Military TBI During the Iraq and Afghanistan Wars

Defense and Veterans Brain Injury Center, Walter Reed Army Medical Center, Washington, DC 20307, USA.
Journal of Head Trauma Rehabilitation (Impact Factor: 2.92). 09/2006; 21(5):398-402. DOI: 10.1097/00001199-200609000-00004
Source: PubMed


Traumatic brain injury (TBI) is an important source of morbidity in the Iraq and Afghanistan wars. Although penetrating brain injuries are more readily identified, closed brain injuries occur more commonly. Explosion or blast injury is the most common cause of war injuries. The contribution of the primary blast wave (primary blast injury) in brain injury is an area of active research. Lessons learned from the sports concussion and civilian mild TBI literature are useful. Individuals with TBI and posttraumatic stress disorder require treatment of both conditions. Families and communities need to be cognizant of the needs of these returning veterans.

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    • "Although improvements in equipment and medical treatment have contributed to higher rates of survival among service members with combat injuries (Lew, 2005; Lew et al., 2007), military personnel sustain more complicated physical injuries and emotional trauma than those in previous wars (Friedemann-Sanchez, Sayer, & Pickett, 2008; Warden, 2006). Many of these injuries have been characterized as " polytrauma, " which the Veterans Affairs Department (VA) defined as " two or more injuries to physical regions or organ systems, one of which may be life threatening, resulting in physical, cognitive, psychological, or psychosocial impairments and functional disability " (VA, 2013, p. 1). "
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    ABSTRACT: Although the relationship between negative affect and psychiatric symptoms has been well-demonstrated in research, less is known about positive affect relative to negative affect, and its relationship to psychiatric symptoms, especially among veterans. This study examined how levels of positive and negative affect are associated with symptoms of depression, anxiety, and posttraumatic stress disorder (PTSD). Data were collected in a veteran polytrauma clinic; analyses were conducted using data from 94 veterans (87 males) with and without a mild traumatic brain injury (mTBI) diagnosis. Results demonstrate that positive and negative affect were separate dimensions and that both were independently related to each symptom measure. After removing the contribution of negative affect from symptom reports, strong relationships remained between positive affect and psychiatric symptoms. Furthermore, the magnitude of the associations for positive affect and for negative affect with symptoms of depression, anxiety, and PTSD were not impacted by a mTBI diagnosis. Altogether, findings suggest that both positive and negative affect should be uniquely considered when conceptualizing, assessing, and treating returning service members; in addition, positive affect may be an appropriate target of assessment and interventions of persons who have experienced polytrauma. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
    Rehabilitation Psychology 12/2014; 60(1). DOI:10.1037/rep0000017 · 1.91 Impact Factor
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    • "Long before traumatic brain injury (TBI) has been termed the " signature injury " of the wars in Iraq and Afghanistan [1] [2] [3], it has been recognized as the major cause of brain damage in children and young adults, as well as the main cause of disability and mortality in these populations. It has been estimated that there are 1.4–2 million new cases of traumatic brain injury (TBI) seen in medical facilities each year in the United States, and there are many more who never seek care [4]. "
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    ABSTRACT: To date, there is yet no established effective treatment (medication or cognitive intervention) for post-traumatic brain injury (TBI) patients with chronic sequelae. Enriched environment (EE) has been recognized of importance in brain regulation, behaviour and physiology. Rodents reared in, or pre-exposed to EE, recovered better from brain insults. Using the concussive head trauma model of minimal TBI in mice, we evaluated the effect of transition to EE following a weight-drop (30 g or 50 g) induced mTBI on behavioural and cognitive parameters in mice in the Novel Object Recognition task, the Y- and the Elevated Plus mazes. In all assays, both mTBI groups (30 g, 50 g) housed in normal conditions were equally and significantly impaired 6 weeks post injury in comparison with the no-mTBI (p < 0.001 and p < 0.03, respectively) and the mTBI + EE groups (p < 0.001 for the 30 g, and p < 0.017 for the 50 g). No differences were found between the control and the EE mice. Two separate finding emerge: (1) the significantly positive effects of the placement in EE following mTBI, on the rehabilitative process of the tested behaviours in the affected mice; (2) the lack of difference between the groups of mice affected by 30 g or by 50 g. Further studies are needed in order to characterize the exact pathways involved in the positive effects of the EE on mice recovery from mTBI. Possible clinical implications indicate the importance of adapting correlates of EE to humans, i.e., prolonged and intensive physical activity – possibly combined with juggling training and intensive cognitive stimulation.
    Behavioural Brain Research 09/2014; 271:59–64. DOI:10.1016/j.bbr.2014.05.060 · 3.03 Impact Factor
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    • "Modern military conflicts in Iraq and Afghanistan emphasize the use of explosive devices, and as a result, about 80% of combat-related injuries are associated with blast injury (Owens et al., 2008; Warden, 2006). Due to advances in the quality of protective equipment worn by servicemen, casualties resulting from explosive blasts are less common, and injuries are less severe than in previous conflicts (Warden, 2006). Still, the number of veterans suffering from traumatic brain injury (TBI), especially mild TBI (mTBI), associated with blast injury continues to rise (Stuhmiller, 2008). "
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    ABSTRACT: The increased use of explosives in combat has resulted in a large number of returning veterans suffering from blast-related mild traumatic brain injury (mTBI) and self-reported complications. It remains unclear whether this increase in self-reported difficulties is unique to the blast mechanism or stressful preinjury environment and whether cognitive-functioning deficits correspond with these difficulties in the postacute phase. This study examined the relationship between cognitive performance and self-reported psychological and somatic symptoms of blast-related mTBI compared with civilian mTBI, independent of comorbid posttraumatic stress disorder (PTSD) symptoms. Twelve veterans with blast-related mTBI were compared to 18 individuals with civilian mTBI on cognitive tests and self-report questionnaires. Univariate analyses failed to reveal differences on any individual cognitive test. Further, veterans reported more psychological and somatic complaints. These self-reported difficulties were not significantly correlated with neuropsychological performance. Overall, preliminary results suggest that in the postacute phase, subjective complaints related to blast-related mTBI do not covary with objective cognitive performance. Additionally, cognitive outcomes from blast-related mTBI were similar to those of civilian forms of mTBI. Future studies should identify the cognitive and self-reported sequelae of blast-related mTBI independent of comorbid PTSD in a larger sample of veterans.
    Applied Neuropsychology: Adult 06/2014; 22(2):1-9. DOI:10.1080/23279095.2013.845823 · 0.65 Impact Factor
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