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March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Military health personnel performing a balance test on a patient Katherine Perlberg, a physical therapist at Landstuhl Regional Medical Center’s Traumatic Brain Injury Clinic, performs a balancing test on Navy Petty Officer 2nd Class John Toomer, a hospital corpsman from Naval Hospital Naples, during Landstuhl Regional Medical Center’s Virtual Health Presenters Course, Sept. 3. (Photo by: William Beach, Landstuhl Regional Medical Center)

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Navy Capt. (Dr.) Scott Pyne sees March’s Brain Injury Awareness Month as an opportunity to highlight what the Traumatic Brain Injury Center of Excellence does all year long.

A traumatic brain injury (TBI) is any blow or jolt to the head that disrupts the normal function of the brain. They can have long-lasting effects. Awareness of TBIs - how to identify them, and ways to mitigate them or seek treatment if an individual thinks they may have one - is an important element of maintaining a medically ready force.

Pyne, division chief for the Silver Spring, Maryland-based TBICoE, said that what many people may not realize about TBIs within the DOD is that they occur more often at home than while deployed.

"TBI is a big issue for the military, especially in a deployed environment, but more TBI actually occurs in the non-deployed environment," Pyne said. "It's really important to be careful about TBI and know about it when you're doing average, day-to-day things like driving your car, riding your bike or motorcycle, skiing, or playing sports."

Pyne said he's seen many changes and advancements surrounding the study and understanding of TBI during his career, and this has led to better guidance for everyone.

"I think the biggest difference is in the area of concussions or mild traumatic brain injury, and this has been pushed out to our line leaders, clinicians, patients, service members, and veterans to be aware of the effects of mild traumatic brain injury," Pyne said. "In the past, concussions happened and people knew about them, but they really didn't pay them much mind."

He said that much of the advancement in understanding TBIs is due to the number of studies that have been done on them over the past several decades, as well as developments in science and technology. This has resulted in better awareness and prevention measures.

Pyne cited an example of when he was involved in sports versus his experience with his children.

"It used to be, if you were able to play through them (brain injuries or concussions), you played through them. You were encouraged to," Pyne said. "I think we now have a whole lot more awareness that there are some problems with that, and that numerous concussions may result in some long-term problems that are difficult to bounce back from. That awareness and understanding has really changed from the time that I was young until the time that I was on the sidelines coaching my own kids."

These advancements are also translating into higher recovery rates.

"The advances that we’re making in severe and penetrating and moderate traumatic brain injury are remarkable. People who would never have recovered in the past are now able to do quite well, and that's based on advances in science," Pyne said. "We always knew it was bad, but I don't think we knew how to take care of it as well as we do now."

On the combat side, Pyne said that post-traumatic stress disorder (PTSD) and brain injuries often go hand-in-hand.

"It's very difficult to discern between the two, and I think they need to be evaluated and treated at the same time," Pyne said. "You can have PTSD without having a traumatic brain injury, and you can have a traumatic brain injury without PTSD, but sometimes they come together."

In fact, the TBICoE is studying the interaction between the two.

"We're finding that people who have an isolated traumatic brain injury do a lot better than those that have a traumatic brain injury and PTSD," Pyne said.

Military personnel in a field crotched over holding a gun
Marine Pfc. Daniel Yates, a rifleman with Bravo Company, Battalion Landing Team 1/1, 11th Marine Expeditionary Unit, provides security while conducting a patrol after a simulated airfield seizure mission during a Realistic Urban Training exercise at Marine Corps Air Station Yuma, Arizona, Feb. 21. (Photo by: Marine Sgt. Alexis Flores)

TBIs' impacts on memory and motor skills are also being studied.

"The other thing that we’ve learned quite a bit about is that when injured, people don’t function the same way as they did prior to their TBI. We know that people’s reaction time, their ability to focus, their ability to memorize things are all impacted," Pyne said."

In a combat environment these things have the potential to become life-threatening, both to an individual and those around them.

"On the athletic playing field, that may equate to you not playing well or your team not winning, but obviously the stakes are much higher in the deployed environment, where you not only have to protect yourself, but also your fellow service members," Pyne said.

"At the end of the day, if you get hit in the head and you can’t focus, think clearly, or concentrate, we need to pull you out of whatever game you’re playing, even if it's the game of life, and try to make you better," Pyne said. "So when you go back, you can go back as healthy and as close to functioning at your normal level as you were before you sustained that injury."

Pyne reiterated the fact that most TBIs occur in a non-deployed environment.

"In the DOD, the ways we think about this happening are when we're being shot at or things are blowing up, but things like standard motor vehicle crashes, falls, and sports are where we see a vast majority of concussions among service members," Pyne said.

"How do you prevent those things? You drive the speed limit, you wear a seatbelt or a helmet, and you're careful and aware of your environment."

Pyne said some key points to remember when assessing if you are “TBI-ready” include asking yourself:

  • Are you ready to prevent yourself from getting a TBI?

  • Are you ready to get yourself taken care of in the event you suffer a TBI?

  • Are you ready to take care of someone who may sustain a TBI, especially as a medical provider or a leader?

A simple bump of the head, coupled by "seeing stars," dizziness or confusion could be a concussion or TBI. The key is looking for signs and getting help if you need it.

He also said that, despite the negative discussions surrounding TBIs, most people fully recover from them.

"The vast majority of people who sustain a mild traumatic brain injury make a full recovery," Pyne said "I think we focus too much on the people who don’t get better and we tend to forget all the people who do get better."

The TBICoE also supports a multi-center network of military treatment facilities and Department of Veterans Affairs medical centers with TBI education and research initiatives. An array of resources from TBICoE are available to service members, their families and providers here on the Military Health System website.

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2017 DoD Worldwide Numbers for TBI

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DVBIC is the Defense Department’s office of responsibility for tracking TBI data in the U.S. military. On this page you’ll find annual and quarterly reports that provide data on the number of active-duty service members — anywhere U.S. forces are located — with a first-time TBI diagnosis since 2000.

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