While many returning Vietnam veterans suffered from the toxic, long-lasting effects of Agent Orange, the signature wound for soldiers returning from Afghanistan and Iraq is TBI.

Compounding the problems for today’s veterans – and for the wider population who have experienced head traumas – is the lack of professionals trained to recognize, assess and treat pediatric TBI, says Adele Proctor, a speech-language pathologist and researcher in the department of speech and hearing science at the University of Illinois at Urbana-Champaign.

Thanks to a $1 million, five-year training grant from the U.S. Department of Education, Proctor and colleagues at the U. of I., working with staff at area and regional hospitals, are hopeful that the situation will improve soon for those suffering from pediatric TBI – traumatic brain injury in people 21 or younger.

“The problem with blast injuries and the returning soldier is … those people did not survive in past wars,” Proctor said. “Now they’re surviving, but they have very different kinds of problems that we were – and are – not prepared to deal with.”

Body armor may prevent fatal injuries when troops are exposed to an improvised explosive device, but more than 20 percent of those who survive incur head, face or neck injuries, Proctor said. Clinicians specializing in care for pediatric TBI survivors are particularly interested in helping these victims because many of them are younger than 25, the age at which the human brain finally is considered to be fully developed.

“The issue with brain injury is you can’t see it,” Proctor said. But when people are affected by TBI, “their behavior is different than before.”

“And there are all kinds of interpretations about the fact that a loved one has come back from war and doesn’t really communicate effectively. He or she didn’t behave like this before.” Proctor said family members often speculate about physical or emotional causes, or even suspect substance abuse.

“TBI is a neurological condition that may result in a constellation of cognitive communication impairments, physical, emotional and neurological deficits that require lifelong adjustments,” said Proctor, who suffered a head injury several years ago in a car accident. At least 1.6 million people in the United States sustain a traumatic brain injury each year – the result of falls, sports injuries, gunshot wounds and other accidents – and that number is on the rise, she said.

Common complaints from people with TBI include memory loss and difficulties paying attention or communicating complex thoughts. They also may have learning and social interaction problems.

“One of the crucial things is that our training provides the kind of knowledge needed to go out and work with returning soldiers,” Proctor said. “So they will understand what a blast injury is, and understand there are no established protocols for treating it, as there are very few for children. But they’ll have that specialization and training you need to reason through a new type of problem … to look up information, know who to call and access information from, how to make appropriate referrals.”

Until recently, Proctor said, “there were only about three places the returning vets were being sent (nationwide),” making it extremely difficult for patients and family members who have to travel long distances to available treatment facilities.

Now in the fourth year of its funding cycle, the training program awards fellowships to first-year graduate students in speech-language pathology who are interested in providing TBI-related services in a variety of settings, from schools and social service agencies to clinics and hospitals.

“The specific focus is on specialty training in pediatric traumatic brain injury for speech-language pathologists,” Proctor said.

“As best as I’m able to determine, we may be the only (place) in the country that has this specialty training,” she said. “Other people may have a course or part of a course on TBI (the U. of I. offers two courses that focus specifically on TBI). But I haven’t been able to identify anyone with the funding and the training that’s combined with the practical experience.”

During the first semester of the program, students spend eight weeks in lecture, followed by eight weeks observing in a hospital-medical facility.

“We only introduce the students, in the first semester, to what goes on,” Proctor said. “They sit back and watch the different types of patients and learn basic information. We don’t ask them to participate in any way. Then they write summaries and we continuously review that information.”

During the second semester, students come to understand the issues involved – from legislative matters to those involving special education systems in public schools, Proctor said.

In the second year of the program, students continue with speech-language pathology training, but ultimately are placed in a hospital setting.

Mary Ratliff, a second-year graduate student from Sea Girt, N.J., said the grant has provided her with “an exceptional opportunity to specialize in TBI, an area of speech pathology that is growing and gaining increased interest.” In particular, she said, “The clinical and administrative observations gave us the chance to see a more holistic picture of our clients and what we can do for them.”

That experience, often in highly select settings, such as the Rehabilitation Institute of Chicago – which Proctor said is regarded as one of the nation’s top facilities for TBI treatment – can be the advantage that lends the program’s graduates an upper hand when they enter the job market.

“In the past, students who earn master’s degrees in speech-language pathology typically wouldn’t automatically get a job in their first year in a medical environment. Those are considered unique positions. They want people with experience. So what we do is provide a level of experience that students are sufficiently knowledgeable to go immediately into a medical setting. The medical settings will look at our students because they have the unique training.”

For TBI sufferers, that means hope – and more options – are on the horizon. In the meantime, Proctor said, individuals with questions about TBI may contact her at aproctor@uiuc.edu. They also may call the U. of I.’s Speech-Language Pathology Clinic, 217-333-2230.

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