Dr. Aditya Bhagwat: Impact of TBI in the Military

Dr. Aditya Bhagwat, a neurospychologist who works at the Defense and Veterans Brain Injury Center, talks about concussions sustained in Iraq and Afghanistan and how the military is dealing with the large numbers.

This is an excerpt from BrainLine's webcast Concussion: Understanding Mild Traumatic Brain Injury. See full webcast here.

Interviewer: What's been the impact of TBI in the military since the wars in Iraq and Afghanistan? Dr. Aditya Bhagwat: It's had a pretty large impact. The number is now around 20 percent of soldiers, or of service members, have suffered some type of traumatic brain injury anywhere on the spectrum from mild to severe. It's also raised awareness of TBI in the military in general so that actually we're better at tracking them and spotting them as well. Interviewer: What's the difference between concussion, which Dr. Kelly talked about, and then some of the moderate to severe TBI cases that you see? Dr. Bhagwat: Well, actually we see--the majority of what we see, even coming back, are mild concussions, but they run the spectrum from mild to severe. The moderate and severe are really a different animal from the concussion we're talking about. They are often more severe loss of consciousness, more severe alteration of consciousness, like Dr. Kelly was talking about. You can see findings on imaging much more often, contusions or bleeds such as hemorrhages in the brain. They are more symptomatic at the time, and recovery can take longer as well. Interviewer: What are some of the causes of those TBIs, and are the causes the same for mild TBIs? Dr. Bhagwat: It depends on the TBI, the type that you're talking about. It can be a matter of severity. Like in a car accident or an MVA in theater, someone could have a mild injury from that or a severe injury. But some of the more moderate and severe injuries we see are more from penetrating injuries as well, such as shrapnel from an improvised explosive device exploding or gunshot wounds to the head. Interviewer: Okay. Anything else? Dr. Bhagwat: There are also--I mean--you see also the falls, and you see motor vehicle accidents. You can have other combat-related injuries. Interviewer: What would some of those injuries be? Dr. Bhagwat: You can have people--I mean--if there are explosions nearby, like the blast injuries that we've talked about, there are primary blast injuries. Even just being near an explosion, a large explosion, can cause an injury. Interviewer: Okay, the IEDs? Dr. Bhagwat: IEDs. Interviewer: Okay. All right. Is there a neurological difference between a concussion that a football player might sustain from a collision compared to the concussion that a soldier sustains when a bomb is exploding? Dr. Bhagwat: That's a great question, and the answer is "maybe." That's where a lot of research is going into right now, to finding the effects of what we call the primary blast injury, which is just the force of the blast itself, the wave coming off the blast. A lot of the folks that we see also have secondary and tertiary injuries, which means the shrapnel injuries, things flying from the explosion and striking them, or them being thrown--the individual being thrown into something. I recently interviewed someone where--a soldier--who had an RPG explode near him. Interviewer: An RPG? Dr. Bhagwat: A rocket-propelled grenade. Interviewer: Okay. Dr. Bhagwat: Where he was thrown against a wall, which caused him to lose consciousness. Interviewer: Oh my goodness. Okay. Are the symptoms the same? Dr. Bhagwat: They are similar. They're very similar. They have--like Dr. Kelly was saying, headaches are the number one, one of the number one symptoms. We have vertigo and dizziness problems, the nausea, some of the photo- and phonophobia, sensitivity to light and noise. Interviewer: Do you see the mood changes as well? Dr. Bhagwat: We see the mood changes as well and, of course, in our population they've also been through very many traumatic experiences, so there is that overlay as well. Interviewer: Okay. What's the military currently doing to try to identify people who might have sustained a mild TBI? Dr. Bhagwat: It's a very strong program, actually, for identifying TBI now. Not only in the wounded that actually come to hospitals, but all returning soldiers that come back get screened one way or another. Oftentimes it's by their physicians, or they also have to fill out a questionnaire that asks about symptoms, and anyone who is reporting symptoms that might be due to a TBI will get referred for a full evaluation. Interviewer: Okay, so once you find them, then tell us how the diagnosis works. Dr. Bhagwat: The diagnosis for us is based on mechanism of injury and what the symptoms were during the injury, such as loss of consciousness, alteration of consciousness. Cognitive and neuropsych testing are a piece of that as well, but it's really based on the interview and medical records that go into it, because while neuropsych testing is very efficient and it's very good at finding-- it's very sensitive to brain dysfunction, it's not very specific, necessarily. So if you test someone and they have deficits on testing, it doesn't automatically mean they had a brain injury. There are other factors that could be affecting testing as well, so the interview is very important. Interviewer: And generally what are you finding out in the interview? Dr. Bhagwat: Well, we talk to the soldier or service member and try to find out from them what they remember of the actual incident. We can also use collateral information from people that were in their unit that have come back that might have seen the person. And like Dr. Kelly was saying, they might not remember what happened to them, but we get reports from others that can tell us what happened.
Posted on BrainLine May 27, 2011.