Tips for Treating Chronic Symptomatic Mild Traumatic Brain Injury and Post-Traumatic Stress Disorder
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| Source: Medical With Family |
Traumatic brain injury (TBI) has been described as the “signature wound” of the conflicts in Iraq and Afghanistan. Modern body armor has greatly enhanced a warrior’s chance of survival after sustaining a TBI. However, with increased awareness and screening measures, mild TBI — otherwise known as concussion — has become a clinical challenge for those who are charged with caring for chronic symptomatic mild TBI patients.
Post-traumatic stress disorder (PTSD) affects thousands of individuals who have experienced a traumatic event. Our nation’s most recent generation of deploying men and women are no exception. The Department of Defense (DoD) has an increased need for psychological health care providers, and many non-military psychological health care providers have answered the call to treat military service members and veterans returning from deployment.
Below are tips, resources and educational information for civilian health care professionals about TBI and PTSD and how to approach military patients.
Getting Ready
Research and develop an understanding of the experiences and exposures that America’s most recent combat veterans have undergone in an effort to recognize the connection between certain health effects and military service.
Become familiar with military culture, including military ranks and the difference between National Guard and Reserves.
Common fundamentals distinguish military culture from many others. Cultural norms include a high standard of discipline, a professional ethos of loyalty and self-sacrifice, a distinct set of ceremony and etiquette, and an emphasis on group cohesion and esprit de corps that connects service members to each other.
These cultural basics can make it challenging for providers and clinicians to help returning warriors with a TBI or with psychological health concerns such as PTSD — especially when compounded with everyday stressors from their civilian lives.
| Overview | Website |
| Become familiar with military ranks and insignias | |
| Be aware of the services and programs offered by the Department of Veterans Affairs (VA) | |
| Review the resources that are available from the DoD, including TRICARE services | |
| Develop partnerships with staff at nearby DoD installations | |
General Considerations in Care1
Build a relationship with the service member first. As with any patient-provider relationship, the interactions between service member or veteran and health care professional will be the starting point for care.
Work from a patient-centered perspective, and take care to find out the current concerns of the patient. What are his or her worries or fears? What practical solutions can you offer for specific problems?
Learn about the symptoms of TBI.
- A TBI is defined as an injury to the brain caused by an external force. This force produces either an alteration of consciousness or a loss of consciousness. It may also be associated with other neurological deficits.
- Some common symptoms of a brain injury include headaches, dizziness, cognitive impairment, fatigue, irritability, vision changes, balance problems, mood changes and sleep difficulty. For mild TBI, these symptoms can resolve in minutes to days.
- About 10 percent of patients with concussion continue to have chronic symptoms.2 Any patient with chronic symptomatic concussion should also be evaluated for other medical problems to include psychological injuries.
Learn about PTSD and its symptoms.
- PTSD is an anxiety disorder that can occur after experiencing a traumatic event. Anyone who has gone through a life-threatening event can develop PTSD. These events can include combat or military exposure, sexual or physical abuse, terrorist attacks and natural disasters.
- Strong emotions caused by the event create changes in the brain that may result in PTSD. Many people who develop PTSD get better at some time. However, about one of every three people with PTSD may continue to have some symptoms, which are categorized into four types: re-living the event, avoidance, numbing and hyperarousal.3
| Type of Symptom | Symptoms |
| Re-living | Feels the same horror and fear that was felt when the event took place; nightmares, flashbacks; sights or sounds that trigger re-living the event |
| Avoidance | Avoiding situations or people that trigger memories of the traumatic event; avoid thinking or talking about the event |
| Numbing | Difficulty expressing feelings; does not feel positive or loving feelings toward others; avoids personal relationships; uninterested in activities that previously brought feelings of joy |
| Hyperarousal | Jittery; constantly on high alert for danger; sudden mood swings; difficulty sleeping; trouble concentrating; always on guard; fearful; very easily startled |
Treatment Tips and Resources
Help the service member or veteran you’re treating stay focused on his or her course of treatment. He or she is likely to feel overwhelmed with a variety of problems — from family and friends, to workplace, finances and physical health. These problems can draw much of his or her attention away from the tasks of therapy and could create a climate of mounting stress that interferes with resolving symptoms. Helping warriors identify, prioritize and take action steps to address their concerns will benefit both patient and health professional and smooth immediate or eventual reintegration into life at home and reduce the likelihood of future problems.
Treating Service Members with a Chronic Symptomatic Mild TBI
Education is the first step in treating anyone with a concussion. The patient should be made aware of possible symptoms and the expected course of recovery. While many patients with a concussion can improve in minutes or days, some people may take up to three months.
4 Rest is one of the most important steps to take at this time as well as avoidance of further injury. For more information on early treatment of concussion, please refer to the
Defense and Veterans Brain Injury Center Website.
Treating Service Members with PTSD
Education is the first step in treating anyone with PTSD. The patient should be made aware of possible symptoms and the expected course of recovery. While there are a number of treatment options for PTSD and as patient response to treatment can vary, some treatments have been shown to have more benefit for patients than others. The main treatments for people with PTSD are counseling or psychotherapy (“talk” therapy), medications or both. To learn more about these treatments, refer to
PTSD Treatment Options or the
Management of Post-Traumatic Stress VA/DoD Clinical Practice Guideline.
Resource List
| | The DCoE Outreach Center provides in-depth information and resources related to the spectrum of PH matters and TBI. Health consultants are available 24/7 to respond to specific research requests by phone, e-mail, chat and fax. |
| | The MHS is a unique partnership of medical educators, medical researchers and health care providers and their support personnel worldwide. |
| | The VA/DoD make available evidence-based clinical practice guidelines for download on PTSD, post-deployment health, and concerns. |
| | A Web-based educational resource that is designed for busy practitioners who provide services to military men and women and their families as they recover from combat stress or other traumatic events. |
| | An educational resource for health professionals. |
| | An educational resource for health professionals. |
Sources
last accessed Apr 17, 2009.
2 Ruff, R., Camenzuli, L., & Mueller, J. (1996). Miserable minority: emotional risk factors that influence the outcome of a mild traumatic brain injury. Brain Injury. 10, 551-65.
last accessed May 14, 2009.
last accessed December 22, 2009.
Additional Resources
Defense and Veterans Brain Injury Center
National Institute of Mental Health
Afterdeployment.org
Walter Reed Army Institute of Research – Psychiatry & Neurosciences
Military Treatment Facility Locator
Center for Deployment Psychology - Password required