(Mild) Traumatic Brain Injury

Undiagnosed brain injury – the hidden legacy of Iraq
Matthew Taylor and Esther Addley
Saturday October 27, 2007, The Guardian

MoD begins study amid fears that up to 20,000 soldiers may be affected

The Ministry of Defence is conducting a major study into brain injury in troops returning from Iraq and Afghanistan amid fears that thousands of soldiers may have suffered damage after being exposed to high-velocity explosions.

The US army says as many as 20% of its soldiers and marines have suffered “mild traumatic brain injury” (mTBI) from blows to the head or shockwaves caused by explosions. The condition, which can lead to memory loss, depression and anxiety, has been designated as one of four “signature injuries” of the Iraq conflict by the US department of defence, which is introducing a large-scale screening programme for troops returning from the frontline.

Defence officials were reluctant to extrapolate directly from the US experience, arguing that the science is still inconclusive and that the US and UK experience in Iraq and Afghanistan has been different. But the Guardian has learned that the government has put in place a series of measures – including a comprehensive screening process – to deal with what could be a 20-fold increase in troops with mTBI. If the most alarming US predictions are accurate, as many as 20,000 UK troops could be at risk.

Kit Malia, a cognitive rehabilitation therapist who will oversee the programme to treat TBI at Headley Court military rehabilitation centre in Surrey, said: “I think the issue is that we don’t know whether the Americans are correct. But if the American figures are correct, this is massive. Absolutely massive.”

Surgeon commodore Lionel Jarvis, director of medical policy at the MoD, said the UK is doing all it can to improve diagnosis and treatment of the condition and is “running very, very much in parallel” with the US. He added: “The only significant difference is that there is a much higher political profile on this in the US.”

He said the MoD had drawn up a list of measures to help deal with mTBI that included circulating information to all ranks in the field on what symptoms to look out for; plans to screen all service personnel when they return from combat; a four-stage treatment programme at Headley Court; and research into body armour to improve protection for the brain.

Liam Fox, the Conservative defence spokesman, said: “It is a dereliction of duty, a failure of duty of care. They are already well behind the US in terms of identifying this disease. We have to ask again why should US troops be getting better care than British troops?”

The mTBI injury can occur when a soldier gets a blow on the head or is in close proximity to an explosion. The increased use of improvised explosive devices (IEDS) – roadside bombs – in Iraq and Afghanistan means more troops are at risk than in previous conflicts, and experts say that even the most advanced helmets cannot protect the brain from the shock waves.

A US neurologist and former doctor at the US department of veterans affairs, P Steven Macedo, said: “The enemy combatants are not trying to put missiles or bullets into our troops – they are trying to blow up their vehicles with IEDs. But the vehicles and the men wear heavy armour so what goes through them in many cases is the blast wave and we are beginning to see the impact this is having on the neurological make-up of our troops. This is the first war since the first world war where the major cause of injuries is blasts.”

Advances in brain scanning have revealed that soldiers can sustain bruising and blood clots on the brain, even if there is no visible injury. If the condition is not diagnosed it can lead to long-term problems – from depression and anxiety to violence and relationship break-up.

Dr Macedo said US army doctors are reporting that up to 20% of soldiers coming home from Iraq have “blast injuries”, with 15% of those never recovering. “Someone suffering from this will still be able to use a knife and fork, still be able to talk and walk but they may struggle with bad moods, memory problems or become easily agitated. It is like a computer which is not running programmes properly: you can function but not as quickly or effectively as before.”


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