Traumatic Brain Injury

            A penetrating traumatic brain injury (TBI) occurs when the skull is penetrated by an object, or by a fall against a sharp object and the brain is damaged by the broken piece of the skull.  Damage to the brain is normally limited to the area of the penetration (Carlson, 2014).  Closed-head TBI do not penetrate the skull and are caused by blows by an object against the skull.  When a significantly forceful blow to the skull occurs, the brain impacts the skull and is referred to as the coup.  After impacting the skull, the brain moves back and strikes the opposite area of the skull, and is referred to as the contrecoup (Carlson, 2014).  Closed-head TBI not only affect the area of the brain impacting the skull, but it also may cause tearing of the axons, ruptured blood vessels, cerebrospinal fluid may alter the shape of the ventricles (Carlson, 2014).  Symptoms of TBI include headache, confusion, lightheadedness, ringing in the ears, sleep disorders, behavioral disorders, and loss of consciousness.

            Servicemen operating in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are more protected by body armor and helmets from penetrating TBI, however many are suffering closed-head TBI as a result of explosions.  Explosions involve more than projectiles, and include rapid shifts in air pressure causing air to be propelled away from the blast site and then drawn back to the blast site.  Natural openings in the skull through ear canals provide a direct route for this pressure to enter the skull and provides the opportunity for the coup and contrecoup to occur (Bogdanova & Verfaellie, 2012).  Veterans of OEF and OIF often experience Post-Traumatic Stress Disorder (PTSD) comorbid with TBI.

            Medicinal treatment is being used to treat symptoms of TBI such as headaches, mood disorders, and sleep disorders.  Current research on OEF and OIF veterans demonstrate TBI victims benefit from evidence-based, cognitive rehabilitation (Bogdanova & Verfaellie, 2012).  Treatment includes the use of problem solving, attention, and memory training.  The label of mental health disorder may be misleading for individuals suffering from TBI, but when comorbid with PTSD, it would be appropriate.

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Reference

Bogdanova, Y., & Verfaellie, M. (2012). Cognitive sequelae of blast-induced traumatic brain injury: Recovery and Rehabilitation. Neuropsychology Review, 22(1), 4-20. doi:10.1007/s11065-012-9192-3

Carlson, N.R. (2014). Foundations of behavioral neuroscience (9th ed.). Boston, MA: Pearson.