The Golden Hour (Scene 1)August 2012

Lesson 1: What is traumatic brain injury?

Soldiers and TBI: Why a concussion isn’t just a simple bump on the head

Injuries are not always obvious, and many times, not even to the victim. Explosions, mortars, and gunfire are potentially common occurrences for a soldier. In battle situations, rushes of adrenaline and the drive to survive the conflict can make some injuries relatively unnoticed until much later.Not realizing the full impact of a particular incident, the injury could be left untreated for long periods of time which could increase the risk of serious side effects. Most of us do not fear the explosion of a rocket in our daily lives, but relatively common events such as car accidents and sports accidents that result in brain injury can still have similar serious negative consequences for a person’s quality of life.

Staff Sgt. Andrew Cooper* had become accustomed to the dangers of his daily life as a tank commander. In July 2007, an enemy projectile suddenly struck the side of the tank. Cooper instructed the driver to return to base immediately. It wasn’t until later that Cooper became woozy and realized that he didn’t remember most of the incident. At first Cooper didn’t think much of hitting his head during the blast and chalked up the light headedness and nausea he was experiencing to the adrenaline rush. The next day, however, his symptoms began to worsen. Cooper continued to vomit and had a massive headache in the morning. His squad members noted that he looked intoxicated despite Cooper’s repeated claims that he felt normal. His superior sent him to the medics. After a battery of cognitive tests, Cooper was medically evacuated out of the combat zone and began a path of healing which continues to this day.

Cooper was diagnosed with a traumatic brain injury (TBI) almost immediately. During his examination, Cooper was tested using the Glasgow Coma Scale. The Glasgow Coma Scale assesses the Verbal, Motor, and Eye response of the patient following an injury. Although he could respond to verbal commands, his inability to remember the damaging incident and his intoxicated appearance indicated possible reduced cognitive stability and amnesia. He also showed reduced eye response to a light pen. The doctors used these examinations to total a Glasgow Coma Scale (GCS) of 13. The GCS is a useful diagnostic tool in assessing traumatic brain injury. Though loss of consciousness is often a key identifying factor in TBI, disruption of brain function can also occur without loss of consciousness. It is important to note that while the incident that causes the injury will vary greatly, visible head injuries may or may not be present. Other signs are needed to accurately recognize a TBI victim. Symptoms such as brief confusion, losing track of time, and a dazed state of mind are not uncommon. Patients like Cooper could also exhibit odd behavior such as having trouble following everyday conversations and following basic commands. They may not always be physically paralyzed, “but there is a paralysis in mental activities” Cooper’s doctor said. Injuries such as Cooper’s are common in the army and the conditions of battle can often make diagnosing the injury challenging. Once Cooper returned to his home, he had difficulty with many everyday activities and had to rely on his wife to assist him with many routines. Due to his frequent headaches, his wife would dim the lights around the house and would have to help him remember nearly everything.

Doctors at the Army Medical Center started Cooper on extensive regimens of cognitive and memory exercises. These activities, such as playing video games, helped Cooper improve his coordination and cognitive skills. The injury left Cooper’s brain in many ways disabled. Although he was capable of many cognitive functions, they required more effort than usual and he would often come up short. A major part of his rehabilitation was exercising his brain which, similar to a muscle, needs to regain and maintain its strength. Many individuals diagnosed with traumatic brain injury are medically discharged from service. Cooper knew he wanted to stay in the army, but he knew he would need to recover before he could take on the duties he once held. “I didn’t want to get out. I knew I could recover and I told myself I was going to recover.”

Cooper now serves as a noncommissioned officer for the Warrior Transition Brigade where he schedules soldiers for classes to assist with their career field and training. He uses a system of sticky notes and to-do lists to aid in his daily responsibilities. After his time with the Warrior Transition Brigade is complete and despite the experience which caused his condition, Cooper plans to return to his former position as a tanker. He is aware that his previous injury makes him susceptible to more serious and even fatal consequences from similar accidents. He has since been cleared by his doctors and is anxious to return to combat. “Its my job. I haven’t been done wrong by the Army doctors and I trust their word. If they say I can go back, I want to go back.” The key in such cases is early detection. If patients wait too long, there can be severe long-term damage to the brain and the way it functions. Fortunately, Cooper’s injury was recognized almost immediately and treatment was sought soon after. It is important for soldiers such as Cooper to recognize the symptoms of a traumatic brain injury not only in fellow soldiers, but also in themselves.

*Names changed for privacy.

Article adapted from

Pariante, Joy. (2010, April 1). Soldiers and TBI: Why a concussion isn’t just a simple bump on the head. Fort Hood Sentinel. Retrieved from

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