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Monday, September 25, 2017

PTSD & TBI

Post Traumatic Stress Disorder (PTSD) as defined by the Department of Veterans’ Affairs, National Center for Posttraumatic Stress Disorder:

Posttraumatic Stress Disorder (PTSD) is an anxiety disorder that can occur after you have been through a traumatic event. A traumatic event is something horrible and scary that you see or that happens to you. During this type of event, you think that your life or others' lives are in danger. You may feel afraid or feel that you have no control over what is happening.

Anyone who has gone through a life-threatening event can develop PTSD. These events can include:

  • Combat or military exposure
  • Child sexual or physical abuse
  • Terrorist attacks
  • Sexual or physical assault
  • Serious accidents, such as a car wreck.
  • Natural disasters, such as a fire, tornado, hurricane, flood, or earthquake.

After the event, you may feel scared, confused, or angry. If these feelings don't go away or they get worse, you may have PTSD. These symptoms may disrupt your life, making it hard to continue with your daily activities.

The National Institute of Health NINDS states: Traumatic brain injury (TBI), a form of acquired brain injury, occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue.  Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain.   A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, 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.  TBI is one result stemming from one or more encounters with Improvised Explosive Devices (IEDs), a weapon of choice in the wars in Iraq and Afghanistan.

Traumatic brain injury (TBI) survivors include patients that span the entire spectrum of TBI and TBI disability: mild, moderate, and severe. TBI is a graded injury with degree of injury, pathological findings, and disability proportional to the magnitude of force impacting the head. Progressively greater force causes greater pathological damage which is composed of elements of injury found in less severe forms of TBI (axonal injury) as well as the pathology specific to more severe levels of injury (parenchymal hemorrhage, extra-parenchymal hemorrhage, etc.).  Blast overpressure, without being accompanied by the same physical trauma seen in sports injuries, automobile accidents, etc., is also causing organic injury that manifests in symptoms virtually identical to the blunt force trauma usually associated with TBI.  It actually is multiple types of brain trauma. As a result, conclusions drawn about treatment of the pathology and disability of mild TBI should also be applicable to more severe degrees of TBI. Despite different definitions of mild TBI, 15-29% of the mild TBI population has appreciable complaints six months after injury. These ongoing symptoms have been termed Post-Concussion Syndrome (PCS), and this syndrome is associated with a high degree of morbidity and unemployment. At one year, the incidence declines slightly to 10-15%, but many of these individuals are at risk for developing persistent PCS, a syndrome of organic and psychiatric pathology.

Both of these syndromes collectively referred to as PCS in this application, have long-term cognitive, social, emotional, and psychological dysfunction that our proposed treatment may address. Since both civilian and military mild TBI patients and mild TBI sequelae patients with PCS comprise the largest, most visible, and controversial of TBI patients this discussion and scientific argument will focus on them, while the study will include both mild and moderate TBI patients.

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