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Traumatic Brain Injury (TBI) has been referred to as the signature injury of the current conflict in Iraq and Afghanistan due to exposure to weapons like rocket-propelled grenades, improvised explosive devices, and landmines. The injured service member survives to be evacuated due to improved body armor and medical advances that allow survival of previously lethal attacks. More and more of our wounded servicemen and women return from the battlefield with mild, moderate, and severe brain injuries. Figures for exposure to blast in the injured returning from the battlefield are around 70% (Warden et al., 2005). Closed head injuries are common. Difficulties after TBI include headache, slowed thinking, decreased memory and attention, concentration problems, irritability, sleep disturbances, depression, and post traumatic stress disorder, among others (Warden et al., 2005).
The Defense and Veterans Brain Injury Center (DVBIC) provides leading edge clinical care, conducts research, and provides education regarding TBI to active duty service members and veterans. The DVBIC has developed improved screening and evidence-based guidelines for improving the standards of care in TBI for our returning service members. As more service members are identified with closed head injuries from blasts sustained while deployed, required services may be necessary far into the future. Community integrated rehabilitation for TBI has emerged as an important issue while the service members cross the threshold into the survivor aspect of rehabilitation process and prepare to re-enter the civilian community. The recovery curve for TBI, especially the moderate to severe TBI, can be a lifelong process as most of the injured are just entering the most productive part of their lives. Cognitive rehabilitation is an important part of the rehabilitation process and has been demonstrated to be an effective form of treatment for TBI and stroke (Cicerone et al., 2000, Carney et al., 1999).
TBI is a critical issue not only for service members, but also for civilians. Providing for the best recovery of TBI survivors is impeded when insurance coverage is denied. Recognizing this ever growing problem and providing the opportunity to facilitate a more productive and independent life at home, in the community, school, or work is essential to reduce the future burden on societal resources.
Carney, N., Chestnut, R.M., Maynard, H., Mann, N.C., Patterson, P., and Helfand, M. (1999). Effect of cognitive rehabilitation on outcomes for persons with traumatic brain injury: A systematic review. Journal of Head Trauma Rehabilitation, 14(3), 277-307.
Cicerone, K.D., Dahlberg, C., Kalmar, K., Langenbahn, D.M., Malec, J.F., Berquist, T.F., Felicetti, T., Giacino, J.T., Harley, J.P., Harrington, D.E., Herzog, J., Kneipp, S., Laatsch, L., and Morse, P.A. (2000). Evidence-based cognitive rehabilitation: Recommendations for clinical practice. Arch Phys Med Rehabil, 81, 1596-1615.
Warden, D.L., Ryan, L.M., Helmick, K.M., Schwab, K., French, L., Lu, W., Lux, W., Ling, G., and Ecklund J (2005). War neurotauma: The Defense and Veterans Brain Injury Center (DVBIC) experience at Walter Reed Army Medical Center (WRAMC). Journal of Neurotrauma, 22(10), 1178.
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