Diagnosing and Treating TBI: Challenges in and Beyond Theater
Army COL Dallas Hack, MD, talks about the challenges in diagnosing and treating TBI — from the dearth of research to the lack of definitive treatments.
The Challenges of dealing with brain injury are multitude. [brainlinemilitary] First of all, this is a very underaddressed area of medicine, in general. It is a difficult area; and medicine has worked on a lot of other things, and worked on strokes a lot but the brain injury part of something to do about brain injury has been so difficult that it has really been a backwater in terms of medical progress. [A service of brainline.org] So first of all, we don't have an objective diagnosis for brain injury. We don't have anything other than their symptoms and doing some functional tests to tell whether they had a brain injury--at least a mild brain injury. If they have a severe brain injury, we can see it on some of the images, like from an X-ray or a scanner that will tell you--an image-- that there's something wrong with the structure. But that's relatively easy. It's the milder ones--the concussions, those kind of things-- we don't have any, really, way other than ask them some questions and see if they can maintain their balance to tell whether they've got a brain injury. So knowing if they have a brain injury or something else is the first problem. And second, we don't have, really, anything we can do for it right now. Our treatment for brain injury right now is largely rest. We tell people to rest. Like a kid on football field--he gets a concussion. Well, you have to stay out for the rest of the game or whatever and, hopefully, by that point, you won't be dizzy anymore and you can go back in. We don't know if that's long enough, we don't know if it's too long. We don't have the measures--the whole field is very undefined in terms of whether there's an injury or not, and when people are recovering from it. That, itself, is the challenge. And then you add to that, in terms of the military, the fact that there are multiple different causes of impact to the head-- whether it's actually striking your head on some object, like a concussion would normally do on a football field or whether it's because of the blasts that we're getting from these explosions that are around people. It's a combination of that that makes a particular challenge for us.
Posted on BrainLine December 1, 2011.
Col. Dallas C. Hack, MD is director of the Combat Casualty Care Research Program and chair, Joint Program Committee 6 (Combat Casualty Care), U.S. Army Medical Research and Materiel Command, Fort Detrick, MD.
Produced by Noel Gunther and Ashley Gilleland, BrainLine.