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.
"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). "
[Show abstract][Hide abstract] ABSTRACT: Though intrinsically of much higher frequency than open-field blast overpressures, high-intensity focused ultrasound (HIFU) pulse trains can be frequency modulated to produce a radiation pressure having a similar form. In this study, 1.5-MHz HIFU pulse trains of 1-ms duration were applied to intact skulls of mice in vivo and resulted in blood-brain barrier disruption and immune responses (astrocyte reactivity and microglial activation). Analyses of variance indicated that 24 h after HIFU exposure, staining density for glial fibrillary acidic protein was elevated in the parietal and temporal regions of the cerebral cortex, corpus callosum and hippocampus, and staining density for the microglial marker, ionized calcium binding adaptor molecule, was elevated 2 and 24 h after exposure in the corpus callosum and hippocampus (all statistical test results, p < 0.05). HIFU shows promise for the study of some bio-effect aspects of blast-related, non-impact mild traumatic brain injuries in animals.
Ultrasound in medicine & biology 01/2014; 40(5). DOI:10.1016/j.ultrasmedbio.2013.11.023 · 2.21 Impact Factor
"Department of Veterans Affairs, Office of Patient Care Services, 2005). Blasts also impact more body systems and organs than other mechanisms of injury (Sayer et al., 2008). Due to improved body armor, surgical care deployed far forward on the battlefield, and rapid evacuation to major hospitals via military aircraft equipped with sophisticated equipment, more individuals are surviving beyond the acute phase of blast injuries (Gawande, 2004). "
[Show abstract][Hide abstract] ABSTRACT: Although the majority of combat veterans reintegrate into civilian life without long-lasting problems, a sizable minority return from deployment with psychiatric or physical injuries that warrant medical attention. Even in the absence of diagnosable disorders, many experience functional problems that impede full reintegration into civilian life. Considerable resources have been allocated to studying, diagnosing, treating, and compensating combat-related disorders. This important work has resulted in significant improvements in healthcare for those with deployment-related difficulties. Nevertheless, many service members and veterans with reintegration difficulty may not receive needed help. Based on our review, we argue that in addition to treatment and compensation for diagnosable postdeployment problems, a comprehensive approach to reintegration is needed that includes partnership between the government, private sector, and the public.
Social Issues and Policy Review 01/2014; 8(1). DOI:10.1111/sipr.12001
"Blast-related brain injuries can be provocatively described as “a silent epidemic of an invisible wound.” Current Explosive mechanisms [improvised explosive devices (IEDs), landmines, and rocket-propelled grenades (RPGs)] are believed to account for 56–78% of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND) related injuries (3, 4). This has led to labeling the blast-induced TBI (bTBI) as the signature brain injury for combat troops in today’s military (5, 6). "
[Show abstract][Hide abstract] ABSTRACT: Among the U.S. military personnel, blast injury is among the leading causes of brain injury. During the past decade, it has become apparent that even blast injury as a form of mild traumatic brain injury (mTBI) may lead to multiple different adverse outcomes, such as neuropsychiatric symptoms and long-term cognitive disability. Blast injury is characterized by blast overpressure, blast duration, and blast impulse. While the blast injuries of a victim close to the explosion will be severe, majority of victims are usually at a distance leading to milder form described as mild blast TBI (mbTBI). A major feature of mbTBI is its complex manifestation occurring in concert at different organ levels involving systemic, cerebral, neuronal, and neuropsychiatric responses; some of which are shared with other forms of brain trauma such as acute brain injury and other neuropsychiatric disorders such as post-traumatic stress disorder. The pathophysiology of blast injury exposure involves complex cascades of chronic psychological stress, autonomic dysfunction, and neuro/systemic inflammation. These factors render blast injury as an arduous challenge in terms of diagnosis and treatment as well as identification of sensitive and specific biomarkers distinguishing mTBI from other non-TBI pathologies and from neuropsychiatric disorders with similar symptoms. This is due to the "distinct" but shared and partially identified biochemical pathways and neuro-histopathological changes that might be linked to behavioral deficits observed. Taken together, this article aims to provide an overview of the current status of the cellular and pathological mechanisms involved in blast overpressure injury and argues for the urgent need to identify potential biomarkers that can hint at the different mechanisms involved.
Frontiers in Neurology 11/2013; 4:186. DOI:10.3389/fneur.2013.00186
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