The 25 year-old man appeared in excellent shape. When asked how things were going, he looked at the floor and answered, “My wife thinks I’m getting worse especially after taking that brain pill.” He had suffered injuries from an improvised explosive device (IED) while serving in Iraq, was treated in multiple facilities; then sent back to his stateside USMC unit and to his wife. He now faced a terrible fear—the thought that his memory, attention and concentration were worsening.
The Marine pulled up computer photos of his demolished Humvee (HMMWV: High-Mobility Multipurpose Wheeled Vehicle), showing the area of impact directly under his seat. He quietly described his ordeal. Fortunately, when the cognitive assessment ended, this Marine got the encouraging news that he was not regressing.
Symptoms of Brain Injury in Activities of Daily Living
What seems to be regression on the home front could stem from several things. While being treated in a hospital facility, structure and schedules rule the day. Go to therapy on schedule, eat when the trays arrive and see the physician on her schedule. When the individual returns home with his deficits not readily apparent, he rejoins his unit. He is asked to do seemingly simple tasks, such as keeping a list of Marines in his unit that need to report to certain places with their gear. Suddenly the list of 12 people that he recalled without effort a few months ago becomes a major challenge. He does not send the right people to the right place and his superior finds out only after there is a problem.
His wife asks him to cut the grass, which he does. It is a relief for her after months of coming home from work to face all the household chores. But he leaves the lawnmower out in the rain, necessitating a repair bill. He forgets where he put his keys, does not remember what time to pick up his son at school, and cannot recall the new phone number his wife got while he was away.
These difficulties do not typically indicate regression, but rather the daily living situation challenging his skills and highlighting his deficits. He needs strategies to improve and manage cognitive deficits.
There are more injured survivors of this war than any other in the past, many with brain injuries. However, TBIs have been under-diagnosed, leading to delays in treatment. So the military adopted a screening tool ( The Brief Traumatic Brain Injury Screen) to administer each injured person (Schwab, et. al.). This is leading to earlier diagnosis and more timely treatment for returning veterans.
Medical personnel in the combat zone have their hands full, but the responsibility is not entirely theirs. Military members may try to hide their symptoms initially in order to avoid a question of competence. Being able to handle whatever comes along is extremely important to persons engaged in “battlemind.” Battlemind is defined by the Army as “the Warrior’s inner strength to face fear and adversity in combat with courage. This is resiliency…” Sustaining vigilance sustains life in a combat situation, so these individuals dare not doubt their mental acuity for fear of endangering themselves and those around them.
A report from the Rand Corporation indicates that an estimated 320,000 veterans report possible brain injuries, ranging from mild concussions to penetrating head wounds. However, only half of those with head injuries have seen a doctor.
Once the veteran sorts out his options for continuing in or discharging from military service, he recognizes the value of treatment—which he prefers to call training. Whether or not he continues in military service, he begins to realize that he must maximize his skills in order to perform well at any job.
Help for Veterans with Brain Injury
When veterans return with symptoms such as memory deficits, irritability, inability to attend to tasks and poor decision making, getting an evaluation is of primary importance. Resources can be accessed through military bases, the VA and the Defense and Veterans Brain Injury Center (DVBIC).