September 14, 2007

VUMC aiding soldiers with brain injuries

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Physical therapist Renee Brown works with Staff Sgt. Clinton Johnson at the Vanderbilt Bill Wilkerson Center. (photo by Anne Rayner)

VUMC aiding soldiers with brain injuries

Occupational therapist Christy Hensley looks on as Specialist Bryan Malone performs a coordination assessment test. (photo by Anne Rayner)

Occupational therapist Christy Hensley looks on as Specialist Bryan Malone performs a coordination assessment test. (photo by Anne Rayner)

Vanderbilt Bill Wilkerson Center's Pi Beta Phi Rehabilita-tion Institute (PBPRI) has developed a partnership with Blanchfield Army Community Hospital in Fort Campbell, Ky., to assess and treat soldiers returning from Operation Iraqi Freedom and Operation Enduring Freedom with traumatic brain injuries (TBI).

PBPRI is seeing roughly 30 infantry soldiers identified as having acquired mild brain injuries and anticipates up to 200 more referrals for neurological rehabilitation as troops return in September.

“Fort Campbell and Blanchfield have gone above and beyond to open the door to make sure their soldiers are getting what they need,” said Pi Beta Phi Rehabilitation Institute Director Sandy Schneider, Ph.D.

“We are a premier traumatic (or acquired) brain injury site now and they absolutely have given us a green light on everything with these soldiers — anything they want, anything they need, anything we identify.”

It is estimated that between 11 percent and 20 percent of returning combat troops will suffer from TBI, labeled as the signature injury of the war because explosion has been the primary wounding mechanism.

Two-thirds of those injured in Iraq and Afghanistan were due to blast injuries, often caused by improvised explosive devices (IEDs).

“We consider ourselves very fortunate to come to a facility like this two days a week,” said Eric O'Brien, a Fort Campbell solider doing rehab at PBPRI for mild TBI.

O'Brien was one of several soldiers lifting weights in the gym at Forward Operating Base (FOB) Rustamiyah when a 107-millimeter rocket came through the roof. He is being treated for short-term memory loss, post-traumatic stress disorder and TBI.

TBI, by definition, is “an injury caused by a blow to the head, penetrating head injury, or violent shaking that disrupts the function of the brain.”

The injury, in some cases, can change a person entirely — how they behave, move, communicate and think.

It affects areas including judgment, organization, memory, awareness and self-control; it can lead to temper outbursts, insomnia, altered personality and immaturity.

Most patients being sent to Vanderbilt are in P3 status, which means they are being considered for medical discharge.

The PBPRI had mainly seen TBI patients from falls, motor vehicle accidents, assaults, sports injuries, workplace injuries, and near drowning before the Blanchfield arrangement was put in place in April.

The military TBI patient is somewhat different than the traditional patient population, Schneider said, because many soldiers are reluctant to admit to symptoms such as fatigue, headaches, dizziness, insomnia and anxiety because they feel like they “just need to tough it out.”

Soldiers considered on P3 status are going through the Medical Evaluation Board process and need their medical concerns identified during visits so they can receive an appropriate Army and VA rating.

“There is much that is not known about how these soldiers will be taken care of when they are discharged from the military,” Schneider said.

“There are meetings and organizations trying to plan for the numbers of soldiers who will be returning with these types of TBI. Everything that you have, even mild TBI, can have consequences down the road. Ten years out you can all of the sudden start to have some memory problems and difficulty focusing, be anxious and not sleeping.”

After a two-week evaluation at PRPRI, a case conference is held with the Fort Campbell/Blanchfield case managers to discuss recommendations.

“We have a staff at PBPRI who feel very honored to be providing this service for these men and women. They very much feel like they are contributing,” she said.

“We have almost doubled the number of patients we usually see due to our involvement with Fort Campbell. The staff here has noticed a major increase in their workload. Their schedules are full, but they are stepping up to the plate amazingly.”