Combat Exposure, PTSD Symptoms, and Cognition Following Blast-Related Traumatic Brain Injury in OEF/OIF/OND Service Members and Veterans

Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

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Improving the Lives of Service Members and Veterans With Mild Traumatic Brain Injury and Their Families: Matching Interventions to Needs

PsycEXTRA Dataset ◽

10.1037/e662582011-001 ◽

2011 ◽

Author(s):

Ann Landes

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Service Members

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Supplemental Material for TBI-CareQOL Military Health Care Frustration in Caregivers of Service Members/Veterans With Traumatic Brain Injury

Rehabilitation Psychology ◽

10.1037/rep0000305.supp ◽

2020 ◽

Keyword(s):

Health Care ◽

Traumatic Brain Injury ◽

Brain Injury ◽

Service Members ◽

Military Health ◽

Military Health Care

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Blood Biomarkers Relate to Cognitive Performance Years after Traumatic Brain Injury in Service Members and Veterans

Journal of the International Neuropsychological Society ◽

10.1017/s1355617720001071 ◽

2020 ◽

pp. 1-7

Author(s):

Sara M. Lippa ◽

Jessica Gill ◽

Tracey A. Brickell ◽

Louis M. French ◽

Rael T. Lange

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Cognitive Outcome ◽

Service Members ◽

Neurocognitive Performance ◽

Blood Biomarkers ◽

Post Injury ◽

Blood Draw ◽

Neurofilament Light ◽

History Of

Abstract Objective: This study examines the relationship of serum total tau, neurofilament light (NFL), ubiquitin carboxyl-terminal hydrolase L1 (UCH-L1), and glial fibrillary acidic protein (GFAP) with neurocognitive performance in service members and veterans with a history of traumatic brain injury (TBI). Method: Service members (n = 488) with a history of uncomplicated mild (n = 172), complicated mild, moderate, severe, or penetrating TBI (sTBI; n = 126), injured controls (n = 116), and non-injured controls (n = 74) prospectively enrolled from Military Treatment Facilities. Participants completed a blood draw and neuropsychological assessment a year or more post-injury. Six neuropsychological composite scores and presence/absence of mild neurocognitive disorder (MNCD) were evaluated. Within each group, stepwise hierarchical regression models were conducted. Results: Within the sTBI group, increased serum UCH-L1 was related to worse immediate memory and delayed memory (R2Δ = .065–.084, ps < .05) performance, while increased GFAP was related to worse perceptual reasoning (R2Δ = .030, p = .036). Unexpectedly, within injured controls, UCH-L1 and GFAP were inversely related to working memory (R2Δ = .052–.071, ps < .05), and NFL was related to executive functioning (R2Δ = .039, p = .021) and MNCD (Exp(B) = 1.119, p = .029). Conclusions: Results suggest GFAP and UCH-L1 could play a role in predicting poor cognitive outcome following complicated mild and more severe TBI. Further investigation of blood biomarkers and cognition is warranted.

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Prevalence and Severity of Psychiatric Disorders and Suicidal Behavior in Service Members and Veterans With and Without Traumatic Brain Injury

Journal of Head Trauma Rehabilitation ◽

10.1097/htr.0000000000000478 ◽

2020 ◽

Vol 35 (1) ◽

pp. 1-13 ◽

Cited By ~ 4

Author(s):

Nancy Greer ◽

Nina A. Sayer ◽

Michele Spoont ◽

Brent C. Taylor ◽

Princess E. Ackland ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Psychiatric Disorders ◽

Suicidal Behavior ◽

Service Members

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Traumatic brain injury and sight loss in military and veteran populations– a review

Military Medical Research ◽

10.1186/s40779-021-00334-3 ◽

2021 ◽

Vol 8 (1) ◽

Author(s):

Syeda F. Hussain ◽

Zara Raza ◽

Andrew T. G. Cash ◽

Thomas Zampieri ◽

Robert A. Mazzoli ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Injury Severity ◽

Vision System ◽

Combat Exposure ◽

Sight Loss ◽

Visual Problems ◽

Explosive Devices ◽

Subsequent Rise ◽

Visual Disturbances

AbstractWar and combat exposure pose great risks to the vision system. More recently, vision related deficiencies and impairments have become common with the increased use of powerful explosive devices and the subsequent rise in incidence of traumatic brain injury (TBI). Studies have looked at the effects of injury severity, aetiology of injury and the stage at which visual problems become apparent. There was little discrepancy found between the frequencies or types of visual dysfunctions across blast and non-blast related groups, however complete sight loss appeared to occur only in those who had a blast-related injury. Generally, the more severe the injury, the greater the likelihood of specific visual disturbances occurring, and a study found total sight loss to only occur in cases with greater severity. Diagnosis of mild TBI (mTBI) is challenging. Being able to identify a potential TBI via visual symptoms may offer a new avenue for diagnosis.

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Neurobehavioral Symptoms in U.S. Special Operations Forces in Rehabilitation After Traumatic Brain Injury: A TBI Model Systems Study

Military Medicine ◽

10.1093/milmed/usab347 ◽

2021 ◽

Author(s):

Amanda Garcia ◽

Shannon R Miles ◽

Tea Reljic ◽

Marc A Silva ◽

Kristen Dams-O’Connor ◽

...

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Symptom Severity ◽

Model Systems ◽

Ptsd Symptoms ◽

Special Operations ◽

Comorbidity Burden ◽

Symptom Intensity ◽

Neurobehavioral Symptoms ◽

Special Operations Forces

ABSTRACT Introduction Special Operations Forces (SOF) personnel are at increased risk for traumatic brain injury (TBI), when compared with conventional forces (CF). Prior studies of TBI in military samples have not typically investigated SOF vs. CF as specific subgroups, despite documented differences in premorbid resilience and post-injury comorbidity burden. The aim of the current study was to compare SOF vs. CF on the presence of neurobehavioral symptoms after TBI, as well as factors influencing perception of symptom intensity. Materials and Methods This study conducted an analysis of the prospective veterans affairs (VA) TBI Model Systems Cohort, which includes service members and veterans (SM/V) who received inpatient rehabilitation for TBI at one of the five VA Polytrauma Rehabilitation Centers. Of those with known SOF status (N = 342), 129 participants identified as SOF (average age = 43 years, 98% male) and 213 identified as CF (average age = 38.7 years, 91% male). SOF vs. CF were compared on demographics, injury characteristics, and psychological and behavioral health symptoms. These variables were then used to predict neurobehavioral symptom severity in univariable and multivariable analyses. Results SOF personnel reported significantly greater posttraumatic stress disorder (PTSD) symptoms but less alcohol and drug use than the CF. SOF also reported greater neurobehavioral symptoms. When examining those with TBIs of all severities, SOF status was not associated with neurobehavioral symptom severity, while race, mechanism of TBI, and PTSD symptoms were. When examining only those with mTBI, SOF status was associated with lower neurobehavioral symptoms, while PTSD severity, white race, and certain mechanisms of injury were associated with greater neurobehavioral symptoms. Conclusions Among those receiving inpatient treatment for TBI, SOF SM/V reported higher neurobehavioral and symptom severity. PTSD was the strongest predictor of neurobehavioral symptoms and should be considered an important treatment target in both SOF and CF with co-morbid PTSD/TBI. A proactive human performance approach towards identification and treatment of psychological and neurobehavioral symptoms is recommended for SOF.

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