Traumatic Brain Injuries – Symptoms and Resources

Known as the "signature injury" of the current military conflict often resulting from improvised explosive devices (IED), traumatic brain injury (TBI) is the result of a blunt force, shock wave force, or penetrating trauma to the head. The brain is injured when the sudden deceleration or rotational acceleration from the trauma generates shearing forces in the brain by forcibly rotating and battering the brain within the skull. The force of the traumatic injury causes brain tissue to rip and stretch, followed by bleeding and swelling.

Two conditions are required to diagnose a history of TBI:

• There must have been an injury event.
• The injury event must have resulted in an alteration of consciousness (from being "dazed," amnesia surrounding the event, or loss of consciousness).

A thorough history can help identify TBI. The Army’s post-deployment assessment (PDA) and post-deployment reassessment (PDRA) screening tools includes the following two yes/no questions:

1. "While deployed, were you exposed to or near a blast, IED, car bomb, suicide explosion, or exposed to any other combat event that caused a blow or jolt to your head?"
2. While deployed, were you involved in a motor vehicle accident, a fall, a sports accident, or any other event that caused a blow to your head or neck whiplash?"

If your patient confirms any of the above, further assessment is warranted. The following information may be helpful to providers in diagnosing TBI:

Neuropsychological Symptoms related to TBI:
Difficulty concentrating	Impulsivity
Difficulty in multi-tasking	Irritability
Difficulty in planning	Loss of balance
Dizziness	Mood changes
Fatigue	Sleep disturbances
Forgetfulness	Slowed Thinking
Headaches

These symptoms may also be present in other neurological or psychiatric disorders, so thorough assessment is encouraged.

Other injuries often caused from blasts
Acute/chronic pain	Soft-tissue damage
Chronic infections	Tinnitus
Hearing loss	Undiscovered fragments
Lung injury/pulmonary contusion	Vestibular problems
Nerve damage	Vision changes/loss
Post Traumatic Stress Disorder (PTSD)

These injuries occurring concurrently with the above neuropsychological symptoms may further your suspicion of TBI.

TBI Resources

The following TBI resources may be helpful to both providers and beneficiaries.

How to Request Assistance for Active Duty Service Members (ADSMs) who have TBI

Each ADSM should be managed by either a MTF or a Veterans Administration provider/care manager. If you are unsure of who to contact, please call TriWest at 1-888-TRIWEST (888-874-9378) for assistance.

Other TBI Resources

• Defense and Veterans Brain Injury Center (DVBIC): http://www.dvbic.org/
  • TBI Screening Tool: http://www.dvbic.org/pdfs/3-Question-Screening-Tool.pdf
  • Telephone: 1-800-870-9244
  • info@dvbic.org
• Wounded Service Members (WSM):http://www.tricare.mil/cap/Related_Sites/WSM.cfm

General Resource Sites

• Military OneSource: http://www.militaryonesource.com
• The U.S. Army Wounded Warrior Program: www.AW2.army.mil
• Marine for Life: https://www.m4l.usmc.mil/
• Heroes to Hometowns: www.militaryhomefront.dod.mil/heroestohometown

Transitional Services

• Seamless Transition – Operation Enduring Freedom/Iraqi Freedom: www.seamlesstransition.va.gov/
• DoDTransPortal – The DoD Web Portal for Military Transitioner: www.dodtransportal.org/dav/lsnmedia/LSN/dodtransportal
• Disabled Transition Assistance Program (DTAP): www.dol.gov/vets/programs/tap/main.htm

TRICARE Resources

Information and Resources for Combat Veterans brochure:

http://www.tricare.mil/tricaresmartfiles/Prod_511/Combat_Veterans_Br_Lo.pdf

TriWest Resources

• www.triwest.com
• 1-888-TRIWEST (888-874-9378)