As Service Members Recover from Traumatic Brain Injuries, the USO is Always by Their Side

By Danielle DeSimone

Between 2000 and 2023, there have been a total of nearly 500,000 traumatic brain injuries among U.S. service members. These traumatic brain injuries – also known as “TBIs” – can happen anywhere, from airborne parachute training, to a motor vehicle accident, to an attack on the front lines.

But regardless of how it happens, we know that while anyone can experience a TBI, according to the CDC, active-duty service members are considered to have a greater likelihood of dying from a TBI or living with long-term problems that resulted from the injury. That is why treatment of these injuries – and support throughout their treatment – is crucial.

As the Department of Defense (DOD) is increasing its efforts to prioritize the health and treatment of service members struggling with TBIs, the USO is right there alongside the people who serve, offering support through USO Centers and programs specifically designed for wounded, ill and injured service members.

The Dangers of a Traumatic Brain Injury (TBI) Within the Military Community

According to Dr. George Smolinski, the medical director of the Traumatic Brain Injury (TBI) & Rehabilitation Clinic at Landstuhl Regional Medical Center in Landstuhl, Germany, the DOD defines a traumatic brain injury as “any sort of blow to the head, or blast, or injury where you either lose consciousness or even if you have alteration of consciousness.”

Dr. Smolinski is a physical medicine and rehab physician who specializes in TBIs. He trained at Walter Reed National Military Medical Center from 2004 to 2008, during the height of the Iraq War and War in Afghanistan, a time in which TBIs became a very common injury among deployed service members. Since then, he has been stationed overseas at several different locations in Europe; then, in 2020, he began leading the TBI clinic at Landstuhl Regional Medical Center, which is the largest U.S. military hospital outside of the continental United States. It is often the first stop for service members who have been injured or fallen ill while downrange in conflict zones overseas. Dr. Smolinski also serves as a colonel in the U.S. Army Reserves.

But day-to-day, his responsibility is overseeing the care of service members who have suffered a traumatic brain injury. In 2022 alone, the Department of Defense reported more than 20,500 traumatic brain injuries among U.S. service members. There are also several levels of severity when it comes to TBIs, depending on the severity of the incident itself that caused the injury. And the injuries themselves can vary.

“It can happen in a variety of ways. It can be from a bad parachute landing fall that happens after an airborne jump. It can be a box gets dropped on your head, it can be you run into the side of an aircraft with your head,” Dr. Smolinski said.

More severe injuries can be as a result of severe impact or an actual penetration of the skull, whether that be from an accident or from attacks on U.S. personnel, such as the most recent missile, mortar and drone attacks in the Middle East, which have resulted in 130 TBIs since October 2023.

But regardless of how severe, the service members receiving treatment at Landstuhl can experience a wide range of symptoms.

This can be anything from cognitive disfunction – such as a patient having difficulty thinking clearly, remembering things, or their brain feeling “slowed down” – to vision blurriness, dizziness, headaches or loss of balance.

“A lot of patients will complain of fatigue or an inability to really get on a good sleep cycle, so they’ll have distorted sleep,” Dr. Smolinski said. “And a lot of times, patients are very frustrated, and have irritability and anxiety. Almost like any injury, they’re injured, but you can’t see the injury. It’s frustrating to them because they’re not recovering, and they’re sleeping terribly and they’re experiencing physical pain.”

Many studies have found that TBIs can also result in exacerbating pre-existing mental health issues, or creating new ones following the injury. This can include anxiety, depression, changes in behavior, difficulty controlling emotions and even suicidal ideation.

With tens of thousands of service members being affected by TBIs each year, treatment of these injuries – and support of the people behind the uniform – is crucial. Dr. Smolinski and his team create treatment plans for each patient depending on the severity of their injury, including everything from cognitive therapy, to vestibular balance therapy to headache treatment and more.

But studies also show that “emotional functioning is integral to well-being and quality of life” of TBI patients, and that community support is essential to rehabilitation.

And that is why the USO is with the people who serve every step of the way – including in these moments of need.

How USO Warrior Centers Support Service Members Recovering from TBIs

The USO is committed to strengthening the well-being of the people who serve in our nation’s Armed Forces. USO staff members and volunteers provide a welcoming USO Center environment and run our programs with the aim of supporting the morale and mental health of service members and military families - but the USO does not provide medical services.

However, we can work in close partnership with those who do.

That is why we have strategically built USO Warrior and Family Centers next to some of the largest U.S. military hospitals in the world, including Walter Reed National Military Medical Center in Bethesda, Maryland; Fort Belvoir, Virginia; San Antonio Military Medical Center in San Antonio, Texas; and Landstuhl Regional Medical Center in Landstuhl, Germany.

The USO Warrior Centers in these locations were built specifically with wounded, ill and injured service members in mind. They feature amenities like ADA-compliant spaces, outdoor gardens, communal kitchens and special programming tailored to engage recovering troops with both visible and invisible wounds, including traumatic brain injuries.

This special programming can include activities such as classes in art, cooking, yoga and music. However, these programs are far more than just relaxing activities – they have been proven to help service members and veterans better navigate difficult emotions post-injury, as well as reduce pain and anxiety.

The USO Warrior Center at Landstuhl is particularly popular among service members for its implementation of the USO Canine Program. Through this program, certified therapy dogs visit USO Centers around the world to provide emotional support and levity to service members, military spouses and military children. The dogs are considered USO Volunteers; they even have their own profiles within the USO volunteer database system. In fact, Penny, a therapy dog who regularly visits the USO Warrior Center at Landstuhl, as well as the nearby hospital, was recently named the 2023 USO Canine Volunteer of the Year.

“Every Thursday, the USO therapy dogs come to the TBI clinic when we have our combat casualty clinic,” Dr. Smolinski said. “They come, the guys from USO come over and bring some coffee and snacks for the injured personnel, and it’s great for everyone involved.”

However, these dog visits are far more than just tail-wagging-fun – research shows that interacting with animals can make an incredible difference – and improvement – in one’s physical and mental health. Studies have also found that petting an animal can lower blood pressure and release hormones such as phenylethylamine, an anti-depressant. Other research shows that after petting animals, people were found to have increased levels of serotonin, prolactin and oxytocin – all hormones that can play a part in elevating moods and decreasing anxiety and the feeling of loneliness, all of which can be symptoms of a TBI.

Beyond these supportive programs that USO Warrior Centers provide, they also quite simply give service members another place to turn to during their recovery – and having a warm, supportive space can also make all the difference in a service member’s morale.

The USO staff and volunteers at the approximately 250+ USO locations around the globe work hard to create a welcoming environment for every service member, military family member or caretaker who walks through our doors. This is especially true at USO Warrior Centers, where creating protective environments can be crucial to the mental health of service members recovering from a difficult injury or illness, such as a TBI. According to the World Health Organization, having a safe, supportive environment plays a large role in mental health. When people feel secure in their surroundings, they experience less anxiety and depression, improve their physical health, have fewer instances of substance abuse and experience an overall improved quality of life and life expectancy.

Of course, when serving in the U.S. military, a safe environment is not always a guarantee, which is why USO Centers can be particularly helpful in these situations – and this is especially true of our USO Warrior Centers, when recovering service members are otherwise confined to somewhat clinical spaces.

“Our clinic is physically located across the street from the USO at Landstuhl, so it’s been great to have [the USO] there because it is a place where injured service members can go and have a little bit of home,” said Dr. Smolinski. “They can go and chill out, watch TV, get some food, chat with other guys that are there.”

The stress of a hospital setting can be challenging. Many of the service members must spend weeks or months in recovery in Landstuhl, where they are disconnected from both their loved ones back home and their units out in the field. This isolation from their networks of support can take a toll on them as they get back on their feet, which is why the USO Warrior Center exists – to fill that gap with familiar faces, engaging activities and a comfortable place to turn to for injured and ill troops far from home. Here, service members can find cozy couches, the friendly faces of our volunteers, kitchens to cook homemade meals in, televisions, books and gaming centers and more.

“We became like their family until they got back to their own families,” explained USO Warrior Center Manager Geno Mendiola. “It’s a pretty profound mission.”

Traumatic brain injuries are a serious issue for many people serving in the U.S. military, and recovery can be challenging. But by providing crucial programs and supportive environments at our USO Warrior Centers, our organization and generous supporters can ensure that they are never alone in their journeys to recovery.