Tag Archives: OIF

Traumatic Brain Injury – TBI and Spinal Cord Injury SCI

The VA says this about TBI and SCI: 

Due to the ongoing conflicts in Afghanistan and Iraq, Traumatic Brain Injury (TBI) and Spinal Cord Injury (SCI) accounts for almost 25% of combat casualties.

Improvised explosive devices, blast (high pressure waves), landmines, and explosive fragments account for the majority of combat injuries in Afghanistan and Iraq. Although Kevlar helmets and advances in body armor have saved the lives of many soldiers, they do not protect against blasts and impacts to the head, face and cervical spinal cord.

Blast injuries often result in multiple traumas, including injuries to internal organs, limb loss, sensory loss, and psychological disorders. The term “polytrauma” has been coined to describe the co-occurring injuries.

The information above and below come from here which are part of an introduction and overview prepared by Joel Kupersmith, MD, Chief Research and Development Officer, VA for the purposes of a proposal solicitation.  I thought the overview might be of interest to those with these injuries and their families.

Traumatic Brain Injury:

Kevlar helmets have done much to protect the head but leave the forehead unprotected. The left and right frontal lobes, located behind the forehead control intellectual abilities such as the ability to plan and organize. This area of the brain also controls personality, behavior, and emotional control.

Concussion or mild TBI is the most common form of combat-related injury. Mild TBI can occur even in those not directly hit by the blast, without obvious external injuries, without loss of consciousness and without visible findings from acute Magnetic Resonance Imaging. Problems with memory, lack of concentration, increased anxiety and irritability are common hallmarks of mild TBI. Although evidence suggests that the majority of OIF/OEF soldiers who suffer mild TBI will recover over time, early diagnoses and treatment are critical so that aberrant behaviors due to TBI are not misinterpreted and soldiers are spared the risk of second impact syndrome. Appropriate recognition of TBI will facilitate quick return to pre-injury activity levels, including return to duty status.

In addition to mild TBI, soldiers close to the blasts are experiencing severe diffuse and contrecoup injuries. Soldiers with a moderate to severe TBI often show the similar symptoms as mild TBI yet also report: worsening headaches; repeated vomiting or nausea; seizures; inability to awaken from sleep; slurred speech; weakness, numbness and loss of coordination. Unlike mild TBI, these problems and others can persist long-term or result in permanent difficulties with memory, reasoning, emotion and expression making it impossible to return to duty, hold steady employment or regain pre-injury quality of life.

Penetrating focal injuries from mortar rounds or other forms of heavy artillery resulting in severe brain injury are not as prevalent. However, focal destruction of brain tissue is the most life-threatening, intractable type of brain injury causing permanent damage to the affected area and the functions it controls.

Spinal Cord Injury:

Current designs in military protective gear and advanced evacuation procedures have resulted in both a decrease in the percentage of spinal cord injured soldiers and an increase in the number of those that ultimately survive. Blast force and shrapnel injuries are most common. For those that survive, the cervical spinal cord, the unprotected and most mobile portion of the spinal cord, is the most common site of injury.

Soldiers with cervical SCI face short- and long-term consequences of losing motor and sensory function below the level of injury, coupled with a loss of autonomic regulation. Every organ system may be affected by cervical spinal cord injury. Alterations in the gastrointestinal, renal, skin and musculoskeletal organs are common, and respiratory problems are the overwhelming cause of morbidity and mortality. In addition, patients may experience chronic pain at or below the level of injury and, less frequently, above it.

Alterations in respiratory mechanics, and the development of alveolar hypoventilation, pneumonia, aspiration of gastric contents, pulmonary embolism, pulmonary edema, and sleep apnea are a few of the common respiratory complications associated with cervical SCI. Ultimately, dysfunction depends on the level and extent of injury. Lesions above C3 paralyze all respiratory muscles. When SCI involves C3 to C5 lesions, profound respiratory muscle dysfunction occurs leaving the patient unable to generate a cough or clear secretions. Because of this, neuroprotective strategies that rescue even one or two segments may be of significant functional benefit to veterans with SCI.

Let’s pray that this proposal results in research that leads to significant help for our injured veterans.    

Oldtimer

Homeless Veterans – Recent Study

How Many Homeless Veterans Are There?

Unless otherwise noted, the data in this article came from: “Ending Homelessness Among Veterans Through Permanent Supportive Housing

The most recent estimate of the number of homeless veterans comes from the FY2005 report of the Community Homelessness Assessment, Local Education and Networking Groups (CHALENG) for Veterans.  

CHaling reports that the number of homeless veterans counted during the point in time count was 195,254.

The VA estimates that nearly 200,000 veterans may be homeless on any given night and 400,000 veterans experience homelessness during a year.

The National Survey of Homeless Assistance Providers and Clients (updated in 1999) found that  23% of all homeless clients and 33% of homeless men are veterans.   Compare that to the 2000 Census that estimates 12.7% of the general population are veterans.  Veterans are 2 to 3 times as likely to be homeless than the general population.

Characteristics of Homeless Veterans

• 45% suffer from mental illness
• 50% have substance abuse problems
• 67% served three or more years
• 33% were stationed in a war zone
• 25% have used VA Homeless Services
• 89% received an honorable discharge

Homeless Veterans vs. Non-Veterans

Homeless male veterans are more likely to be chronically homeless than homeless male non-veterans.  “32 percent of homeless male veterans report that their last homeless episode lasted 13 or more months, compared to 17 percent of male nonveterans.”

They are also more likely to abuse alcohol than homeless non-veterans.

Homeless veterans are better educated than homeless non-veterans, less likely to have never married, and more likely to be working for pay.

Why Do Veterans Go Homelessness?

A study of Vietnam-era veterans by Rosenheck and Fontana demonstrated that the two factors with the greatest effect on homelessness were 1) (lack of) support in the year after discharge from military service and 2) social isolation.

This is consistent with the results of a study by Tessler and Rosenheck which showed that homeless veterans experiencing the longest current episodes of homelessness were those who also had “behavioral risk factors with possible early onset, and those who were lacking in social bonds to civilian society that are normally conferred by employment, marriage, and support from family of origin.”

 Veterans Returning from Iraq and Afghanistan

Initial data indicates rates of mental health disorders that could surpass those seen among Vietnam Veterans. A study by Charles Hoge et al found that:

19 percent of soldiers who served in Iraq screened positive for a potential mental health disorder, including PTSD compared with 11 percent for veterans of the war in Afghanistan. National Guard soldiers, one study found, were about 2 percentage points more likely to experience problems.

This is particularly distressing when coupled with the fact that among veterans “whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care” and the GAO finding that the “[Department of Defense] cannot provide reasonable assurance that OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) servicemembers who need referrals receive them.”

Homeless Veterans from Iraq and Afghanistan

Although many Vietnam veterans did not experience homelessness until 10-15 years after they left the service, homeless service providers are seeing veterans of OEF/OIF already. Social workers fear that “the trickle of stunned soldiers returning from Baghdad and Kabul has the potential to become a tragic tide.” Homeless OEF/OIF veterans themselves are saying “they [are] surprised how quickly they slid into the streets.”

Hypotheses for this quicker descent into homelessness include a tighter housing market than existed during the Vietnam era and a higher percentage of troops exposed to trauma during their service.

There Are Homeless Heroes Out There