Traumatic Brain Injury TBI

Paolo Prolo and Anna N. Taylor 17.1 Introduction

Unexpected crises have set the rhythm of our days after the fall of the Berlin Wall, the dismemberment of the Soviet Union and the dissolution of the Warsaw Pact. In a world that still needs to find a clear path to be open toward the future and to think about the new and the possible, as recently stated by philosopher Bodei (2006), we have unfortunately witnessed the events of September 11, 2001 in New York, March 11, 2004 in Madrid, July 19, 2005 in London and a series of armed conflicts, from Kosovo to Sudan, from East Timor to Afghanistan, Iraq, and the Middle East. All these changes in the world political climate have brought an increase in the incidence of traumatic brain injury (TBI) and spinal cord injury (SCI) both in soldiers and in civilians from war zones and terrorist attacks.

TBI has proven unusually common in the current conflicts in Iraq and Afghanistan, in which new body armor saves soldiers from injuries that would have killed them in the past but cannot keep their brains from banging against the walls of their skulls (San Francisco Chronicle, July 19, 2004; USA Today, March 4-6, 2005). The weapons preferred by those attacking U.S. troops and those attacking ordinary people—suicide terrorists, car bombs, land mines, improvised explosive devices, mortars—deliver precisely the kind of concussive blast that can injure the brain in addition to other body parts or systems resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability, i.e., polytrauma (Lew 2005). There is little information on the pattern of neuroendocrine and immune impairments after TBI, and their influence on sleep. Moreover, closed brain injuries and mild TBI may not be readily apparent, particularly in the presence of externally evident injuries or other life-threatening conditions requiring immediate attention. However, once a diagnosis of TBI is obvious, rehabilitation may be a lengthy process, encompassing a range of behavioral and physiological functions that direct the adaptive function of regulating bodily systems in response to past, present and future challenges.

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