Treating Symptoms of TBI and Combat Stress Separately but Holistically
Combat exposure can damage the brain physically and psychologically. Working to find the causes of these injuries will help with the nuances of treatment.
We know that combat exposure is not good for the human brain and not good for the human mind. With explosive munitions, there are significant amounts of individuals who are getting blast-based concussions. We also know that the rigors and the vigilance required to be in a combat environment produce really significant combat stress syndromes at the back end. It is not uncommon for our patients that we see in the VA who are typically 2-3 years removed from the combat environment and a year removed from their DOD activity once they're in our outpatient clinics to have some combination of a history of a traumatic brain injury as well as some pretty significant combat stress syndromes. The teams that we have, and to do it really effectively, you need to be aware of both of these things, both of these entities, and they do appear to be relatively separate entities from the penetrance of the problems. The issues and the symptoms that the individuals are having at the back end can be relatively similar, but it is incredibly important that when you treat an individual with a traumatic brain injury that you recognize and also effectively treat the other issues that someone is having. For some reason, the medical community and the lay community don't see what we term psychological injuries as being as important and as weighty as physical injuries. If we look at someone with a mild traumatic brain injury who has blindness, we're obviously going to adjust the way that we treat that individual and set up their care plan to try to, again, help them be people again. It's the same thing with the "psychological injuries" of combat. Without recognizing those things and treating those things, there's no way that those individuals - let me put it a different way. It's going to be a lot harder for those individuals to get better and to rediscover their lives and flip the chapters over and find out what's next if you can't direct your treatment at exactly what the person is suffering from. When we talk about trying to figure out what psychological burden somebody is carrying, be it an anxiety-based disorder like combat stress syndrome or be it depression, it's important where it comes from; i.e., is it from a TBI, is it from the PTSD, is it from substance abuse, to help treat those things. So when somebody has a TBI and they've got significant neurocognitive issues, the pathways that you're going to use to treat the PTSD are going to be different. The counseling-based sessions, the cognitive processing therapy, the CBT, and the different things that we use to try to help them get better, they don't have the cognitive skills necessary to fully engage in those things, we need to build those pieces up over time. We touched upon sleep a bit. If there is one thing, there is one burden that this population seems to be carrying that is just ultimately terribly destructive, it's anxiety with sleep, an inability to get restful sleep over time. we know that both traumatic brain injury and PTSD can negatively impact our ability to get restorative sleep, and as you talk to these young men and these young women who have served our country in the outpatient clinics months and years afterwards, their sleep patterns are just devastated. Without an ability to kind of get in there and really help them get to sleep again and to restore it's really challenging to help them.
Posted on BrainLine September 27, 2012.
Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.
Shane McNamee, MD serves as chief of Physical Medicine and Rehabilitation at the Richmond VAMC and has worked extensively on the development and implementation of the Polytrauma System of Care in the Veterans Health Administration.