Mary Alexis Iaccarino, MD: TBI in Military Service Members and Civilians Is Not the Same

Once upon a time, researchers and doctors treated all traumatic brain injuries the same, but they now know that the mechanism of injury plays a key role in diagnosis and treatment. There are many parallels for civilians and service members who sustain a traumatic brain injury, but the people are very different. Athletes who sustain a TBI most likely will not have the overlapping emotional challenges that service members may who sustained their injury in combat or in a more threatening setting. Helping service members and veterans often includes treating them for both TBI and PTSD simultaneously.

Dr. Mary Alexis Iaccarino is director, Clinical TBI and Brain Health Services, Home Base

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I have the great benefit of treating civilians. I work in sport concussion, and then also treating service members. So, there’s definitely some parallels in the neurological injury itself, but the people are very different. And I think that’s really important to recognize. There’s a very different culture as a military service member or veteran, and also the mechanism of injury is very different. So, where once upon a time we thought that all brain injury was the same, and we even in research and clinical care, lumped everyone together – “oh, this is traumatic brain injury; this is traumatic brain injury.” We now know that the mechanism of those injuries can really be quite different in how it affects the brain tissue, and then also in the kind of symptoms it produces. So in veterans, military service members we’re thinking about blast-related injury, we’re thinking about injuries that, to the brain, that happen in the setting of a co-occurring psychological trauma, such as loss of life or a threat to loss of life. We’re also thinking about all of the other exposures that these people may have - burn pit exposure, inhaling of different substances, sleep deprivation. And this is very different than maybe what a civilian might experience or potentially what an athlete might experience when they have a concussion or a TBI. So, I think there’s a lot of difference in culture, and there’s a lot of difference in exposure that makes these injuries, and the people who experience them, very unique. I think one of the most important things is recognizing that there is likely going to be an overlapping emotional difficulty in someone who experiences a TBI in military service. It’s not necessarily that this is all an emotional health problem, which, you know, some people worry is how it’s being portrayed. Right? That this is all a psychological problem. There are neuro physiologic changes on the brain that are occurring. However, the brain is also the organ of our emotions and the mind. And so, when we have these injuries occurring together to the same organ, oftentimes from the same exposure or experience, we have to be very mindful of that. So, when we design treatment programs we need to think about treating these things together. And so, at Home Base and across the Warrior Care Network, that’s really how we’ve developed our programs. We started with treating both invisible ones of war, as we call it, which would be post-traumatic stress and TBI. Looking at how they interact and then treating both problems together. And we’ve really found that we get a lot more traction in getting people feeling better when we come at it from both sides of the picture. BrainLine is powered in part by Wounded Warrior Project to honor and empower post-9/11 injured service members, veterans, and their families.

Posted on BrainLine September 28, 2021. Reviewed September 28, 2021.

About the author: Mary Alexis Iaccarino, MD

Mary Alexis Iaccarino, MD, is a board-certified physiatrist with sub-specialty training in brain injury medicine. Her clinical and research areas of interest include diagnostic and treatment strategies in mild traumatic brain injury including blast and sport-related concussion. Dr. Iaccarino joined the Home Base team in 2016 as a brain injury physiatrist for the Intensive Clinical Program (ICP) and outpatient TBI program. Her goal is to provide comprehensive, evidenced-based brain injury care to veterans through multidisciplinary collaboration with psychology, neuropsychology, physical therapy, psychiatry, and other specialists. She specializes in the treatment of physical, cognitive, and behavioral deficits that occur after brain injury including headaches, pain, dizziness and vision symptoms, sleep difficulties, fatigue, concentration, and memory problems.

Headshot of Dr. Mary Alexis Iaccarino in a salmon button-down shirt