Wars as a Laboratory

Veterans who suffer from traumatic brain injury are going to provide doctors and surgeons with new opportunities for brain rehabilitation.

By PETER ROUSMANIERE, the Risk & Insurance® workers' compensation columnist

Ironically, the wars in Iraq and Afghanistan will prove to be the most advanced real-world laboratory for studying and treating brain injuries. So thinks Marilyn Spivak, who works at Spaulding Rehabilitation in Boston.

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"What this war has done for brain injury is what World War II did for spinal cord injury," said Spivak, one of the founders of the brain injury association movement in 1970s. "The movement was born, the technologies were developed, treatment was improved, and hope emerged. Each war is a little bit of lemonade."

More than 80 percent of brain injuries sustained in war, sports or civilian work are typically classified as mild. Most of these cases will be resolved without the need for expensive in-depth treatment.

Concussions suffered by high-school football players are an example. The contact may leave them dizzy for a few seconds, but leave no lasting injuries--so long as players stay off the field.

Slip-and-fall victims who suffer from a bad bump to the head usually suffer no lasting damage.

But the "mild" label fails to reveal how insidiously the condition can worsen over time, including lasting memory loss, difficulty articulating, impulse problems, headaches and depression. Brain injuries take a toll on married couples, who often call it quits.

Veterans Affairs and National Guard executives are aware of the risks untreated brain injuries pose to the thousands of returning troops, and outreach to civilian warriors is improving.

Veterans Affairs routinely screens all new Iraq-Afghanistan war patients for brain injury. The National Guard in Vermont has hired a team of soldiers to go to members' homes to search out hidden cases of brain injury, post-traumatic stress disorder and other personal problems.

In Maine, the National Guard is beginning to run newly mobilized and freshly demobilized troops through a computer-based brain injury screen that is a standard annual procedure in the National Football League.

Brain injury rehabilitation specialists say that Veterans Affairs needs to go a lot further to help civilian warriors at their civilian jobs. They say that VA counselors trained in brain injury should advise at the worksite about coping with memory lapses, competing job demands, anger and distractions.

August 1, 2009

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