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By: Marla Knox, MA CTRS
Balboa Warrior Athlete Program
Naval Medical Center San Diego
Things to consider when working with the military population:
  • Active duty vs veterans
  • Know your service branches
  • Registration form ~does it apply to military population?
  • Patients  (medical clearances, legal clearances)
  • Work with hospital or facility staff. Find a contact!  
  • What problems is the individual having?
  • What are their rehab or individual goals? Make sure they coincide with your program goals.
  • You are a part of the rehabilitation team!
  • Not everyone is injured in combat (OEF/OIF). Know the difference between ill, injured and wounded.
  • Connect with staff in facility (military vs clinician)


Traumatic brain injury (TBI) is being named the "signature injury" for the current war in Iraq & Afghanistan

  • TBI occurs when a person’s brain is physically injured, usually by a sudden force i.e. concussive blast or explosion.
  • It can also be caused by falls, motor vehicle accidents, assaults, or any sudden blow to the head.
  • The injury is unique to the individual much like one’s own signature.
  • Invisibly wounded
TBI Stats
  • Based on existing data, veterans’ advocates believe that between 10 and 20% of Iraq veterans, or 150,000 and 300,000 people, have some level of TBI. Among wounded troops, the rate of TBI rises to 33%.
  • More than 11,800 troops have been seriously injured in an IED attack, and many thousands more have been near enough to suffer a concussion.
  • As of October 31st, 2006, only 1,652 soldiers and marines who served in Iraq and Afghanistan have been officially diagnosed with a Traumatic Brain Injury.
  • About 7 percent reported both a probable brain injury and current PTSD or major depression.
Mild TBI ~ Present functionally
  • Fatigue  (cognitive and physical)
  • Headaches (can be triggered by activity, altitude, etc.)
  • Visual disturbances
  • Short term memory loss
  • Poor attention and concentration
  • Sleep disturbances
  • Dizziness/loss of balance
  • Irritability-emotional disturbances
  • Feelings of depression
  • Sensitivity to light and sounds
  • Getting lost or confused
  • Slowness in thinking
  • Diminished judgment
Moderate TBI~
  • Trouble organizing thoughts
  • Easily confused
  • Often forgetful
  • Difficulty solving problems
  • Difficulty making decisions
  • Difficulty planning
  • Problems with judgment
  • Decreased inhibition
  • Inability to filter what they are thinking and what they say.
  • Difficulty describing situations or explaining things
  • Speech problems (slow, slurred, difficult to understand)
  • Difficulty finding words or forming sentences
Severe TBI Deficits
  • Physical paralysis/spasticity, chronic pain, control of bowel and bladder
  • Cognitive difficulties with attention, concentration, distractibility, memory, speed of processing, confusion, perseveration, impulsiveness
  • Speech and Language not understanding the spoken word (receptive aphasia), difficulty speaking and being understood (expressive aphasia), slurred speech, speaking very fast or very slow, problems reading, problems writing
TBI & Sports Activity
  • Fatigue—chronic pain, sleep disturbances, and depression. Appropriately timed activities can help tremendously (e.g., certain times of the day, carefully timed bursts of aerobic activity). This applies to cognition as well
  • Slowed thinking—Takes longer to process the information. Make sure to have a clear and concise breakdown of tasks.  Don’t overwhelm participant
  • Memory and initiation—Have a properly structured workout and use repetitions and review.
  • Medications—Ask the participants
  • Emotional Behaviors—Impulsivity, poor judgment, indecision, and irritability are all examples. Simply focus on the task or try redirecting the negative behavior.


  • Learn new recreation, sports or fitness activities
  • Relearn/reconnect previous activities
  • Provide participant with new community resources (DSUSA, CAF, Paralympics, local municipalities)
  • Increase endurance and overall fitness
  • Enhance quality of life though participation n activity
  • Introduce participant to adaptive equipment if applicable
  • Work collaboratively with rehab staff on patients goals (balance, vestibular, etc.)
  • Make activities challenging but safe
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