Blast Injury and Veteran TBI

what makes a veteran?

formed member of US armed forces

may served in combat or non-combat roles

includes active duty, reserves, national guard

what are some unique exposures veterans may experience?

blast injuries (IEDs)

multiple deployments

prolonged high-stress environments

mTBI is the ________ of recent military conflicts (OEF/OIF)

signature injury

why are veterans “unique” when it comes to mild TBI (mTBI)?

includes blast-related injuries

higher risk of comorbidities (PTSD, depression, sleep disturbance, etc.)

persistent cognitive complaints despite “mild” classification

combination of psychological, physical and moral injuries

blast injury

caused by exposure to explosives (IEDs, grenades, landmines)

primary blast injury

over-pressurization wave directly impacts body tissues

secondary blast injury

injuries from flying debris

tertiary blast injury

injuries from being thrown against objects

quaternary blast injuries

burns, inhalation injuries, psychological trauma

primary blast injury: tympanic membrane rupture

ear drum ruptures from pressure wave

leads to HL, tinnitus, balance issues

primary blast injury: pulmonary damage

fragile lung tissue may bleed or rupture

risk of pneumothorax (collapsed lung)

primary blast injury: gastrointestinal damage

pressure shifts can cause internal bleeding or abdominal injury

primary blast injury: TBI

shearing of brain tissue (diffuse axonal injury), vascular damage, chemical disruption

primary blast injury: vestibular and visual dysfunction

damage to inner ear and oculomotor pathways

dizziness, blurred vision, poor tracking

primary blast injury: cognitive, emotional, behavioral symptoms

result from brain injury and/or secondary stressors (PTSD, chronic pain)

what are open head injuries?

skull fracture, penetrating injury, more focal brain damage

what are closed head injuries?

no skull penetration, diffuse axonal injury is common

disruption of brain networks affecting cognition, memory and emotion

list some companies mTBI veterans have

attention/concentration problems

memory issues

processing speed difficulties

word-finding/organization issues

fatigue and mental exhaustion

function troubles (work, school, social)

as an SLP, what are key concepts regarding this type of patient?

symptoms may NOT match to formal cog test scores

standard neuropsychological tests often fail to capture real-life challenges

functional assessment is critical

what would a functional assessment keep in mind?

how do problems show up in daily life

what matters to the veteran (work, family, independence)

list the 6 guiding principles for therapy

recruit resilience

cultivate therapeutic alliance

acknowledge multifactorial complexities

build a team

focus on function

promote realistic expectations

T or F: an SLP should capitalize on the veteran’s maintained strengths

TRUE; therapy should build on the strengths rather than focusing on deficits. this may look like using compensatory strategies, checklists, task logs similar to military planning tools

how might an SLP build a therapeutic alliance?

build trust, mutual spect, collaboration

acknowledge military culture and experiences

focus on what matters to veteran

validate any concerns

why may building an alliance take longer in this population?

veteran may have trauma, hypervigiliance, institutional mistrust

it is important that we demonstrate a cultural competence to the military norms

how might an SLP acknowledge any complexities

keep in mind co-occuring conditions that could interact with cog issues

modify sessions based on pain, sleep, PTSD

short sessions with frequent breaks if needed

T or F: Blast injury occurs in isolation, separate from other issues/conditions

FALSE; it rarely occurs in isolation, usually coexists with PTSD, chronic pain, sleep disturbance, hearing/vestibular deficits

this can complicate assessment and treatment

clinicians should interpret cognitive and communication symptoms through a ______ lens

biopsychosocial

(is slowed processing due to fatigue, tinnitus, anxiety, central injury?)

________ is essential to avoid fragmented or contradictory care plans

interdisciplinary communication

what does the rehab team look like?

mental health, PT (vestibular rehab), vocational rehab, case management, SLP

when an SLP is focusing on function, what might that look like?

manage medication schedules

organize paperwork

plan work or school tasks

how would an SLP support the client in understanding recovery trajectory?

set realistic, meaningful goals

celebrate small gains

how do you balance optimism with realism during therapy?

improvement may come through adaptation rather than full restoration. encourage patience and self-compassion, framing “new normal” as continued strength - not loss