, making diagnosis a challenge. And when a brain injury does occur, he says, it often presents with no obvious symptoms that can be detected by X-ray or imaging scans.

    In such cases, the problem likely is “more of a microscopic type of injury within the brain,” Livingston says.

    Most civilians probably assume that brain injuries among service people are caused mostly by blasts and blunt-force trauma to the head. Yet, Livingston says, most are caused by motor vehicle collisions, training-related accidents, falls and sports and recreational activities.

    Whatever the cause, military personnel are reluctant to report an injury or seek care for it. The current campaign is designed to raise awareness of brain injuries among service people, promote ways to prevent it when possible, and encourage men and women to report it and get it checked out, Livingston says.

    “It’s well-known in scientific literature that the earlier someone reports a mild traumatic brain injury and goes to seek help, the better the chances are for better and more complete recovery,” he says.

    During his treatment, Dexter participated in a program that paired injured veterans with service dogs. His experience with a dog named Ricochet was so good that he later welcomed the chance to be paired with Captain.

    Dexter and Captain are a great team. Dexter says the dog can detect impending anxiety attacks even before he does, and that the dog can serve as a physical shield and protector in such public places as big-box retail stores, which can be particularly unnerving places for those with PTSD.

    The true test of Captain’s effectiveness is that the dog has allowed Dexter to significantly reduce the medications he has to take. Today, it would be difficult for someone who doesn’t know the back story to detect Dexter’s struggles with traumatic brain injury, and it was his own previous interest in speaking out publicly about his conditions that led to his participation in the new awareness campaign.

    Dexter now attends UNLV, where he’s majoring in communication studies and Spanish. He has been active on the debate teams, will be a peer adviser for other veterans, and hopes to kick off a music show on the university’s HD/internet radio station.

    Dexter hopes his video and his story will help to persuade other veterans and active service people to seek out help for PTSD and brain injury. That can be difficult, he notes, because the standard soldier’s stance is that, whatever is happening, “you just deal with it, and that’s true across the whole military culture.”

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    By Alyssa Navarro, Tech Times (August 23, 2016) — Federal health regulators in the United States approved on Monday the use of two new computer softwares as cognitive screening tests for traumatic head injury patients.

    Known as ImPACT or the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT), the new testing device, as well as a similar test designed for children, can be used by doctors to evaluate signs and symptoms of head injuries that could indicate concussion.

    ImPACT is designed for patients aged 12 to 59 years old, while ImPACT Pediatric is intended for children aged 5 to 11 years old, officials said. Licensed health care professionals are the only ones allowed to perform the analysis and interpret the results.

    The software can be accessed easily because it runs on both desktop computers and laptops, according to the U.S. Food and Drug Administration (FDA). Both tests the first ever devices permitted by the FDA to assess cognitive function after experiencing a possible concussion. They are designed to be part of medical evaluations in hospitals.

    Although ImPACT and ImPACT Pediatric will definitely be useful for doctors, both tests are not meant to diagnose concussions or determine treatments that are appropriate for such cases, the FDA said.

    Instead, both devices are only designed to test cognitive skills such as reaction time, memory and word recognition. All of these can be impacted by head injuries. Afterwards, the results are compared to a patient’s pre-injury baseline scores or an age-matched control database, the FDA said.

    Dr. Carlos Peña, director of the neurological and physical medicine division at the Center for Devices and Radiological Health, acknowledges that the two testing devices can provide useful information that can aid doctors in the evaluation of people who are experiencing potential signs of concussion.

    However, Peña says that clinicians should not completely depend on the tests alone to rule out concussion or to decide whether a player with a head injury should return to a game.

    Statistics from the Centers for Disease Control and Prevention (CDC) reveal that traumatic brain injuries are responsible for more than 2 million visits to the emergency room in the country annually. Traumatic brain injuries also account for more than 50,000 deaths in America every year.

    Cases of head injury among kids have been increasing. In May, a CDC report showed that from January 2001 to December 2013, approximately 214,883 children aged 14 years old and below were brought to emergency departments due to head injuries.

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    1st Lt. Timothy Dwyer performs a cognitive test, as occupational therapist Jenny Owens takes notes at the Fort Campbell Army base in Fort Campbell, Ky. Soldiers from the Army’s 52nd Ordnance Group based at Fort Campbell have undergone hours of exhaustive cognitive testing in the military’s first-of-its-kind study of mild traumatic brain injury.

    Military is doing first-of-its-kind study on mild traumatic brain injury

    by Kristin M. Hall, Associated Press

    FORT CAMPBELL, Ky. — Motivated by the deaths of two friends in war-zone explosions, 1st Lt. Timothy Dwyer decided to become a bomb hunter.

    By joining an explosive ordnance disposal unit, Dwyer put himself at a high risk not just of being killed, but of falling victim to another, more insidious threat: repeated concussions from blasts that don’t kill.

    Soldiers from the Army’s 52nd Ordnance Group based at Fort Campbell have undergone hours of exhaustive cognitive testing in the military’s first-of-its-kind study of mild traumatic brain injury. This focus on the soldiers who find and destroy the powerful and deadly weapons is part of a larger effort by the military this year to better track and treat mild brain injuries.

    The Fort Campbell bomb specialists will be tracked during their upcoming Afghanistan deployment for concussions and head injuries to look for effects on brain functions.

    “No one wants to get hurt, but being a soldier, being (in explosive ordnance disposal), it’s just one of those things you’ve come to expect that might happen to you,” said Dwyer, a 23-year-old platoon leader with three kids who is leaving this year for his first deployment.

    The nature of the ordnance group’s work makes its members the ideal patients for the study of mild brain injuries, said Dr. Bret Logan, deputy commander for managed care and compliance at Blanchfield Army Community Hospital at Fort Campbell.

    “We tried to identify those populations that we could have almost an assured likelihood that they would have a concussive episode,” Logan said.

    Active in high school sports, Dwyer said he’d had at least three diagnosed concussions before joining the Army. In addition to those, Dwyer admitted, “I’ve had a lot of concussions that I have never gone to the doctor for.”

    During the testing, the soldiers are subjected to numerous mental exercises and given puzzles and quizzes that give a baseline of a soldier’s brain functions before an injury. One test required Dwyer to quickly press a series of blinking lights while doing math problems in his head. In another, he was asked to recall a list of words that he was given earlier.

    Dr. Tamara Moreland, a physical therapist at the Traumatic Brain Injury Center at Fort Campbell, instructed Dwyer to stand on a platform that shifted and rocked under him. The test measured how well his inner ear works to keep his balance, an area of common injury after explosions.

    In a small office at the post’s center, another EOD officer, 1st Lt. Jay Park, was fitted with what looked like a swim cap with electrodes jutting out and clips on his ears. Cotton balls taped over his eyes reduced eye movement during the testing, and wires from the cap plugged into a computer that measured activity in different parts of his brain.

    178,000 soldiers diagnosed with traumatic brain injuries since 2000
    The Department of Defense says 178,000 troops have been diagnosed with traumatic brain injuries since 2000, mostly mild Fortcases. Even those can have wide-ranging effects on concentration, speech, balance and eyesight.

    The Army released new rules this year for soldiers who are within 50 meters of a blast, are in a vehicle that rolls over or are in a vehicle involved in a blast. Those soldiers now must undergo a medical evaluation and be put on 24 hours of rest before returning to duty. Comprehensive evaluations will be mandatory after three concussions in one year.

    Studies have shown that a person can fully recover after a concussion, but another concussion without time to rest can impair healing.

    “The brain is using a lot of energy to heal, and if you stress the brain so that it runs out of energy, it’s actually going to cause death of neurons,” said Dr. David Twillie, director of Fort Campbell’s Traumatic Brain Injury Center.

    Twillie said he understands that some soldiers will not want to take a break from the fighting after a concussion, but he said the rest will keep more soldiers ready for battle.

    “You can actually conserve the fighting strength by having a soldier take a knee versus breaking the soldier to the point where they won’t be able to return,” he said.

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