The history and evolution of traumatic brain injury rehabilitation in military service members and veterans.
ABSTRACT The field of traumatic brain injury has evolved since the time of the Civil War in response to the needs of patients with injuries and disabilities resulting from war. The Department of Veterans Affairs and the Defense and Veterans Brain Injury Center have been in the forefront of the development of the interdisciplinary approach to the rehabilitation of soldiers with traumatic brain injury, particularly those injured from the recent conflicts in Iraq and Afghanistan. The objectives of this literature review are to examine how the casualties resulting from major wars in the past led to the establishment of the current model of evaluation and treatment of traumatic brain injury and to review how the field has expanded in response to the growing cohort of military service members and veterans with TBI.
SourceAvailable from: Judith L Babcock-Parziale[Show abstract] [Hide abstract]
ABSTRACT: To synthesize evidence and report findings from a systematic search and descriptive analysis of peer-reviewed published evidence of the accuracy of tests used for diagnosing mild traumatic brain injury (mTBI). The article also summarizes points of concurrence and divergence regarding case definitions of mTBI identified during the review. TYPE: Systematic review and descriptive analysis of published evidence. A search of PubMed, PsychInfo, and the Cochrane Library for peer-reviewed publications between 1990 and July 6, 2011, identified 1218 abstracts; 277 articles were identified for full review, and 13 articles met the criteria for evaluation. Manuscript inclusion criteria were (1) reported sensitivity (Se) and specificity (Sp), or reported data were sufficient to compute Se and Sp; (2) >1 participant in the study; (3) at least 80% of the study cohort was ≥18 years of age; and (4) written in English. Articles describing clinical practice guidelines, opinions, theories, or clinical protocols were excluded. Seven investigators independently evaluated each article according to the Standards for Reporting of Diagnostic Accuracy (STARD) criteria. Findings indicate that all 13 studies involved civilian noncombat populations. In 7 studies, authors examined acute mTBI, and in 4 studies, historical remote mTBI was examined. In the 13 studies, Se ranged from 13%-92% and Sp ranged from 72%-99%, but confidence in these findings is problematic because the STARD review indicates opportunities for bias in each study. Findings indicate that no well-defined definition or clinical diagnostic criteria exist for mTBI and that diagnostic accuracy is currently insufficient for discriminating between mTBI and co-occurring mental health conditions for acute and historic mTBI. Findings highlight the need for research examining the diagnostic accuracy for acute and historic mTBI.PM&R 10/2013; 5(10):856-81. DOI:10.1016/j.pmrj.2013.06.007 · 1.66 Impact Factor
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ABSTRACT: A history of mild traumatic brain injury (mTBI) is common among military members who served in Operations Enduring Freedom, Iraqi Freedom, and New Dawn (OEF/OIF/OND). We completed a systematic review to describe the cognitive, mental health, physical health, functional, social, and cost consequences of mTBI in Veteran and military personnel. Of 2668 reviewed abstracts, the 31 included studies provided very low strength evidence for the questions of interest. Cognitive, physical, and mental health symptoms were commonly reported by Veterans/military members with a history of mTBI. On average, these symptoms were not significantly more common in those with a history of mTBI than in those without, although a lack of significant mean differences does not preclude the possibility that some individuals could experience substantial effects related to mTBI history. Evidence of potential risk or protective factors moderating mTBI outcomes was unclear. Although the overall strength of evidence is very low due to methodological limitations of included studies, our findings are consistent with civilian studies. Appropriate re-integration services are needed to address common comorbid conditions, such as treatment for post-traumatic stress disorder, substance use disorders, headaches, and other difficulties that Veterans and members of the military may experience after deployment regardless of mTBI history. (JINS, 2014, 20, 1-13).Journal of the International Neuropsychological Society 02/2014; DOI:10.1017/S135561771300146X · 3.01 Impact Factor
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ABSTRACT: The U.S. Veterans Health Administration established the Polytrauma System of Care (PSC) in response to the growing need for Traumatic Brain Injury (TBI) and polytrauma rehabilitation services for our returning war heroes. The unique and complex patterns of injuries sustained during the conflicts in Iraq and Afghanistan have resulted in significant physical, cognitive, and psychological impairments which require an extraordinary level of specialized training and skill provided by the PSC interdisciplinary team. The PSC offers a holistic, coordinated, and comprehensive continuum of polytrauma/brain injury rehabilitation. These services range from intensive inpatient rehabilitation to residential and outpatient programs designed to address all facets of combat injury. These services are available to Veterans and service members across the nation and have been involved in the direct care of tens of thousands of combat injured personnel. This article provides an overview of services and new initiatives created by the PSC to provide the best care for our Veterans and service members.09/2013; 1(3). DOI:10.1007/s40141-013-0023-0