This subject is relevant for insideveniceflorida.com  readers, not only because all of us have a concern that members of the armed forces who have suffered in the service of our nation, receive appropriate treatment; but because the leading causes of “head injury” or “traumatic brain injury,” (TBI), in the nation are “falls,” 28 percent; followed by motor vehicle injuries, 20 percent.

    Woodruff’s recent report on ABC and an interview on PBS’ “Newshour” with Paul Rieckenhoff, executive director of “Iraq and Afghanistan Veterans Association” (IAVA), suggest that the Veteran’s Administration is not prepared to deal effectively with veterans with TBI. Rieckenhoff, an ex-Lieutenant, served as a Platoon Leader in Iraq. VA Secretary Jim Nicholson was also interviewed on the PBS and Woodruff programs.

    My work with people with disabilities has helped me to know a number of people with TBI, among them several from automobile accidents, one from a gunshot wound by the “Son of Sam” killer in New York, another hit by a power staple shot through a wall board being installed. They were enrolled in the rehabilitation and job training program I headed at the National Center for Disability Services on Long Island, NY.

Symptoms of TBI

     TBI ranges in severity from mild to severe. A person with a mild TBI may have had an injury which did not cause them to lose consciousness, or do so only briefly. Others, like Woodruff, were in comas, sometimes for many months. The symptoms after hospitalization or emergency room treatment also fall along a continuum of severity.

   Readers who have had a relative or friend who has suffered a “stoke” or a child with a neurological injury, may recognize some of these symptoms. In my work with clients who had strokes and with their families, the most puzzling and frustrating experiences, beside the loss of communication skills that often results, is the change in personality. “I don’t know him,” a wife or child might say.

    One way to understand some of these changes is to understand that an important way that the nervous system functions is to inhibit various parts of its functioning. For example the brain may give a signal to an arm muscle to flex, such as in bending an arm. At the same time, it sends a signal to relax to the muscles that would oppose that motion, e.g., straighten the arm. If a person has a certain kind of brain injury, both signals might be sent, leaving the arm “spastic”, locked between competing impulses. The normal functioning brain inhibits impulses to one set of muscles.

    As part of his rehabilitation he performed tasks around the center-the kind that might be useful on a job. He had a friendly, outgoing, personality. After he seemed ready, we were able to help him secure a job, and one of our staff went with him, part time, to ease the transition period. On the second day she received a worried call from the boss’ secretary.

    The young man had delivered something to her office, chatted a bit and then asked her for a date. The social inappropriateness had frightened her. We were able to reassure her that nothing in the young man’s history suggested any improper contact with others, and also tried hard to help him understand a boundary line that at one time his nervous system would have preserved without his even thinking about it.

Problems with VA

    Veteran’s Affairs Secretary Jim Nicholson, a West Point graduate and Vietnam veteran, who was head of the Republican National Committee before being appointed as Ambassador to the Vatican in 2001 and to the VA in 2005, did not come across positively in his replies. He suggested various discrepancies in numbers issued by his agency and the Department of Defense were because many Veterans used the hospitals for everyday needs. Many come for “dental work” he suggested. He also said head injuries were “new” and that most came from sports. The Brain Injury Association of America is now 25 years old.

    Rieckenhoff of IAVA says that the VA local facilities have almost no expertise in treating TBI and also reported that the president’s budget suggested cuts in various services for veterans. Congress will deal with the budget and citizens may want to watch that process carefully.