Traumatic brain injury - Part 2

TRAUMATIC BRAIN INJURY

Introduction

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Though soldiers of the 21st century in the battle field are more protected from injuries than their predecessors in the I & II World War respectively, levels of Traumatic Brain Injuries remain relatively high (Army Medical Department, 2006).  US recent war in Afghanistan and Iraq produced very high numbers of soldiers with post traumatic stress disorders.  Disabilities from TBI depend on the levels of severity, location, age and the victim’s general health status.  Traumatic brain injury (TBI) occurs when an external force traumatically injures the brain.  Therefore, constant researches and studies have been initiated in search for an effective way of addressing the problem for the fast rising disorder ion the society.  Most often, it is classified depending on the severity or mechanism of harm to the head like close or penetrating head injury.  This definition has been extended to involve broader categories on structures other than the brain.

Literature Review.

Levels and types of Traumatic Brain Injuries

Brain injuries have often been categorized as “head and back”, however this definition has been used to derivate a shallow meaning as opposed to the weighty nature of the subject - Traumatic brain injury introduction. Besides, majority of the military operations are kept secret making it hard to arrive at a correct figure on the affected individuals especially in the battle field.  According to warden (2006), TBI is categorized into primary blast injury which takes place from objects put in motion by the blast and then hitting the head and secondary blast that involves individuals themselves being put into motions by the blast and hitting hard objects with their heads.  A tertiary form has been added and denotes the blast moving radially in open fields and deflects off services making the individuals to sustain injuries depending on the deflective waves created.

Warden (2006) continues to say that since the onset of the war in Iraq and Afghanistan, 28% of the soldiers had Traumatic Brain Injuries.  Symptoms of acute stress have been reported in bulk of the cases of the soldiers who suffered TBI from blast as opposed to those who got it from else where.  Besides, he continues to say that people with mild TBI are at higher risks of suffering from Post Traumatic Stress Disorder after they leave the battle ground.  Post Traumatic Stress Disorder symptoms have been indicated to have far reaching implications to the community and the society at large.  Flashbacks and other re-experiencing phenomena as well as anxiety, depression, attention problems and difficulty in concentrating indicate acute effects of the TBI at an advanced stage (Carrie & Eric, 2006).

Extended impacts of sleep deprivation.

Sleep deprivation in animals as well as human beings demonstrates major characteristics in terms of biochemical, neurophysiological and behavioral changes that can either be permanent or temporary depending with the severity of the damage in the head (Banks & Dinges, 2007).  Soldiers in the battle fields undergo 24 hours service depending with the nature of the operation.  Adding to the prior TBI, the studies have indicated that brain deficits occasionally resulted along different areas of the brain.  However, this deficit is hard to estimate in the case of human beings.  Sleep deprivation in human beings have been indicated to cause slow processing speed of various simplistic messages and information.  Previously understood concepts take longer to be comprehended while minor calculations are hard.

To add to that, there is usually an increased perseveration and immediate impairment in the working memory of the affected individual.  Altered thermo regulation coupled with high and increasing temperatures raises the risk to delete prior information that could have been stored in the brain.  This extensive lack of sleep has been linked to high deleterious nature of the immediately released chemicals that make a person to forget minor and major concepts.   Accompanying these changes include major changes in the temperature regulation capacity by the body, glucose control and metabolism.  Therefore, there is an increase in production of inflammatory cells in major organs resulting to highly negative effects in the body.  Liver, pancreas and more so the brain linings are damaged by these inflammatory cytokines (Everson, 2005).  In the brain, high levels of cortical excitability have been recorded to trigger seizures as a possible secondary injury.  In the liver, there develops swollen cells and congested blood vessels which diminish the overall ability of the liver to get rid of the toxic substances from the body (Beishuizen & Thijs 2003, Cirelli et al, 2006, Dixon, 1991).

Chemical and behavioral research with rodents.

In animals, there is high changes in the manner and mode of genes expression as well as neural genesis.  To establish the ability of the brain to respond to the injuries induced Traumatic Brain Injury should be established at different capacities to different rats and then their behavior observed to determine the extent of the damage and whether there are possibilities of reversing the same.  Traumatic Brain Injury is surgically induced using Controlled Cortical Impact to impose injury to the rats, similar changes in thermal regulation and metabolism indicators have been generated.   In Controlled Cortical Impact research, the effectiveness is enhanced by observing the sensorimotor cortex effectiveness of the rat.  Therefore, the forelimb reaching task and bilateral tactile tests are conducted for a given length of time for enough data to be gathered for analysis (Kokino et al, 2006).

In this research, sleep deprivation models create similar conditions that are achieved by alteration of glucose metabolism which is theoretically associated with high levels of pathological injury following Traumatic Brain Injury.  Using this method it have been found to be highly effective in determining the various levels that can be harmful to them and then applied to study the extent to which the soldiers are exposed to Traumatic Brain Injury in the battle fields.  Unlike the use of Controlled Cortical Impact, military have been responding with higher levels of getting seizures during and after the major operations.  To add to that, military soldiers have been reported to suffer from severe edema later in their lives especially if the condition was not adequately addressed.  Through Rat Model Experimental Conditions (REM), further focal and more diffuse neuropathologic changes have been identified (Kreutzberg, 1996).

REM sleep Deprivation (RSD) Model in rodents.

REM sleep deprivation model involves placing a rat on a small platform in a plastic bucket with water and then observing it.  Ordinarily, the rat is expected to remain alert when suspended in water.  With induced stress deprivation, the rat will react differently to different stimulus like food.  However, the fact that it is suspended in water will make it remain there to the length of the experiment.  However, it may forget depending with the levels of Traumatic Brain Injury induced in it (Carrie & Eric, 2006).

Due to lack of extensive research that directly links biochemical mechanism to other major and varying operations in the body, there is high possibility of further impacts that are directly or indirectly linked to Traumatic Brain Injury and sleep deprivation for the people in the battle lines.  This is especially possible due to the fact that the chemicals these rodents are unit directional and may be hard to extrapolate to real field situations (Prigent et al, 2006).  In the battle fields, the soldiers may face major challenges as physical injuries may be worsened or altered by the varying chemicals that they will experience or be exposed to in the field.  Besides, bodies react very differently to different chemicals that may be subjected to them at different instances (Lawrence, J. & Nathan, 1996).

Combat operations and related functions.

Over the years, military operations and activities have been made highly confidential with little getting out in public domain especially in a well researched and sounded scholarly material work.  However, military management have established combat operations that are meant to assist in establishing the least vulnerable individuals to include in the military delineations with a view of reducing the overall vulnerability of the military operation staff to Traumatic Brain Injuries.  Therefore, initial trials similar to Rat Model Experimental Conditions (REM) have increasingly been employed.  To add to that, soldiers have been provided with effective head covers that prevents them from majority of the head injuries that may result during the operations.   People with very high resistance and able to tolerate higher levels of war blast effects are easily absorbed into the army.  However, this has been criticized as majority of the people who turn for the military recruitment have at times been from the low and middle living classes with limited career choices (Arthur, & Danny, 2007).

Other consequences of TBI

Following the major bodily harm as indicated above, there has been increased levels of external extended impacts to the particular individual as well as the immediate society in which these people from the war move to live in.  They are reported to have high levels of substance abuse in the community as they try to counter the resultant cumulative stresses from the battle fields.  As previously indicated cognitive capacity may have decreased so much that they fail to effectively reason the repercussion of the same substances abuse in the society.  Over 90% of all the soldiers have been found to be drunkards after major operations.  Besides, over 95% of all the Traumatic Brain Injuries affected soldiers abuse other harmful drugs like heroine which may serve to accelerate their unhealthy condition.  As a result, they easily become burdensome to their families at very early ages and have highly reduced life expectancy (National Center for Injury Prevention & Control, 2006).

In the community, the Traumatic Brain Injury affected people have been involved with major criminal especially homicides, robbery with violence and sexual harassment.  Therefore, it has been argued that they rarely help themselves with the ransom amounts they get from major operations.  After return from Afghanistan, over 20% of the married soldiers planned to get separated from their wives and live solitary lives which they perceived to be better and free of increased responsibility.  As a result, people have stated developing a strong negative attitude towards them as well as the whole forces careers in US.  Scholars have raised major concerns over ethical aspects that revolve around recent use of other nations especially blacks in the military and considered it as a sign of skipping responsibilities (Ponsford et al, 2002).

Treatment and deprivation of mental health care.

Controlled Cortical Impacts through altering the immediate environment is of great importance in that it assists in determining the direct and indirect requirements in the immediate treatment and possible recovery of the soldiers from the field.  With application of the behavioral and chemical rodents’ model tests; it is clear that treatment of the condition is not simplistic either in approach or in application.  Through inclusive research, immediate cognitive therapy has been found to be very effective to long term treat the condition.  Besides, drugs like serotonin enhancing chemicals have assisted greatly especially those with mild Traumatic Brain Injuries (Knutson et al, 2007).

Caring for mild Traumatic Brain Injuries has been described as one of the most challenging aspect as they are forgetful and require constant care and watch.  Sports medicine has been introduced as a method of keeping them not just busy, but healthy and reducing their chances of being involved in major substances abuse.  Forced limb movements, treadmill activities as well as other physical activities help them to increase brain plasticity and thus improve the repair capacity.  Through initial outlay of the major requirements and the rules of the game, it is easy to identify the affected people from their reaction and ability to follow instructions (Wallace, 2006).  Besides, it is also a recovery procedure for the affected people as they slowly do away with their past and focus on the immediate games aspects.  Therefore, the trainers are able to assess the direct recovery of the affected people in the session with time. As indicated by the stress given to the body during the varying instances of blasts in the battle filed, the heart fast rate of pumping blood acts to deprive the body including the brain and the heart tissues enough oxygen during that time.  Therefore, ample exercises that ensure adequate preparation for such situations should be made by practicing in the field.

Military personnel in US have considered Traumatic Brain Injury as “Signature injury” in both the war in Iraq and Afghanistan as the numbers are among the highest than any other previous period.  Therefore, the Department Of Defense has set Neuropsychological and rehabilitation centers to cater for the affected military from the two wars.  Defense and Veterans Brain Injury Center and the Head Injury Rehabilitation & Referral services, Inc offers highly qualified specialists in the field of neuropsychology as a major boost and step to assist the affected soldiers (Gondusky &  Reiter, 2005).  Besides, the centers offer inclusive clinical research into the problem and also educative programs especially to those on training.

The DOD also gives standard care that helps in pre-assessment of the Traumatic Brain Injury susceptible people before recruitments and also before deployment into the military grounds through the same centers.  Due to the high levels of Traumatic Brain Injury after the war in Iraq and Afghanistan, the department has made it mandatory to screen all the recruits getting into the forces.  Besides, it is also supposed to look into the benefits offer to the affected people and the patients rights Gondusky & Reiter, 2005).

Walter Army Research Institute (WRAIR), in the year 2007, established the NNZ-2566 compound for treating Traumatic Brain Injury for the soldiers who had suffered closed head injury model.  Though high tolerance and safety are still debatable for humans with longer infusions, the second phase on the same is expected to address the problem holistically (Brian & Victoria 2008).  Besides, there has been strong need for cooperation between the different organizations in addressing the problem taking into consideration that the affected people still return to the society.

Counseling therapies.

For along time, counseling has been found to be very effective in assisting the affected people to slowly recover from Traumatic Brain Injury.  Younger Traumatic Brain Injury affected people react faster and have been found to recover faster compared to the older people suffering from the same ailment.  Counseling programs in the Department Of Defense have for long served as the main tool for reducing the overall effects to the people themselves as well as to the society.  Counselors try to bring the affected people to terms with the reality and therefore assist them to accept the reality and assume positive living (Wallace, 2006).  As indicated earlier, there is high tendency of these people to be involved in drugs abuse and crime.  About 9% of the total affected cases have been successfully treated by intensive counseling.  However, the method requires adequate follow up to ensure sustained growth and efficiency in the recovery process.

Women who have suffered Prolonged Traumatic Stress Disorder are being subjected to “prolonged exposure therapy” applied along with cognitive approach for faster and higher efficiency (Jennifer & Chris, 2005).  This therapy exposes the client gradually to various images that are very threatening and the client repeatedly recounts the traumatic memories.  Women have been found to respond better and faster to the treatment than men in most of the therapies.

Conclusion.

Traumatic Brain Injury effects in the last two decades have been very much felt than any other period in history.  With increased claims from some authorities and families of the affected people of unsounded involvement in the Afghanistan and Iraq war, there has been strong need to ensure that ample study and treatment systems have been developed for them.  Through induced Traumatic Brain Injuries on the rodents like rats, the extent and link of the injuries to Post Traumatic Stress Disorder has been categorized.  As indicated in the literature above, Traumatic Brain Injuries are complex and require integrative efforts for increased efficiency in treatment and prevention.  Counseling therapies should be increased besides all other methods of treatment due to their effectiveness and ability to follow up the patients and thus track their recovery ability.  Though US government keeps the matter relating to these issues of high secret with little if any research being accepted into the affected soldiers, the best remedy has been indicated to be a war free society.  To add to that, there should be more capacity building to the general public to understand the situation and thus be bale to make the correct decisions as they decide to join the forces.  However, more research should be done to ensure that all the effects of the problem have been well studied and the magnitude of the affected soldiers also determined.

 

 

 

 

 

 

 

 

 

Reference list.

Army Medical Department (AMEDD). (2006). The army medical evacuation statistics for          Operations Iraqi Freedom & Enduring Freedom page. Available at:             http://www.armymedicine.army.mil/news/medevacstats/medevacstats.htm.

Arthur, M. & Danny, W. (2007). The Neuropsychology Handbook. London:  Springer Publishing           Company.

Banks, S, Dinges, DF. (2007). Behavioral and physiological consequences of sleep restriction.    60(4): A13-15.

Beishuizen, A. & Thijs, l. (2003). Endotoxins and the hypothalamo-pituitary-adrenal (HPA) axis.            Journal of endotoxin research. 9:3-24.

Brian, J. & Victoria, T. (2008). Biobehavioral Resilience to Stress. Washington: CRC Press.

Carrie, H. & Eric, Z. (2006). Military Psychology: Clinical and Operational Applications. New Jersey: Guilford Press..

Cirelli, C., Faraguna, U. & Tononi, G. (2006). Changes in brain gene expression after long term             sleep deprivation. Journal of Nuerochem, 98(5):1632-45.

Dixon, CE.,Clifton GL., Lighthall, JW., Yaghamai, AA., & Hayes, RL. A. (1991). Controlled     cortical impact model of traumatic brain injury in the rat. Journal of Neural science          Methods. 3(3):253-262.

Everson, CA. (2005). Clinical assessment of blood leukocytes, serum cytokines, and serum         immunoglobulins as responses to sleep deprivation in laboratory rats. 289(4):R1054-63.

Gondusky, J. &  Reiter, M. (2005). Protecting military convoys in Iraq: an examination of battle             injuries sustained by a mechanized battalion during Operation Iraqi Freedom II. Mil Med.           170(6):546–549.

Jennifer, J.& Chris, B. (2005). Neuropsychology of PTSD: Biological, Cognitive, and Clinical     Perspectives. New Jersey: Guilford Press.

Lawrence, J. & Nathan, D. (1996). Medical Rehabilitation of Traumatic Brain Injury: A Hanley &         Belfus Publication. New York: John Wiley & Son publishing company.

Knutson, K., Spiegel, K., Penev, P. & Van, C. (2007). The metabolic Consequences of sleep       deprivation. Sleep Med Rev. 11(3):159-162.

Kokino, O, . Murashow, A. & Hoane, M. (2006). Administration of raloxifene reduces sensorimotor       and working memory deficits following traumatic brain injury. Behavioral Brain Research,       New York: Sage.

Kreutzberg, G. (1996). Microglia: A sensor for pathological events in the CNS. Trends Neurosci.            19(8):312-318.

National Center for Injury Prevention & Control. (2006). ” What is Traumatic Brain Injury?       Retrieved from: http://www.cdc.gov/ncipc/tbi/TBI.htm.

Ponsford, J., Willmott, C. & Rothwell, A. (2002). Impact of early intervention on outcome following      mild head injury in adults. Journal of  Neurol Neurosurg Psychiatry. 73:330–332

Prigent, H., Mxime, V. & Annane, D. (2006). Administration of raloxifene reduces sensorimotor and      working memory deficits following traumatic brain injury. Behavioral Brain Research, 170,           233-240.

Wallace, M. (2006). The wounds of war. CBS News. February 12, 2006. Available at:      www.CBSNews.com.

Warden, D. (2006). TBI During the Iraq and Afghanistan wars. J Head Trauma Reharb. 21(5):398-402.

 

 

 

 

 

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