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Traumatic Brain Injury (TBI)


o Attention: Imagine yourself on a white beach with a drink in your hand.
All you hear are the waves crashing against the shore and the sight of the
sun behind the clouds. Sounds like a great way to spend an October night
right? Not for my cousin Lance Corporal Colin Smith. He didn’t have a
nice vacation to embark on. He was part of the War on Terror. On October
30, 2006. He was peering out of one of the first vehicle’s gun turrets and
was shot in the head. Dr Kirby was quoted in the New York Time stating
“The impact with the Kevlar stopped most of it,” he said. “But it tore
through, hit his head, went through and came out.” Because of this, he was
left with severe brain damage and completely had to start from square one,
just like a newborn child would.
o Credibility: My family and I have heard a lot about what kinds of
treatment he is being put through.
o Purpose: Today, I would like introduce you to the idea of Traumatic Brain
Injury treatment.
o Thesis: Though many servicemen come back to the United States having
different Traumatic Brain Injuries doesn’t mean that is no hope that they
could be back to full health before you know it.

(I) Traumatic Brain Injury, also known as TBI, can be found in the 2010 version
of the Encyclopedia Britannica and is defined as “The concussive and
shearing stresses of head injury may cause concussion, contusion of the
brain or laceration of the brain tissue.” TBI can also be known as
Craniocerebral Trauma and is often called the “signature” injury that
soldiers are diagnosed with, either physically or emotionally.

(A)An article from the Journal of Rehabilitation states that “An estimated
22% of all Operation Iraqi Freedom and Enduring Freedom
combat injuries involve some for of brain injury. TBI and
PTSD (Post Traumatic Stress Disorder) are commonly referred to
as the “signature” injuries of military personnel serving in the Iraq
War. An alarming number of veterans are incurring a
combination of these two disabilities.”

(II)There are 3 types of treatment for any patient, servicemen or not, to

rehabilitate after TBI.
(A)Acute Treatment (to stabilize the patient directly after injury)
(i) Many types of surgery may be performed depending on what type
of brain injury the patient is dealing with.
(ii) Nurses keep an eye on the ICP monitor for a constant pressure
reading on the skull.
(iii) A shunt may be put in to drain out the access fluid in the
(iv)The patient may be give antiseizure medicine because seizures are
expected to occur often during this time of treatment.
1. Landsthuhl
(v) Colin was mainly taken care of at the scene. They medic that was
on scene was able to stop the blood and somewhat stabilize
him as much as possible. He then was taken by helicopter
to Landsthuhl Regional Medical Center in Germany for
blood transfusions and removing brain tissue and was held
there until stabilized and was then sent to the Bethesda
Naval Hospital where he was in a coma for a few weeks.
When he came out of the coma, the only thing that he could
do was blink. Second came the movement of his fingers, and
then the rest of his limbs on the right side as the movement on
the left side was not able to because of the damage to his

(B) Subacute Treatment

(i) Early detection of complications
1. The nurses would keep a steady eye on the patient
and make sure there isn’t anything abnormal going
on in the brain such as access fluid.
(ii) Facilitation of Neurological and Functional Recovery
1. Neurological functions must improve for there to
be any progress with the therapists, nurses,
neuropsychologists, neurologists, and others
specializing in traumatic brain
(iii) Prevention of Injury
1. According to www.allabouttbi.com “During PTA, many
patients experience poor balance, in coordination,
weakness, or cognitive impairments that
place them at risk for injury. They may be
impulsive and unaware of their physical limitations
and may try to climb out of bed or walk by
themselves when it is unsafe to do so. Agitation and
restlessness may also lead to injury. A well-designed
rehabilitation unit and well-trained staff can keep them
safe, using little or no medication.”
1.Bethesda Naval Hospital is one of the top hospitals for
recently injured servicemen that are
transferred from overseas. It is
located in Bethesda, Maryland.
i. “We don’t work to get awards. We work to care for
one another...This is about how we respond to the needs
of the beneficiaries that it is our honor to serve and to
care for.”
— Rear Adm. Adam Robinson Jr.
National Naval Medical Center Commander

(iv) Colin at this point in time was undergoing massive amount of

physically therapy. After the movement of his right
side was made, the physical therapist worked on getting
the left side of his body to function just as well, but
it took a while. He had to learn to walk with the
assistance of a nurse, as he wore a belt that they held on to him
with. Also at the time he was learning his ABC’s and 123’s
all over again.

(C) Chronic Treatment

(i) Community-based Rehabilitation
1. Most often, it is the case that patients do better in therapy
outside the facility or at home.
(ii) Treatment of Consequences of TBI
1. Abnormal muscle tone
2. Chronic pain
3. Depression, anxiety, and behavioral problems
4. Seizures and headaches
(iii) At this current time he is living at home with his parents and is
on a bowling team, with the help of his dad, and can put
words into sentences, but cannot make complete
sentences yet. He is living with his parents and is still
seeking much attention from several types of medical help
to continue his rehabilitation.

(III) Post Traumatic Stress Disorder is often diagnosed after TBI is due to the
patient being under massive amounts of stress after they are
brought back from the war and in normal lifestyles for several months.

(A) PTSD is most commonly diagnosed after several months of living in

the normal environment that they once were before war.
(i) According to an article from the American Journal of Psychiatry
“consecutive adult patients who sustained a mild traumatic
brain injury following a motor vehicle accident
(N=79) were assessed for acute stress disorder
within 1 month of their trauma with the Acute Stress
Disorder Inventory. Patients were followed up 6 months
after the trauma. Acute stress disorder was diagnosed
in 14% of patients, and at follow-up 24% satisfied
criteria for PTSD. Six months after the trauma PTSD was
diagnosed in 82% of patients who had been diagnosed
with acute stress disorder and in 11% of those who
had not been diagnosed with acute stress disorder.”

o Summary: Since given the opportunity too see what it is
like to walk in the shoes of someone with TBI; I hope you
realize that this isn’t a cakewalk for them. Even the easiest
of tasks for us could be some of the hardest for these
o Refocus: Next time when you are on vacation, don’t take
for granted the things that you have because there are
others on the other side of the world thinking the same
things, but they are fighting for your freedom. Along with
this comes with the risk of TBI and many other injuries.

Works Cited
“Bethesda." Http://www.navy.com. Navy. Web. 26 Feb. 2010.
Bryant, Richard A., and Allison G. Harvey. "Relationship Between Acute Stress
Disorder and Posttraumatic Stress Disorder Following Mild Traumatic Brain
Injury." The American Journal of Psychiatry (1998). Web. 10 Mar. 2010.

Burke, Hillary S. A New Disability for Rehabilitation Counselors: Iraq War Veterans
with Traumatic Brain Injury and Post-traumatic Stress Disorder. 75.3 (2009).

Http://www.bethesda.med.navy.mil. National Naval Medical Center. Web. 25 Feb. 2010.


"nervous system disease." Encyclopedia Britannica. 2010. Encyclopedia Britannica

Online. 28 Feb. 2010

"Traumatic Brain Injury Rehabilitation." Www.allabouttbi.com. July 2009. Web. 26 Feb.

2010. <http://www.allabouttbi.com/rehabilitation/>