What you need to know about the concussion crisis impacting U.S. troops

[Boats]

What you need to know about the concussion crisis impacting U.S. troops
By: Ben Wolfgang - The Washington Times - 03-02-20
Re: https://www.washingtontimes.com/news...ssion-crisis-/

A decadelong push by the Pentagon has brought to light the startling frequency of brain injuries within the ranks of the U.S. military, helping to erase the concept that concussions can be simply brushed off.

Much like the National Football League and other corners of American society, the military has only relatively recently begun to delve deeply into brain injuries, their prevalence and the impact they could have on morale and performance. Here is what you need to know:

* Head injuries and long-term brain damage, once largely dismissed as a lesser health concern, are getting an increasingly intense focus from the Pentagon.

* More than 100 U.S. service personnel were treated for ‘traumatic brain injuries’ (TBI) in the weeks after an Iranian missile attack on U.S. positions in Iraq in January, after the
Pentagon first reported no injuries.

* Since 2000, more than 408,000 cases of TBI have been diagnosed in American military personnel serving globally.

* U.S. veterans groups are increasingly vocal about the short- and long-term damage to service personnel from traumatic brain injuries.

* The Pentagon has instituted new screening protocols that now monitor service members for days and weeks after a potentially dangerous incident.

* Most military TBI cases are caused not by blast injuries or missile strikes, but by the same events that result in brain injuries in the civilian population, specialists say.

History Note:

“If you go back through thousands of years of military history, go back to the Greeks and the Romans, they talked about people who were wounded warriors, or the walking wounded, shell-shocked — every war has had some term for them. What we’ve not had are good ways to evaluate these soldiers, sailors, airmen and Marines at the time that they were injured or afterwards, when they came and sought care,” Air Force Brig. Gen. Paul Friedrichs, Joint Staff surgeon, recently told reporters at the Pentagon.

Today we recognized this beginning early in the current conflicts and began working with the [Department of Veterans Affairs], as well as with the NCAA, the NFL and other stakeholders to develop a series of screening measures, which we’ve updated over the years, and we’re able to use very effectively during this event,” he added.

-----------------------------------------------------------------------------------------------------
Concussion Symptoms fit into four categories:

* Thinking and remembering
* Physical
* Emotional and mood
* Sleep

A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head or by a hit to the body that causes the head and brain to move rapidly back and forth. Rapid movement causes brain tissue to change shape, which can stretch and damage brain cells. This damage also causes chemical and metabolic changes within the brain cells, making it more difficult for cells to function and communicate. Since the brain is the body’s control center, the effects of a concussion can be far-reaching.

Concussions are usually not life-threatening, but the effects of a concussion can change a life and the injury should be treated seriously.

Common concussion signs include:

* Loss of consciousness
* Problems with balance
* Glazed look in the eyes
* Amnesia
* Delayed response to questions
* Forgetting an instruction, confusion about an assignment or position, or confusion of the game, score, or opponent
* Inappropriate crying
* Inappropriate laughter
* Vomiting

COMPLEX RECOVERY: POST-CONCUSSION SYNDROME

Recovering from concussion means your brain cells must return to the normal function by rebalancing levels of chemicals, like sodium and calcium, inside and outside of the cell. This process takes a lot of energy, so it is important to conserve energy during recovery. When properly managed, the majority of concussion symptoms will resolve within a couple of weeks, however over-exertion of brain cells during recovery can cause symptoms to persist for months or even years. A significant percentage (estimates vary between 10% and 30%) of concussion patients suffer from extended recovery, known as Post-Concussion Syndrome.

CATASTROPHIC RE-INJURY: SECOND IMPACT SYNDROME

During recovery, the brain is more vulnerable to re-injury. In rare cases, a second concussion sustained during recovery can cause the brain to undergo massive swelling. This extremely rare condition is known as Second Impact Syndrome (SIS). Approximately half of SIS patients die from their injuries, and the survivors often suffer from life-long
disability.

The military defines concussion in a way that's very consistent with the civilian definitions, and it is a change in neurological function, especially an alteration in mental function-- mental status--as a result of a biomechanical blow to the body, not necessarily even the head.

Traumatic brain injury (TBI) is a significant health issue which affects service members and veterans during times of both peace and war. ... The impacts of TBI are felt within each branch of the service and throughout both the Department of Defense (DoD) and the Department of Veterans Affairs (VA) health care systems.

Abstract
Mild traumatic brain injury (mTBI) includes concussion, subconcussion, and most exposures to explosive blast from improvised explosive devices. mTBI is the most common traumatic brain injury affecting military personnel; however, it is the most difficult to diagnose and the least well understood. It is also recognized that some mTBIs have persistent, and sometimes progressive, long-term debilitating effects. Increasing evidence suggests that a single traumatic brain injury can produce long-term gray and white matter atrophy, precipitate or accelerate age-related neurodegeneration, and increase the risk of developing Alzheimer's disease, Parkinson's disease, and motor neuron disease. In addition, repetitive mTBIs can provoke the development of a tauopathy, chronic traumatic encephalopathy. We found early changes of chronic traumatic encephalopathy in four young veterans of the Iraq and Afghanistan conflict who were exposed to explosive blast and in another young veteran who was repetitively concussed. Four of the five veterans with early-stage chronic traumatic encephalopathy were also diagnosed with posttraumatic stress disorder. Advanced chronic traumatic encephalopathy has been found in veterans who experienced repetitive neurotrauma while in service and in others who were accomplished athletes. Clinically, chronic traumatic encephalopathy is associated with behavioral changes, executive dysfunction, memory loss, and cognitive impairments that begin insidiously and progress slowly over decades. Pathologically, chronic traumatic encephalopathy produces atrophy of the frontal and temporal lobes, thalamus, and hypothalamus; septal abnormalities; and abnormal deposits of hyperphosphorylated tau as neurofibrillary tangles and disordered neurites throughout the brain. The incidence and prevalence of chronic traumatic encephalopathy and the genetic risk factors critical to its development are currently unknown. Chronic traumatic encephalopathy has clinical and pathological features that overlap with postconcussion syndrome and posttraumatic stress disorder, suggesting that the three disorders might share some biological underpinnings.