March is Traumatic Brain Injury (TBI) Awareness Month, and much like traumatic brain injuries themselves, you may have spent most of this past month not even aware of your proximity to it. TBI is the leading cause of disability for people under 40, it is estimated by the Centers for Disease Control (CDC) that on average 1.5 million Americans suffer a new TBI per year while for service-members it is reported that, worldwide, at least 414,000 TBIs occurred between 2000 and late 2019. Among USAF, this is estimated to be 52,282 (AD and Reserve Component combined).
During the month of March we recognize TBI Awareness Month, a time to reflect on and support those impacted by these injuries. TBI can occur when an external force impacts the head or body, during which the brain undergoes trauma and may have resulting changes to brain function. This can happen in several ways, such as when the head is struck directly (e.g., hitting the head during a fall), whiplash (e.g., head being snapped forward during a vehicular accident), or shockwaves traveling through the head (e.g., close proximity to the detonation of an improvised or conventional explosive device). Warning signs of a TBI with immediate risk to life (such as brain bleeding) include one pupil being larger, drowsiness or inability to wake up, worsening headache, slurred speech, vomiting, nausea, unusual behavior (confusion, agitation, restlessness), or loss of consciousness. See below CDC article on “Concussion Danger Signs” for all ages and “Recovery from Concussion” article for special tips for young children.
TBI as a medical condition can be difficult to diagnose and treat while being even more challenging for those affected to live with. Also known as “silent wounds” due to the frequent absence of immediately visible impact, TBIs are injuries that can affect any and every factor of a person’s life.
Some TBIs can be assessed through diagnostic imaging (e.g., CT scan, MRI) but not all. Additional criteria may include physical (e.g., loss or alteration of consciousness, seizures, pupil dilatation, loss of coordination, and more) and psychological (confusion, agitation, slurred speech, impulsivity, personality changes, impact to learning, memory, decision-making, and more) symptoms occurring after a head injury not better explained by another existing medical condition.
While most TBIs are minimally impacting and their associated symptoms diminish over time, not all do. When a TBI is diagnosed and the effects continue, effective treatment focuses on both the impact of the TBI as well as the patient’s strengths and motivation for pursuing sustainable health. Because TBI affects a person’s brain, it can cause associated mental health symptoms (e.g., anxiety, depression) and make other conditions (e.g., Alzheimer’s, Dementia, PTSD) more likely and therefore a holistic approach often works best for affected persons. Medication, occupational therapy, pain management, psychotherapy, and speech-pathology therapy can all make a difference (see below article from Rand Corporation to learn more about treatment of TBI within the military health system). Other actions that may help include making time for recreation, managing stress (call Dyess Mental Health Clinic at 325-696-5380 to learn more), exercise, keeping any alcohol and other substance use at a healthy limit (call Dyess ADAPT at 325-696-5380 to learn more), getting adequate sleep (see below Dyess AFB article on sleep hygiene), and identifying and pursuing reasonable expectations informed by your medical provider.
For caregivers, caring for a family member with TBI can be rewarding and/or challenging, depending on the day (see below article from brainline.org for caregiver tips). Please know it is ok to not always feel ok with TBI (and any other medical condition) and it is also ok to acknowledge that giving support can sometimes take a toll on the caregiver and engage in some self-care as well. Those affected need and benefit from the help in visualizing together a way to be healthy and pursue it, especially considering that suicide has been identified (as of 2017 research from the CDC) as the leading category of TBI-related death. While suicide is often more prevalent in those who are hopeless about the future and engage in negative and inaccurate self-talk that isolates them from their loved ones and hope for the future, there are tools and techniques to address it (see below article from PsychCentral for tips on how to challenge negative self-talk)
In closing, while it is impossible to know who in a person’s day-to-day life may be experiencing consequences of TBI, approaching others with awareness of and empathy toward this often hidden medical condition can inspire those impacted toward patience and perseverance in supporting, managing, and going beyond perceived limitations (see below Brainline article for personal stories from those with TBI, including veterans). Help is available, healing is possible, and the future can be built through support and effort that can be found right now. Please ask your PCM, family doctor, or helping agencies staff member (Mental Health, Family Advocacy, ADAPT, all reachable at 325-696-5380) to learn more and help to not limit TBI awareness to only one month per year.
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