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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    • "Blast-induced neurotrauma is one of the principal causes of casualties in the Iraq and Afghanistan wars [1]. Although improved head protective equipment has provided better protection from injuries resulting from blunt impacts, shrapnel or projectiles, they are not designed for protection against blast waves, leading to an increased incidence of mild traumatic brain injury (mTBI) [2]. "
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    ABSTRACT: Purpose The role of ear canal in transmitting blast waves to the brain is not clear. The goal of this work is to characterize the influence of ear canal on blast-induced mild traumatic brain injury through a computational approach. Methods A three-dimensional human head model with single-side ear canal details was reconstructed from computed tomography images. The ear canal was positioned either facing the incident blast wave or facing away from the blast wave. Results The blast wave-head interaction has demonstrated that the overpressure within the ear canal was substantially amplified when the ear directly faced the blast wave. When it faced away from the blast wave, the overpressure within the ear canal was less than the actual incident blast pressure. Regardless of the substantial pressure differences within the ear canal induced by the blast wave, the resulting intracranial pressures were almost the same for both cases. Conclusions The blast wave-head interaction has demonstrated that the role of the ear canal in brain dynamics, and thus brain injury, was negligible. However, the peak overpressure within the ear canal exceeded the documented tympanic membrane rupture and inner ear damage thresholds. This was speculated to cause the degeneration of axons along the auditory pathway up to the midbrain. This work provided fundamental understanding of the load transmission through the ear canal and could serve as a platform for designing better protective armors.
    Preview · Article · Dec 2015 · Biomedical Engineering Letters
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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]. "

    Full-text · Article · Mar 2015 · Journal of Neuropsychiatry
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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).
    Full-text · Article · Dec 2014 · Rehabilitation Psychology
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