Researchers at Purdue University believe oxygen saturation will help Post Traumatic Stress Disorder and Traumatic Brain Injury victims from Syria and elsewhere recover more quickly from their wounds.
15 veterans will receive treatment for a year at a Jeffersonville, Indiana hospital. The study includes multiple MRIs and 40 hours in a hyperbaric oxygen chamber. Hyperbaric Oxygen Therapy (HBOT) has been part of the hospital’s wound care program since 2017. Oxygen saturation increases white blood cell count and also helps connective tissue heal faster. Researchers hope the therapy will be an important step in the brain injury recovery process.
“This is a big deal,” said former Army Captain and Purdue grad student Art Terlep. “The data that we get from this will help inform other future studies and other grants that we go for in the future related to this. This is the data set that you keep adding and piling onto and say, OK, we’ve started from this, we’ve seen what this can do, now what else can we discover from it.”
TBIs
Traumatic Brain Injuries have been called the signature wound of the Iraq War. These wounds are common among veterans of the War on Terror. Anti-terrorism operations in Souhwest Asia and other theaters combaine all three common TBI causes, which are:
- Motion: Sometimes, the fall itself causes a brain injury. The brain does not fit snugly against the skull. Instead, the skull is basically a water tank that suspends the brain in cerebrospinal fluid. So, a quick, violent motion is like shaking a raw egg. That movement often scrambles the egg, or the brain, without breaking the shell, or the skull.
- Trauma: Blunt force to the head, often hitting the ground after a fall, causes many TBIs. Penetrating wounds, from bullets or shrapnel, also cause many of these injuries.
- Noise: Researchers recently discovered that explosive blasts trigger shock waves which disrupt brain functions. So, noise-related TBIs might be the single most significant TBI cause in Southwest Asia. Since many of these victims have no trauma symptoms, noise-induced brain injuries are very difficult to diagnose.
Overall, doctors have a hard time recognizing brain injuries, mostly because early diagnosis relies heavily on patient-provided information. The brain is adept at hiding its own injuries. So, many of these victims say they “feel fine.” That is the main reason concussed athletes ask their coaches to let them back in the game.
As a result, many TBI victims do not immediately get the treatment they need. That is especially true if, as is often the case, the victim has no signature symptoms, such as vomiting and unconsciousness. By the time victims display more advanced symptoms, such as flashbacks and personality changes, TBIs are much more difficult to treat.
Brain injuries are permanent. Once brain cells die, they never regenerate. Stem cells might soon change this reality, but that day is still rather far away. For now, physical therapy is the only way to effectively address most brain injuries. More on that below.
PTSD
Like a TBI, PTSD is a physical brain injury. It is not a processing disorder. Yet for many years, it was treated as such, both by doctors and the general public.
Vietnam-era veterans diagnosed with PTSD have had a hard time. Popular movies, such as First Blood, Taxi Driver, and The Deer Hunter, depicted these individuals as PTSD monsters who could not function in society. By the time their injuries were properly diagnosed, they had reached advanced stages and were more difficult to treat, as mentioned above.
This attitude was certainly not new. In World War I, doctors often diagnosed PTSD victims with “battle fatigue.” At some points during the conflict, these victims made up about a quarter of the patients at military field hospitals. Generally, doctors sedated these men, let them rest for a day or two, and then sent them back to the front. As a result, their physical injuries deteriorated.
Yes, we said that PTSD is a physical injury. It is not a processing disorder. Exposure to combat stress creates a chemical imbalance in the brain. The cerebral cortex, which controls logical responses, shrinks. The amygdala, which controls emotional responses, expands. As a result, PTSD victims experience symptoms like:
- Nightmares,
- Depression,
- Heightened awareness,
- Unreasonable fits of anger, and
- Flashbacks.
To visualize the interplay between the amygdala and cerebral cortex, think about a wild horse and a rider. As long as the rider controls the horse, the rider moves in the right direction. But if the rider is even slightly incapacitated, the wild horse takes control.
PTSD injuries might date back even further. In William Shakespear’s Henry IV, Part I, Lady Percy delivers a soliloquy about her husband, who has just returned from a forign war. She bemoans the fact that he is having problems adjusting to civilian life:
O my good lord, why are you thus alone?
For what offense have I this fortnight been
A banished woman from my Harry’s bed?
Tell me, sweet lord, what is ‘t that takes from thee
Thy stomach, pleasure, and thy golden sleep?
Why dost thou bend thine eyes upon the earth,
And start so often when thou sit’st alone?
Some of these symptoms, such as depression and heightened awareness, probably sound familiar to PTSD victims and their families.
The Defense Base Act and Physical Therapy
Oxygen saturation might help brain injury victims make more progress in physical therapy. Brain injury therapists train uninjured areas of the brain to take over lost functions. So, victims can live more normal lives.
Unlike muscular physical therapy, brain injury therapy is usually not straight-line progress. Instead, improvement comes in fits and starts. A sudden breakthrough might occur after weeks or even months of plateauing.
In these situations, penny-pinching insurance companies often pressure therapists to declare that the victim has reached MMI (maximum medical improvement). If that happens, physical therapy stops, and victims might not get all the compensation they deserve.
Defense Base Act benefits include the right to choose your own doctor and to change physicians at any time during the course of treatment. So, if one therapist is not helping the victim make progress, there are plenty of others out there who are more dedicated.
Additionally, DBA attorneys advocate for victims on an ongoing basis. It is often easy for a lawyer to bully a nonlawyer, but other attorneys do not back down so easily.
DBA medical benefits include much more than physical therapy. The insurance company usually pays all reasonably necessary expenses. That includes direct costs, like hospital bills, and indirect costs, like transportation expenses. Generally, providers bill the insurance company and victims never see a bill. And, they are not financially responsible for any unpaid bills.
Contact Barnett, Lerner, Karsen, Frankel & Castro, P.A. for more information about the DBA process.