waves monitored, undergone CT and MRI scans, had his vision and hear- ing examined, and received psycho- logical testing. “I’m hoping that they can figure out what’s going [on] with my brain,” Hopper says of his deci- sion to participate, “and also help the younger generation of soldiers.” TBI is a signature condition of the
wars in Afghanistan and Iraq, affecting more than 300,000 military personnel between 2000-13, according to DoD. The majority of cases were the result of exposure to explosive blasts such as enemy IEDs and the smaller-intensity charges used by military breachers (those tasked to set charges) to access buildings. A smaller number resulted from training accidents and other noncombat-related incidents.
A century of concern TBI dramatically can affect service- members’ lives, researchers warn, affecting family and work and per- haps even placing them at greater risk of neurodegenerative condi- tions such as Alzheimer’s disease later in life. There’s still much to learn, but DoD and the VA are on the front lines, partnering with ex- perts in academia to decipher this perplexing problem and develop new and better tools for diagnosis and treatment. TBI has garnered much atten-
tion in recent years, but it’s a mili- tary concern that dates back nearly a century. One of the first medical reports on the subject appeared in the February 1915 issue of the British medical journal The Lancet, in an ar- ticle about three British soldiers who complained of a variety of symptoms, including memory loss and visual impairment, after repeated exposure to exploding artillery shells. (The term “shell shock” was published for the first time in this article.) Initially, the condition was thought to be an emotional response to the extreme
94 MILITARY OFFICER MARCH 2016
stresses of war; only much later did doctors conclusively link TBI to ex- posure to concussive events. Clinicians today divide TBI into
three categories: mild (more com- monly known as a concussion, and the most common form of TBI), moderate, and severe, reports Dr. Sandeep Vaishnavi, a neuropsychia- trist at the Duke University Medical Center in North Carolina, direc- tor of the Neuropsychiatric Clinic at Carolina Partners in Raleigh, N.C., and coauthor of The Trau- matized Brain: A Family Guide to Understanding Mood, Memory, and Behavior after Brain Injury (Johns Hopkins Press, 2015). One of the biggest factors in determining the severity of a TBI, Vaishnavi says, is the patient’s level of awareness, or dazing, follow- ing a concussive event. “With mild TBI, impaired awareness or loss of consciousness may be momentary or it may last up to 30 minutes,” he
explains. “For a moderate injury, it would be 30 minutes to 24 hours. And for a severe injury, it would last more than 24 hours.” Additional indications of TBI over time might include dizziness, anxiety, mood swings, depression, severe head- aches, and behavioral changes. An explosive blast can damage
the brain in multiple ways, Vaishnavi notes. There might be an external force, such as being struck in the head by flying debris; a penetrat- ing injury, such as when shrapnel pierces the skull; or a blast wave that causes pressure changes in the envi- ronment around the brain. Once it became evident roadside
bombs would be a continuing men- ace in Afghanistan and Iraq, DoD raced to protect servicemembers. Vehicles were “up-armored,” and protective gear became mandatory. This saved lives by protecting the torso but, ironically, placed troops at higher risk of TBI by directing the
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