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ADVANCE Perspective: Physical Therapy & Rehab Medicine

CSM 2012: Wounded Warriors

Published February 15, 2012 10:10 AM by Danielle Bullen

From the recent lawsuits brought by former players against the NFL to the death last year of hockey enforcer Derek Boogaard, mild traumatic brain injuries have been in the news a lot lately. Yet sports is not the only arena where concussions are a risk. In the CSM presentation "Military Initiatives to Provide Guidance for Assessment/Intervention of Individuals with Concussion/Mild Traumatic Brain Injury," Maggie Weightman, PT, PhD and Karen McCulloch, PT, PhD, NCS talked about how soldiers are rehabilitated following battlefield related TBI. "There's a difference between a concussion occurring in a military setting and on a hockey rink," said Dr. Weightman. The two speakers are fellows in the Office of The Surgeon General's Rehabilitation and Reintegration Division.  The division provides oversight of rehab process for a variety of wounded warrior injuries, including concussions.

Advanced helmet technology lets soldiers survive injuries that 20 years ago would have been fatal; yet they do not emerge unscathed. In the battlefield, 50% of cases of mild TBI came from blasts. Diagnosing these brain injuries can be tricky. Compared to athletes, another population that is at risk for concussions, active duty military personnel have higher baseline stress and sleep deprivation levels. Sleep disturbances and anxiety and mood swings are some of the symptoms of mild TBI.  The question for clinicians is whether these signs manifest from a brain injury or just normal wear and tear on the body.

Another challenge in diagnosing and treating military-related mild TBI is the culture. Soldiers may be more concerned with those who have more severe injuries and the culture demands that they stay and fight. The Rehabilitation and Reintegration Division is working on patient education programs to promote the idea that it is OK to sit out and be evaluated for a concussion. Promoting rest and slow return to activities is also important as that can prevent second impact syndrome.

Together with occupational therapists, the speakers created a tool kit for the military to assess and treat mild TBI. They asked themselves, what would care look like without insurance constraints and designed a comprehensive rehab package. On the one hand, it can be customized to individual service member needs, but it is also designed for the general practice PT to understand.  The military recognizes the importance of correctly diagnosing and treating mild TBI. Last year, the Army surgeon general listed implantation of concussive injury protocols as one of the top 10 initiatives for Army medicine. If the work of Drs. Weigtman and McCulloch is any indication, there will be plenty of attention paid to this quiet risk.


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