Brain injury can be treated effectively at JBER clinic

by Air Force Staff Sgt. Wes Wright
JBER Public Affairs

4/21/2014 - JOINT BASE ELMENDORF-RICHARDSON, Alaska -- 'Traumatic brain injury' has become a buzzword in the military with the Department of Defense deeming it the "signature injury of the war on terror."

According to the Centers for Disease Control and Prevention, a traumatic brain injury occurs when there is a bump, blow or jolt to the head, or a penetrating head injury which disrupts the normal function of the brain.

Symptoms include headaches, sensitivity to noise or light, nausea, vision problems and dizziness, just to name a few.

Experts in the field agree diagnosing and treating TBI can be a difficult endeavor requiring devoted and highly skilled professionals.

To provide this, last year the TBI Clinic opened at the JBER hospital.

"The mission of the TBI Clinic is delivering comprehensive, evidence-based treatments to the mind, while providing the highest standard of care to the person," said Tech. Sgt. Seth Russell, 673d Medical Operations Squadron noncomissioned officer-in-charge of the clinic.

A dedicated staff of 13, which includes neuropsychologists, speech and language pathologists, occupational therapists and nurse case managers, as well as an entire hospital, stands ready to help treat patients within their respective disciplines.
They compose JBER's capability to diagnose and treat TBI cases.

"Cases we see come primarily in the form of a concussion or some other traumatic blow to the head," said Air Force Maj. Joel Cartier, 673d MDOS licensed clinical social worker and TBI clinic director. "It's like a bruise on the brain. There's swelling and centralization of blood."

TBI symptoms are classified by the medical community in three categories: physical, cognitive and emotional.

Physical symptoms include headaches, dizziness and sensitivity to light.

Cognitively, patients can experience concentration problems, attention problems and difficulty finding words.

Emotionally, there can be irritability, anxiety and depression.

The physical symptoms of TBIs eventually go away, and the rest can be treated through a variety of medications and therapy, Cartier said.

"The physical signs of a TBI will go away. The symptoms can often times linger. That is the issue we deal with a lot," Cartier said.

"If you were to do an MRI on somebody who had a concussion two to three months after the fact, you're not going to see anything. But the psychological problems can persist."
Cognitive problems present their own unique challenges to Cartier's team.

"To address cognitive problems patients may have, we have to retrain the brain," Cartier said. "We have speech and language pathology and occupational therapy to help with those sorts of things."

Cartier said it can be difficult for patients to tackle the associated stress that can come with a TBI.

"If I have a TBI, my brain isn't working as well as it used to and that, in and of itself, is stressful," Cartier said. "In the military, we generally have somewhat stressful
jobs - lots of demands and expectations placed upon us. So, if my job was at
all stressful in the first place, now I have the stressor of not being able to function as well with those same stressors.

"We oftentimes take that stress home and it bleeds over into the family which can cause family problems."

Russell and Cartier agreed dealing with TBI is the easy part of their job.

"If it's strictly TBI, that's the easy part," Cartier said. "The problem is with a TBI is we're generally dealing with so many other things - chronic pain, post-traumatic stress disorder, etc. PTSD is oftentimes more difficult to deal with than an a TBI."

According to the National Council on Disability, PTSD and TBI are often addressed together for two reasons.

First, the symptoms may be similar, so it is difficult to distinguish between the two injuries.
Second, the two are often related - especially in the military, where a large proportion of brain injuries are suffered due to explosions in a combat zone - which are often traumatic.
Although PTSD is a biological/psychological injury and TBI is a neurological trauma, the symptoms of the two injuries have some parallel features.

In both injuries, the symptoms may show up months after someone has returned from war, and in both injuries, the veteran may 'self-medicate.'

Overlapping symptoms include sleep disturbances, irritability, physical restlessness, difficulty concentrating and some memory disturbances.

While there are similarities, there are also significant differences.

For example, with PTSD, individuals may have trouble remembering the traumatic event, but otherwise their memory and ability to learn is intact.

With TBI, the individual has preserved older memories, but may have difficulty retaining new memories learning new things.

At each initial screening, Cartier's team determines if a patient with a concussion may potentially have PTSD.

Depending on their findings, some patients are referred for additional treatment.
Russell said TBI is getting much more attention at a federal level lately as leaders realize the impact of the injury.

Additionally, the Department of Veteran Affairs has expanded benefits for veterans with TBI and announced new regulations to make it easier for those vets to receive additional disability pay.

However, Cartier does not believe thses changes will result in over-diagnosis of TBI cases.

"TBI isn't easy to fake," Cartier said. "We have a lot of different assessments we do to tease out whether or not you're having cognitive deficiencies."

Russell believes the recent influx of TBI diagnoses is because "medical professionals have gotten smarter in the way we've assessed it and calling it what it is."

Cartier emphasized the importance of people seeking out help if they even think they might have experienced a TBI.

"It's critical for people to come get the help they need," Cartier said. "In any TBI, the expectation is that you can get better.

We can help you get back on track.

"You might not be able to make it all the way back to who you were before, but the progress we make will be of value."

Russell echoed his boss's statement.

"Life is too short not to live it well," Russell said. "Get the help you need before it gets the best of you."

For more information, people can contact the TBI clinic at 580-0014.

See your primary care provider for a referral before scheduling an appointment.