Mild Traumatic Brain Injury (mTBI)
Mild traumatic Brain Injury (mTBI) is considered a signature injury of the Iraq and Afghanistan wars. Concussion and mTBI are considered interchangeable terms. Brain injury is typically used in reference to moderate or severe TBI. Most mTBI cases are due to exposure to IED blast. Up to 80 % of military mTBI cases are due to exposure to IED blast. Motor vehicle accidents causing contra-coup head injuries are also common. Modern technology has also resulted in more military personnel surviving serious wounds they may not have previously survived.
Military medicine leans heavily on the sports medicine world for research and information about mTBI. However, the amount of injury events in the two current wars has pushed both the academic and medical communities to more consistently and succinctly define the differences between acute, moderate and mild TBI. It is also more widely accepted that immediate rest and restriction of strenuous activity for a 24 hour period can be beneficial in promoting the resolution of symptoms which emerge secondary to a mTBI.
Management of symptoms is crucial to maintaining military personnel in their assigned deployment. Recent DOD guidelines require that all military personnel not in a vehicle and within 50 meters of an IED blast point need a concussion evaluation and follow-up management. If any Service member in a vehicle is exposed to a blast or has a roll over then ALL Service members in that vehicle will be required to have a concussion evaluation. Service members experiencing three concussions in one deployment are now removed from active combat duty. A Significant Action (SIGACT) is generated for each concussive event documented by field and/or medical personnel. This requires command personnel to respond to the event within 24 hours.
A focus on promoting positive expectations for recovery is also supported at this time. Research suggests that 90 % of all individuals suffering a concussion resulting from a mTBI get better within one week. Communicating this to a service member can aid in their recovery. Promoting accurate symptom reporting and active management of persistent symptoms can lead to a quick and complete return to duty.
Advances in military medicine have also resulted in a more clear understanding of why symptoms of a concussion may persist beyond a month or two. It is commonly accepted that postconcussive symptoms persist when there is co-occurring Posttraumatic Stress Disorder (PTSD) or other mood disturbance or AXIS I/II psychopathology. The presence of PTSD is highly correlated with the DSM IV diagnostic criteria for postconcussion disorder. Resulting post traumatic headaches and migraines, sleep disturbance and cognitive fatigue can frequently become genuinely debilitating if not treated.
The Military Acute Concussion Evaluation (MACE) is a screening and documentation measure which is used to gauge the severity of symptoms and cognitive deficits after a diagnosis of a concussion has been made. Talking less than 10 minutes to administer, it involves collecting a history of the injury event and the symptoms experienced at that time and followed by a brief neurological screening and brief cognitive testing. The score is presented with a listing of symptoms endorsed and a red or green light regarding the neurological screen. All cases of a concussion have restricted duty for 24 hours. The MACE is most effective if given within 24 hours of the injury event.
