Integrated Care for Multisensory Injury

Abstract : In 1994, the National Football League initiated a research endeavor to address problems associated with head injuries sustained by professional athletes. This ongoing study tracks the incidence, biomechanics, and recovery outcomes of head injuries suffered by players. Brain injury has also become a pressing concern in the US military, primarily due to blast-related traumas that have occurred during Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). Reports estimate mild traumatic brain injuries (mTBIs) after blast exposure account for 85% of all battlefield injuries. Between 2003 and 2009, nearly one-third of US service members wounded in combat and evacuated to the Walter Reed Army Medical Center were diagnosed with TBI. In a military cohort of immediate evacuees sustaining body-wide injuries, TBI incidence was 54%, with 14% of TBI incidences documented by abnormal neuroimaging. In this analysis, a higher Injury Severity Score (ISS) was significantly associated with abnormal neuroimaging, longer hospitalization, and more severe brain injury. These data demonstrate the high prevalence of TBI, its typical invisible nature, and the higher probability of diagnosing structural abnormalities as nonneurologic injuries worsen. Although TBI is recognized as the signature injury of recent military conflicts and has been the subject of media attention due to its incidence in contact sports, our understanding of TBI across the continuum of care is still limited. TBI often affects numerous brain systems, causing sensorineural deficits with or without any physical damage to peripheral sensory organs and systems. Repeat head injuries, in particular, may lead to chronic encephalopathy. Appropriate TBI diagnosis and treatment remains elusive, however, and is complicated by injury type (blast/non-blast, penetrating, etc) and injury severity (mild, moderate, severe).