Characteristics and Rehabilitation Outcomes Among Patients With Blast and Other Injuries Sustained During the Global War on Terror

Center for Chronic Disease Outcomes Research, VA Medical Center, Minneapolis, MN 55417, USA.
Archives of physical medicine and rehabilitation (Impact Factor: 2.44). 02/2008; 89(1):163-70. DOI: 10.1016/j.apmr.2007.05.025
Source: PubMed

ABSTRACT To describe characteristics and rehabilitation outcomes among patients who received inpatient rehabilitation for blast and other injuries sustained in Iraq and Afghanistan during the Global War on Terror.
Observational study based on chart review and Department of Veterans Affairs (VA) administrative data.
The 4 VA polytrauma rehabilitation centers (PRCs).
Service members (N=188) admitted to a PRC during the first 4 years of the Global War on Terror for injuries sustained during Operation Iraqi Freedom or Operation Enduring Freedom.
Multidisciplinary comprehensive rehabilitation program.
Cognitive and motor FIM instrument gain scores and length of stay (LOS).
Most war-injured patients had traumatic brain injury, injuries to several other body systems and organs, and associated pain. Fifty-six percent had blast-related injuries, and the pattern of injuries was unique among those with injuries secondary to blasts. Soft tissue, eye, oral and maxillofacial, otologic, penetrating brain injuries, symptoms of post-traumatic stress disorder, and auditory impairments were more common in blast-injured patients than in those with war injuries of other etiologies. The mechanism of the injury did not predict functional outcomes. LOS was variable, particularly for those with blast injuries. Patients with low levels of independence at admissions made the most progress but remained more dependent at discharge compared with other PRC patients. The rate of gain was slower in this low-functioning group.
Blasts produce a unique constellation of injuries but do not make a unique contribution to functional gain scores. Findings underscore the need for assessment and treatment of pain and mental health problems among patients with polytrauma and blast-related injuries. Patients with polytrauma have lifelong needs, and future research should examine needs over time after community re-entry.

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    • "In military populations, a RAND report (Tanielian and Jaycox 2008) estimated that as many as 20% (320,000) of military personnel experienced some form of traumatic brain injury (TBI). In terms of severe TBI, a recent survey found that the majority are related to explosives (Wojcik et al. 2010), and severe blastrelated traumatic brain injuries are a component of multiple injuries; a significant challenge to polytrauma care specialists (Aschkenasy-Steuer et al. 2005; DuBose et al. 2011) and a hardship to the patient and family during rehabilitation and lifestyle adjustments (Bazarian et al. 2009; Sayer et al. 2008). "
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    • "In a 2008 study of OBF/OIF veterans (Hoge et al., 2008), those with PTSD were more likely to have reported an mTBI compared with veterans who suffered no injury, although the neurological mechanism underlying the connection between the mTBI and PTSD is unknown (Vasterling et al, 2009). Further, TBI has been found to coexist with many mental illnesses (Sayer et al., 2008). "
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    • "Previous studies (Lippa et al., 2010; Wilk et al., 2010; Belanger et al., 2011; Luethcke et al., 2011) have generally found no differences between blast and non-blast TBI on a range of symptoms such as depression, alcohol, happiness, vigor, fatigue, restlessness, anxiety, anger, and postconcussion symptoms. However , some studies have shown a relation between blast-related injury and PTSD symptom reporting (Sayer et al., 2008; Belanger et al., 2009, 2011; Kennedy et al., 2010; Lippa et al., 2010). "
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    ABSTRACT: This review focuses on the application of functional magnetic resonance imaging (fMRI) to the investigation of blast-related traumatic brain injury (bTBI). Relatively little is known about the exact mechanisms of neurophysiological injury and pathological and functional sequelae of bTBI. Furthermore, in mild bTBI, standard anatomical imaging techniques (MRI and computed tomography) generally fail to show focal lesions and most of the symptoms present as subjective clinical functional deficits. Therefore, an objective test of brain functionality has great potential to aid in patient diagnosis and provide a sensitive measurement to monitor disease progression and treatment. The goal of this review is to highlight the relevant body of blast-related TBI literature and present suggestions and considerations in the development of fMRI studies for the investigation of bTBI. The review begins with a summary of recent bTBI publications followed by discussions of various elements of blast-related injury. Brief reviews of some fMRI techniques that focus on mental processes commonly disrupted by bTBI, including working memory, selective attention, and emotional processing, are presented in addition to a short review of resting state fMRI. Potential strengths and weaknesses of these approaches as regards bTBI are discussed. Finally, this review presents considerations that must be made when designing fMRI studies for bTBI populations, given the heterogeneous nature of bTBI and its high rate of comorbidity with other physical and psychological injuries.
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