Maj. Alan Hopewell, officer in charge of the Traumatic Brain Injury Clinic at the Carl R. Darnall Army Medical Hospital, said the Defense and Veterans Brain Injury Center is reporting that Army-wide 90 percent of soldiers are returning to duty after treatment and therapy.
"We don't have the breakdown yet, but the large majority are getting well and able to return to duty," Hopewell said. "I think the public and the media thinks everyone that's injured is having problems. But the good news is they are doing well. It's only a small number that we have to do more aggressive treatment."
The Traumatic Brain Injury Clinic at Fort Hood sees close to 10,000 patients a year.
The rate of soldiers returning to duty is very high, a clinic spokesman said.
Hopewell said the number of patients seen in 2008 was five short of 10,000. This year the clinic has seen more than 9,000, Hopewell said. He expects that number to reach 10,000 or more by year's end.
Hopewell said traumatic brain injury, called TBI for short, is not new. The Army has been treating it since Vietnam.
Hopewell, a Vietnam-era veteran, said he was at Landstuhl Regional Medical Center in Germany when soldiers from Vietnam were coming through for treatment.
"Today we are taking what we were doing in Vietnam and using that as lessons learned," he said.
The treatment is a combination of psychological and medical treatments.
"This is a medical injury, not a psychological injury," Hopewell said. "It's a medical injury that affects the nervous system in the body. People can have psychological reactions to it. For example they may hurt or not be able to work."
Medications are used to help stabilize the brain and how it works. In a rare form TBI can develop electrical abnormalities in the brain, Hopewell said. There are medications that will calm the nervous system. Other medications treat nausea, balance, and vision problems.
"We are looking at secondary effects in ears and eyes that may take consultation by an eye doctor or ear nose and throat specialist."
Other treatments involve speech and occupational therapists. Their treatments improve speech communication and thinking and reasoning ability, Hopewell said. These are things disrupted by concussion or head injury.
"The two biggest symptoms by far for TBI are speech disruption and headache," Hopewell said. "Psychological treatments will help these symptoms as well as anxiety."
Surgery is used for treatment only to prevent further damage, he said. It won't cure anything. Surgery normally is used for treatment in a combat zone to relieve pressure or stop bleeding – a frequent problem with trauma to the head from a hard hit. These are lessons learned from Vietnam, Hopewell said. Surgery is also used to remove bullet fragments or shrapnel.
Viewed as a flow chart, a Fort Hood soldier injured in combat goes first to an aid station, then to a Level II medical clinic or the combat support hospital. After that it's evacuation time to Balad, Iraq or Landstuhl, Germany. These are staging points for a lot of brain injuries.
Afterward it's to Fort Hood if the patient is doing well. If they are having problems they go to Walter Reed Army Medical Center in Washington or Brooke Army Medical Center in San Antonio.
"Screening for TBI is not just done at Fort Hood," Hopewell said. "It's done at every step along the way."
He said every time a soldier comes into a clinic with a suspected injury certain screening techniques are used. That soldier will be screened again at a combat support hospital and again at Walter Reed or Brooke.
"When I see a soldier in my clinic I am able to go back and look at results of all the exams and the doctors who have seen them," Hopewell said. "They are screened three times at Fort Hood."
The military acute concussion evaluation is a brief test to check short-term memory, repeat things back to the evaluator.
It's a mental status test, Hopewell said. If there is a change in the ability to respond to the test material, the patient may have been affected by the blast.
An MRI is not needed early on, he said. It's a tool used if a more serious injury is suspected later.
After screening, it's treatment and therapy time.
The goal is to return soldiers to duty unless there is some reason they can't, he said. In that case they will go to a medical board and if medical separation or retirement is recommended the soldier is referred to the VA and enters their treatment and rehab program.
Hopewell specializes in clinical neuropsychology and psychopharmacology.
