Experts come together to discuss brain injures

ALEXANDRIA BAY — When Col. James D. McDonough Jr. left the war in Iraq to return to Fort Drum, he was given a health assessment form to fill out on the airplane. Like many other soldiers, he wrote that he was "fine," he told an audience Thursday at a brain injury conference at the Bonnie Castle Resort.

But some soldiers aren't.

In fact, he said, traumatic brain injuries are the signature injury of the wars in Iraq and Afghanistan. About 22 percent of injured soldiers have been diagnosed with a brain injury, and 40 percent to 50 percent also could develop post-traumatic stress disorder, according to experts at the conference.

With the sixth anniversary of the Iraq war Thursday, and actress Natasha J. Richardson's death Wednesday after a ski accident, organizers said the time was right to talk about traumatic brain injuries. About 100 people gathered to hear experts discuss the causes, types and services.

While some brain injuries have obvious signs right after the injury is suffered, others take longer to make themselves known, according to Steven Flanagan, a professor and medical director of the Rusk Institute of Rehabilitation Medicine at New York University.

For example, he said, Ms. Richardson, 45, reportedly didn't show any signs of injury until hours after her accident, but the New York City medical examiner's office said Thursday she was suffering an epidural hematoma that led to her death two days later. Mr. Flanagan called this a "talk and die" brain injury.

Too often, experts said, people don't think they need medical help and aren't aware of how common or serious brain injuries are. Such injuries are more common than breast cancer, HIV/AIDS, multiple sclerosis and spinal cord injuries combined, Mr. Flanagan said.

"Your head never has to hit anything to have a traumatic brain injury," he said.

The top causes of brain injuries are car collisions, assault, falls, recreational sports and, in the military, improvised explosive devices, Mr. Flanagan said.

Allan M. Landes, a neuropsychologist at the Syracuse Veterans Affairs Medical Center, said chances are no two people have the same brain injury, and there are few consistent patterns of symptoms — "the things that in other areas create syndromes."

With each patient, he has to give tests and study behavior to determine which link is missing.

"The chain is only as strong as its weakest link," he said. "Two people could fail hand-raising tests for very different reasons."

Capt. Jeremy A. Reynolds, a physician's assistant with the 10th Mountain Division's 2nd Brigade, said he'll bring the information he learned about symptom variability and fluctuation back to base.

"Commanders that are having problems with soldiers come to me, and being able to explain to them the fluctuation of the disorder will help the soldier to be understood better," he said. "They like to pour stress on them, but they have to understand that there are days they're just not going to be able to do it."

Capt. Reynolds said he thinks the base has greatly improved its mental health services.

"Since we came back in 2007 it seems like there's a lot more out there available to soldiers," he said.

Although many in attendance were from Fort Drum, some civilians, such as Cheryl A. Stevens, service coordinator with Sibley Nursing, a home care provider, came to collect information to pass on to patients.

"I'll be educating, passing on information and helping everyone learn ... so both participants and families can be successful," she said.

Kate L. Falb, a community mental health educator for Cornell Cooperative Extension of Jefferson County, which co-sponsored the event with the Brain Injury Association of New York State, said she was pleased with the turnout.

"It's nice to have a lot of Fort Drum and community people in the same room to talk about an issue," she said. "I think we all just want to support our service members and their families the best we can, and collaboration is a good way to do that."