The soldiers who informed that their injury didn't include any altered mental status or the loss of consciousness worked as the reference group for all of the analyses (2008).
Mild TBI was significantly correlated with psychiatric symptoms -- especially PTSD, and the correlation maintained its significance after combat experiences had been controlled for (Hoge et al. 2008). Over 40% of soldiers with injuries linked with loss of consciousness met the standards for PTSD. This information shows that a history of mild TBI in combat scenarios -- especially when related with loss of consciousness -- mirrors exposure to an intense situation that threatens the life of the soldiers and thus makes the chance of PTSD greater (2008).
The study on soldiers returning from Iraq is especially important and, though it used a nonrandom sample from two distinct brigades, it can be considered as being representative of soldiers working ground units in Iraq. The most interesting aspect of the study is that mild TBI was associated with PTSD. More than 40% of the soldiers, quite a large percentage, with injuries that included a loss of consciousness, met the criteria for PTSD (Hoge et al. 2008). Other strong associations were found between mild PTSD, depression, and physical health symptoms in combat soldiers show that there needs to be a focus returned to primary care.
Both of these articles introduced some interesting findings regarding TBI. The first study, however, seemed to have some contradicting outcomes that were not easily understood. The second study on Iraqi War veterans found some important correlations between mental disorders and the existence of TBI. This study could be very helpful in treating war veterans and should be further investigated so as to learn more about the direct links between TBI and PTSD, depression, anxiety, etc.
C. Hypothesis: the hypothesis is that there is a higher percentage of behavioral and emotional symptoms in soldiers who return from OIF and OEF with a TBI diagnosis. The research will specifically study the degree of empathy that the patients have and how well they are able to exhibit empathy themselves or see it in others. Emotional problems are more difficult to detect, which means that they may go longer without being treated, which can lead to permanent changes in personality.
D. Rationale: TBI is often difficult to recognize for doctors, patients and their families. After an injury, speech can be limited and nonsensical but oftentimes expressive aphasia will resolve itself after the brain's swelling has abated. However, emotional problems may not be recognized immediately. Family members may not notice changes like lack of warmth or love or other emotional problems until long after the initial injury as they may chalk it up to stress, etc. Because emotion-processing areas of the brain -- like the frontal cortex -- are especially susceptible to damage in TBI due to their location at the front of the brain, this area of research needs to be studied. If left untreated, these patients may not recover fully and their quality of life will diminish.
II. RESEARCH DESIGN
A. The emotional and social behavioral of TBI patients will be assessed with questionnaires that are completed by both the patient and a close family member such as a spouse or parent.
Patients will also be asked to look at several different pictures where different emotions will be portrayed. The patients will be asked to answer what the emotion is and why they think that. The questionnaires as well as the results of the pictures will be compared to healthy groups of individuals.
III. DATA ANALYSIS and INTERPRETATION
A. The sample of TBI patients will be selected with the help of the VA hospital in order to ensure that there is a range of TBI severity -- from mild to severe -- and they will be of different age ranges. This study is going to use men only as there are more male soldiers sufferer from TBI as opposed to female soldiers. Also, there is worry that combining male and females may confuse the study as females and males tend to dramatically differ in the way they see and express their emotions. The healthy control group will be formed with volunteers who are considered emotionally stable and healthy based on questionnaires that will be created for this purpose. The healthy control group will also be asked to look at selected pictures in order to ensure that they are individuals who are able to see and feel empathy. Again, the group will consist of males only. TBI will be the independent variable for this study with other variables being level of empathy in TBI patients and their ability to feel it and see it in others.
For individuals with TBI and other cognitive disorders, a loss in the ability to feel and see empathy is something that needs to be researched as related to distress caused by exposure to high-risk war situations.
Levin, H.S., Gary, H.E., Eisenberg, H.M., Ruff, R.M., Barth, J.T., & Kreutzer J. et al.
(1990). Neurobehavioral outcome 1-year after severe head injury experience of the Traumatic Coma Data Bank. J Neurosurg, 44: 699-709.
H.R. (2004) Employment following traumatic head injuries. Archives Neurol, 51:
Cifu, D.X., Keyser-Marcus, L., Lopez, E., Wehman, P., Kreutzer, J.S., & Englander, J. et
al. (1997). Acute predictors of successful return to work 1-year after traumatic brain injury: a multicenter analysis. Archive Phys Med Rehabil, 78: 125-31.
Corrigan, J.D., Smith-Knapp, K., & Granger, C.V. Outcomes in the first five years after traumatic brain injury. Brain injury, 9:11-20.
Gollaher, K., High, W., Sherer, M., Bergloff, P., Boake, C., & Young, M.E. et al. (1998)
Prediction of employment outcome one to three years following traumatic brain injury (TBI). Brain Injury, 12:255-63.
Novack, T.A., Bush, B.A., Meythaler, J.M., & Canupp, K. (2001). Outcome after traumatic brain injury: Pathway analysis of contributions from premorbid, injury severity, and recovery variables. Physical medicine and rehabilitation, 82