Traumatic Brain Injury Each New War PresentsResearch Proposal

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Traumatic Brain Injury

Each new war presents new clinical challenges and the wars in Iraq (Operation Iraqi Freedom -- OIF) and Afghanistan (Operation Enduring Freedom -- OEF) put U.S. soldiers in dangerous situations related to combat stress and explosive hazards. It is suggested that TBI is specific to these wars as Agent Orange was to the Vietnam War. Until recently, research had not been done on the relationship between OIF and OEF soldiers and TBI due to bombings, blasts, and accidents such as falls or accidents involving heavy equipment. For this paper, the hypothesis is that there is a higher percentage of behavioral and emotional symptoms in soldiers who return from OIF and OEF with a TBI diagnosis. The research will specifically study the degree of empathy that the patients have and how well they are able to exhibit empathy themselves or see it in others. Emotional problems are more difficult to detect, which means that they may go longer without being treated, which can lead to permanent changes in personality.


A. Background: Traumatic brain injuries (TBI) are due to sudden trauma to the head that causes damage to the brain. It can happen after sudden blunt force to the head or piercing of the brain by an object. The symptoms can range from mild to severe, depending on the extent of the injury to the brain. Loss of consciousness for seconds to minutes can happen when trauma is present as we will see in one of the studies concerning Iraq War soldiers documented in this paper.

Symptoms of mild TBI can include; headache, confusion, feeling "dazed," lightheadedness, dizziness, blurred vision or tired eyes, "seeing stars," ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking. Moderate to severe TBI symptoms include all the symptoms of mild TBI, but can also have headaches that are persistent or continue to worsen with repeated vomiting and/or nausea, convulsions, seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.

Medical attention for moderate to severe TBI is extremely imperative in order to prevent as little damage to the brain as possible. Moderate to severe TBI patients will require recovery time for their injuries and this recovery can range from rehabilitation that involves individual treatment programs of physical therapy, occupational therapy, speech/language therapy, medicine, psychology/psychiatry, and social support. There are also long-term problems associated with TBI such as Alzheimer's disease, dementia (which is quite common in boxers), and post-traumatic dementia. People with traumatic brain injuries may experience personality changes that can significantly affect their lives.

In neurology literature, "empathy" is defined into three general categories: 1) cognitive empathy -- knowing what another is feeling; 2) emotional empathy -- feeling what another is feeling; and, 3) compassionate empathy -- responding compassionately another's distress (Decety & Jackson 2006). Being aware of one's emotions is something that allows an individual to reflect on them. Individuals who can regulate their emotions are more likely to feel empathy for others and act in morally desirous ways, according to Decety and Jackson (2006).

B. Literature Review: The First study entitled, "Outcome after traumatic brain injury: Pathway analysis of contributions from premorbid, injury severity, and recovery variables," Novack et al., (2008) examined the relationship of premorbid variables, injury severity, and cognitive and functional status to outcome 1-year after TBI with the attempt to assess the viability of multivariate path analysis as a way to shed some light on those relationships.

The study's procedure was based on hospital patients' admission to the neurointensive care unit after having been identified as patients who had experienced TBI. The findings of the study show a need to emphasize the need for researchers to be very cautious when looking at the relationship of individual variables to outcome (Novack et al., 2008). Simply using a handful of variables, or 1 element of TBI, one may recognize "a relationship that would not fare well in a multivariate study" (2008). An example: the relation between Injury Severity and Outcome will probably be greater if there aren't any other variables that could be a factor in outcome are considered (2008). "This misunderstanding might lead to inappropriate emphasis on some aspects of TBI recovery, while overlooking more informative factors in recovery" (2008).

Overall, the cognitive issues that they subjects suffered were similar to what has been described in other studies -- particularly in Levin et al. (1990) where such deficits in memory function and mental processing speed were very clearly present. There were ways, however, in which this study was distinct from others. Looking at the FIM scores during the time in which the subjects were undergoing rehabilitation, the sample appeared to be more impaired than others that was found in different literature -- specifically Cifu et al. (1997) and Harrison-Felix et al. (1996). The outcomes at the 6 and 12-month mark, in terms of the DRS and CIQ, were not as good as reported in other studies (Novack et al., 2008). In this study, only 17.8% had the possibility of returning back to work (22.1% for the individuals who were employed pre-injury) (2008). In comparison with other studies that reported the possibility of returning to work at 20% to 35% of severe TBI cases in the same period of time (2008).

What this study shows is that while the sample is similar to that of other studies in the same category -- such as Corrigan et al. (1998) and Dikmen et al. (1994) and Gollaher et al. (1998), it looks like the level of impairment was much more severe, which was illustrated in the lower FIM scores during the rehabilitation period and showed an overall less successful outcome (2008). Corrigan et al. (1998) and Gollaher et al. (1998) studied the outcomes after TBI from 1 to 5 years and 1 to 3 years, respectively, while Dikmen et al. (1994) focused on employment factors after sustaining a TBI.

The second study was published in the New England journal of medicine and is entitled "Mild traumatic brain injury in U.S. soldiers returning from Iraq" (Hoge et al. 2008). This study emphasizes the importance of the concern for potential long-term effects of mild TBI, or concussion, from blast explosions and such pertaining to U.S. soldiers returning from the war in Iraq. The study states that, "the epidemiology of combat-related mild traumatic brain injury is poorly understood" (2008). Because of better protective gear, there is a higher percentage of soldiers who are surviving injuries that, in past wars, would have resulted in death.

Head and neck injuries, including severe brain trauma, have been reported in one quarter of service members who have been evacuated from Iraq and Afghanistan. Concern has been emerging about the possible long-term effect of mild traumatic brain injury, or concussion, characterized by brief loss of consciousness or altered mental status, as a result of deployment-related injuries, particularly those resulting from proximity to explosions. Traumatic brain injury has been labeled a signature injury of the wars in Iraq and Afghanistan (Hoge et al. 2008).

The study surveyed 2,525 U.S. Army infantry soldiers approximately 3 to 4 months after their return from a deployment in Iraq, which was the length of one year. Valid clinical instruments were utilized to compare soldiers who reported mild TBI (defined as an injury that resulted in a loss of consciousness or altered mental status -- like confusion), with soldiers who had reported other injuries (Hoge et al. 2008).

In 2006, Hoge et al. (2008) conducted an anonymous survey of 2,714 soldiers from two U.S. Army combat infantry brigades -- an active and reserve component -- 3 to 4 months after they had returned from a year-long deployment in Iraq. Both of the units witnessed very intense levels of combat, like many other infantry units. The 3-to-4-month point was decided upon to diminish recall partiality as well as for its aptness in determining persistent post-concussive symptoms (2008). Of the 4,618 soldiers in the two brigades, 2,714 -- 59% - completed a questionnaire, which asked soldiers if they had been injured during their deployment by an explosion or other kind of blast -- like a bullet, piece of shrapnel, a fall, accident in a motor vehicle, etc. (2008). TBI in a soldier was considered if: (1) the person had been knocked out and lost consciousness; (2) the person had felt dazed or confused; or, (3) the person didn't remember the injury (2008). If any one of these questions was affirmative, then the soldier was labeled as having a mild TBI injury. The questions were based on certain definitions that came from the Centers for Disease Control and Prevention and the World Health Organization that were adapted by the Defense and Veterans Brain Injury Center working group for military use in the U.S. (2008). The question… [END OF PREVIEW]

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