Haran, F J; Slaboda, J C; King, L A; Wright, W G; Houlihan, D; Norris, J N
Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment Journal Article
In: Journal of Neurotrauma, vol. 33, no. 7, pp. 705–711, 2016.
Abstract | Links | BibTeX | Tags: adult, Afghanistan, Article, Balance Error Scoring System, BESS, body posture, brain injury assessment, controlled study, CONVALESCENCE, human, integration, major clinical study, Male, Military, military deployment, mTBI, scoring system, Sensory Organization Test, SOT, traumatic brain injury, visual disorder, War
@article{Haran2016,
title = {Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment},
author = {Haran, F J and Slaboda, J C and King, L A and Wright, W G and Houlihan, D and Norris, J N},
doi = {10.1089/neu.2015.4060},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {7},
pages = {705--711},
abstract = {This study evaluated the utility of the Balance Error Scoring System (BESS) and the Sensory Organization Test (SOT) as tools for the screening and monitoring of Service members (SMs) with mild traumatic brain injury (mTBI) in a deployed setting during the acute and subacute phases of recovery. Patient records (N = 699) were reviewed for a cohort of SMs who sustained a blast-related mTBI while deployed to Afghanistan and were treated at the Concussion Restoration Care Center (CRCC) at Camp Leatherneck. On initial intake into the CRCC, participants completed two assessments of postural control, the BESS, and SOT. SMs with mTBI performed significantly worse on the BESS and SOT when compared with comparative samples. When the SOT data were further examined using sensory ratios, the results indicated that postural instability was primarily a result of vestibular and visual integration dysfunction (r \> 0.62). The main finding of this study was that the sensitivity of the SOT composite score (50-58%) during the acute phase was higher than previous sensitivities found in the sports medicine literature for impact-related trauma. Copyright © 2016 Mary Ann Liebert, Inc.},
keywords = {adult, Afghanistan, Article, Balance Error Scoring System, BESS, body posture, brain injury assessment, controlled study, CONVALESCENCE, human, integration, major clinical study, Male, Military, military deployment, mTBI, scoring system, Sensory Organization Test, SOT, traumatic brain injury, visual disorder, War},
pubstate = {published},
tppubtype = {article}
}
Hoffer, M E; Szczupak, M; Kiderman, A; Crawford, J; Murphy, S; Marshall, K; Pelusso, C; Balaban, C
Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury Journal Article
In: PLoS ONE, vol. 11, no. 1, pp. e0146039, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Vestibular Function Tests, acute disease, Adolescent, adult, Affective Symptoms/et [Etiology], Brain Injuries/di [Diagnosis], Cluster Analysis, Dizziness/et [Etiology], Emergency Service, Fatigue/et [Etiology], Female, Gait Disorders, Headache/et [Etiology], Hospital, Hospitals, Humans, Male, middle aged, Mild Cognitive Impairment/et [Etiology], Military, Nausea/et [Etiology], Neurologic/et [Etiology], Neuropsychological Tests, Principal Component Analysis, Prognosis, Sex Factors, Surveys and Questionnaires, symptom assessment, Trauma Severity Indices, university, Young Adult
@article{Hoffer2016,
title = {Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury},
author = {Hoffer, M E and Szczupak, M and Kiderman, A and Crawford, J and Murphy, S and Marshall, K and Pelusso, C and Balaban, C},
year = {2016},
date = {2016-01-01},
journal = {PLoS ONE},
volume = {11},
number = {1},
pages = {e0146039},
abstract = {Mild Traumatic Brain Injury (mTBI) is a prominent public health issue. To date, subjective symptom complaints primarily dictate diagnostic and treatment approaches. As such, the description and qualification of these symptoms in the mTBI patient population is of great value. This manuscript describes the symptoms of mTBI patients as compared to controls in a larger study designed to examine the use of vestibular testing to diagnose mTBI. Five symptom clusters were identified: Post-Traumatic Headache/Migraine, Nausea, Emotional/Affective, Fatigue/Malaise, and Dizziness/Mild Cognitive Impairment. Our analysis indicates that individuals with mTBI have headache, dizziness, and cognitive dysfunction far out of proportion to those without mTBI. In addition, sleep disorders and emotional issues were significantly more common amongst mTBI patients than non-injured individuals. A simple set of questions inquiring about dizziness, headache, and cognitive issues may provide diagnostic accuracy. The consideration of other symptoms may be critical for providing prognostic value and treatment for best short-term outcomes or prevention of long-term complications.},
keywords = {*Brain Injuries/co [Complications], *Vestibular Function Tests, acute disease, Adolescent, adult, Affective Symptoms/et [Etiology], Brain Injuries/di [Diagnosis], Cluster Analysis, Dizziness/et [Etiology], Emergency Service, Fatigue/et [Etiology], Female, Gait Disorders, Headache/et [Etiology], Hospital, Hospitals, Humans, Male, middle aged, Mild Cognitive Impairment/et [Etiology], Military, Nausea/et [Etiology], Neurologic/et [Etiology], Neuropsychological Tests, Principal Component Analysis, Prognosis, Sex Factors, Surveys and Questionnaires, symptom assessment, Trauma Severity Indices, university, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Xydakis, M S; Mulligan, L P; Smith, A B; Olsen, C H; Lyon, D M; Belluscio, L
Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study Journal Article
In: Neurology, vol. 84, pp. 1559–1567, 2015.
Abstract | BibTeX | Tags: Military
@article{Xydakis2015,
title = {Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study},
author = {Xydakis, M S and Mulligan, L P and Smith, A B and Olsen, C H and Lyon, D M and Belluscio, L},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {84},
pages = {1559--1567},
address = {Xydakis,Michael S. From Otorhinolaryngology/Head \& Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.)},
abstract = {OBJECTIVE: To determine whether a structured and quantitative assessment of differential olfactory performance-recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group-can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. METHODS: We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 21/2-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. RESULTS: Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70-0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98-9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. CONCLUSION: Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%-51.7%) and specificity of 100% (95% CI 97.7%-100.0%).Copyright © 2015 American Academy of Neurology.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Robinson, M E; Lindemer, E R; Fonda, J R; Milberg, W P; McGlinchey, R E; Salat, D H
Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure Journal Article
In: Human Brain Mapping, vol. 36, pp. 911–922, 2015.
Abstract | BibTeX | Tags: Military
@article{Robinson2015,
title = {Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure},
author = {Robinson, M E and Lindemer, E R and Fonda, J R and Milberg, W P and McGlinchey, R E and Salat, D H},
year = {2015},
date = {2015-01-01},
journal = {Human Brain Mapping},
volume = {36},
pages = {911--922},
address = {Robinson,Meghan E. Neuroimaging Research for Veterans Center (NeRVe), VA Boston Healthcare System, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts.},
abstract = {Although there is emerging data on the effects of blast-related concussion (or mTBI) on cognition, the effects of blast exposure itself on the brain have only recently been explored. Toward this end, we examine functional connectivity to the posterior cingulate cortex, a primary region within the default mode network (DMN), in a cohort of 134 Iraq and Afghanistan Veterans characterized for a range of common military-associated comorbidities. Exposure to a blast at close range (\<10 meters) was associated with decreased connectivity of bilateral primary somatosensory and motor cortices, and these changes were not different from those seen in participants with blast-related mTBI. These results remained significant when clinical factors such as sleep quality, chronic pain, or post traumatic stress disorder were included in the statistical model. In contrast, differences in functional connectivity based on concussion history and blast exposures at greater distances were not apparent. Despite the limitations of a study of this nature (e.g., assessments long removed from injury, self-reported blast history), these data demonstrate that blast exposure per se, which is prevalent among those who served in Iraq and Afghanistan, may be an important consideration in Veterans' health. It further offers a clinical guideline for determining which blasts (namely, those within 10 meters) are likely to lead to long-term health concerns and may be more accurate than using concussion symptoms alone.Copyright Published 2014. This article is a U.S. Government work and is in the public domain in the USA.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bogner, J; French, L M; Lange, R T; Corrigan, J D
Pilot study of traumatic brain injury and alcohol misuse among service members Journal Article
In: Brain Injury, vol. 29, pp. 905–914, 2015.
Abstract | BibTeX | Tags: Military
@article{Bogner2015,
title = {Pilot study of traumatic brain injury and alcohol misuse among service members},
author = {Bogner, J and French, L M and Lange, R T and Corrigan, J D},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {905--914},
address = {Bogner,Jennifer. The Ohio State University , Columbus, OH , USA .},
abstract = {OBJECTIVE: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse. PARTICIPANTS: Service members (n=93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom. METHODS AND MATERIALS: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-III, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory. RESULTS: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse. CONCLUSIONS: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ling, G; Ecklund, J M; Bandak, F A
Brain injury from explosive blast: description and clinical management Journal Article
In: Handbook of Clinical Neurology, vol. 127, pp. 173–180, 2015.
Abstract | BibTeX | Tags: Military
@article{Ling2015,
title = {Brain injury from explosive blast: description and clinical management},
author = {Ling, G and Ecklund, J M and Bandak, F A},
year = {2015},
date = {2015-01-01},
journal = {Handbook of Clinical Neurology},
volume = {127},
pages = {173--180},
address = {Ling,G. Department of Neurology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address: geoffrey.ling@usuhs.edu. Ecklund,J M. Department of Neurosciences, Inova Fairfax Medical Cam},
abstract = {Accumulating clinical experience is indicating that explosive blast brain injury is becoming recognized as a disease distinct from the penetrating form of blast injury as well as the classic closed head injury (CHI). In recent US conflicts in Iraq and Afghanistan, over 60% of combat casualties were from explosive blast with the hallmark explosive weapon being the improvised explosive device (IED). Explosive blast TBI is a condition afflicting many combat injured warfighters potentially constituting another category of TBI. Clinically, it shares many features with conventional TBI but possesses some unique aspects. In its mild form, it also shares many clinical features with PTSD but here again has distinct aspects. Although military medical providers depend on civilian standard of care guidelines when managing explosive blast mTBI, they are continually adapting their medical practice in order to optimize the treatment of this disease, particularly in a theater of war. It is clear that further rigorous scientific study of explosive blast mTBI at both the basic science and clinical levels is needed. This research must include improved understanding of the causes and mechanisms of explosive blast TBI as well as comprehensive epidemiologic studies to determine the prevalence of this disease and its risk factors. A widely accepted unambiguous clinical description of explosive blast mTBI with diagnostic criteria would greatly improve diagnosis. It is hoped that through appropriate research meaningful prevention, mitigation, and treatment strategies for explosive blast mTBI can be speedily realized.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Newsome, M R; Durgerian, S; Mourany, L; Scheibel, R S; Lowe, M J; Beall, E B; Koenig, K A; Parsons, M; Troyanskaya, M; Reece, C; Wilde, E; Fischer, B L; Jones, S E; Agarwal, R; Levin, H S; Rao, S M
Disruption of caudate working memory activation in chronic blast-related traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 543–553, 2015.
Abstract | BibTeX | Tags: Military
@article{Newsome2015,
title = {Disruption of caudate working memory activation in chronic blast-related traumatic brain injury},
author = {Newsome, M R and Durgerian, S and Mourany, L and Scheibel, R S and Lowe, M J and Beall, E B and Koenig, K A and Parsons, M and Troyanskaya, M and Reece, C and Wilde, E and Fischer, B L and Jones, S E and Agarwal, R and Levin, H S and Rao, S M},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {543--553},
address = {Newsome,Mary R. Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA ; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. Durgerian,Sally. Department of Neurology, Medic},
abstract = {Mild to moderate traumatic brain injury (TBI) due to blast exposure is frequently diagnosed in veterans returning from the wars in Iraq and Afghanistan. However, it is unclear whether neural damage resulting from blast TBI differs from that found in TBI due to blunt-force trauma (e.g., falls and motor vehicle crashes). Little is also known about the effects of blast TBI on neural networks, particularly over the long term. Because impairment in working memory has been linked to blunt-force TBI, the present functional magnetic resonance imaging (fMRI) study sought to investigate whether brain activation in response to a working memory task would discriminate blunt-force from blast TBI. Twenty-five veterans (mean age = 29.8 years, standard deviation = 6.01 years, 1 female) who incurred TBI due to blast an average of 4.2 years prior to enrollment and 25 civilians (mean age = 27.4 years, standard deviation = 6.68 years, 4 females) with TBI due to blunt-force trauma performed the Sternberg Item Recognition Task while undergoing fMRI. The task involved encoding 1, 3, or 5 items in working memory. A group of 25 veterans (mean age = 29.9 years, standard deviation = 5.53 years, 0 females) and a group of 25 civilians (mean age = 27.3 years, standard deviation = 5.81 years, 0 females) without history of TBI underwent identical imaging procedures and served as controls. Results indicated that the civilian TBI group and both control groups demonstrated a monotonic relationship between working memory set size and activation in the right caudate during encoding, whereas the blast TBI group did not (p \< 0.05, corrected for multiple comparisons using False Discovery Rate). Blast TBI was also associated with worse performance on the Sternberg Item Recognition Task relative to the other groups, although no other group differences were found on neuropsychological measures of episodic memory, inhibition, and general processing speed. These results could not be attributed to caudate atrophy or the presence of PTSD symptoms. Our results point to a specific vulnerability of the caudate to blast injury. Changes in activation during the Sternberg Item Recognition Task, and potentially other tasks that recruit the caudate, may serve as biomarkers for blast TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Dretsch, M N; Kelly, M P; Coldren, R L; Parish, R V; Russell, M L
In: Journal of Neurotrauma, vol. 32, no. 16, pp. 1217–1222, 2015.
Abstract | Links | BibTeX | Tags: 2003-2011, acute disease, Adolescent, adult, amnesia, ANAM, Article, assessment of humans, Automated Neuropsychological Assessment Metrics, Blast injuries, blast injury, blunt trauma, brain concussion, clinical article, cognition, Cognition Disorders, cognitive screening, comparative study, complication, concussion mechanism, Demography, deployment, Female, follow up, health status, human, Humans, Iraq War, Male, middle aged, Military, Military Acute Concussion Evaluation, Military personnel, neuropsychological test, Neuropsychological Tests, soldier, unconsciousness, UNITED States, War, Young Adult
@article{Dretsch2015a,
title = {No Significant Acute and Subacute Differences between Blast and Blunt Concussions across Multiple Neurocognitive Measures and Symptoms in Deployed Soldiers},
author = {Dretsch, M N and Kelly, M P and Coldren, R L and Parish, R V and Russell, M L},
doi = {10.1089/neu.2014.3637},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {16},
pages = {1217--1222},
abstract = {Seventy-one deployed U.S. Army soldiers who presented for concussion care due to either blast or blunt mechanisms within 72 h of injury were assessed using the Military Acute Concussion Evaluation, the Automated Neuropsychological Assessment Metrics (ANAM), traditional neuropsychological tests, and health status questionnaires. Follow-up ANAM testing was performed 10 d after initial testing (±5 d). Twenty-one soldiers were excluded: two for poor effort and 19 who had combined blast/blunt injuries. Of the remaining 50 male participants, 34 had blast injuries and 16 had blunt injuries. There were no statistically significant differences between blast injury and blunt injury participants in demographic, physical, or psychological health factors, concussive symptoms, or automated and traditional neurocognitive testing scores within 72 h post-injury. In addition, follow-up ANAM scores up to 15 d post-injury were not significantly different (available on 21 blast-injured and 13 blunt-injured subjects). Pre-injury baseline ANAM scores were compared where available, and revealed no statistically significant differences between 22 blast injury and eight blunt injury participants. These findings suggest there are no significant differences between mechanisms of injury during both the acute and subacute periods in neurobehavioral concussion sequelae while deployed in a combat environment. The current study supports the use of sports/mechanical concussion models for early concussion management in the deployed setting and exploration of variability in potential long-term outcomes. © Copyright 2015, Mary Ann Liebert, Inc.},
keywords = {2003-2011, acute disease, Adolescent, adult, amnesia, ANAM, Article, assessment of humans, Automated Neuropsychological Assessment Metrics, Blast injuries, blast injury, blunt trauma, brain concussion, clinical article, cognition, Cognition Disorders, cognitive screening, comparative study, complication, concussion mechanism, Demography, deployment, Female, follow up, health status, human, Humans, Iraq War, Male, middle aged, Military, Military Acute Concussion Evaluation, Military personnel, neuropsychological test, Neuropsychological Tests, soldier, unconsciousness, UNITED States, War, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Cook, G A; Hawley, J S
A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology Journal Article
In: Military Medicine, vol. 179, pp. 1083–1089, 2014.
Abstract | Links | BibTeX | Tags: Military
@article{Cook2014,
title = {A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology},
author = {Cook, G A and Hawley, J S},
doi = {10.7205/MILMED-D-13-00435},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1083--1089},
abstract = {Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies\textemdashsoluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography\textemdashthat are of particular interest within military medicine. © AMSUS. All rights reserved.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
McCrea, M; Guskiewicz, K; Doncevic, S; Helmick, K; Kennedy, J; Boyd, C; Asmussen, S; Ahn, K W; Wang, Y; Hoelzle, J; Jaffee, M
Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF Journal Article
In: Military Medicine, vol. 179, pp. 990–997, 2014.
Abstract | BibTeX | Tags: Military
@article{McCrea2014,
title = {Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF},
author = {McCrea, M and Guskiewicz, K and Doncevic, S and Helmick, K and Kennedy, J and Boyd, C and Asmussen, S and Ahn, K W and Wang, Y and Hoelzle, J and Jaffee, M},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {990--997},
address = {McCrea,Michael. Departments of Neurosurgery and Neurology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226. Guskiewicz,Kevin. Injury Prevention Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall},
abstract = {OBJECTIVES: The study investigated the clinical validity of the cognitive screening component of the Military Acute Concussion Evaluation (MACE) for the evaluation of acute mild traumatic brain injury (mTBI) in a military operational setting. METHODS: This was a retrospective data study involving analysis of MACE data on Operation Enduring Freedom/Operation Iraqi Freedom deployed service members with mTBI. In total, 179 cases were included in analyses based on ICD-9 diagnostic codes and characteristics of mTBI, and availability of MACE data on day of injury. MACE data from the mTBI group was compared to a military sample without mTBI administered the MACE as part of a normative data project. RESULTS: On day of injury, the mTBI group performed worse than controls on the MACE cognitive test (d = 0.90), with significant impairments in all cognitive domains assessed. MACE cognitive score was strongly associated with established indicators of acute injury severity. Lower MACE cognitive performance on day of injury was predictive of lengthier postinjury recovery time and time until return to duty after mTBI. CONCLUSIONS: Findings from the current study support the use of the MACE as a valid screening tool to assess for cognitive dysfunction in military service members during the acute phase after mTBI.Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Johnson, M A; Hawley, J S; Theeler, B J
Management of acute concussion in a deployed military setting Journal Article
In: Current Treatment Options in Neurology, vol. 16, pp. 311, 2014.
Abstract | BibTeX | Tags: Military
@article{Johnson2014a,
title = {Management of acute concussion in a deployed military setting},
author = {Johnson, M A and Hawley, J S and Theeler, B J},
year = {2014},
date = {2014-01-01},
journal = {Current Treatment Options in Neurology},
volume = {16},
pages = {311},
address = {Johnson,Michael A L. Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of Health Sciences, 8901 Rockville Pike, Bethesda, MD, 20889-5600, USA, maullionheart@gmail.com.},
abstract = {OPINION STATEMENT: The DoD has established clinical guidelines and policies creating a system of care for the management of battlefield concussion. Within these instructions, medical providers have standardized guidance for screening and diagnosing concussion, along with guidelines for treating common concussion symptoms. Underlying these policies is the principle that concussion is an important injury, and SMs need to be removed from combat during the acute period to ensure full recovery before return to duty. As our understanding of concussion advances, the DoD will incorporate these advances into the current system of care, ensuring that SMs have the highest level of care possible for concussions sustained on the battlefield.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
de Lanerolle, N C; Hamid, H; Kulas, J; Pan, J W; Czlapinski, R; Rinaldi, A; Ling, G; Bandak, F A; Hetherington, H P
Concussive brain injury from explosive blast Journal Article
In: Annals of Clinical & Translational Neurology, vol. 1, pp. 692–702, 2014.
Abstract | BibTeX | Tags: Military
@article{DeLanerolle2014,
title = {Concussive brain injury from explosive blast},
author = {de Lanerolle, N C and Hamid, H and Kulas, J and Pan, J W and Czlapinski, R and Rinaldi, A and Ling, G and Bandak, F A and Hetherington, H P},
year = {2014},
date = {2014-01-01},
journal = {Annals of Clinical \& Translational Neurology},
volume = {1},
pages = {692--702},
address = {de Lanerolle,Nihal C. Department of Neurosurgery, Yale University New Haven, Connecticut, 06520. Hamid,Hamada. Department of Neurology, Yale University New Haven, Connecticut, 06520 ; Department of Psychiatry, Yale University New Haven, Connecticut, 06520},
abstract = {OBJECTIVE: Explosive blast mild traumatic brain injury (mTBI) is associated with a variety of symptoms including memory impairment and posttraumatic stress disorder (PTSD). Explosive shock waves can cause hippocampal injury in a large animal model. We recently reported a method for detecting brain injury in soldiers with explosive blast mTBI using magnetic resonance spectroscopic imaging (MRSI). This method is applied in the study of veterans exposed to blast. METHODS: The hippocampus of 25 veterans with explosive blast mTBI, 20 controls, and 12 subjects with PTSD but without exposure to explosive blast were studied using MRSI at 7 Tesla. Psychiatric and cognitive assessments were administered to characterize the neuropsychiatric deficits and compare with findings from MRSI. RESULTS: Significant reductions in the ratio of N-acetyl aspartate to choline (NAA/Ch) and N-acetyl aspartate to creatine (NAA/Cr) (P \< 0.05) were found in the anterior portions of the hippocampus with explosive blast mTBI in comparison to control subjects and were more pronounced in the right hippocampus, which was 15% smaller in volume (P \< 0.05). Decreased NAA/Ch and NAA/Cr were not influenced by comorbidities - PTSD, depression, or anxiety. Subjects with PTSD without blast had lesser injury, which tended to be in the posterior hippocampus. Explosive blast mTBI subjects had a reduction in visual memory compared to PTSD without blast. INTERPRETATION: The region of the hippocampus injured differentiates explosive blast mTBI from PTSD. MRSI is quite sensitive in detecting and localizing regions of neuronal injury from explosive blast associated with memory impairment.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Spooner, S P; Tyner, S D; Sowers, C; Tsao, J; Stuessi, K
Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care Journal Article
In: Military Medicine, vol. 179, pp. 1319–1324, 2014.
Abstract | BibTeX | Tags: Military
@article{Spooner2014,
title = {Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care},
author = {Spooner, S P and Tyner, S D and Sowers, C and Tsao, J and Stuessi, K},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1319--1324},
address = {Spooner,Shawn P. Captain James A. Lovell Federal Healthcare Center, 3001 Green Bay Road, North Chicago, IL 60064. Tyner,Stuart D. U.S. Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Pass Ste B, JBSA FT Sam Houston, TX 78234-7767. Sow},
abstract = {Combat-related concussions are significant sources of injury and morbidity among deployed military service members. Musculoskeletal injury also is one of the most prevalent battle and nonbattle-related deployed injury types. Both injuries threaten the service member's physical condition as well as unit and mission readiness due to reduced duty status or evacuation from military theater of operations. In August 2010, the Concussion Restoration Care Center (CRCC) was established at Camp Leatherneck, Afghanistan, to address the need for consistent and specialized evaluation and care of concussion and musculoskeletal injury. This performance improvement effort examined evaluation and treatment of concussion and musculoskeletal injury at the CRCC. Among 4,947 military personnel evaluated at the CRCC between August 2010 and May 2013, 97.9% were returned to duty and retained in theater. Members averaged 10 to 12 days of limited duty status to achieve complete recovery. Concussion injury was secondary to blast injury in 90% of cases. Sport/recreation, occupational, and other accidental injuries each represented 30% of the musculoskeletal injuries with only 10% reported as result of combat. The utilization patterns and outcome measures demonstrate the success and utility of a multidisciplinary clinical model of care for these two types of injuries in the far-forward deployed setting. Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Miller, Kelly J; Ivins, Brian J; Schwab, Karen A
Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 31–38, 2013.
Abstract | BibTeX | Tags: Military
@article{Miller2013a,
title = {Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI},
author = {Miller, Kelly J and Ivins, Brian J and Schwab, Karen A},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {31--38},
address = {Defense and Veterans Brain Injury Center, Rockville, Maryland (Ms Miller, Mr Ivins, and Dr Schwab); and Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Schwab).},
abstract = {OBJECTIVE: : To investigate the potential cumulative impact of mild traumatic brain injury (MTBI) on postconcussive symptoms. PARTICIPANTS: : A total of 224 active duty soldiers reporting MTBI within 1 year of testing. For 101, this MTBI was their only reported traumatic brain injury (TBI); 123 had sustained at least 1 additional MTBI during their lifetime. A No TBI control group (n = 224) was included for comparison. MAIN MEASURE: : Self-report symptoms data via questionnaire. Within time since injury subgroups (\<=3 months; Post-3 months), symptom endorsement (no symptoms, 1 or 2 symptoms, 3+ symptoms) among soldiers with 1 MTBI was compared with that of soldiers with 2 or more MTBIs. Injured soldiers' symptom endorsement was compared with that of soldiers who had not sustained a TBI. RESULTS: : Among the recently injured (\<=3 months), those with 2 or more MTBIs endorsed significantly more symptoms than those with 1 MTBI: 67% of soldiers with 2 or more MTBIs reported 3+ symptoms, versus 29% of One MTBI soldiers. Among Post-3 month soldiers, there were no significant differences between MTBI groups. Overall, soldiers with MTBI endorsed significantly more symptoms than those without TBI. CONCLUSION: : Past experience of MTBI may be a risk factor for increased symptom difficulty for several months postinjury. Clinicians should ascertain lifetime history of brain injury when evaluating patients for MTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Weaver, L; Manukyan, Z; Halberstadt, S M; Lindblad, A S
In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury Journal Article
In: Military Medicine, vol. 178, pp. viii–ix, 2013.
@article{Weaver2013,
title = {In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury},
author = {Weaver, L and Manukyan, Z and Halberstadt, S M and Lindblad, A S},
year = {2013},
date = {2013-01-01},
journal = {Military Medicine},
volume = {178},
pages = {viii--ix},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Lamberty, Greg J; Nelson, Nathaniel W; Yamada, Torrii
Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications Journal Article
In: Behavioral Sciences & the Law, vol. 31, pp. 814–832, 2013, ISSN: 1099-0798.
Abstract | Links | BibTeX | Tags: Military
@article{Lamberty2013,
title = {Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications},
author = {Lamberty, Greg J and Nelson, Nathaniel W and Yamada, Torrii},
doi = {10.1002/bsl.2091},
issn = {1099-0798},
year = {2013},
date = {2013-01-01},
journal = {Behavioral Sciences \& the Law},
volume = {31},
pages = {814--832},
abstract = {Traumatic brain injury (TBI) is a prominent public health problem in both civilian and military settings. This article discusses similarities and differences in the assessment and treatment of TBI and the attendant forensic implications. Acute care and management of moderate/severe TBI tend to be similar across environments, as is the recognition of disability status in affected individuals. By contrast, an increased focus on mild TBI in recent years has resulted in a reliance on self-report and screening measures to validate the occurrence of events leading to injury. This has complicated assessment, treatment and subsequent medicolegal proceedings. The neuropsychological literature has provided significant guidance on these difficult issues, although the complexity of disability adjudication for active duty members of the military and veterans continues to pose challenges for clinicians in evaluative and treatment contexts.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Mendez, Mario F; Owens, Emily M; Jimenez, Elvira E; Peppers, Dominique; Licht, Eliot A
Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces Journal Article
In: Brain Injury, vol. 27, pp. 10–18, 2013.
Abstract | BibTeX | Tags: Military
@article{Mendez2013,
title = {Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces},
author = {Mendez, Mario F and Owens, Emily M and Jimenez, Elvira E and Peppers, Dominique and Licht, Eliot A},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {10--18},
address = {Department of Neurology.},
abstract = {Introduction: Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI). Objective: This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI. Methods: Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n=12), as compared to those who sustained pure blunt-force mTBI (n=12). Inclusion criteria included absence of any mixed blast-blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe). Results: There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof-introverted and apathetic. Conclusion: These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bryan, Craig J; Clemans, Tracy A; Hernandez, Ann Marie; Rudd, Michael David
Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 13–20, 2013.
Abstract | BibTeX | Tags: Military
@article{Bryan2013,
title = {Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury},
author = {Bryan, Craig J and Clemans, Tracy A and Hernandez, Ann Marie and Rudd, Michael David},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {13--20},
address = {National Center for Veterans Studies, University of Utah, Salt Lake City (Drs Bryan and Rudd); VISN 19 Mental Illness Research Education Clinical Center, Department of Psychiatry, University of Colorado Denver School of Medicine, Denver (Dr Clemans); and},
abstract = {OBJECTIVE: : To identify clinical variables associated with suicidality in military personnel with mild traumatic brain injury (mTBI) while deployed to Iraq. SETTING: : Outpatient TBI clinic on a US military base in Iraq. PARTICIPANTS: : Military personnel (N = 158) referred to an outpatient TBI clinic for a standardized intake evaluation, 135 (85.4%) who had a diagnosis of mTBI and 23 (14.6%) who did not meet criteria for TBI. MAIN MEASURES: : Suicidal Behaviors Questionnaire-Revised, Depression subscale of the Behavioral Health Measure-20, Posttraumatic Stress Disorder Checklist-Military Version, Insomnia Severity Index, self-report questionnaire, and clinical interview addressing TBI-related symptoms. RESULTS: : Among patients with mTBI, increased suicidality was significantly associated with depression and the interaction of depression with posttraumatic stress disorder symptoms. Longer duration of loss of consciousness was associated with decreased likelihood for any suicidality. CONCLUSION: : Assessment after TBI in a combat zone may assist providers in identifying those at risk for suicidality and making treatment recommendations for service members with mTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Larson, Eric B; Kondiles, Bethany R; Starr, Christine R; Zollman, Felise S
Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 88–95, 2013.
Abstract | BibTeX | Tags: Military
@article{Larson2013a,
title = {Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans},
author = {Larson, Eric B and Kondiles, Bethany R and Starr, Christine R and Zollman, Felise S},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {88--95},
address = {1 Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois.},
abstract = {The etiology of postconcussive symptoms is not clearly understood. Development of etiological models of those symptoms will be helpful for accurate diagnosis and for planning effective treatment. Such a model should characterize the role of subject characteristics (education, premorbid intelligence), social psychological factors and symptom validity. Toward that end, the present study examined the association of postconcussive complaints and cognitive performance with symptom attribution and level of effort on testing. In a sample of 155 veterans, attribution to concussion was associated with endorsement of more severe postconcussive complaints, after controlling for the effects of other factors such as subject characteristics. Similarly, effort was associated with cognitive performance after controlling for the effects of these other factors. The present findings are consistent with previous reports that illness perception and effort on testing are associated with postconcussive complaints. This supports previous recommendations to routinely educate all concussion patients immediately after injury to reduce distorted perceptions and related persistent complaints. Finally, these findings highlight a need for routine assessment of patients' perception of their injury to identify cases that may require psychotherapy to address any misattributions that develop. (JINS, 2013, 19, 1-8).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Macgregor, Andrew J; Dougherty, Amber L; Tang, Janet J; Galarneau, Michael R
Postconcussive Symptom Reporting Among US Combat Veterans With Mild Traumatic Brain Injury From Operation Iraqi Freedom Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 59–67, 2013.
Abstract | BibTeX | Tags: Military
@article{Macgregor2013,
title = {Postconcussive Symptom Reporting Among US Combat Veterans With Mild Traumatic Brain Injury From Operation Iraqi Freedom},
author = {Macgregor, Andrew J and Dougherty, Amber L and Tang, Janet J and Galarneau, Michael R},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {59--67},
address = {Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center, San Diego, California.},
abstract = {OBJECTIVE: : To examine the association between postconcussive symptoms and mild traumatic brain injury (MTBI) among combat veterans while adjusting for posttraumatic stress disorder (PTSD) and depression. PATIENTS: : Military personnel with provider-diagnosed MTBI (n = 334) or nonhead injury (n = 658) were identified from the Expeditionary Medical Encounter Database. MAIN OUTCOME MEASURES: : Post-Deployment Health Assessments and Re-Assessments were used to examine postconcussive symptoms and self-rated health. RESULTS: : Personnel with MTBI were more likely to report headache (odds ratio [OR] = 3.37; 95% confidence interval [CI] = 2.19-5.17), back pain (OR = 1.79; 95% CI = 1.23-2.60), memory problems (OR = 1.86; 95% CI = 1.20-2.88), tinnitus (OR = 1.63; 95% CI = 1.10-2.41), and dizziness (OR = 2.13; 95% CI = 1.06-4.29) compared with those with non-head injuries. Among those with MTBI, self-reported decline in health was associated with memory problems (OR = 5.07; 95% CI = 2.56-10.02) and dizziness (OR = 10.60; 95% CI = 3.48-32.27). CONCLUSIONS: : Mild traumatic brain injury is associated with reports of negative health consequences among combat veterans even when accounting for co-occurring psychological morbidity. The identification of postconcussive symptoms related to declines in a service member's self-rated health may be important in targeting and prioritizing clinical interventions.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Verfaellie, Mieke; Lafleche, Ginette; Spiro, Avron; Tun, Carlos; Bousquet, Kathryn
Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 1–10, 2013.
Abstract | BibTeX | Tags: Military
@article{Verfaellie2013,
title = {Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure},
author = {Verfaellie, Mieke and Lafleche, Ginette and Spiro, Avron and Tun, Carlos and Bousquet, Kathryn},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {1--10},
address = {1 Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts.},
abstract = {Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment. (JINS, 2013, 19, 1-10).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Capehart, Bruce; Bass, Dale
Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury Journal Article
In: Journal of Rehabilitation Research & Development, vol. 49, pp. 789–812, 2012.
Abstract | BibTeX | Tags: Military
@article{Capehart2012,
title = {Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury},
author = {Capehart, Bruce and Bass, Dale},
year = {2012},
date = {2012-01-01},
journal = {Journal of Rehabilitation Research \& Development},
volume = {49},
pages = {789--812},
address = {Durham VA Medical Center OEF/OIF Program and Mental Health Service Line (116A), 508 Fulton St, Durham, NC 27705. bruce.capehart@va.gov.},
abstract = {Military deployments to Afghanistan and Iraq have been associated with elevated prevalence of both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) among combat veterans. The diagnosis and management of PTSD when a comorbid TBI may also exist presents a challenge to interdisciplinary care teams at Department of Veterans Affairs (VA) and civilian medical facilities, particularly when the patient reports a history of blast exposure. Treatment recommendations from VA and Department of Defense's (DOD) recently updated VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress are considered from the perspective of simultaneously managing comorbid TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Hoffman, Stuart N; Zhang, Xiaopeng; Erlich, Porat M; Boscarino, Joseph A
Grapheme-color synesthesia and posttraumatic stress disorder: preliminary results from the veterans health study Journal Article
In: Psychosomatic Medicine, vol. 74, pp. 912–915, 2012.
Abstract | BibTeX | Tags: Military
@article{Hoffman2012,
title = {Grapheme-color synesthesia and posttraumatic stress disorder: preliminary results from the veterans health study},
author = {Hoffman, Stuart N and Zhang, Xiaopeng and Erlich, Porat M and Boscarino, Joseph A},
year = {2012},
date = {2012-01-01},
journal = {Psychosomatic Medicine},
volume = {74},
pages = {912--915},
address = {MPH, Center for Health Research, Geisinger Clinic, 100 N Academy Ave, Danville, PA 17822-4400. jaboscarino@geisinger.edu.},
abstract = {Objective Posttraumatic stress disorder (PTSD) is associated with altered neuropsychological function, possibly including complex visual information processing. Grapheme-color synesthesia refers to the phenomenon that a particular letter or number elicits the visual perception of a specific color. The study objective was to assess if grapheme-color synesthesia was associated with PTSD among US veterans. Method We surveyed 700 veterans who were outpatients in a multihospital system in Pennsylvania. All veterans had served at least one warzone deployment. PTSD and grapheme-color synesthesia were assessed using validated research instruments. Results The mean age of veterans was 59 years, and 96% were men. The prevalence of current PTSD was 7% (95% confidence interval [CI] = 5.1-8.8), and current partial PTSD was 11% (95% CI = 9.3-14.0). The prevalence of current depression was 6% (95% CI = 4.7-8.3). Altogether, 6% (95% CI = 4.8-8.5) of veterans screened positive for grapheme-color synesthesia. Bivariate analyses suggested that grapheme-color synesthesia was associated with current PTSD (odds ratio [OR] = 3.4},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vincent, A S; Roebuck-Spencer, T; Gilliland, K; Schlegel, R
Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury Battery: Military normative data Journal Article
In: Military Medicine, vol. 177, pp. 256–269, 2012, ISSN: 0026-4075.
Abstract | BibTeX | Tags: Military
@article{Vincent2012,
title = {Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury Battery: Military normative data},
author = {Vincent, A S and Roebuck-Spencer, T and Gilliland, K and Schlegel, R},
issn = {0026-4075},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {256--269},
abstract = {The aim of the present study was to establish normative data for the Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury (ANAM4 TBI) battery in a military context. ANAM4 data from over 107,500 active duty service members ranging from 17 to 65 years of age were included in this study. The influence of the demographic variables of age and gender were also examined. These norms, stratified by age and gender, represent a more comprehensive set of norms than previously available and are provided as a representative set of norms for clinical practice. Additionally, base rates of below average performance in a normal population are provided to help inform clinical decision making.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Hampton, Carolyn E; Vandevord, Pamela J
Vibrational frequency response to impact loading of skull models Journal Article
In: Biomedical Sciences Instrumentation, vol. 48, pp. 157–164, 2012.
Abstract | BibTeX | Tags: Military
@article{Hampton2012,
title = {Vibrational frequency response to impact loading of skull models},
author = {Hampton, Carolyn E and Vandevord, Pamela J},
year = {2012},
date = {2012-01-01},
journal = {Biomedical Sciences Instrumentation},
volume = {48},
pages = {157--164},
address = {Wayne State University.},
abstract = {More than 73% of soldiers returning from duty are injured by explosive devices. The shock waves generated are believed to cause injury via intracranial pressure and skull flexure. Prior modal analyses of spherical shells as skull substitutes using analytical solutions to the wave equation indicate the impact point and opposite side as areas of intense bending. In this study, finite element models extend modal analyses and applied impulse scenarios for a variety of altered spherical geometries. Holes of differing sizes, the direction of impact, and the presence of water inside were considered. The finite element model matched the analytical modal frequencies within 4%. The discrete modal frequencies are lost as the geometry deviates from the ideal sphere. The frequency response to impact was complex with many participating modal frequencies. The deformation near holes increased as the hole increased in size. Impacts in line with holes increased the minimum to maximum spread by 30% whereas angled impacts caused more pronounced motion near holes. Filling the sphere interior with liquid diverted some load from the shell and decreased the maximum deflections by 80%. Avenues of further research focused on more accurate geometries are discussed.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Tsai, Jack; Whealin, Julia M; Scott, J Cobb; Harpaz-Rotem, Ilan; Pietrzak, Robert H
Examining the relation between combat-related concussion, a novel 5-factor model of posttraumatic stress symptoms, and health-related quality of life in Iraq and Afghanistan veterans Journal Article
In: Journal of Clinical Psychiatry, vol. 73, pp. 1110–1118, 2012.
Abstract | BibTeX | Tags: Military
@article{Tsai2012,
title = {Examining the relation between combat-related concussion, a novel 5-factor model of posttraumatic stress symptoms, and health-related quality of life in Iraq and Afghanistan veterans},
author = {Tsai, Jack and Whealin, Julia M and Scott, J Cobb and Harpaz-Rotem, Ilan and Pietrzak, Robert H},
year = {2012},
date = {2012-01-01},
journal = {Journal of Clinical Psychiatry},
volume = {73},
pages = {1110--1118},
address = {Yale University, Department of Psychiatry, 950 Campbell Ave, 151D, West Haven, CT 06516 Jack.Tsai@yale.edu.},
abstract = {OBJECTIVE: This study examined demographic, military, and clinical characteristics associated with combat-related concussion and persistent postconcussive symptoms; and how combat-related concussion and persistent postconcussive symptoms and a novel 5-factor model of posttraumatic stress disorder (PTSD) symptoms are related to physical and mental health-related quality of life in veterans who served in Iraq and Afghanistan. METHOD: 233 veterans recruited from the Veterans Affairs Hawaii Program Registry who served in Iraq and Afghanistan completed a survey in 2010 that assessed combat-related concussion and persistent postconcussive symptoms, PTSD (DSM-IV criteria), alcohol use problems, and physical and mental health-related quality of life. The primary measure was physical and mental health-related quality of life as assessed by the 12-item Short-Form Health Survey, version 2. RESULTS: Veterans who screened positive for combat-related concussion and persistent postconcussive symptoms were more likely than those who did not to report direct combat exposure (chi2 = 15.46, P \< .001), living in a rural area (chi2 = 6.86, P \< .01), and screening positive for PTSD (chi2 = 37.67, P \< .001) and alcohol use problems (chi2 = 11.62, P \< .01); 57.3% of veterans who screened positive for combat-related concussion and persistent postconcussive symptoms screened positive for PTSD. In bivariate analyses, combat-related concussion and persistent postconcussive symptoms were associated with lower scores on measures of physical and mental health-related quality of life (r = -0.27 to -0.45, P \< .001). In multivariate analyses, combat-related concussion and persistent postconcussive symptoms were no longer related to these outcomes, with PTSD-related dysphoric arousal symptoms as the strongest predictor of physical health-related quality of life (beta = -0.55, P \< .001) and PTSD-related emotional numbing symptoms (beta = -0.56, P \< .001) as the strongest predictor of mental health-related quality of life. CONCLUSIONS: Results of this study suggest that a 5-factor model of PTSD symptoms may provide greater specificity in understanding the relation between combat-related concussion and persistent postconcussive symptoms, PTSD symptoms, and health-related physical and mental quality of life in Iraq/Afghanistan veterans. Psychiatric clinicians should consider this heterogeneity of PTSD symptoms when assessing and treating symptomatic veterans.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Kennedy, Carrie H; Porter Evans, J; Chee, Shawnna; Moore, Jeffrey L; Barth, Jeffrey T; Stuessi, Keith A
Return to combat duty after concussive blast injury Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 817–827, 2012.
Abstract | BibTeX | Tags: Military
@article{Kennedy2012,
title = {Return to combat duty after concussive blast injury},
author = {Kennedy, Carrie H and {Porter Evans}, J and Chee, Shawnna and Moore, Jeffrey L and Barth, Jeffrey T and Stuessi, Keith A},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {817--827},
address = {Department of Behavioral Sciences, Marine Corps Embassy Security Group, Quantico, VA, USA.},
abstract = {Little data exist regarding the acute assessment of blast concussion and the course of recovery in the combat zone, as most research has examined service members long after they have returned home. This manuscript examined a case series of 377 service members seen for acute concussion evaluation following medical evacuation from the battlefield in Helmand Province, Afghanistan. Of these, 111 were assessed for concussion prior to their return to the continental USA for other severe physical injuries. Of the remainder, and when comparing those who returned to duty (RTD)/recovered from concussion in the combat zone and those who did not, data indicate that those who did not RTD were older and were more likely to endorse symptoms of combat stress. Quicker recovery times were associated with less severe headaches and fewer acute symptoms at the time of injury as well as the absence of combat stress reaction. Variables that were not associated with RTD and/or recovery were Military Acute Concussion Evaluation (MACE) cognitive scores and whether or not individuals suffered loss of consciousness. While MACE scores were not associated with recovery, they were deemed clinically useful as a part of a serial concussion evaluation if the initial MACE was given within 6 h of the blast. Implications for battlefield concussion assessment and management as well as future research directions are discussed.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Silva, Marc A; Donnell, Alison J; Kim, Michelle S; Vanderploeg, Rodney D
Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls Journal Article
In: Clinical Neuropsychologist, vol. 26, pp. 1102–1116, 2012.
Abstract | BibTeX | Tags: Military
@article{Silva2012,
title = {Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls},
author = {Silva, Marc A and Donnell, Alison J and Kim, Michelle S and Vanderploeg, Rodney D},
year = {2012},
date = {2012-01-01},
journal = {Clinical Neuropsychologist},
volume = {26},
pages = {1102--1116},
address = {a Division of Mental Health and Behavioral Sciences , James A. Haley Veterans' Hospital , Tampa , FL , USA.},
abstract = {In those with a history of mild traumatic brain injury (mTBI), cognitive and emotional disturbances are often misattributed to that preexisting injury. However, causal determinations of current symptoms cannot be conclusively determined because symptoms are often nonspecific to etiology and offer virtually no differential diagnostic value in postacute or chronic phases. This population-based study examined whether the presence of abnormalities during neurological examination would distinguish between mTBI (in the chronic phase), healthy controls, and selected psychiatric conditions. Retrospective analysis of data from 4462 community-dwelling Army veterans was conducted. Diagnostically unique groups were compared on examination of cranial nerve function and other neurological signs. Results demonstrated that individuals with mTBI were no more likely than those with a major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, or somatoform disorder to show any abnormality. Thus, like self-reported cognitive and emotional symptoms, the presence of cranial nerve or other neurological abnormalities offers no differential diagnostic value. Clinical implications and study limitations are presented.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Masel, Brent E; Bell, Randy S; Brossart, Shawn; Grill, Raymond J; Hayes, Ronald L; Levin, Harvey S; Rasband, Matthew N; Ritzel, David V; Wade, Charles E; DeWitt, Douglas S
Galveston Brain Injury Conference 2010: clinical and experimental aspects of blast injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2143–2171, 2012.
Abstract | BibTeX | Tags: Military
@article{Masel2012,
title = {Galveston Brain Injury Conference 2010: clinical and experimental aspects of blast injury},
author = {Masel, Brent E and Bell, Randy S and Brossart, Shawn and Grill, Raymond J and Hayes, Ronald L and Levin, Harvey S and Rasband, Matthew N and Ritzel, David V and Wade, Charles E and DeWitt, Douglas S},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2143--2171},
address = {Transitional Learning Center, Galveston, Texas, USA.},
abstract = {Blast injury is the most prevalent source of mortality and morbidity among combatants in Operations Iraqi and Enduring Freedom. Blast-induced neurotrauma (BINT) is a common cause of mortality, and even mild BINT may be associated with chronic cognitive and emotional deficits. In addition to military personnel, the increasing use of explosives by terrorists has resulted in growing numbers of blast injuries in civilian populations. Since the medical and rehabilitative communities are likely to be faced with increasing numbers of patients suffering from blast injury, the 2010 Galveston Brain Injury Conference focused on topics related to the diagnosis, treatment, and mechanisms of BINT. Although past military actions have resulted in large numbers of blast casualties, BINT is considered the signature injury of the conflicts in Iraq and Afghanistan. The attention focused on BINT has led to increased financial support for research on blast effects, contributing to the development of better experimental models of blast injury and a clearer understanding of the mechanisms of BINT. This more thorough understanding of blast injury mechanisms will result in novel and more effective therapeutic and rehabilitative strategies designed to reduce injury and facilitate recovery, thereby improving long-term outcomes in patients suffering from the devastating and often lasting effects of BINT. The following is a summary of the 2010 Galveston Brain Injury Conference, that included presentations related to the diagnosis and treatment of acute BINT, the evaluation of the long-term neuropsychological effects of BINT, summaries of current experimental models of BINT, and a debate about the relative importance of primary blast effects on the acute and long-term consequences of blast exposure.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Lange, Rael T; Brickell, Tracey A; French, Louis M; Merritt, Victoria C; Bhagwat, Aditya; Pancholi, Sonal; Iverson, Grant L
Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 480–494, 2012.
Abstract | BibTeX | Tags: Military
@article{Lange2012c,
title = {Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel},
author = {Lange, Rael T and Brickell, Tracey A and French, Louis M and Merritt, Victoria C and Bhagwat, Aditya and Pancholi, Sonal and Iverson, Grant L},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {480--494},
address = {Defense and Veterans Brain Injury Center, North Bethesda, MD 20852, USA. rlange@dvbic.org},
abstract = {This study compared the neuropsychological outcome in military personnel following mild-to-moderate traumatic brain injury (TBI). Participants were 83 service members divided into three injury severity groups: uncomplicated mild TBI (MTBI; n = 24), complicated MTBI (n = 17), and moderate TBI (n = 42). Participants were evaluated within 6 months following injury (73% within 3 months) using neurocognitive testing and the Personality Assessment Inventory (PAI). There were no significant differences between the three groups on the majority of neurocognitive measures. Similarly, there were no significant differences between the three groups on the majority of PAI clinical scales (all p \> .05), with the exception of two scales. The uncomplicated MTBI group had significantly higher scores on the Anxiety-Related Disorders and Aggression scales compared with the complicated MTBI group, but not the moderate TBI group. Overall, these results suggest that within the first 6 months post injury, there were few detectable differences in the neuropsychological outcome following uncomplicated MTBI, complicated MTBI, or moderate TBI in this military sample.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vasterling, Jennifer J; Brailey, Kevin; Proctor, Susan P; Kane, Robert; Heeren, Timothy; Franz, Molly
Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers Journal Article
In: British Journal of Psychiatry, vol. 201, pp. 186–192, 2012.
Abstract | BibTeX | Tags: Military
@article{Vasterling2012,
title = {Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers},
author = {Vasterling, Jennifer J and Brailey, Kevin and Proctor, Susan P and Kane, Robert and Heeren, Timothy and Franz, Molly},
year = {2012},
date = {2012-01-01},
journal = {British Journal of Psychiatry},
volume = {201},
pages = {186--192},
address = {VA Boston Healthcare System and Boston University School of Medicine, Boston, MA 02130, USA. jennifer.vasterling@va.gov},
abstract = {BACKGROUND: Traumatic brain injury (TBI) is a concern of contemporary military deployments. Whether milder TBI leads to enduring impairment remains controversial. AIMS: To determine the influence of deployment TBI, and post-traumatic stress disorder (PTSD) and depression symptoms on neuropsychological and functional outcomes. METHOD: A sample of 760 US Army soldiers were assessed pre- and post-deployment. Outcomes included neuropsychological performances and subjective functional impairment. RESULTS: In total, 9% of the participants reported (predominantly mild) TBI with loss of consciousness between pre- and post-deployment. At post-deployment, 17.6% of individuals with TBI screened positive for PTSD and 31.3% screened positive for depression. Before and after adjustment for psychiatric symptoms, TBI was significantly associated only with functional impairment. Both PTSD and depression symptoms adjusted for TBI were significantly associated with several neuropsychological performance deficits and functional impairment. CONCLUSIONS: Milder TBI reported by deployed service members typically has limited lasting neuropsychological consequences; PTSD and depression are associated with more enduring cognitive compromise.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vanderploeg, Rodney D; Belanger, Heather G; Horner, Ronnie D; Spehar, Andrea M; Powell-Cope, Gail; Luther, Stephen L; Scott, Steven G
Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida national guard Journal Article
In: Archives of Physical Medicine & Rehabilitation, vol. 93, pp. 1887–1895, 2012.
Abstract | BibTeX | Tags: Military
@article{Vanderploeg2012,
title = {Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida national guard},
author = {Vanderploeg, Rodney D and Belanger, Heather G and Horner, Ronnie D and Spehar, Andrea M and Powell-Cope, Gail and Luther, Stephen L and Scott, Steven G},
year = {2012},
date = {2012-01-01},
journal = {Archives of Physical Medicine \& Rehabilitation},
volume = {93},
pages = {1887--1895},
address = {Mental Health and Behavioral Sciences - Psychology Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA. Rodney.Vanderploeg@va.gov},
abstract = {OBJECTIVES: To determine the association between specific military deployment experiences and immediate and longer-term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries (TBIs) on health outcomes. DESIGN: Online survey of cross-sectional cohort. Odds ratios were calculated to assess the association between deployment-related factors (ie, physical injuries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild TBI) and current health status, controlling for potential confounders, demographics, and predeployment experiences. SETTING: Nonclinical. PARTICIPANTS: Members (N=3098) of the Florida National Guard (1443 deployed, 1655 not deployed). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of current psychiatric diagnoses and health outcomes, including postconcussive and non-postconcussive symptoms. RESULTS: Surveys were completed an average of 31.8 months (SD=24.4},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Russo, Arthur C
Symptom validity test performance and consistency of self-reported memory functioning of operation enduring freedom/operation iraqi freedom veterans with positive veteran health administration comprehensive traumatic brain injury evaluations Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 840–848, 2012.
Abstract | BibTeX | Tags: Military
@article{Russo2012,
title = {Symptom validity test performance and consistency of self-reported memory functioning of operation enduring freedom/operation iraqi freedom veterans with positive veteran health administration comprehensive traumatic brain injury evaluations},
author = {Russo, Arthur C},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {840--848},
address = {Psychology Department, Veterans Administration New York Harbor Healthcare System, Brooklyn, NY, USA.},
abstract = {Operation Enduring Freedom and Operation Iraqi Freedom combat veterans given definite diagnoses of mild Traumatic Brain Injury (TBI) during the Veteran Health Administration (VHA) Comprehensive TBI evaluation and reporting no post-deployment head injury were examined to assess (a) consistency of self-reported memory impairment and (b) symptom validity test (SVT) performance via a two-part study. Study 1 found that while 49 of 50 veterans reported moderate to very severe memory impairment during the VHA Comprehensive TBI evaluation, only 7 had reported any memory problem at the time of their Department of Defense (DOD) post-deployment health assessment. Study 2 found that of 38 veterans referred for neuropsychological evaluations following a positive VHA Comprehensive TBI evaluation, 68.4% failed the Word Memory Test, a forced choice memory recognition symptom validity task. Together, these studies raise questions concerning the use of veteran symptom self-report for TBI assessments and argue for the inclusion of SVTs and the expanded use of contemporaneous DOD records to improve the diagnostic accuracy of the VHA Comprehensive TBI evaluation.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Wolf, George; Cifu, David; Baugh, Laura; Carne, William; Profenna, Leonardo
The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2606–2612, 2012.
Abstract | BibTeX | Tags: Military
@article{Wolf2012a,
title = {The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury},
author = {Wolf, George and Cifu, David and Baugh, Laura and Carne, William and Profenna, Leonardo},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2606--2612},
address = {1 USAF School of Aerospace Medicine, Hyperbaric Medicine Department, Wilford Hall Ambulatory Surgical Center , Lackland AFB, Texas.},
abstract = {Abstract In this single-center, double-blind, randomized, sham-controlled, prospective trial at the U.S. Air Force School of Aerospace Medicine, the effects of 2.4 atmospheres absolute (ATA) hyperbaric oxygen (HBO(2)) on post-concussion symptoms in 50 military service members with at least one combat-related, mild traumatic brain injury were examined. Each subject received 30 sessions of either a sham compression (room air at 1.3 ATA) or HBO(2) treatments at 2.4 ATA over an 8-week period. Individual and total symptoms scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT([REGISTERED])) and composite scores on Post-traumatic Disorder Check List-Military Version (PCL-M) were measured just prior to intervention and 6 weeks after completion of intervention. Difference testing of post-intervention means between the sham-control and HBO(2) group revealed no significant differences on the PCL-M composite score (t=-0.205},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Matthews, Scott C; Spadoni, Andrea D; Lohr, James B; Strigo, Irina A; Simmons, Alan N
Diffusion tensor imaging evidence of white matter disruption associated with loss versus alteration of consciousness in warfighters exposed to combat in Operations Enduring and Iraqi Freedom Journal Article
In: Psychiatry Research, vol. 204, pp. 149–154, 2012.
Abstract | BibTeX | Tags: Military
@article{Matthews2012a,
title = {Diffusion tensor imaging evidence of white matter disruption associated with loss versus alteration of consciousness in warfighters exposed to combat in Operations Enduring and Iraqi Freedom},
author = {Matthews, Scott C and Spadoni, Andrea D and Lohr, James B and Strigo, Irina A and Simmons, Alan N},
year = {2012},
date = {2012-01-01},
journal = {Psychiatry Research},
volume = {204},
pages = {149--154},
address = {Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Drive, Mail code 116-A, La Jolla, CA 92093-0603, USA; VA Center of Excellence for Stress and Mental Health},
abstract = {The effects on the human brain of mild traumatic brain injury (mTBI), which is defined as a brief alteration (AOC) or loss of consciousness (LOC), are incompletely understood. Major psychiatric illnesses such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are common after mTBI. Prior research suggests that individuals who develop MDD after blast-related mTBI versus those who do not show significant white matter disruption and higher rates of LOC, suggesting that LOC might be uniquely associated with brain changes that increase the risk of developing mental illness after neurotrauma. Therefore, the objective of this study was to examine the effects of LOC, MDD, and PTSD on white matter integrity in individuals who reported experiencing mTBI during combat in Operations Enduring and Iraqi Freedom. We hypothesized that LOC would be associated with significant disruption of white matter, above and beyond putative effects of MDD and PTSD. To test this hypothesis, 46 individuals who experienced blast-related mTBI underwent a detailed clinical assessment and diffusion tensor imaging. As hypothesized, LOC versus AOC individuals displayed significantly lower fractional anisotropy (FA) in 14 regions, which included the superior longitudinal fasciculus and corpus callosum. No regions of significant FA difference were identified between individuals with and without PTSD, or between individuals with and without MDD. These preliminary results show that LOC is associated with detectable alterations in brain microstructure and may suggest a brain basis for psychiatric symptoms and mental illness after mTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Benson, Randall R; Gattu, Ramtilak; Sewick, Bradley; Kou, Zhifeng; Zakariah, Nisrine; Cavanaugh, John M; Haacke, E Mark
Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation Journal Article
In: NeuroRehabilitation, vol. 31, pp. 261–279, 2012.
Abstract | BibTeX | Tags: Military
@article{Benson2012,
title = {Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation},
author = {Benson, Randall R and Gattu, Ramtilak and Sewick, Bradley and Kou, Zhifeng and Zakariah, Nisrine and Cavanaugh, John M and Haacke, E Mark},
year = {2012},
date = {2012-01-01},
journal = {NeuroRehabilitation},
volume = {31},
pages = {261--279},
address = {Center for Neurological Studies, Novi, MI, USA. drbenson@neurologicstudies.com},
abstract = {INTRODUCTION: There is a need to more accurately diagnose milder traumatic brain injuries with increasing awareness of the high prevalence in both military and civilian populations. Magnetic resonance imaging methods may be capable of detecting a number of the pathoanatomical and pathophysiological consequences of focal and diffuse traumatic brain injury. Susceptibility-weighted imaging (SWI) detects heme iron and reveals even small venous microhemorrhages occurring in diffuse vascular injury. Diffusion tensor imaging (DTI) reveals axonal injury by detecting alterations in water flow in and around injured axons. The overarching hypothesis of this paper is that newer, advanced MR imaging generates sensitive biomarkers of regional brain injury which allows for correlation with clinical signs and symptoms. METHODS: Studies involving subjects with a history of traumatic brain injury as well as healthy, non-trauma controls were used. Analysis involved comparison of TBI patients' imaging results with healthy controls as well as correlation of imaging findings with clinical measures of injury severity. An additional animal study of Sprague-Dawley albino rats compared imaging results with histopathological findings after the animals were sacrificed and stained for b-APP. RESULTS: SWI revealed small foci of hemosiderin for some patients while aggregate lesion volume on SWI correlated with clinical injury severity indices. Similarly, DTI showed striking group differences for fractional anisotropy over the white matter globally, while tract and voxel-based regional results colocalized with SWI and FLAIR lesions in some cases and correlated with clinical deficits. For the rats, correlations were seen between imaging findings and staining of axonal injury. DISCUSSION: Animal data gave important tissue correlations with imaging results. SWI and DTI are commercially available sequences that can improve the diagnostic and prognostic ability of the trauma clinician. These biomarkers of regional brain injury which are present in imaging shortly after acute injury and persist indefinitely can inform clinicians and researchers about not only injury severity but also which neurobehavioral systems were injured. Analogous to stroke rehabilitation, having an understanding of the distribution of brain injury should ultimately allow for development of more effective rehabilitation strategies and more efficient clinical interventional trials.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Schmid, K E; Tortella, F C
The diagnosis of traumatic brain injury on the battlefield Journal Article
In: Frontiers in Neurology, vol. 3, pp. 90, 2012.
Abstract | BibTeX | Tags: Military
@article{Schmid2012,
title = {The diagnosis of traumatic brain injury on the battlefield},
author = {Schmid, K E and Tortella, F C},
year = {2012},
date = {2012-01-01},
journal = {Frontiers in Neurology},
volume = {3},
pages = {90},
address = {Schmid,Kara E. Brain Trauma Neuroprotection and Neurorestoration Department, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research Silver Spring, MD, USA.},
abstract = {The conflicts in Iraq and Afghanistan have placed an increased awareness on traumatic brain injury (TBI). Various publications have estimated the incidence of TBI for our deployed servicemen, however all have been based on extrapolations of data sets or subjective evaluations due to our current method of diagnosing a TBI. Therefore it has been difficult to get an accurate rate and severity of deployment related TBIs, or the incidence of multiple TBIs our service members are experiencing. As such, there is a critical need to develop a rapid objective method to diagnose TBI on the battlefield. Because of the austere environment of the combat theater the ideal diagnostic platform faces numerous logistical constraints not encountered in civilian trauma centers. Consequently, a simple blood test to diagnosis TBI represents a viable option for the military. This perspective will provide information on some of the current options for TBI biomarkers, detail concerning battlefield constraints, and a possible acquisition strategy for the military. The end result is a non-invasive TBI diagnostic platform capable of providing much needed advances in objective triage capabilities and improved clinical management of in-Theater TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ettenhofer, Mark L; Melrose, Rebecca J; Delawalla, Zainab; Castellon, Steven A; Okonek, Anna
Correlates of functional status among OEF/OIF veterans with a history of traumatic brain injury Journal Article
In: Military Medicine, vol. 177, pp. 1272–1278, 2012.
Abstract | BibTeX | Tags: Military
@article{Ettenhofer2012a,
title = {Correlates of functional status among OEF/OIF veterans with a history of traumatic brain injury},
author = {Ettenhofer, Mark L and Melrose, Rebecca J and Delawalla, Zainab and Castellon, Steven A and Okonek, Anna},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {1272--1278},
address = {Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.},
abstract = {This study was conducted to identify factors related to functional status within a clinical sample of Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with a history of traumatic brain injury (TBI). Medical chart review was conducted for a consecutive group of OEF/OIF Veterans who were referred for neuropsychological evaluation within a Veterans Affairs Medical Center Polytrauma Program related to history of TBI (n = 57). Level of involvement in occupational and academic activity, presence or absence of housing insecurity, and clinician ratings of overall functioning served as indicators of functional status. Reduced functional status was most strongly related to poorer cognitive function, particularly motor function, processing speed, and executive function. Lower levels of functioning were also related to increased severity of postconcussive symptoms, lower levels of education, and ongoing medication treatment for sleep or psychiatric symptoms. Comprehensive evaluation of cognitive, affective, and behavioral functioning among OEF/OIF Veterans with a history of TBI is likely to provide valuable information to inform rehabilitation strategies and identify potential warning signs for poor postdeployment reintegration. Increased awareness of these factors may aid clinicians in identifying patients at risk for poor outcomes and in more effectively targeting symptoms for intervention.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Heltemes, Kevin J; Holbrook, Troy L; Macgregor, Andrew J; Galarneau, Michael R
Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel Journal Article
In: Injury, vol. 43, pp. 1990–1995, 2012.
Abstract | BibTeX | Tags: Military
@article{Heltemes2012,
title = {Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel},
author = {Heltemes, Kevin J and Holbrook, Troy L and Macgregor, Andrew J and Galarneau, Michael R},
year = {2012},
date = {2012-01-01},
journal = {Injury},
volume = {43},
pages = {1990--1995},
address = {Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, United States. kevin.heltemes@med.navy.mil},
abstract = {INTRODUCTION: Mild traumatic brain injury (MTBI) has emerged as the preeminent injury of combat from the recent conflicts in Iraq and Afghanistan. Very little is known about short- and long-term outcomes after combat-related MTBI. As a measure of outcome after injury, self-rated health is a reliable, widely used measure that assesses perceived health. The primary aim of this study was to determine the effect of combat-related MTBI on self-reported health status after return from deployment. The secondary objective was to examine predictors of a decline in self-reported health status amongst US service members with MTBI, as compared to those service members with other minor non-TBI injuries. PATIENTS AND METHODS: MTBI cases and an injured comparison group were identified from the Expeditionary Medical Encounter Database records of 1129 male, US service members who experienced blast-related injuries in Iraq from March 2004 to March 2008. Self-rated health was assessed from the routinely administered pre- and post-deployment health assessment questionnaires by the following question, "Overall, how would you rate your health during the past month?" Possible responses were "poor", "fair", "good", "very good", or "excellent." A distinction was made between minor and major negative changes in health (i.e., very good to fair) based on these self-rated health outcomes captured post-injury. RESULTS: For all personnel, post-injury levels of self-rated health were statistically significantly worse than pre-injury health rating. At 6months post-injury, service members with MTBI were 5 times more likely to report a major negative change in health as compared to members with other mild injuries. This association was independent of age, rank, branch of service, Injury Severity Score, mental health diagnosis prior to injury, and having been referred to a health care professional. DISCUSSION: Blast-related injuries, specifically MTBI, during deployment have negative consequences on service members' perception of health. Future research is needed to improve our understanding of the overall effects of MTBI on health and quality of life.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Elder, Gregory A; Dorr, Nathan P; De Gasperi, Rita; Gama Sosa, Miguel A; Shaughness, Michael C; Maudlin-Jeronimo, Eric; Hall, Aaron A; McCarron, Richard M; Ahlers, Stephen T
Blast exposure induces post-traumatic stress disorder-related traits in a rat model of mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2564–2575, 2012.
Abstract | BibTeX | Tags: Military
@article{Elder2012,
title = {Blast exposure induces post-traumatic stress disorder-related traits in a rat model of mild traumatic brain injury},
author = {Elder, Gregory A and Dorr, Nathan P and {De Gasperi}, Rita and {Gama Sosa}, Miguel A and Shaughness, Michael C and Maudlin-Jeronimo, Eric and Hall, Aaron A and McCarron, Richard M and Ahlers, Stephen T},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2564--2575},
address = {1 Neurology Service, James J. Peters Department of Veterans Affairs Medical Center , Bronx, New York.},
abstract = {Abstract Blast related traumatic brain injury (TBI) has been a major cause of injury in the wars in Iraq and Afghanistan. A striking feature of the mild TBI (mTBI) cases has been the prominent association with post-traumatic stress disorder (PTSD). However, because of the overlapping symptoms, distinction between the two disorders has been difficult. We studied a rat model of mTBI in which adult male rats were exposed to repetitive blast injury while under anesthesia. Blast exposure induced a variety of PTSD-related behavioral traits that were present many months after the blast exposure, including increased anxiety, enhanced contextual fear conditioning, and an altered response in a predator scent assay. We also found elevation in the amygdala of the protein stathmin 1, which is known to influence the generation of fear responses. Because the blast overpressure injuries occurred while animals were under general anesthesia, our results suggest that a blast-related mTBI exposure can, in the absence of any psychological stressor, induce PTSD-related traits that are chronic and persistent. These studies have implications for understanding the relationship of PTSD to mTBI in the population of veterans returning from the wars in Iraq and Afghanistan.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Cooper, Douglas B; Chau, Phuong M; Armistead-Jehle, Patrick; Vanderploeg, Rodney D; Bowles, Amy O
Relationship between mechanism of injury and neurocognitive functioning in OEF/OIF service members with mild traumatic brain injuries Journal Article
In: Military Medicine, vol. 177, pp. 1157–1160, 2012.
Abstract | BibTeX | Tags: Military
@article{Cooper2012,
title = {Relationship between mechanism of injury and neurocognitive functioning in OEF/OIF service members with mild traumatic brain injuries},
author = {Cooper, Douglas B and Chau, Phuong M and Armistead-Jehle, Patrick and Vanderploeg, Rodney D and Bowles, Amy O},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {1157--1160},
address = {Traumatic Brain Injury Service, Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234 USA.},
abstract = {Military personnel deployed to combat theaters in Iraq and Afghanistan are at risk of sustaining mild traumatic brain injuries (mTBI) from causes such as improvised explosive devices, motor vehicle accidents, and falls. Despite the high incidence of mTBI in deployed personnel, questions remain about the effects of blast-related vs. non-blast-related mTBI on acute and long-term sequelae. This investigation is a retrospective review of service members who presented for evaluation of suspected mTBI and underwent neurocognitive screening evaluation, mTBI diagnosis was made by semistructured clinical interview. Only individuals in whom mechanism of injury could be determined (blast vs. non-blast) were included. Sixty individuals were included in the final sample: 32 with blast mTBI and 28 with non-blast mTBI. There were no differences between the blast-related and non-blast-related mTBI groups on age, time since injury, combat stress symptoms, or headache. Analysis of variance showed no significant between-group differences on any of the neurocognitive performance domains. Although speculation remains that the effects of primary blast exposure are unique, the results of this study are consistent with prior research suggesting that blast-related mTBI does not differ from other mechanisms of injury with respect to cognitive sequelae in the postacute phase.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Balakathiresan, Nagaraja; Bhomia, Manish; Chandran, Raghavendar; Chavko, Mikulas; McCarron, Richard M; Maheshwari, Radha K
MicroRNA let-7i is a promising serum biomarker for blast-induced traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 1379–1387, 2012.
Abstract | BibTeX | Tags: Military
@article{Balakathiresan2012,
title = {MicroRNA let-7i is a promising serum biomarker for blast-induced traumatic brain injury},
author = {Balakathiresan, Nagaraja and Bhomia, Manish and Chandran, Raghavendar and Chavko, Mikulas and McCarron, Richard M and Maheshwari, Radha K},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {1379--1387},
address = {Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.},
abstract = {Blast-induced traumatic brain injury (TBI) is of significant concern in soldiers returning from the current conflicts in Iraq and Afghanistan. Incidents of TBI have increased significantly in the current conflicts compared to previous wars, and a majority of these injuries are caused by improvised explosive devices. Currently, no specific technique or biomarker is available for diagnosing TBI when no obvious clinical symptoms are present. Micro-RNAs are small RNA ($sim$ 22nts) molecules that are expressed endogenously and play an important role in regulating gene expression. MicroRNAs have emerged as novel serum diagnostic biomarkers for various diseases. In this study, we studied the effect of blast overpressure injury on the microRNA signatures in the serum of rats. Rats were exposed to three serial 120-kPa blast overpressure exposures through a shockwave tube. Blood and cerebrospinal fluid were collected at various time points after injury, and microRNA modulation was analyzed using real-time PCR. Five microRNAs were significantly modulated in the serum samples of these animals at three time points post-injury. Further, we also found that the levels of microRNA let-7i are also elevated in cerebrospinal fluid post-blast wave exposure. The presence of microRNA in both serum and cerebrospinal fluid immediately after injury makes microRNA let-7i an ideal candidate for further studies of biomarkers in TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Brenner, Lisa A; Bahraini, Nazanin; Hernandez, Theresa D
Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms Journal Article
In: Frontiers in Neurology, vol. 3, pp. 31, 2012.
Abstract | BibTeX | Tags: Military
@article{Brenner2012a,
title = {Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms},
author = {Brenner, Lisa A and Bahraini, Nazanin and Hernandez, Theresa D},
year = {2012},
date = {2012-01-01},
journal = {Frontiers in Neurology},
volume = {3},
pages = {31},
address = {Veterans Integrated Service Network 19, Mental Illness Research Education and Clinical Center Denver, CO, USA.},
abstract = {Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic), behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI) and/or post traumatic stress disorder (PTSD). Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast) traumatic brain injury can be used to facilitate the development of clinically relevant blast models.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Nelson, Nathaniel W; Hoelzle, James B; Doane, Bridget M; McGuire, Kathryn A; Ferrier-Auerbach, Amanda G; Charlesworth, Molly J; Lamberty, Gregory J; Polusny, Melissa A; Arbisi, Paul A; Sponheim, Scott R
Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology Journal Article
In: Journal of the International Neuropsychological Society, vol. 18, pp. 845–855, 2012.
Abstract | BibTeX | Tags: Military
@article{Nelson2012,
title = {Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology},
author = {Nelson, Nathaniel W and Hoelzle, James B and Doane, Bridget M and McGuire, Kathryn A and Ferrier-Auerbach, Amanda G and Charlesworth, Molly J and Lamberty, Gregory J and Polusny, Melissa A and Arbisi, Paul A and Sponheim, Scott R},
year = {2012},
date = {2012-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {18},
pages = {845--855},
address = {Graduate School of Professional Psychology, University of St. Thomas, Minneapolis, Minnesota 55403, USA. nels0600@stthomas.edu},
abstract = {This study explored whether remote blast-related MTBI and/or current Axis I psychopathology contribute to neuropsychological outcomes among OEF/OIF veterans with varied combat histories. OEF/OIF veterans underwent structured interviews to evaluate history of blast-related MTBI and psychopathology and were assigned to MTBI (n = 18), Axis I (n = 24), Co-morbid MTBI/Axis I (n = 34), or post-deployment control (n = 28) groups. A main effect for Axis I diagnosis on overall neuropsychological performance was identified (F(3,100) = 4.81; p = .004), with large effect sizes noted for the Axis I only (d = .98) and Co-morbid MTBI/Axis I (d = .95) groups relative to the control group. The latter groups demonstrated primary limitations on measures of learning/memory and processing speed. The MTBI only group demonstrated performances that were not significantly different from the remaining three groups. These findings suggest that a remote history of blast-related MTBI does not contribute to objective cognitive impairment in the late stage of injury. Impairments, when present, are subtle and most likely attributable to PTSD and other psychological conditions. Implications for clinical neuropsychologists and future research are discussed. (JINS, 2012, 18, 1-11).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Finkel, Alan
Headaches in soldiers with mild traumatic brain injury--additional data Journal Article
In: Headache, vol. 52, pp. 1320, 2012.
@article{Finkel2012,
title = {Headaches in soldiers with mild traumatic brain injury--additional data},
author = {Finkel, Alan},
year = {2012},
date = {2012-01-01},
journal = {Headache},
volume = {52},
pages = {1320},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ruff, Robert Louis; Riechers 2nd, Ronald George; Wang, Xiao-Feng; Piero, Traci; Ruff, Suzanne Smith
A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI Journal Article
In: BMJ Open, vol. 2, pp. e000312, 2012.
Abstract | BibTeX | Tags: Military
@article{Ruff2012,
title = {A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI},
author = {Ruff, Robert Louis and {Riechers 2nd}, Ronald George and Wang, Xiao-Feng and Piero, Traci and Ruff, Suzanne Smith},
year = {2012},
date = {2012-01-01},
journal = {BMJ Open},
volume = {2},
pages = {e000312},
address = {Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.},
abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown. OBJECTIVE: To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan. METHODS: This was a case-control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians. RESULTS: Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was \>90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS). CONCLUSIONS: Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Wall, Pamela L Herbig
Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis Journal Article
In: Journal of the American Psychiatric Nurses Association, vol. 18, pp. 278–298, 2012.
Abstract | BibTeX | Tags: Military
@article{Wall2012,
title = {Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis},
author = {Wall, Pamela L Herbig},
year = {2012},
date = {2012-01-01},
journal = {Journal of the American Psychiatric Nurses Association},
volume = {18},
pages = {278--298},
address = {University of Pennsylvania, Philadelphia, PA, USA. luvridley@aol.com},
abstract = {BACKGROUND: The use of unconventional weaponry combined with decreased mortality rates and servicemembers being exposed to intense ground combat during multiple deployments has increased the risk of servicemembers living with the consequences of traumatic brain injuries (TBI) and combat operational stress. OBJECTIVE: The purpose of this article is to perform a critical analysis of the literature to identify current rates of comorbid posttraumatic stress disorder (PTSD) and TBI in military and veteran populations who have served in Iraq or Afghanistan and their combined effects on persistent postconcussive symptoms. DESIGN: A search of the literature with military and veteran populations published after 2001 in Pubmed, OVID/Medline, Cochran Database, Embase, Scopus, CINAHL, and PsychInfo was conducted using keywords. RESULTS: Twenty studies met inclusion criteria. The literature search yielded mixed results for rates of PTSD, TBI, and comorbid conditions. CONCLUSIONS: There is some evidence that comorbid PTSD and TBI result in greater reports of postconcussive symptomology than either condition alone. Limitations include lack of consistency of measurements, sampling biases, and lack of experimental design, and these warrant further exploration. Future research is needed to decrease variability in study findings and elucidate relationships between these disorders and their effects on persistent postconcussive symptomology.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Huang, Ming-Xiong; Nichols, Sharon; Robb, Ashley; Angeles, Annemarie; Drake, Angela; Holland, Martin; Asmussen, Sarah; D'Andrea, John; Chun, Won; Levy, Michael; Cui, Li; Song, Tao; Baker, Dewleen G; Hammer, Paul; McLay, Robert; Theilmann, Rebecca J; Coimbra, Raul; Diwakar, Mithun; Boyd, Cynthia; Neff, John; Liu, Thomas T; Webb-Murphy, Jennifer; Farinpour, Roxanna; Cheung, Catherine; Harrington, Deborah L; Heister, David; Lee, Roland R
An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes Journal Article
In: Neuroimage, vol. 61, pp. 1067–1082, 2012.
Abstract | BibTeX | Tags: Military
@article{Huang2012,
title = {An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes},
author = {Huang, Ming-Xiong and Nichols, Sharon and Robb, Ashley and Angeles, Annemarie and Drake, Angela and Holland, Martin and Asmussen, Sarah and D'Andrea, John and Chun, Won and Levy, Michael and Cui, Li and Song, Tao and Baker, Dewleen G and Hammer, Paul and McLay, Robert and Theilmann, Rebecca J and Coimbra, Raul and Diwakar, Mithun and Boyd, Cynthia and Neff, John and Liu, Thomas T and Webb-Murphy, Jennifer and Farinpour, Roxanna and Cheung, Catherine and Harrington, Deborah L and Heister, David and Lee, Roland R},
year = {2012},
date = {2012-01-01},
journal = {Neuroimage},
volume = {61},
pages = {1067--1082},
address = {Radiology, Research, Rehab, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA. mxhuang@ucsd.edu},
abstract = {Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. Injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4 Hz) that can be measured and localized by magnetoencephalography (MEG). We developed a new automated MEG low-frequency source imaging method and applied this method in 45 mild TBI (23 from combat-related blasts, and 22 from non-blast causes) and 10 moderate TBI patients (non-blast causes). Seventeen of the patients with mild TBI from blasts had tertiary injuries resulting from the blast. The results show our method detected abnormalities at the rates of 87% for the mild TBI group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities were 96% and 77% for the blast and non-blast TBI groups, respectively. The spatial characteristics of abnormal slow-wave generation measured by Z scores in the mild blast TBI group significantly correlated with those in non-blast mild TBI group. Among 96 cortical regions, the likelihood of abnormal slow-wave generation was less in the mild TBI patients with blast than in the mild non-blast TBI patients, suggesting possible protective effects due to the military helmet and armor. Finally, the number of cortical regions that generated abnormal slow-waves correlated significantly with the total post-concussive symptom scores in TBI patients. This study provides a foundation for using MEG low-frequency source imaging to support the clinical diagnosis of TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bogdanova, Y; Verfaellie, M
Cognitive sequelae of blast-induced traumatic brain injury: Recovery and rehabilitation Journal Article
In: Neuropsychology Review, vol. 22, pp. 4–20, 2012, ISSN: 1040-7308.
Abstract | Links | BibTeX | Tags: Military
@article{Bogdanova2012,
title = {Cognitive sequelae of blast-induced traumatic brain injury: Recovery and rehabilitation},
author = {Bogdanova, Y and Verfaellie, M},
doi = {10.1007/s11065-012-9192-3},
issn = {1040-7308},
year = {2012},
date = {2012-01-01},
journal = {Neuropsychology Review},
volume = {22},
pages = {4--20},
abstract = {Blast-related traumatic brain injury (bTBI) poses a significant concern for military personnel engaged in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Given the highly stressful context in which such injury occurs, psychiatric comorbidities are common. This paper provides an overview of mild bTBI and discusses the cognitive sequelae and course of recovery typical of mild TBI (mTBI). Complicating factors that arise in the context of co-morbid posttraumatic stress disorder (PTSD) are considered with regard to diagnosis and treatment. Relatively few studies have evaluated the efficacy of cognitive rehabilitation in civilian mTBI, but we discuss cognitive training approaches that hold promise for addressing mild impairments in executive function and memory, akin to those seen in OEF/OIF veterans with bTBI and PTSD. Further research is needed to address the patient and environmental characteristics associated with optimal treatment outcome.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bass, Cameron R; Panzer, Matthew B; Rafaels, Karen A; Wood, Garrett; Shridharani, Jay; Capehart, Bruce
Brain injuries from blast Journal Article
In: Annals of Biomedical Engineering, vol. 40, pp. 185–202, 2012.
Abstract | BibTeX | Tags: Military
@article{Bass2012,
title = {Brain injuries from blast},
author = {Bass, Cameron R and Panzer, Matthew B and Rafaels, Karen A and Wood, Garrett and Shridharani, Jay and Capehart, Bruce},
year = {2012},
date = {2012-01-01},
journal = {Annals of Biomedical Engineering},
volume = {40},
pages = {185--202},
address = {Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Durham, NC 27708, USA. dale.bass@duke.edu},
abstract = {Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions that are similar to human long-duration nuclear blasts, not high explosive blasts.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Haran, F J; Slaboda, J C; King, L A; Wright, W G; Houlihan, D; Norris, J N
Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment Journal Article
In: Journal of Neurotrauma, vol. 33, no. 7, pp. 705–711, 2016.
@article{Haran2016,
title = {Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment},
author = {Haran, F J and Slaboda, J C and King, L A and Wright, W G and Houlihan, D and Norris, J N},
doi = {10.1089/neu.2015.4060},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {7},
pages = {705--711},
abstract = {This study evaluated the utility of the Balance Error Scoring System (BESS) and the Sensory Organization Test (SOT) as tools for the screening and monitoring of Service members (SMs) with mild traumatic brain injury (mTBI) in a deployed setting during the acute and subacute phases of recovery. Patient records (N = 699) were reviewed for a cohort of SMs who sustained a blast-related mTBI while deployed to Afghanistan and were treated at the Concussion Restoration Care Center (CRCC) at Camp Leatherneck. On initial intake into the CRCC, participants completed two assessments of postural control, the BESS, and SOT. SMs with mTBI performed significantly worse on the BESS and SOT when compared with comparative samples. When the SOT data were further examined using sensory ratios, the results indicated that postural instability was primarily a result of vestibular and visual integration dysfunction (r \> 0.62). The main finding of this study was that the sensitivity of the SOT composite score (50-58%) during the acute phase was higher than previous sensitivities found in the sports medicine literature for impact-related trauma. Copyright © 2016 Mary Ann Liebert, Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Hoffer, M E; Szczupak, M; Kiderman, A; Crawford, J; Murphy, S; Marshall, K; Pelusso, C; Balaban, C
Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury Journal Article
In: PLoS ONE, vol. 11, no. 1, pp. e0146039, 2016.
@article{Hoffer2016,
title = {Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury},
author = {Hoffer, M E and Szczupak, M and Kiderman, A and Crawford, J and Murphy, S and Marshall, K and Pelusso, C and Balaban, C},
year = {2016},
date = {2016-01-01},
journal = {PLoS ONE},
volume = {11},
number = {1},
pages = {e0146039},
abstract = {Mild Traumatic Brain Injury (mTBI) is a prominent public health issue. To date, subjective symptom complaints primarily dictate diagnostic and treatment approaches. As such, the description and qualification of these symptoms in the mTBI patient population is of great value. This manuscript describes the symptoms of mTBI patients as compared to controls in a larger study designed to examine the use of vestibular testing to diagnose mTBI. Five symptom clusters were identified: Post-Traumatic Headache/Migraine, Nausea, Emotional/Affective, Fatigue/Malaise, and Dizziness/Mild Cognitive Impairment. Our analysis indicates that individuals with mTBI have headache, dizziness, and cognitive dysfunction far out of proportion to those without mTBI. In addition, sleep disorders and emotional issues were significantly more common amongst mTBI patients than non-injured individuals. A simple set of questions inquiring about dizziness, headache, and cognitive issues may provide diagnostic accuracy. The consideration of other symptoms may be critical for providing prognostic value and treatment for best short-term outcomes or prevention of long-term complications.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Xydakis, M S; Mulligan, L P; Smith, A B; Olsen, C H; Lyon, D M; Belluscio, L
Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study Journal Article
In: Neurology, vol. 84, pp. 1559–1567, 2015.
@article{Xydakis2015,
title = {Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study},
author = {Xydakis, M S and Mulligan, L P and Smith, A B and Olsen, C H and Lyon, D M and Belluscio, L},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {84},
pages = {1559--1567},
address = {Xydakis,Michael S. From Otorhinolaryngology/Head \& Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.)},
abstract = {OBJECTIVE: To determine whether a structured and quantitative assessment of differential olfactory performance-recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group-can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. METHODS: We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 21/2-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. RESULTS: Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70-0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98-9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. CONCLUSION: Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%-51.7%) and specificity of 100% (95% CI 97.7%-100.0%).Copyright © 2015 American Academy of Neurology.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Robinson, M E; Lindemer, E R; Fonda, J R; Milberg, W P; McGlinchey, R E; Salat, D H
Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure Journal Article
In: Human Brain Mapping, vol. 36, pp. 911–922, 2015.
@article{Robinson2015,
title = {Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure},
author = {Robinson, M E and Lindemer, E R and Fonda, J R and Milberg, W P and McGlinchey, R E and Salat, D H},
year = {2015},
date = {2015-01-01},
journal = {Human Brain Mapping},
volume = {36},
pages = {911--922},
address = {Robinson,Meghan E. Neuroimaging Research for Veterans Center (NeRVe), VA Boston Healthcare System, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts.},
abstract = {Although there is emerging data on the effects of blast-related concussion (or mTBI) on cognition, the effects of blast exposure itself on the brain have only recently been explored. Toward this end, we examine functional connectivity to the posterior cingulate cortex, a primary region within the default mode network (DMN), in a cohort of 134 Iraq and Afghanistan Veterans characterized for a range of common military-associated comorbidities. Exposure to a blast at close range (\<10 meters) was associated with decreased connectivity of bilateral primary somatosensory and motor cortices, and these changes were not different from those seen in participants with blast-related mTBI. These results remained significant when clinical factors such as sleep quality, chronic pain, or post traumatic stress disorder were included in the statistical model. In contrast, differences in functional connectivity based on concussion history and blast exposures at greater distances were not apparent. Despite the limitations of a study of this nature (e.g., assessments long removed from injury, self-reported blast history), these data demonstrate that blast exposure per se, which is prevalent among those who served in Iraq and Afghanistan, may be an important consideration in Veterans' health. It further offers a clinical guideline for determining which blasts (namely, those within 10 meters) are likely to lead to long-term health concerns and may be more accurate than using concussion symptoms alone.Copyright Published 2014. This article is a U.S. Government work and is in the public domain in the USA.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bogner, J; French, L M; Lange, R T; Corrigan, J D
Pilot study of traumatic brain injury and alcohol misuse among service members Journal Article
In: Brain Injury, vol. 29, pp. 905–914, 2015.
@article{Bogner2015,
title = {Pilot study of traumatic brain injury and alcohol misuse among service members},
author = {Bogner, J and French, L M and Lange, R T and Corrigan, J D},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {905--914},
address = {Bogner,Jennifer. The Ohio State University , Columbus, OH , USA .},
abstract = {OBJECTIVE: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse. PARTICIPANTS: Service members (n=93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom. METHODS AND MATERIALS: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-III, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory. RESULTS: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse. CONCLUSIONS: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Ling, G; Ecklund, J M; Bandak, F A
Brain injury from explosive blast: description and clinical management Journal Article
In: Handbook of Clinical Neurology, vol. 127, pp. 173–180, 2015.
@article{Ling2015,
title = {Brain injury from explosive blast: description and clinical management},
author = {Ling, G and Ecklund, J M and Bandak, F A},
year = {2015},
date = {2015-01-01},
journal = {Handbook of Clinical Neurology},
volume = {127},
pages = {173--180},
address = {Ling,G. Department of Neurology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address: geoffrey.ling@usuhs.edu. Ecklund,J M. Department of Neurosciences, Inova Fairfax Medical Cam},
abstract = {Accumulating clinical experience is indicating that explosive blast brain injury is becoming recognized as a disease distinct from the penetrating form of blast injury as well as the classic closed head injury (CHI). In recent US conflicts in Iraq and Afghanistan, over 60% of combat casualties were from explosive blast with the hallmark explosive weapon being the improvised explosive device (IED). Explosive blast TBI is a condition afflicting many combat injured warfighters potentially constituting another category of TBI. Clinically, it shares many features with conventional TBI but possesses some unique aspects. In its mild form, it also shares many clinical features with PTSD but here again has distinct aspects. Although military medical providers depend on civilian standard of care guidelines when managing explosive blast mTBI, they are continually adapting their medical practice in order to optimize the treatment of this disease, particularly in a theater of war. It is clear that further rigorous scientific study of explosive blast mTBI at both the basic science and clinical levels is needed. This research must include improved understanding of the causes and mechanisms of explosive blast TBI as well as comprehensive epidemiologic studies to determine the prevalence of this disease and its risk factors. A widely accepted unambiguous clinical description of explosive blast mTBI with diagnostic criteria would greatly improve diagnosis. It is hoped that through appropriate research meaningful prevention, mitigation, and treatment strategies for explosive blast mTBI can be speedily realized.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Newsome, M R; Durgerian, S; Mourany, L; Scheibel, R S; Lowe, M J; Beall, E B; Koenig, K A; Parsons, M; Troyanskaya, M; Reece, C; Wilde, E; Fischer, B L; Jones, S E; Agarwal, R; Levin, H S; Rao, S M
Disruption of caudate working memory activation in chronic blast-related traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 543–553, 2015.
@article{Newsome2015,
title = {Disruption of caudate working memory activation in chronic blast-related traumatic brain injury},
author = {Newsome, M R and Durgerian, S and Mourany, L and Scheibel, R S and Lowe, M J and Beall, E B and Koenig, K A and Parsons, M and Troyanskaya, M and Reece, C and Wilde, E and Fischer, B L and Jones, S E and Agarwal, R and Levin, H S and Rao, S M},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {543--553},
address = {Newsome,Mary R. Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA ; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. Durgerian,Sally. Department of Neurology, Medic},
abstract = {Mild to moderate traumatic brain injury (TBI) due to blast exposure is frequently diagnosed in veterans returning from the wars in Iraq and Afghanistan. However, it is unclear whether neural damage resulting from blast TBI differs from that found in TBI due to blunt-force trauma (e.g., falls and motor vehicle crashes). Little is also known about the effects of blast TBI on neural networks, particularly over the long term. Because impairment in working memory has been linked to blunt-force TBI, the present functional magnetic resonance imaging (fMRI) study sought to investigate whether brain activation in response to a working memory task would discriminate blunt-force from blast TBI. Twenty-five veterans (mean age = 29.8 years, standard deviation = 6.01 years, 1 female) who incurred TBI due to blast an average of 4.2 years prior to enrollment and 25 civilians (mean age = 27.4 years, standard deviation = 6.68 years, 4 females) with TBI due to blunt-force trauma performed the Sternberg Item Recognition Task while undergoing fMRI. The task involved encoding 1, 3, or 5 items in working memory. A group of 25 veterans (mean age = 29.9 years, standard deviation = 5.53 years, 0 females) and a group of 25 civilians (mean age = 27.3 years, standard deviation = 5.81 years, 0 females) without history of TBI underwent identical imaging procedures and served as controls. Results indicated that the civilian TBI group and both control groups demonstrated a monotonic relationship between working memory set size and activation in the right caudate during encoding, whereas the blast TBI group did not (p \< 0.05, corrected for multiple comparisons using False Discovery Rate). Blast TBI was also associated with worse performance on the Sternberg Item Recognition Task relative to the other groups, although no other group differences were found on neuropsychological measures of episodic memory, inhibition, and general processing speed. These results could not be attributed to caudate atrophy or the presence of PTSD symptoms. Our results point to a specific vulnerability of the caudate to blast injury. Changes in activation during the Sternberg Item Recognition Task, and potentially other tasks that recruit the caudate, may serve as biomarkers for blast TBI.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Dretsch, M N; Kelly, M P; Coldren, R L; Parish, R V; Russell, M L
In: Journal of Neurotrauma, vol. 32, no. 16, pp. 1217–1222, 2015.
@article{Dretsch2015a,
title = {No Significant Acute and Subacute Differences between Blast and Blunt Concussions across Multiple Neurocognitive Measures and Symptoms in Deployed Soldiers},
author = {Dretsch, M N and Kelly, M P and Coldren, R L and Parish, R V and Russell, M L},
doi = {10.1089/neu.2014.3637},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {16},
pages = {1217--1222},
abstract = {Seventy-one deployed U.S. Army soldiers who presented for concussion care due to either blast or blunt mechanisms within 72 h of injury were assessed using the Military Acute Concussion Evaluation, the Automated Neuropsychological Assessment Metrics (ANAM), traditional neuropsychological tests, and health status questionnaires. Follow-up ANAM testing was performed 10 d after initial testing (±5 d). Twenty-one soldiers were excluded: two for poor effort and 19 who had combined blast/blunt injuries. Of the remaining 50 male participants, 34 had blast injuries and 16 had blunt injuries. There were no statistically significant differences between blast injury and blunt injury participants in demographic, physical, or psychological health factors, concussive symptoms, or automated and traditional neurocognitive testing scores within 72 h post-injury. In addition, follow-up ANAM scores up to 15 d post-injury were not significantly different (available on 21 blast-injured and 13 blunt-injured subjects). Pre-injury baseline ANAM scores were compared where available, and revealed no statistically significant differences between 22 blast injury and eight blunt injury participants. These findings suggest there are no significant differences between mechanisms of injury during both the acute and subacute periods in neurobehavioral concussion sequelae while deployed in a combat environment. The current study supports the use of sports/mechanical concussion models for early concussion management in the deployed setting and exploration of variability in potential long-term outcomes. © Copyright 2015, Mary Ann Liebert, Inc.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Spooner, S P; Tyner, S D; Sowers, C; Tsao, J; Stuessi, K
Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care Journal Article
In: Military Medicine, vol. 179, pp. 1319–1324, 2014.
@article{Spooner2014,
title = {Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care},
author = {Spooner, S P and Tyner, S D and Sowers, C and Tsao, J and Stuessi, K},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1319--1324},
address = {Spooner,Shawn P. Captain James A. Lovell Federal Healthcare Center, 3001 Green Bay Road, North Chicago, IL 60064. Tyner,Stuart D. U.S. Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Pass Ste B, JBSA FT Sam Houston, TX 78234-7767. Sow},
abstract = {Combat-related concussions are significant sources of injury and morbidity among deployed military service members. Musculoskeletal injury also is one of the most prevalent battle and nonbattle-related deployed injury types. Both injuries threaten the service member's physical condition as well as unit and mission readiness due to reduced duty status or evacuation from military theater of operations. In August 2010, the Concussion Restoration Care Center (CRCC) was established at Camp Leatherneck, Afghanistan, to address the need for consistent and specialized evaluation and care of concussion and musculoskeletal injury. This performance improvement effort examined evaluation and treatment of concussion and musculoskeletal injury at the CRCC. Among 4,947 military personnel evaluated at the CRCC between August 2010 and May 2013, 97.9% were returned to duty and retained in theater. Members averaged 10 to 12 days of limited duty status to achieve complete recovery. Concussion injury was secondary to blast injury in 90% of cases. Sport/recreation, occupational, and other accidental injuries each represented 30% of the musculoskeletal injuries with only 10% reported as result of combat. The utilization patterns and outcome measures demonstrate the success and utility of a multidisciplinary clinical model of care for these two types of injuries in the far-forward deployed setting. Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
McCrea, M; Guskiewicz, K; Doncevic, S; Helmick, K; Kennedy, J; Boyd, C; Asmussen, S; Ahn, K W; Wang, Y; Hoelzle, J; Jaffee, M
Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF Journal Article
In: Military Medicine, vol. 179, pp. 990–997, 2014.
@article{McCrea2014,
title = {Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF},
author = {McCrea, M and Guskiewicz, K and Doncevic, S and Helmick, K and Kennedy, J and Boyd, C and Asmussen, S and Ahn, K W and Wang, Y and Hoelzle, J and Jaffee, M},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {990--997},
address = {McCrea,Michael. Departments of Neurosurgery and Neurology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226. Guskiewicz,Kevin. Injury Prevention Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall},
abstract = {OBJECTIVES: The study investigated the clinical validity of the cognitive screening component of the Military Acute Concussion Evaluation (MACE) for the evaluation of acute mild traumatic brain injury (mTBI) in a military operational setting. METHODS: This was a retrospective data study involving analysis of MACE data on Operation Enduring Freedom/Operation Iraqi Freedom deployed service members with mTBI. In total, 179 cases were included in analyses based on ICD-9 diagnostic codes and characteristics of mTBI, and availability of MACE data on day of injury. MACE data from the mTBI group was compared to a military sample without mTBI administered the MACE as part of a normative data project. RESULTS: On day of injury, the mTBI group performed worse than controls on the MACE cognitive test (d = 0.90), with significant impairments in all cognitive domains assessed. MACE cognitive score was strongly associated with established indicators of acute injury severity. Lower MACE cognitive performance on day of injury was predictive of lengthier postinjury recovery time and time until return to duty after mTBI. CONCLUSIONS: Findings from the current study support the use of the MACE as a valid screening tool to assess for cognitive dysfunction in military service members during the acute phase after mTBI.Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Cook, G A; Hawley, J S
A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology Journal Article
In: Military Medicine, vol. 179, pp. 1083–1089, 2014.
@article{Cook2014,
title = {A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology},
author = {Cook, G A and Hawley, J S},
doi = {10.7205/MILMED-D-13-00435},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1083--1089},
abstract = {Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies\textemdashsoluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography\textemdashthat are of particular interest within military medicine. © AMSUS. All rights reserved.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Johnson, M A; Hawley, J S; Theeler, B J
Management of acute concussion in a deployed military setting Journal Article
In: Current Treatment Options in Neurology, vol. 16, pp. 311, 2014.
@article{Johnson2014a,
title = {Management of acute concussion in a deployed military setting},
author = {Johnson, M A and Hawley, J S and Theeler, B J},
year = {2014},
date = {2014-01-01},
journal = {Current Treatment Options in Neurology},
volume = {16},
pages = {311},
address = {Johnson,Michael A L. Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of Health Sciences, 8901 Rockville Pike, Bethesda, MD, 20889-5600, USA, maullionheart@gmail.com.},
abstract = {OPINION STATEMENT: The DoD has established clinical guidelines and policies creating a system of care for the management of battlefield concussion. Within these instructions, medical providers have standardized guidance for screening and diagnosing concussion, along with guidelines for treating common concussion symptoms. Underlying these policies is the principle that concussion is an important injury, and SMs need to be removed from combat during the acute period to ensure full recovery before return to duty. As our understanding of concussion advances, the DoD will incorporate these advances into the current system of care, ensuring that SMs have the highest level of care possible for concussions sustained on the battlefield.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
de Lanerolle, N C; Hamid, H; Kulas, J; Pan, J W; Czlapinski, R; Rinaldi, A; Ling, G; Bandak, F A; Hetherington, H P
Concussive brain injury from explosive blast Journal Article
In: Annals of Clinical & Translational Neurology, vol. 1, pp. 692–702, 2014.
@article{DeLanerolle2014,
title = {Concussive brain injury from explosive blast},
author = {de Lanerolle, N C and Hamid, H and Kulas, J and Pan, J W and Czlapinski, R and Rinaldi, A and Ling, G and Bandak, F A and Hetherington, H P},
year = {2014},
date = {2014-01-01},
journal = {Annals of Clinical \& Translational Neurology},
volume = {1},
pages = {692--702},
address = {de Lanerolle,Nihal C. Department of Neurosurgery, Yale University New Haven, Connecticut, 06520. Hamid,Hamada. Department of Neurology, Yale University New Haven, Connecticut, 06520 ; Department of Psychiatry, Yale University New Haven, Connecticut, 06520},
abstract = {OBJECTIVE: Explosive blast mild traumatic brain injury (mTBI) is associated with a variety of symptoms including memory impairment and posttraumatic stress disorder (PTSD). Explosive shock waves can cause hippocampal injury in a large animal model. We recently reported a method for detecting brain injury in soldiers with explosive blast mTBI using magnetic resonance spectroscopic imaging (MRSI). This method is applied in the study of veterans exposed to blast. METHODS: The hippocampus of 25 veterans with explosive blast mTBI, 20 controls, and 12 subjects with PTSD but without exposure to explosive blast were studied using MRSI at 7 Tesla. Psychiatric and cognitive assessments were administered to characterize the neuropsychiatric deficits and compare with findings from MRSI. RESULTS: Significant reductions in the ratio of N-acetyl aspartate to choline (NAA/Ch) and N-acetyl aspartate to creatine (NAA/Cr) (P \< 0.05) were found in the anterior portions of the hippocampus with explosive blast mTBI in comparison to control subjects and were more pronounced in the right hippocampus, which was 15% smaller in volume (P \< 0.05). Decreased NAA/Ch and NAA/Cr were not influenced by comorbidities - PTSD, depression, or anxiety. Subjects with PTSD without blast had lesser injury, which tended to be in the posterior hippocampus. Explosive blast mTBI subjects had a reduction in visual memory compared to PTSD without blast. INTERPRETATION: The region of the hippocampus injured differentiates explosive blast mTBI from PTSD. MRSI is quite sensitive in detecting and localizing regions of neuronal injury from explosive blast associated with memory impairment.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Weaver, L; Manukyan, Z; Halberstadt, S M; Lindblad, A S
In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury Journal Article
In: Military Medicine, vol. 178, pp. viii–ix, 2013.
@article{Weaver2013,
title = {In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury},
author = {Weaver, L and Manukyan, Z and Halberstadt, S M and Lindblad, A S},
year = {2013},
date = {2013-01-01},
journal = {Military Medicine},
volume = {178},
pages = {viii--ix},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Lamberty, Greg J; Nelson, Nathaniel W; Yamada, Torrii
Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications Journal Article
In: Behavioral Sciences & the Law, vol. 31, pp. 814–832, 2013, ISSN: 1099-0798.
@article{Lamberty2013,
title = {Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications},
author = {Lamberty, Greg J and Nelson, Nathaniel W and Yamada, Torrii},
doi = {10.1002/bsl.2091},
issn = {1099-0798},
year = {2013},
date = {2013-01-01},
journal = {Behavioral Sciences \& the Law},
volume = {31},
pages = {814--832},
abstract = {Traumatic brain injury (TBI) is a prominent public health problem in both civilian and military settings. This article discusses similarities and differences in the assessment and treatment of TBI and the attendant forensic implications. Acute care and management of moderate/severe TBI tend to be similar across environments, as is the recognition of disability status in affected individuals. By contrast, an increased focus on mild TBI in recent years has resulted in a reliance on self-report and screening measures to validate the occurrence of events leading to injury. This has complicated assessment, treatment and subsequent medicolegal proceedings. The neuropsychological literature has provided significant guidance on these difficult issues, although the complexity of disability adjudication for active duty members of the military and veterans continues to pose challenges for clinicians in evaluative and treatment contexts.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Mendez, Mario F; Owens, Emily M; Jimenez, Elvira E; Peppers, Dominique; Licht, Eliot A
Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces Journal Article
In: Brain Injury, vol. 27, pp. 10–18, 2013.
@article{Mendez2013,
title = {Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces},
author = {Mendez, Mario F and Owens, Emily M and Jimenez, Elvira E and Peppers, Dominique and Licht, Eliot A},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {10--18},
address = {Department of Neurology.},
abstract = {Introduction: Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI). Objective: This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI. Methods: Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n=12), as compared to those who sustained pure blunt-force mTBI (n=12). Inclusion criteria included absence of any mixed blast-blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe). Results: There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof-introverted and apathetic. Conclusion: These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Bryan, Craig J; Clemans, Tracy A; Hernandez, Ann Marie; Rudd, Michael David
Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 13–20, 2013.
@article{Bryan2013,
title = {Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury},
author = {Bryan, Craig J and Clemans, Tracy A and Hernandez, Ann Marie and Rudd, Michael David},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {13--20},
address = {National Center for Veterans Studies, University of Utah, Salt Lake City (Drs Bryan and Rudd); VISN 19 Mental Illness Research Education Clinical Center, Department of Psychiatry, University of Colorado Denver School of Medicine, Denver (Dr Clemans); and},
abstract = {OBJECTIVE: : To identify clinical variables associated with suicidality in military personnel with mild traumatic brain injury (mTBI) while deployed to Iraq. SETTING: : Outpatient TBI clinic on a US military base in Iraq. PARTICIPANTS: : Military personnel (N = 158) referred to an outpatient TBI clinic for a standardized intake evaluation, 135 (85.4%) who had a diagnosis of mTBI and 23 (14.6%) who did not meet criteria for TBI. MAIN MEASURES: : Suicidal Behaviors Questionnaire-Revised, Depression subscale of the Behavioral Health Measure-20, Posttraumatic Stress Disorder Checklist-Military Version, Insomnia Severity Index, self-report questionnaire, and clinical interview addressing TBI-related symptoms. RESULTS: : Among patients with mTBI, increased suicidality was significantly associated with depression and the interaction of depression with posttraumatic stress disorder symptoms. Longer duration of loss of consciousness was associated with decreased likelihood for any suicidality. CONCLUSION: : Assessment after TBI in a combat zone may assist providers in identifying those at risk for suicidality and making treatment recommendations for service members with mTBI.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Miller, Kelly J; Ivins, Brian J; Schwab, Karen A
Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 31–38, 2013.
@article{Miller2013a,
title = {Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI},
author = {Miller, Kelly J and Ivins, Brian J and Schwab, Karen A},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {31--38},
address = {Defense and Veterans Brain Injury Center, Rockville, Maryland (Ms Miller, Mr Ivins, and Dr Schwab); and Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Schwab).},
abstract = {OBJECTIVE: : To investigate the potential cumulative impact of mild traumatic brain injury (MTBI) on postconcussive symptoms. PARTICIPANTS: : A total of 224 active duty soldiers reporting MTBI within 1 year of testing. For 101, this MTBI was their only reported traumatic brain injury (TBI); 123 had sustained at least 1 additional MTBI during their lifetime. A No TBI control group (n = 224) was included for comparison. MAIN MEASURE: : Self-report symptoms data via questionnaire. Within time since injury subgroups (\<=3 months; Post-3 months), symptom endorsement (no symptoms, 1 or 2 symptoms, 3+ symptoms) among soldiers with 1 MTBI was compared with that of soldiers with 2 or more MTBIs. Injured soldiers' symptom endorsement was compared with that of soldiers who had not sustained a TBI. RESULTS: : Among the recently injured (\<=3 months), those with 2 or more MTBIs endorsed significantly more symptoms than those with 1 MTBI: 67% of soldiers with 2 or more MTBIs reported 3+ symptoms, versus 29% of One MTBI soldiers. Among Post-3 month soldiers, there were no significant differences between MTBI groups. Overall, soldiers with MTBI endorsed significantly more symptoms than those without TBI. CONCLUSION: : Past experience of MTBI may be a risk factor for increased symptom difficulty for several months postinjury. Clinicians should ascertain lifetime history of brain injury when evaluating patients for MTBI.},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Larson, Eric B; Kondiles, Bethany R; Starr, Christine R; Zollman, Felise S
Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 88–95, 2013.
@article{Larson2013a,
title = {Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans},
author = {Larson, Eric B and Kondiles, Bethany R and Starr, Christine R and Zollman, Felise S},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {88--95},
address = {1 Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois.},
abstract = {The etiology of postconcussive symptoms is not clearly understood. Development of etiological models of those symptoms will be helpful for accurate diagnosis and for planning effective treatment. Such a model should characterize the role of subject characteristics (education, premorbid intelligence), social psychological factors and symptom validity. Toward that end, the present study examined the association of postconcussive complaints and cognitive performance with symptom attribution and level of effort on testing. In a sample of 155 veterans, attribution to concussion was associated with endorsement of more severe postconcussive complaints, after controlling for the effects of other factors such as subject characteristics. Similarly, effort was associated with cognitive performance after controlling for the effects of these other factors. The present findings are consistent with previous reports that illness perception and effort on testing are associated with postconcussive complaints. This supports previous recommendations to routinely educate all concussion patients immediately after injury to reduce distorted perceptions and related persistent complaints. Finally, these findings highlight a need for routine assessment of patients' perception of their injury to identify cases that may require psychotherapy to address any misattributions that develop. (JINS, 2013, 19, 1-8).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Verfaellie, Mieke; Lafleche, Ginette; Spiro, Avron; Tun, Carlos; Bousquet, Kathryn
Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 1–10, 2013.
@article{Verfaellie2013,
title = {Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure},
author = {Verfaellie, Mieke and Lafleche, Ginette and Spiro, Avron and Tun, Carlos and Bousquet, Kathryn},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {1--10},
address = {1 Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts.},
abstract = {Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment. (JINS, 2013, 19, 1-10).},
keywords = {},
pubstate = {published},
tppubtype = {article}
}
Haran, F J; Slaboda, J C; King, L A; Wright, W G; Houlihan, D; Norris, J N
Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment Journal Article
In: Journal of Neurotrauma, vol. 33, no. 7, pp. 705–711, 2016.
Abstract | Links | BibTeX | Tags: adult, Afghanistan, Article, Balance Error Scoring System, BESS, body posture, brain injury assessment, controlled study, CONVALESCENCE, human, integration, major clinical study, Male, Military, military deployment, mTBI, scoring system, Sensory Organization Test, SOT, traumatic brain injury, visual disorder, War
@article{Haran2016,
title = {Sensitivity of the Balance Error Scoring System and the Sensory Organization Test in the Combat Environment},
author = {Haran, F J and Slaboda, J C and King, L A and Wright, W G and Houlihan, D and Norris, J N},
doi = {10.1089/neu.2015.4060},
year = {2016},
date = {2016-01-01},
journal = {Journal of Neurotrauma},
volume = {33},
number = {7},
pages = {705--711},
abstract = {This study evaluated the utility of the Balance Error Scoring System (BESS) and the Sensory Organization Test (SOT) as tools for the screening and monitoring of Service members (SMs) with mild traumatic brain injury (mTBI) in a deployed setting during the acute and subacute phases of recovery. Patient records (N = 699) were reviewed for a cohort of SMs who sustained a blast-related mTBI while deployed to Afghanistan and were treated at the Concussion Restoration Care Center (CRCC) at Camp Leatherneck. On initial intake into the CRCC, participants completed two assessments of postural control, the BESS, and SOT. SMs with mTBI performed significantly worse on the BESS and SOT when compared with comparative samples. When the SOT data were further examined using sensory ratios, the results indicated that postural instability was primarily a result of vestibular and visual integration dysfunction (r \> 0.62). The main finding of this study was that the sensitivity of the SOT composite score (50-58%) during the acute phase was higher than previous sensitivities found in the sports medicine literature for impact-related trauma. Copyright © 2016 Mary Ann Liebert, Inc.},
keywords = {adult, Afghanistan, Article, Balance Error Scoring System, BESS, body posture, brain injury assessment, controlled study, CONVALESCENCE, human, integration, major clinical study, Male, Military, military deployment, mTBI, scoring system, Sensory Organization Test, SOT, traumatic brain injury, visual disorder, War},
pubstate = {published},
tppubtype = {article}
}
Hoffer, M E; Szczupak, M; Kiderman, A; Crawford, J; Murphy, S; Marshall, K; Pelusso, C; Balaban, C
Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury Journal Article
In: PLoS ONE, vol. 11, no. 1, pp. e0146039, 2016.
Abstract | BibTeX | Tags: *Brain Injuries/co [Complications], *Vestibular Function Tests, acute disease, Adolescent, adult, Affective Symptoms/et [Etiology], Brain Injuries/di [Diagnosis], Cluster Analysis, Dizziness/et [Etiology], Emergency Service, Fatigue/et [Etiology], Female, Gait Disorders, Headache/et [Etiology], Hospital, Hospitals, Humans, Male, middle aged, Mild Cognitive Impairment/et [Etiology], Military, Nausea/et [Etiology], Neurologic/et [Etiology], Neuropsychological Tests, Principal Component Analysis, Prognosis, Sex Factors, Surveys and Questionnaires, symptom assessment, Trauma Severity Indices, university, Young Adult
@article{Hoffer2016,
title = {Neurosensory Symptom Complexes after Acute Mild Traumatic Brain Injury},
author = {Hoffer, M E and Szczupak, M and Kiderman, A and Crawford, J and Murphy, S and Marshall, K and Pelusso, C and Balaban, C},
year = {2016},
date = {2016-01-01},
journal = {PLoS ONE},
volume = {11},
number = {1},
pages = {e0146039},
abstract = {Mild Traumatic Brain Injury (mTBI) is a prominent public health issue. To date, subjective symptom complaints primarily dictate diagnostic and treatment approaches. As such, the description and qualification of these symptoms in the mTBI patient population is of great value. This manuscript describes the symptoms of mTBI patients as compared to controls in a larger study designed to examine the use of vestibular testing to diagnose mTBI. Five symptom clusters were identified: Post-Traumatic Headache/Migraine, Nausea, Emotional/Affective, Fatigue/Malaise, and Dizziness/Mild Cognitive Impairment. Our analysis indicates that individuals with mTBI have headache, dizziness, and cognitive dysfunction far out of proportion to those without mTBI. In addition, sleep disorders and emotional issues were significantly more common amongst mTBI patients than non-injured individuals. A simple set of questions inquiring about dizziness, headache, and cognitive issues may provide diagnostic accuracy. The consideration of other symptoms may be critical for providing prognostic value and treatment for best short-term outcomes or prevention of long-term complications.},
keywords = {*Brain Injuries/co [Complications], *Vestibular Function Tests, acute disease, Adolescent, adult, Affective Symptoms/et [Etiology], Brain Injuries/di [Diagnosis], Cluster Analysis, Dizziness/et [Etiology], Emergency Service, Fatigue/et [Etiology], Female, Gait Disorders, Headache/et [Etiology], Hospital, Hospitals, Humans, Male, middle aged, Mild Cognitive Impairment/et [Etiology], Military, Nausea/et [Etiology], Neurologic/et [Etiology], Neuropsychological Tests, Principal Component Analysis, Prognosis, Sex Factors, Surveys and Questionnaires, symptom assessment, Trauma Severity Indices, university, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Xydakis, M S; Mulligan, L P; Smith, A B; Olsen, C H; Lyon, D M; Belluscio, L
Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study Journal Article
In: Neurology, vol. 84, pp. 1559–1567, 2015.
Abstract | BibTeX | Tags: Military
@article{Xydakis2015,
title = {Olfactory impairment and traumatic brain injury in blast-injured combat troops: a cohort study},
author = {Xydakis, M S and Mulligan, L P and Smith, A B and Olsen, C H and Lyon, D M and Belluscio, L},
year = {2015},
date = {2015-01-01},
journal = {Neurology},
volume = {84},
pages = {1559--1567},
address = {Xydakis,Michael S. From Otorhinolaryngology/Head \& Neck Surgery (M.S.X.), Neurosurgery (L.P.M.), and Neuroradiology (A.B.S.), Walter Reed National Military Medical Center, Bethesda; Traumatic Brain Injury Surgical Research Program (M.S.X., L.P.M., D.M.L.)},
abstract = {OBJECTIVE: To determine whether a structured and quantitative assessment of differential olfactory performance-recognized between a blast-injured traumatic brain injury (TBI) group and a demographically comparable blast-injured control group-can serve as a reliable antecedent marker for preclinical detection of intracranial neurotrauma. METHODS: We prospectively and consecutively enrolled 231 polytrauma inpatients, acutely injured from explosions during combat operations in either Afghanistan or Iraq and requiring immediate stateside evacuation and sequential admission to our tertiary care medical center over a 21/2-year period. This study correlates olfactometric scores with both contemporaneous neuroimaging findings as well as the clinical diagnosis of TBI, tabulates population-specific incidence data, and investigates return of olfactory function. RESULTS: Olfactometric score predicted abnormal neuroimaging significantly better than chance alone (area under the curve = 0.78, 95% confidence interval [CI] 0.70-0.87). Normosmia was present in all troops with mild TBI (i.e., concussion) and all control subjects. Troops with radiographic evidence of frontal lobe injuries were 3 times more likely to have olfactory impairment than troops with injuries to other brain regions (relative risk 3.0, 95% CI 0.98-9.14). Normalization of scores occurred in all anosmic troops available for follow-up testing. CONCLUSION: Quantitative identification olfactometry has limited sensitivity but high specificity as a marker for detecting acute structural neuropathology from trauma. When considering whether to order advanced neuroimaging, a functional disturbance with central olfactory impairment should be regarded as an important tool to inform the decision process. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that central olfactory dysfunction identifies patients with TBI who have intracranial radiographic abnormalities with a sensitivity of 35% (95% CI 20.6%-51.7%) and specificity of 100% (95% CI 97.7%-100.0%).Copyright © 2015 American Academy of Neurology.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Robinson, M E; Lindemer, E R; Fonda, J R; Milberg, W P; McGlinchey, R E; Salat, D H
Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure Journal Article
In: Human Brain Mapping, vol. 36, pp. 911–922, 2015.
Abstract | BibTeX | Tags: Military
@article{Robinson2015,
title = {Close-range blast exposure is associated with altered functional connectivity in Veterans independent of concussion symptoms at time of exposure},
author = {Robinson, M E and Lindemer, E R and Fonda, J R and Milberg, W P and McGlinchey, R E and Salat, D H},
year = {2015},
date = {2015-01-01},
journal = {Human Brain Mapping},
volume = {36},
pages = {911--922},
address = {Robinson,Meghan E. Neuroimaging Research for Veterans Center (NeRVe), VA Boston Healthcare System, Boston, Massachusetts; Translational Research Center for TBI and Stress Disorders (TRACTS), VA Boston Healthcare System, Boston, Massachusetts.},
abstract = {Although there is emerging data on the effects of blast-related concussion (or mTBI) on cognition, the effects of blast exposure itself on the brain have only recently been explored. Toward this end, we examine functional connectivity to the posterior cingulate cortex, a primary region within the default mode network (DMN), in a cohort of 134 Iraq and Afghanistan Veterans characterized for a range of common military-associated comorbidities. Exposure to a blast at close range (\<10 meters) was associated with decreased connectivity of bilateral primary somatosensory and motor cortices, and these changes were not different from those seen in participants with blast-related mTBI. These results remained significant when clinical factors such as sleep quality, chronic pain, or post traumatic stress disorder were included in the statistical model. In contrast, differences in functional connectivity based on concussion history and blast exposures at greater distances were not apparent. Despite the limitations of a study of this nature (e.g., assessments long removed from injury, self-reported blast history), these data demonstrate that blast exposure per se, which is prevalent among those who served in Iraq and Afghanistan, may be an important consideration in Veterans' health. It further offers a clinical guideline for determining which blasts (namely, those within 10 meters) are likely to lead to long-term health concerns and may be more accurate than using concussion symptoms alone.Copyright Published 2014. This article is a U.S. Government work and is in the public domain in the USA.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bogner, J; French, L M; Lange, R T; Corrigan, J D
Pilot study of traumatic brain injury and alcohol misuse among service members Journal Article
In: Brain Injury, vol. 29, pp. 905–914, 2015.
Abstract | BibTeX | Tags: Military
@article{Bogner2015,
title = {Pilot study of traumatic brain injury and alcohol misuse among service members},
author = {Bogner, J and French, L M and Lange, R T and Corrigan, J D},
year = {2015},
date = {2015-01-01},
journal = {Brain Injury},
volume = {29},
pages = {905--914},
address = {Bogner,Jennifer. The Ohio State University , Columbus, OH , USA .},
abstract = {OBJECTIVE: Explore relationships among traumatic brain injury (TBI), substance misuse and other mental health disorders in US service members and to identify risk factors for substance misuse. PARTICIPANTS: Service members (n=93 in final sample) injured while deployed to Operation Enduring Freedom or Operation Iraqi Freedom. METHODS AND MATERIALS: Longitudinal survey at 6 and 12 months post-intake. The following measures were used: problem substance use, Alcohol Expectancies Questionnaire-III, MINI International Neuropsychiatric Interview Substance Abuse Modules, Ohio State University TBI Identification Method, Neurobehavioural Symptom Inventory, Rivermead Post-Concussion Symptoms Questionnaire, Buss-Perry Aggression Questionnaire, Post-Traumatic Stress Disorder Checklist-Civilian Version, Beck Depression Inventory-II, Beck Anxiety Inventory. RESULTS: More severe TBI and post-traumatic stress disorder (PTSD) symptoms at 6 months post-enrolment were associated with decreased odds of substance misuse 12 months after study enrolment. Alcohol expectancies and incurring a TBI at a younger age increased the odds of substance misuse. CONCLUSIONS: While the ability to generalize the current findings to a larger population is limited, the results provide direction for future studies on the prevention and treatment of substance misuse following TBI. The unexpected protective effect of more severe TBI may result from prospective attention to the injury and its consequences. Greater preventive benefit may result from identifying more service members with elevated risk. Lifetime history of TBI and alcohol expectancies may be candidate indicators for greater attention.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ling, G; Ecklund, J M; Bandak, F A
Brain injury from explosive blast: description and clinical management Journal Article
In: Handbook of Clinical Neurology, vol. 127, pp. 173–180, 2015.
Abstract | BibTeX | Tags: Military
@article{Ling2015,
title = {Brain injury from explosive blast: description and clinical management},
author = {Ling, G and Ecklund, J M and Bandak, F A},
year = {2015},
date = {2015-01-01},
journal = {Handbook of Clinical Neurology},
volume = {127},
pages = {173--180},
address = {Ling,G. Department of Neurology, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA. Electronic address: geoffrey.ling@usuhs.edu. Ecklund,J M. Department of Neurosciences, Inova Fairfax Medical Cam},
abstract = {Accumulating clinical experience is indicating that explosive blast brain injury is becoming recognized as a disease distinct from the penetrating form of blast injury as well as the classic closed head injury (CHI). In recent US conflicts in Iraq and Afghanistan, over 60% of combat casualties were from explosive blast with the hallmark explosive weapon being the improvised explosive device (IED). Explosive blast TBI is a condition afflicting many combat injured warfighters potentially constituting another category of TBI. Clinically, it shares many features with conventional TBI but possesses some unique aspects. In its mild form, it also shares many clinical features with PTSD but here again has distinct aspects. Although military medical providers depend on civilian standard of care guidelines when managing explosive blast mTBI, they are continually adapting their medical practice in order to optimize the treatment of this disease, particularly in a theater of war. It is clear that further rigorous scientific study of explosive blast mTBI at both the basic science and clinical levels is needed. This research must include improved understanding of the causes and mechanisms of explosive blast TBI as well as comprehensive epidemiologic studies to determine the prevalence of this disease and its risk factors. A widely accepted unambiguous clinical description of explosive blast mTBI with diagnostic criteria would greatly improve diagnosis. It is hoped that through appropriate research meaningful prevention, mitigation, and treatment strategies for explosive blast mTBI can be speedily realized.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Newsome, M R; Durgerian, S; Mourany, L; Scheibel, R S; Lowe, M J; Beall, E B; Koenig, K A; Parsons, M; Troyanskaya, M; Reece, C; Wilde, E; Fischer, B L; Jones, S E; Agarwal, R; Levin, H S; Rao, S M
Disruption of caudate working memory activation in chronic blast-related traumatic brain injury Journal Article
In: NeuroImage Clinical, vol. 8, pp. 543–553, 2015.
Abstract | BibTeX | Tags: Military
@article{Newsome2015,
title = {Disruption of caudate working memory activation in chronic blast-related traumatic brain injury},
author = {Newsome, M R and Durgerian, S and Mourany, L and Scheibel, R S and Lowe, M J and Beall, E B and Koenig, K A and Parsons, M and Troyanskaya, M and Reece, C and Wilde, E and Fischer, B L and Jones, S E and Agarwal, R and Levin, H S and Rao, S M},
year = {2015},
date = {2015-01-01},
journal = {NeuroImage Clinical},
volume = {8},
pages = {543--553},
address = {Newsome,Mary R. Research Service Line, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA ; Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA. Durgerian,Sally. Department of Neurology, Medic},
abstract = {Mild to moderate traumatic brain injury (TBI) due to blast exposure is frequently diagnosed in veterans returning from the wars in Iraq and Afghanistan. However, it is unclear whether neural damage resulting from blast TBI differs from that found in TBI due to blunt-force trauma (e.g., falls and motor vehicle crashes). Little is also known about the effects of blast TBI on neural networks, particularly over the long term. Because impairment in working memory has been linked to blunt-force TBI, the present functional magnetic resonance imaging (fMRI) study sought to investigate whether brain activation in response to a working memory task would discriminate blunt-force from blast TBI. Twenty-five veterans (mean age = 29.8 years, standard deviation = 6.01 years, 1 female) who incurred TBI due to blast an average of 4.2 years prior to enrollment and 25 civilians (mean age = 27.4 years, standard deviation = 6.68 years, 4 females) with TBI due to blunt-force trauma performed the Sternberg Item Recognition Task while undergoing fMRI. The task involved encoding 1, 3, or 5 items in working memory. A group of 25 veterans (mean age = 29.9 years, standard deviation = 5.53 years, 0 females) and a group of 25 civilians (mean age = 27.3 years, standard deviation = 5.81 years, 0 females) without history of TBI underwent identical imaging procedures and served as controls. Results indicated that the civilian TBI group and both control groups demonstrated a monotonic relationship between working memory set size and activation in the right caudate during encoding, whereas the blast TBI group did not (p \< 0.05, corrected for multiple comparisons using False Discovery Rate). Blast TBI was also associated with worse performance on the Sternberg Item Recognition Task relative to the other groups, although no other group differences were found on neuropsychological measures of episodic memory, inhibition, and general processing speed. These results could not be attributed to caudate atrophy or the presence of PTSD symptoms. Our results point to a specific vulnerability of the caudate to blast injury. Changes in activation during the Sternberg Item Recognition Task, and potentially other tasks that recruit the caudate, may serve as biomarkers for blast TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Dretsch, M N; Kelly, M P; Coldren, R L; Parish, R V; Russell, M L
In: Journal of Neurotrauma, vol. 32, no. 16, pp. 1217–1222, 2015.
Abstract | Links | BibTeX | Tags: 2003-2011, acute disease, Adolescent, adult, amnesia, ANAM, Article, assessment of humans, Automated Neuropsychological Assessment Metrics, Blast injuries, blast injury, blunt trauma, brain concussion, clinical article, cognition, Cognition Disorders, cognitive screening, comparative study, complication, concussion mechanism, Demography, deployment, Female, follow up, health status, human, Humans, Iraq War, Male, middle aged, Military, Military Acute Concussion Evaluation, Military personnel, neuropsychological test, Neuropsychological Tests, soldier, unconsciousness, UNITED States, War, Young Adult
@article{Dretsch2015a,
title = {No Significant Acute and Subacute Differences between Blast and Blunt Concussions across Multiple Neurocognitive Measures and Symptoms in Deployed Soldiers},
author = {Dretsch, M N and Kelly, M P and Coldren, R L and Parish, R V and Russell, M L},
doi = {10.1089/neu.2014.3637},
year = {2015},
date = {2015-01-01},
journal = {Journal of Neurotrauma},
volume = {32},
number = {16},
pages = {1217--1222},
abstract = {Seventy-one deployed U.S. Army soldiers who presented for concussion care due to either blast or blunt mechanisms within 72 h of injury were assessed using the Military Acute Concussion Evaluation, the Automated Neuropsychological Assessment Metrics (ANAM), traditional neuropsychological tests, and health status questionnaires. Follow-up ANAM testing was performed 10 d after initial testing (±5 d). Twenty-one soldiers were excluded: two for poor effort and 19 who had combined blast/blunt injuries. Of the remaining 50 male participants, 34 had blast injuries and 16 had blunt injuries. There were no statistically significant differences between blast injury and blunt injury participants in demographic, physical, or psychological health factors, concussive symptoms, or automated and traditional neurocognitive testing scores within 72 h post-injury. In addition, follow-up ANAM scores up to 15 d post-injury were not significantly different (available on 21 blast-injured and 13 blunt-injured subjects). Pre-injury baseline ANAM scores were compared where available, and revealed no statistically significant differences between 22 blast injury and eight blunt injury participants. These findings suggest there are no significant differences between mechanisms of injury during both the acute and subacute periods in neurobehavioral concussion sequelae while deployed in a combat environment. The current study supports the use of sports/mechanical concussion models for early concussion management in the deployed setting and exploration of variability in potential long-term outcomes. © Copyright 2015, Mary Ann Liebert, Inc.},
keywords = {2003-2011, acute disease, Adolescent, adult, amnesia, ANAM, Article, assessment of humans, Automated Neuropsychological Assessment Metrics, Blast injuries, blast injury, blunt trauma, brain concussion, clinical article, cognition, Cognition Disorders, cognitive screening, comparative study, complication, concussion mechanism, Demography, deployment, Female, follow up, health status, human, Humans, Iraq War, Male, middle aged, Military, Military Acute Concussion Evaluation, Military personnel, neuropsychological test, Neuropsychological Tests, soldier, unconsciousness, UNITED States, War, Young Adult},
pubstate = {published},
tppubtype = {article}
}
Cook, G A; Hawley, J S
A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology Journal Article
In: Military Medicine, vol. 179, pp. 1083–1089, 2014.
Abstract | Links | BibTeX | Tags: Military
@article{Cook2014,
title = {A review of mild traumatic brain injury diagnostics: Current perspectives, limitations, and emerging technology},
author = {Cook, G A and Hawley, J S},
doi = {10.7205/MILMED-D-13-00435},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1083--1089},
abstract = {Mild traumatic brain injury (mTBI) or concussion is a common battlefield and in-garrison injury caused by transmission of mechanical forces to the head. The energy transferred in such events can cause structural and/or functional changes in the brain that manifest as focal neurological, cognitive, or behavioral dysfunction. Current diagnostic criteria for mTBI are highly limited, variable, and based on subjective self-report. The subjective nature of the symptoms, both in quantity and quality, together with their large overlap in other physical and behavioral maladies, limit the clinician's ability to accurately diagnose, treat, and make prognostic decisions after such injuries. These diagnostic challenges are magnified in an operational environment as well. The Department of Defense has invested significant resources into improving the diagnostic tools and accuracy for mTBI. This focus has been to supplement the clinician's examination with technology that is better able to objectify brain dysfunction after mTBI. Through this review, we discuss the current state of three promising technologies\textemdashsoluble protein biomarkers, advanced neuroimaging, and quantitative electroencephalography\textemdashthat are of particular interest within military medicine. © AMSUS. All rights reserved.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
McCrea, M; Guskiewicz, K; Doncevic, S; Helmick, K; Kennedy, J; Boyd, C; Asmussen, S; Ahn, K W; Wang, Y; Hoelzle, J; Jaffee, M
Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF Journal Article
In: Military Medicine, vol. 179, pp. 990–997, 2014.
Abstract | BibTeX | Tags: Military
@article{McCrea2014,
title = {Day of injury cognitive performance on the Military Acute Concussion Evaluation (MACE) by U.S. military service members in OEF/OIF},
author = {McCrea, M and Guskiewicz, K and Doncevic, S and Helmick, K and Kennedy, J and Boyd, C and Asmussen, S and Ahn, K W and Wang, Y and Hoelzle, J and Jaffee, M},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {990--997},
address = {McCrea,Michael. Departments of Neurosurgery and Neurology, Medical College of Wisconsin, 8701 West Watertown Plank Road, Milwaukee, WI 53226. Guskiewicz,Kevin. Injury Prevention Research Center, University of North Carolina at Chapel Hill, 209 Fetzer Hall},
abstract = {OBJECTIVES: The study investigated the clinical validity of the cognitive screening component of the Military Acute Concussion Evaluation (MACE) for the evaluation of acute mild traumatic brain injury (mTBI) in a military operational setting. METHODS: This was a retrospective data study involving analysis of MACE data on Operation Enduring Freedom/Operation Iraqi Freedom deployed service members with mTBI. In total, 179 cases were included in analyses based on ICD-9 diagnostic codes and characteristics of mTBI, and availability of MACE data on day of injury. MACE data from the mTBI group was compared to a military sample without mTBI administered the MACE as part of a normative data project. RESULTS: On day of injury, the mTBI group performed worse than controls on the MACE cognitive test (d = 0.90), with significant impairments in all cognitive domains assessed. MACE cognitive score was strongly associated with established indicators of acute injury severity. Lower MACE cognitive performance on day of injury was predictive of lengthier postinjury recovery time and time until return to duty after mTBI. CONCLUSIONS: Findings from the current study support the use of the MACE as a valid screening tool to assess for cognitive dysfunction in military service members during the acute phase after mTBI.Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Johnson, M A; Hawley, J S; Theeler, B J
Management of acute concussion in a deployed military setting Journal Article
In: Current Treatment Options in Neurology, vol. 16, pp. 311, 2014.
Abstract | BibTeX | Tags: Military
@article{Johnson2014a,
title = {Management of acute concussion in a deployed military setting},
author = {Johnson, M A and Hawley, J S and Theeler, B J},
year = {2014},
date = {2014-01-01},
journal = {Current Treatment Options in Neurology},
volume = {16},
pages = {311},
address = {Johnson,Michael A L. Department of Neurology, Walter Reed National Military Medical Center, Uniformed Services University of Health Sciences, 8901 Rockville Pike, Bethesda, MD, 20889-5600, USA, maullionheart@gmail.com.},
abstract = {OPINION STATEMENT: The DoD has established clinical guidelines and policies creating a system of care for the management of battlefield concussion. Within these instructions, medical providers have standardized guidance for screening and diagnosing concussion, along with guidelines for treating common concussion symptoms. Underlying these policies is the principle that concussion is an important injury, and SMs need to be removed from combat during the acute period to ensure full recovery before return to duty. As our understanding of concussion advances, the DoD will incorporate these advances into the current system of care, ensuring that SMs have the highest level of care possible for concussions sustained on the battlefield.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
de Lanerolle, N C; Hamid, H; Kulas, J; Pan, J W; Czlapinski, R; Rinaldi, A; Ling, G; Bandak, F A; Hetherington, H P
Concussive brain injury from explosive blast Journal Article
In: Annals of Clinical & Translational Neurology, vol. 1, pp. 692–702, 2014.
Abstract | BibTeX | Tags: Military
@article{DeLanerolle2014,
title = {Concussive brain injury from explosive blast},
author = {de Lanerolle, N C and Hamid, H and Kulas, J and Pan, J W and Czlapinski, R and Rinaldi, A and Ling, G and Bandak, F A and Hetherington, H P},
year = {2014},
date = {2014-01-01},
journal = {Annals of Clinical \& Translational Neurology},
volume = {1},
pages = {692--702},
address = {de Lanerolle,Nihal C. Department of Neurosurgery, Yale University New Haven, Connecticut, 06520. Hamid,Hamada. Department of Neurology, Yale University New Haven, Connecticut, 06520 ; Department of Psychiatry, Yale University New Haven, Connecticut, 06520},
abstract = {OBJECTIVE: Explosive blast mild traumatic brain injury (mTBI) is associated with a variety of symptoms including memory impairment and posttraumatic stress disorder (PTSD). Explosive shock waves can cause hippocampal injury in a large animal model. We recently reported a method for detecting brain injury in soldiers with explosive blast mTBI using magnetic resonance spectroscopic imaging (MRSI). This method is applied in the study of veterans exposed to blast. METHODS: The hippocampus of 25 veterans with explosive blast mTBI, 20 controls, and 12 subjects with PTSD but without exposure to explosive blast were studied using MRSI at 7 Tesla. Psychiatric and cognitive assessments were administered to characterize the neuropsychiatric deficits and compare with findings from MRSI. RESULTS: Significant reductions in the ratio of N-acetyl aspartate to choline (NAA/Ch) and N-acetyl aspartate to creatine (NAA/Cr) (P \< 0.05) were found in the anterior portions of the hippocampus with explosive blast mTBI in comparison to control subjects and were more pronounced in the right hippocampus, which was 15% smaller in volume (P \< 0.05). Decreased NAA/Ch and NAA/Cr were not influenced by comorbidities - PTSD, depression, or anxiety. Subjects with PTSD without blast had lesser injury, which tended to be in the posterior hippocampus. Explosive blast mTBI subjects had a reduction in visual memory compared to PTSD without blast. INTERPRETATION: The region of the hippocampus injured differentiates explosive blast mTBI from PTSD. MRSI is quite sensitive in detecting and localizing regions of neuronal injury from explosive blast associated with memory impairment.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Spooner, S P; Tyner, S D; Sowers, C; Tsao, J; Stuessi, K
Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care Journal Article
In: Military Medicine, vol. 179, pp. 1319–1324, 2014.
Abstract | BibTeX | Tags: Military
@article{Spooner2014,
title = {Utility of a sports medicine model in military combat concussion and musculoskeletal restoration care},
author = {Spooner, S P and Tyner, S D and Sowers, C and Tsao, J and Stuessi, K},
year = {2014},
date = {2014-01-01},
journal = {Military Medicine},
volume = {179},
pages = {1319--1324},
address = {Spooner,Shawn P. Captain James A. Lovell Federal Healthcare Center, 3001 Green Bay Road, North Chicago, IL 60064. Tyner,Stuart D. U.S. Army Institute of Surgical Research, Fort Sam Houston, 3698 Chambers Pass Ste B, JBSA FT Sam Houston, TX 78234-7767. Sow},
abstract = {Combat-related concussions are significant sources of injury and morbidity among deployed military service members. Musculoskeletal injury also is one of the most prevalent battle and nonbattle-related deployed injury types. Both injuries threaten the service member's physical condition as well as unit and mission readiness due to reduced duty status or evacuation from military theater of operations. In August 2010, the Concussion Restoration Care Center (CRCC) was established at Camp Leatherneck, Afghanistan, to address the need for consistent and specialized evaluation and care of concussion and musculoskeletal injury. This performance improvement effort examined evaluation and treatment of concussion and musculoskeletal injury at the CRCC. Among 4,947 military personnel evaluated at the CRCC between August 2010 and May 2013, 97.9% were returned to duty and retained in theater. Members averaged 10 to 12 days of limited duty status to achieve complete recovery. Concussion injury was secondary to blast injury in 90% of cases. Sport/recreation, occupational, and other accidental injuries each represented 30% of the musculoskeletal injuries with only 10% reported as result of combat. The utilization patterns and outcome measures demonstrate the success and utility of a multidisciplinary clinical model of care for these two types of injuries in the far-forward deployed setting. Reprint \& Copyright © 2014 Association of Military Surgeons of the U.S.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Miller, Kelly J; Ivins, Brian J; Schwab, Karen A
Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 31–38, 2013.
Abstract | BibTeX | Tags: Military
@article{Miller2013a,
title = {Self-Reported Mild TBI and Postconcussive Symptoms in a Peacetime Active Duty Military Population: Effect of Multiple TBI History Versus Single Mild TBI},
author = {Miller, Kelly J and Ivins, Brian J and Schwab, Karen A},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {31--38},
address = {Defense and Veterans Brain Injury Center, Rockville, Maryland (Ms Miller, Mr Ivins, and Dr Schwab); and Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland (Dr Schwab).},
abstract = {OBJECTIVE: : To investigate the potential cumulative impact of mild traumatic brain injury (MTBI) on postconcussive symptoms. PARTICIPANTS: : A total of 224 active duty soldiers reporting MTBI within 1 year of testing. For 101, this MTBI was their only reported traumatic brain injury (TBI); 123 had sustained at least 1 additional MTBI during their lifetime. A No TBI control group (n = 224) was included for comparison. MAIN MEASURE: : Self-report symptoms data via questionnaire. Within time since injury subgroups (\<=3 months; Post-3 months), symptom endorsement (no symptoms, 1 or 2 symptoms, 3+ symptoms) among soldiers with 1 MTBI was compared with that of soldiers with 2 or more MTBIs. Injured soldiers' symptom endorsement was compared with that of soldiers who had not sustained a TBI. RESULTS: : Among the recently injured (\<=3 months), those with 2 or more MTBIs endorsed significantly more symptoms than those with 1 MTBI: 67% of soldiers with 2 or more MTBIs reported 3+ symptoms, versus 29% of One MTBI soldiers. Among Post-3 month soldiers, there were no significant differences between MTBI groups. Overall, soldiers with MTBI endorsed significantly more symptoms than those without TBI. CONCLUSION: : Past experience of MTBI may be a risk factor for increased symptom difficulty for several months postinjury. Clinicians should ascertain lifetime history of brain injury when evaluating patients for MTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Weaver, L; Manukyan, Z; Halberstadt, S M; Lindblad, A S
In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury Journal Article
In: Military Medicine, vol. 178, pp. viii–ix, 2013.
@article{Weaver2013,
title = {In Response to: The ANAM lacks utility as a diagnostic or screening tool for concussion more than 10 days following injury},
author = {Weaver, L and Manukyan, Z and Halberstadt, S M and Lindblad, A S},
year = {2013},
date = {2013-01-01},
journal = {Military Medicine},
volume = {178},
pages = {viii--ix},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Lamberty, Greg J; Nelson, Nathaniel W; Yamada, Torrii
Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications Journal Article
In: Behavioral Sciences & the Law, vol. 31, pp. 814–832, 2013, ISSN: 1099-0798.
Abstract | Links | BibTeX | Tags: Military
@article{Lamberty2013,
title = {Effects and Outcomes in Civilian and Military Traumatic Brain Injury: Similarities, Differences, and Forensic Implications},
author = {Lamberty, Greg J and Nelson, Nathaniel W and Yamada, Torrii},
doi = {10.1002/bsl.2091},
issn = {1099-0798},
year = {2013},
date = {2013-01-01},
journal = {Behavioral Sciences \& the Law},
volume = {31},
pages = {814--832},
abstract = {Traumatic brain injury (TBI) is a prominent public health problem in both civilian and military settings. This article discusses similarities and differences in the assessment and treatment of TBI and the attendant forensic implications. Acute care and management of moderate/severe TBI tend to be similar across environments, as is the recognition of disability status in affected individuals. By contrast, an increased focus on mild TBI in recent years has resulted in a reliance on self-report and screening measures to validate the occurrence of events leading to injury. This has complicated assessment, treatment and subsequent medicolegal proceedings. The neuropsychological literature has provided significant guidance on these difficult issues, although the complexity of disability adjudication for active duty members of the military and veterans continues to pose challenges for clinicians in evaluative and treatment contexts.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Mendez, Mario F; Owens, Emily M; Jimenez, Elvira E; Peppers, Dominique; Licht, Eliot A
Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces Journal Article
In: Brain Injury, vol. 27, pp. 10–18, 2013.
Abstract | BibTeX | Tags: Military
@article{Mendez2013,
title = {Changes in personality after mild traumatic brain injury from primary blast vs. blunt forces},
author = {Mendez, Mario F and Owens, Emily M and Jimenez, Elvira E and Peppers, Dominique and Licht, Eliot A},
year = {2013},
date = {2013-01-01},
journal = {Brain Injury},
volume = {27},
pages = {10--18},
address = {Department of Neurology.},
abstract = {Introduction: Injuries from explosive devices can cause blast-force injuries, including mild traumatic brain injury (mTBI). Objective: This study investigated changes in personality from blast-force mTBI in comparison to blunt-force mTBI. Methods: Clinicians and significant others assessed US veterans who sustained pure blast-force mTBI (n=12), as compared to those who sustained pure blunt-force mTBI (n=12). Inclusion criteria included absence of any mixed blast-blunt trauma and absence of post-traumatic stress disorder. Measures included the Interpersonal Measure of Psychopathy (IM-P), the Big Five Inventory (BFI), the Interpersonal Adjectives Scale (IAS) and the Frontal Systems Behaviour Scale (FrSBe). Results: There were no group differences on demographic or TBI-related variables. Compared to the Blunt Group, the Blast Group had more psychopathy on the IM-P, with anger, frustration, toughness and boundary violations and tended to more neuroticism on the BFI. When pre-TBI and post-TBI assessments were compared on the IAS and FrSBe, only the patients with blast force mTBI had become more cold-hearted, aloof-introverted and apathetic. Conclusion: These results suggest that blast forces alone can cause negativistic behavioural changes when evaluated with selected measures of personality. Further research on isolated blast-force mTBI should focus on these personality changes and their relationship to blast over-pressure.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bryan, Craig J; Clemans, Tracy A; Hernandez, Ann Marie; Rudd, Michael David
Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 13–20, 2013.
Abstract | BibTeX | Tags: Military
@article{Bryan2013,
title = {Loss of consciousness, depression, posttraumatic stress disorder, and suicide risk among deployed military personnel with mild traumatic brain injury},
author = {Bryan, Craig J and Clemans, Tracy A and Hernandez, Ann Marie and Rudd, Michael David},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {13--20},
address = {National Center for Veterans Studies, University of Utah, Salt Lake City (Drs Bryan and Rudd); VISN 19 Mental Illness Research Education Clinical Center, Department of Psychiatry, University of Colorado Denver School of Medicine, Denver (Dr Clemans); and},
abstract = {OBJECTIVE: : To identify clinical variables associated with suicidality in military personnel with mild traumatic brain injury (mTBI) while deployed to Iraq. SETTING: : Outpatient TBI clinic on a US military base in Iraq. PARTICIPANTS: : Military personnel (N = 158) referred to an outpatient TBI clinic for a standardized intake evaluation, 135 (85.4%) who had a diagnosis of mTBI and 23 (14.6%) who did not meet criteria for TBI. MAIN MEASURES: : Suicidal Behaviors Questionnaire-Revised, Depression subscale of the Behavioral Health Measure-20, Posttraumatic Stress Disorder Checklist-Military Version, Insomnia Severity Index, self-report questionnaire, and clinical interview addressing TBI-related symptoms. RESULTS: : Among patients with mTBI, increased suicidality was significantly associated with depression and the interaction of depression with posttraumatic stress disorder symptoms. Longer duration of loss of consciousness was associated with decreased likelihood for any suicidality. CONCLUSION: : Assessment after TBI in a combat zone may assist providers in identifying those at risk for suicidality and making treatment recommendations for service members with mTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Larson, Eric B; Kondiles, Bethany R; Starr, Christine R; Zollman, Felise S
Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 88–95, 2013.
Abstract | BibTeX | Tags: Military
@article{Larson2013a,
title = {Postconcussive Complaints, Cognition, Symptom Attribution and Effort among Veterans},
author = {Larson, Eric B and Kondiles, Bethany R and Starr, Christine R and Zollman, Felise S},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {88--95},
address = {1 Brain Injury Medicine and Rehabilitation Program, Rehabilitation Institute of Chicago, Chicago, Illinois.},
abstract = {The etiology of postconcussive symptoms is not clearly understood. Development of etiological models of those symptoms will be helpful for accurate diagnosis and for planning effective treatment. Such a model should characterize the role of subject characteristics (education, premorbid intelligence), social psychological factors and symptom validity. Toward that end, the present study examined the association of postconcussive complaints and cognitive performance with symptom attribution and level of effort on testing. In a sample of 155 veterans, attribution to concussion was associated with endorsement of more severe postconcussive complaints, after controlling for the effects of other factors such as subject characteristics. Similarly, effort was associated with cognitive performance after controlling for the effects of these other factors. The present findings are consistent with previous reports that illness perception and effort on testing are associated with postconcussive complaints. This supports previous recommendations to routinely educate all concussion patients immediately after injury to reduce distorted perceptions and related persistent complaints. Finally, these findings highlight a need for routine assessment of patients' perception of their injury to identify cases that may require psychotherapy to address any misattributions that develop. (JINS, 2013, 19, 1-8).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Macgregor, Andrew J; Dougherty, Amber L; Tang, Janet J; Galarneau, Michael R
Postconcussive Symptom Reporting Among US Combat Veterans With Mild Traumatic Brain Injury From Operation Iraqi Freedom Journal Article
In: Journal of Head Trauma Rehabilitation, vol. 28, pp. 59–67, 2013.
Abstract | BibTeX | Tags: Military
@article{Macgregor2013,
title = {Postconcussive Symptom Reporting Among US Combat Veterans With Mild Traumatic Brain Injury From Operation Iraqi Freedom},
author = {Macgregor, Andrew J and Dougherty, Amber L and Tang, Janet J and Galarneau, Michael R},
year = {2013},
date = {2013-01-01},
journal = {Journal of Head Trauma Rehabilitation},
volume = {28},
pages = {59--67},
address = {Department of Medical Modeling, Simulation and Mission Support, Naval Health Research Center, San Diego, California.},
abstract = {OBJECTIVE: : To examine the association between postconcussive symptoms and mild traumatic brain injury (MTBI) among combat veterans while adjusting for posttraumatic stress disorder (PTSD) and depression. PATIENTS: : Military personnel with provider-diagnosed MTBI (n = 334) or nonhead injury (n = 658) were identified from the Expeditionary Medical Encounter Database. MAIN OUTCOME MEASURES: : Post-Deployment Health Assessments and Re-Assessments were used to examine postconcussive symptoms and self-rated health. RESULTS: : Personnel with MTBI were more likely to report headache (odds ratio [OR] = 3.37; 95% confidence interval [CI] = 2.19-5.17), back pain (OR = 1.79; 95% CI = 1.23-2.60), memory problems (OR = 1.86; 95% CI = 1.20-2.88), tinnitus (OR = 1.63; 95% CI = 1.10-2.41), and dizziness (OR = 2.13; 95% CI = 1.06-4.29) compared with those with non-head injuries. Among those with MTBI, self-reported decline in health was associated with memory problems (OR = 5.07; 95% CI = 2.56-10.02) and dizziness (OR = 10.60; 95% CI = 3.48-32.27). CONCLUSIONS: : Mild traumatic brain injury is associated with reports of negative health consequences among combat veterans even when accounting for co-occurring psychological morbidity. The identification of postconcussive symptoms related to declines in a service member's self-rated health may be important in targeting and prioritizing clinical interventions.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Verfaellie, Mieke; Lafleche, Ginette; Spiro, Avron; Tun, Carlos; Bousquet, Kathryn
Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure Journal Article
In: Journal of the International Neuropsychological Society, vol. 19, pp. 1–10, 2013.
Abstract | BibTeX | Tags: Military
@article{Verfaellie2013,
title = {Chronic Postconcussion Symptoms and Functional Outcomes in OEF/OIF Veterans with Self-Report of Blast Exposure},
author = {Verfaellie, Mieke and Lafleche, Ginette and Spiro, Avron and Tun, Carlos and Bousquet, Kathryn},
year = {2013},
date = {2013-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {19},
pages = {1--10},
address = {1 Memory Disorders Research Center, VA Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts.},
abstract = {Postconcussion symptoms (PCS) and functional outcomes were evaluated in 91 OEF/OIF outpatient veterans with reported histories of blast-exposure, with the goal of evaluating (1) the association between these outcomes and a clinical diagnosis of mild traumatic brain injury (mTBI) with or without loss of consciousness (LOC); and (2) the influence of post-traumatic stress disorder (PTSD) and depression on PCS reporting and perceived functional limitations. Individuals who reported mTBI with LOC had greater PCS complaints than individuals who reported mTBI without LOC or individuals without mTBI. However, after adjusting for severity of PTSD and depression symptoms, this group difference disappeared. Functional limitations were particularly prominent in the psychosocial domain. Again, PTSD was significantly associated with functional outcomes, but the mTBI with LOC group had greater psychosocial limitations than the other two groups, even when PTSD and depression symptoms were taken into account. These findings highlight the role of mental health in both outcomes, but additionally point to the impact of mTBI with LOC on long-term psychosocial adjustment. (JINS, 2013, 19, 1-10).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Capehart, Bruce; Bass, Dale
Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury Journal Article
In: Journal of Rehabilitation Research & Development, vol. 49, pp. 789–812, 2012.
Abstract | BibTeX | Tags: Military
@article{Capehart2012,
title = {Review: Managing posttraumatic stress disorder in combat veterans with comorbid traumatic brain injury},
author = {Capehart, Bruce and Bass, Dale},
year = {2012},
date = {2012-01-01},
journal = {Journal of Rehabilitation Research \& Development},
volume = {49},
pages = {789--812},
address = {Durham VA Medical Center OEF/OIF Program and Mental Health Service Line (116A), 508 Fulton St, Durham, NC 27705. bruce.capehart@va.gov.},
abstract = {Military deployments to Afghanistan and Iraq have been associated with elevated prevalence of both posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI) among combat veterans. The diagnosis and management of PTSD when a comorbid TBI may also exist presents a challenge to interdisciplinary care teams at Department of Veterans Affairs (VA) and civilian medical facilities, particularly when the patient reports a history of blast exposure. Treatment recommendations from VA and Department of Defense's (DOD) recently updated VA/DOD Clinical Practice Guideline for Management of Post-Traumatic Stress are considered from the perspective of simultaneously managing comorbid TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Hoffman, Stuart N; Zhang, Xiaopeng; Erlich, Porat M; Boscarino, Joseph A
Grapheme-color synesthesia and posttraumatic stress disorder: preliminary results from the veterans health study Journal Article
In: Psychosomatic Medicine, vol. 74, pp. 912–915, 2012.
Abstract | BibTeX | Tags: Military
@article{Hoffman2012,
title = {Grapheme-color synesthesia and posttraumatic stress disorder: preliminary results from the veterans health study},
author = {Hoffman, Stuart N and Zhang, Xiaopeng and Erlich, Porat M and Boscarino, Joseph A},
year = {2012},
date = {2012-01-01},
journal = {Psychosomatic Medicine},
volume = {74},
pages = {912--915},
address = {MPH, Center for Health Research, Geisinger Clinic, 100 N Academy Ave, Danville, PA 17822-4400. jaboscarino@geisinger.edu.},
abstract = {Objective Posttraumatic stress disorder (PTSD) is associated with altered neuropsychological function, possibly including complex visual information processing. Grapheme-color synesthesia refers to the phenomenon that a particular letter or number elicits the visual perception of a specific color. The study objective was to assess if grapheme-color synesthesia was associated with PTSD among US veterans. Method We surveyed 700 veterans who were outpatients in a multihospital system in Pennsylvania. All veterans had served at least one warzone deployment. PTSD and grapheme-color synesthesia were assessed using validated research instruments. Results The mean age of veterans was 59 years, and 96% were men. The prevalence of current PTSD was 7% (95% confidence interval [CI] = 5.1-8.8), and current partial PTSD was 11% (95% CI = 9.3-14.0). The prevalence of current depression was 6% (95% CI = 4.7-8.3). Altogether, 6% (95% CI = 4.8-8.5) of veterans screened positive for grapheme-color synesthesia. Bivariate analyses suggested that grapheme-color synesthesia was associated with current PTSD (odds ratio [OR] = 3.4},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vincent, A S; Roebuck-Spencer, T; Gilliland, K; Schlegel, R
Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury Battery: Military normative data Journal Article
In: Military Medicine, vol. 177, pp. 256–269, 2012, ISSN: 0026-4075.
Abstract | BibTeX | Tags: Military
@article{Vincent2012,
title = {Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury Battery: Military normative data},
author = {Vincent, A S and Roebuck-Spencer, T and Gilliland, K and Schlegel, R},
issn = {0026-4075},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {256--269},
abstract = {The aim of the present study was to establish normative data for the Automated Neuropsychological Assessment Metrics (v4) Traumatic Brain Injury (ANAM4 TBI) battery in a military context. ANAM4 data from over 107,500 active duty service members ranging from 17 to 65 years of age were included in this study. The influence of the demographic variables of age and gender were also examined. These norms, stratified by age and gender, represent a more comprehensive set of norms than previously available and are provided as a representative set of norms for clinical practice. Additionally, base rates of below average performance in a normal population are provided to help inform clinical decision making.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Hampton, Carolyn E; Vandevord, Pamela J
Vibrational frequency response to impact loading of skull models Journal Article
In: Biomedical Sciences Instrumentation, vol. 48, pp. 157–164, 2012.
Abstract | BibTeX | Tags: Military
@article{Hampton2012,
title = {Vibrational frequency response to impact loading of skull models},
author = {Hampton, Carolyn E and Vandevord, Pamela J},
year = {2012},
date = {2012-01-01},
journal = {Biomedical Sciences Instrumentation},
volume = {48},
pages = {157--164},
address = {Wayne State University.},
abstract = {More than 73% of soldiers returning from duty are injured by explosive devices. The shock waves generated are believed to cause injury via intracranial pressure and skull flexure. Prior modal analyses of spherical shells as skull substitutes using analytical solutions to the wave equation indicate the impact point and opposite side as areas of intense bending. In this study, finite element models extend modal analyses and applied impulse scenarios for a variety of altered spherical geometries. Holes of differing sizes, the direction of impact, and the presence of water inside were considered. The finite element model matched the analytical modal frequencies within 4%. The discrete modal frequencies are lost as the geometry deviates from the ideal sphere. The frequency response to impact was complex with many participating modal frequencies. The deformation near holes increased as the hole increased in size. Impacts in line with holes increased the minimum to maximum spread by 30% whereas angled impacts caused more pronounced motion near holes. Filling the sphere interior with liquid diverted some load from the shell and decreased the maximum deflections by 80%. Avenues of further research focused on more accurate geometries are discussed.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Tsai, Jack; Whealin, Julia M; Scott, J Cobb; Harpaz-Rotem, Ilan; Pietrzak, Robert H
Examining the relation between combat-related concussion, a novel 5-factor model of posttraumatic stress symptoms, and health-related quality of life in Iraq and Afghanistan veterans Journal Article
In: Journal of Clinical Psychiatry, vol. 73, pp. 1110–1118, 2012.
Abstract | BibTeX | Tags: Military
@article{Tsai2012,
title = {Examining the relation between combat-related concussion, a novel 5-factor model of posttraumatic stress symptoms, and health-related quality of life in Iraq and Afghanistan veterans},
author = {Tsai, Jack and Whealin, Julia M and Scott, J Cobb and Harpaz-Rotem, Ilan and Pietrzak, Robert H},
year = {2012},
date = {2012-01-01},
journal = {Journal of Clinical Psychiatry},
volume = {73},
pages = {1110--1118},
address = {Yale University, Department of Psychiatry, 950 Campbell Ave, 151D, West Haven, CT 06516 Jack.Tsai@yale.edu.},
abstract = {OBJECTIVE: This study examined demographic, military, and clinical characteristics associated with combat-related concussion and persistent postconcussive symptoms; and how combat-related concussion and persistent postconcussive symptoms and a novel 5-factor model of posttraumatic stress disorder (PTSD) symptoms are related to physical and mental health-related quality of life in veterans who served in Iraq and Afghanistan. METHOD: 233 veterans recruited from the Veterans Affairs Hawaii Program Registry who served in Iraq and Afghanistan completed a survey in 2010 that assessed combat-related concussion and persistent postconcussive symptoms, PTSD (DSM-IV criteria), alcohol use problems, and physical and mental health-related quality of life. The primary measure was physical and mental health-related quality of life as assessed by the 12-item Short-Form Health Survey, version 2. RESULTS: Veterans who screened positive for combat-related concussion and persistent postconcussive symptoms were more likely than those who did not to report direct combat exposure (chi2 = 15.46, P \< .001), living in a rural area (chi2 = 6.86, P \< .01), and screening positive for PTSD (chi2 = 37.67, P \< .001) and alcohol use problems (chi2 = 11.62, P \< .01); 57.3% of veterans who screened positive for combat-related concussion and persistent postconcussive symptoms screened positive for PTSD. In bivariate analyses, combat-related concussion and persistent postconcussive symptoms were associated with lower scores on measures of physical and mental health-related quality of life (r = -0.27 to -0.45, P \< .001). In multivariate analyses, combat-related concussion and persistent postconcussive symptoms were no longer related to these outcomes, with PTSD-related dysphoric arousal symptoms as the strongest predictor of physical health-related quality of life (beta = -0.55, P \< .001) and PTSD-related emotional numbing symptoms (beta = -0.56, P \< .001) as the strongest predictor of mental health-related quality of life. CONCLUSIONS: Results of this study suggest that a 5-factor model of PTSD symptoms may provide greater specificity in understanding the relation between combat-related concussion and persistent postconcussive symptoms, PTSD symptoms, and health-related physical and mental quality of life in Iraq/Afghanistan veterans. Psychiatric clinicians should consider this heterogeneity of PTSD symptoms when assessing and treating symptomatic veterans.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Kennedy, Carrie H; Porter Evans, J; Chee, Shawnna; Moore, Jeffrey L; Barth, Jeffrey T; Stuessi, Keith A
Return to combat duty after concussive blast injury Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 817–827, 2012.
Abstract | BibTeX | Tags: Military
@article{Kennedy2012,
title = {Return to combat duty after concussive blast injury},
author = {Kennedy, Carrie H and {Porter Evans}, J and Chee, Shawnna and Moore, Jeffrey L and Barth, Jeffrey T and Stuessi, Keith A},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {817--827},
address = {Department of Behavioral Sciences, Marine Corps Embassy Security Group, Quantico, VA, USA.},
abstract = {Little data exist regarding the acute assessment of blast concussion and the course of recovery in the combat zone, as most research has examined service members long after they have returned home. This manuscript examined a case series of 377 service members seen for acute concussion evaluation following medical evacuation from the battlefield in Helmand Province, Afghanistan. Of these, 111 were assessed for concussion prior to their return to the continental USA for other severe physical injuries. Of the remainder, and when comparing those who returned to duty (RTD)/recovered from concussion in the combat zone and those who did not, data indicate that those who did not RTD were older and were more likely to endorse symptoms of combat stress. Quicker recovery times were associated with less severe headaches and fewer acute symptoms at the time of injury as well as the absence of combat stress reaction. Variables that were not associated with RTD and/or recovery were Military Acute Concussion Evaluation (MACE) cognitive scores and whether or not individuals suffered loss of consciousness. While MACE scores were not associated with recovery, they were deemed clinically useful as a part of a serial concussion evaluation if the initial MACE was given within 6 h of the blast. Implications for battlefield concussion assessment and management as well as future research directions are discussed.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Silva, Marc A; Donnell, Alison J; Kim, Michelle S; Vanderploeg, Rodney D
Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls Journal Article
In: Clinical Neuropsychologist, vol. 26, pp. 1102–1116, 2012.
Abstract | BibTeX | Tags: Military
@article{Silva2012,
title = {Abnormal Neurological Exam Findings in Individuals with Mild Traumatic Brain Injury (mTBI) Versus Psychiatric and Healthy Controls},
author = {Silva, Marc A and Donnell, Alison J and Kim, Michelle S and Vanderploeg, Rodney D},
year = {2012},
date = {2012-01-01},
journal = {Clinical Neuropsychologist},
volume = {26},
pages = {1102--1116},
address = {a Division of Mental Health and Behavioral Sciences , James A. Haley Veterans' Hospital , Tampa , FL , USA.},
abstract = {In those with a history of mild traumatic brain injury (mTBI), cognitive and emotional disturbances are often misattributed to that preexisting injury. However, causal determinations of current symptoms cannot be conclusively determined because symptoms are often nonspecific to etiology and offer virtually no differential diagnostic value in postacute or chronic phases. This population-based study examined whether the presence of abnormalities during neurological examination would distinguish between mTBI (in the chronic phase), healthy controls, and selected psychiatric conditions. Retrospective analysis of data from 4462 community-dwelling Army veterans was conducted. Diagnostically unique groups were compared on examination of cranial nerve function and other neurological signs. Results demonstrated that individuals with mTBI were no more likely than those with a major depressive disorder, generalized anxiety disorder, posttraumatic stress disorder, or somatoform disorder to show any abnormality. Thus, like self-reported cognitive and emotional symptoms, the presence of cranial nerve or other neurological abnormalities offers no differential diagnostic value. Clinical implications and study limitations are presented.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Masel, Brent E; Bell, Randy S; Brossart, Shawn; Grill, Raymond J; Hayes, Ronald L; Levin, Harvey S; Rasband, Matthew N; Ritzel, David V; Wade, Charles E; DeWitt, Douglas S
Galveston Brain Injury Conference 2010: clinical and experimental aspects of blast injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2143–2171, 2012.
Abstract | BibTeX | Tags: Military
@article{Masel2012,
title = {Galveston Brain Injury Conference 2010: clinical and experimental aspects of blast injury},
author = {Masel, Brent E and Bell, Randy S and Brossart, Shawn and Grill, Raymond J and Hayes, Ronald L and Levin, Harvey S and Rasband, Matthew N and Ritzel, David V and Wade, Charles E and DeWitt, Douglas S},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2143--2171},
address = {Transitional Learning Center, Galveston, Texas, USA.},
abstract = {Blast injury is the most prevalent source of mortality and morbidity among combatants in Operations Iraqi and Enduring Freedom. Blast-induced neurotrauma (BINT) is a common cause of mortality, and even mild BINT may be associated with chronic cognitive and emotional deficits. In addition to military personnel, the increasing use of explosives by terrorists has resulted in growing numbers of blast injuries in civilian populations. Since the medical and rehabilitative communities are likely to be faced with increasing numbers of patients suffering from blast injury, the 2010 Galveston Brain Injury Conference focused on topics related to the diagnosis, treatment, and mechanisms of BINT. Although past military actions have resulted in large numbers of blast casualties, BINT is considered the signature injury of the conflicts in Iraq and Afghanistan. The attention focused on BINT has led to increased financial support for research on blast effects, contributing to the development of better experimental models of blast injury and a clearer understanding of the mechanisms of BINT. This more thorough understanding of blast injury mechanisms will result in novel and more effective therapeutic and rehabilitative strategies designed to reduce injury and facilitate recovery, thereby improving long-term outcomes in patients suffering from the devastating and often lasting effects of BINT. The following is a summary of the 2010 Galveston Brain Injury Conference, that included presentations related to the diagnosis and treatment of acute BINT, the evaluation of the long-term neuropsychological effects of BINT, summaries of current experimental models of BINT, and a debate about the relative importance of primary blast effects on the acute and long-term consequences of blast exposure.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Lange, Rael T; Brickell, Tracey A; French, Louis M; Merritt, Victoria C; Bhagwat, Aditya; Pancholi, Sonal; Iverson, Grant L
Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 480–494, 2012.
Abstract | BibTeX | Tags: Military
@article{Lange2012c,
title = {Neuropsychological outcome from uncomplicated mild, complicated mild, and moderate traumatic brain injury in US military personnel},
author = {Lange, Rael T and Brickell, Tracey A and French, Louis M and Merritt, Victoria C and Bhagwat, Aditya and Pancholi, Sonal and Iverson, Grant L},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {480--494},
address = {Defense and Veterans Brain Injury Center, North Bethesda, MD 20852, USA. rlange@dvbic.org},
abstract = {This study compared the neuropsychological outcome in military personnel following mild-to-moderate traumatic brain injury (TBI). Participants were 83 service members divided into three injury severity groups: uncomplicated mild TBI (MTBI; n = 24), complicated MTBI (n = 17), and moderate TBI (n = 42). Participants were evaluated within 6 months following injury (73% within 3 months) using neurocognitive testing and the Personality Assessment Inventory (PAI). There were no significant differences between the three groups on the majority of neurocognitive measures. Similarly, there were no significant differences between the three groups on the majority of PAI clinical scales (all p \> .05), with the exception of two scales. The uncomplicated MTBI group had significantly higher scores on the Anxiety-Related Disorders and Aggression scales compared with the complicated MTBI group, but not the moderate TBI group. Overall, these results suggest that within the first 6 months post injury, there were few detectable differences in the neuropsychological outcome following uncomplicated MTBI, complicated MTBI, or moderate TBI in this military sample.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vasterling, Jennifer J; Brailey, Kevin; Proctor, Susan P; Kane, Robert; Heeren, Timothy; Franz, Molly
Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers Journal Article
In: British Journal of Psychiatry, vol. 201, pp. 186–192, 2012.
Abstract | BibTeX | Tags: Military
@article{Vasterling2012,
title = {Neuropsychological outcomes of mild traumatic brain injury, post-traumatic stress disorder and depression in Iraq-deployed US Army soldiers},
author = {Vasterling, Jennifer J and Brailey, Kevin and Proctor, Susan P and Kane, Robert and Heeren, Timothy and Franz, Molly},
year = {2012},
date = {2012-01-01},
journal = {British Journal of Psychiatry},
volume = {201},
pages = {186--192},
address = {VA Boston Healthcare System and Boston University School of Medicine, Boston, MA 02130, USA. jennifer.vasterling@va.gov},
abstract = {BACKGROUND: Traumatic brain injury (TBI) is a concern of contemporary military deployments. Whether milder TBI leads to enduring impairment remains controversial. AIMS: To determine the influence of deployment TBI, and post-traumatic stress disorder (PTSD) and depression symptoms on neuropsychological and functional outcomes. METHOD: A sample of 760 US Army soldiers were assessed pre- and post-deployment. Outcomes included neuropsychological performances and subjective functional impairment. RESULTS: In total, 9% of the participants reported (predominantly mild) TBI with loss of consciousness between pre- and post-deployment. At post-deployment, 17.6% of individuals with TBI screened positive for PTSD and 31.3% screened positive for depression. Before and after adjustment for psychiatric symptoms, TBI was significantly associated only with functional impairment. Both PTSD and depression symptoms adjusted for TBI were significantly associated with several neuropsychological performance deficits and functional impairment. CONCLUSIONS: Milder TBI reported by deployed service members typically has limited lasting neuropsychological consequences; PTSD and depression are associated with more enduring cognitive compromise.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Vanderploeg, Rodney D; Belanger, Heather G; Horner, Ronnie D; Spehar, Andrea M; Powell-Cope, Gail; Luther, Stephen L; Scott, Steven G
Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida national guard Journal Article
In: Archives of Physical Medicine & Rehabilitation, vol. 93, pp. 1887–1895, 2012.
Abstract | BibTeX | Tags: Military
@article{Vanderploeg2012,
title = {Health outcomes associated with military deployment: mild traumatic brain injury, blast, trauma, and combat associations in the Florida national guard},
author = {Vanderploeg, Rodney D and Belanger, Heather G and Horner, Ronnie D and Spehar, Andrea M and Powell-Cope, Gail and Luther, Stephen L and Scott, Steven G},
year = {2012},
date = {2012-01-01},
journal = {Archives of Physical Medicine \& Rehabilitation},
volume = {93},
pages = {1887--1895},
address = {Mental Health and Behavioral Sciences - Psychology Service, James A. Haley Veterans' Hospital, Tampa, FL 33612, USA. Rodney.Vanderploeg@va.gov},
abstract = {OBJECTIVES: To determine the association between specific military deployment experiences and immediate and longer-term physical and mental health effects, as well as examine the effects of multiple deployment-related traumatic brain injuries (TBIs) on health outcomes. DESIGN: Online survey of cross-sectional cohort. Odds ratios were calculated to assess the association between deployment-related factors (ie, physical injuries, exposure to potentially traumatic deployment experiences, combat, blast exposure, and mild TBI) and current health status, controlling for potential confounders, demographics, and predeployment experiences. SETTING: Nonclinical. PARTICIPANTS: Members (N=3098) of the Florida National Guard (1443 deployed, 1655 not deployed). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Presence of current psychiatric diagnoses and health outcomes, including postconcussive and non-postconcussive symptoms. RESULTS: Surveys were completed an average of 31.8 months (SD=24.4},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Russo, Arthur C
Symptom validity test performance and consistency of self-reported memory functioning of operation enduring freedom/operation iraqi freedom veterans with positive veteran health administration comprehensive traumatic brain injury evaluations Journal Article
In: Archives of Clinical Neuropsychology, vol. 27, pp. 840–848, 2012.
Abstract | BibTeX | Tags: Military
@article{Russo2012,
title = {Symptom validity test performance and consistency of self-reported memory functioning of operation enduring freedom/operation iraqi freedom veterans with positive veteran health administration comprehensive traumatic brain injury evaluations},
author = {Russo, Arthur C},
year = {2012},
date = {2012-01-01},
journal = {Archives of Clinical Neuropsychology},
volume = {27},
pages = {840--848},
address = {Psychology Department, Veterans Administration New York Harbor Healthcare System, Brooklyn, NY, USA.},
abstract = {Operation Enduring Freedom and Operation Iraqi Freedom combat veterans given definite diagnoses of mild Traumatic Brain Injury (TBI) during the Veteran Health Administration (VHA) Comprehensive TBI evaluation and reporting no post-deployment head injury were examined to assess (a) consistency of self-reported memory impairment and (b) symptom validity test (SVT) performance via a two-part study. Study 1 found that while 49 of 50 veterans reported moderate to very severe memory impairment during the VHA Comprehensive TBI evaluation, only 7 had reported any memory problem at the time of their Department of Defense (DOD) post-deployment health assessment. Study 2 found that of 38 veterans referred for neuropsychological evaluations following a positive VHA Comprehensive TBI evaluation, 68.4% failed the Word Memory Test, a forced choice memory recognition symptom validity task. Together, these studies raise questions concerning the use of veteran symptom self-report for TBI assessments and argue for the inclusion of SVTs and the expanded use of contemporaneous DOD records to improve the diagnostic accuracy of the VHA Comprehensive TBI evaluation.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Wolf, George; Cifu, David; Baugh, Laura; Carne, William; Profenna, Leonardo
The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2606–2612, 2012.
Abstract | BibTeX | Tags: Military
@article{Wolf2012a,
title = {The effect of hyperbaric oxygen on symptoms after mild traumatic brain injury},
author = {Wolf, George and Cifu, David and Baugh, Laura and Carne, William and Profenna, Leonardo},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2606--2612},
address = {1 USAF School of Aerospace Medicine, Hyperbaric Medicine Department, Wilford Hall Ambulatory Surgical Center , Lackland AFB, Texas.},
abstract = {Abstract In this single-center, double-blind, randomized, sham-controlled, prospective trial at the U.S. Air Force School of Aerospace Medicine, the effects of 2.4 atmospheres absolute (ATA) hyperbaric oxygen (HBO(2)) on post-concussion symptoms in 50 military service members with at least one combat-related, mild traumatic brain injury were examined. Each subject received 30 sessions of either a sham compression (room air at 1.3 ATA) or HBO(2) treatments at 2.4 ATA over an 8-week period. Individual and total symptoms scores on Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT([REGISTERED])) and composite scores on Post-traumatic Disorder Check List-Military Version (PCL-M) were measured just prior to intervention and 6 weeks after completion of intervention. Difference testing of post-intervention means between the sham-control and HBO(2) group revealed no significant differences on the PCL-M composite score (t=-0.205},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Matthews, Scott C; Spadoni, Andrea D; Lohr, James B; Strigo, Irina A; Simmons, Alan N
Diffusion tensor imaging evidence of white matter disruption associated with loss versus alteration of consciousness in warfighters exposed to combat in Operations Enduring and Iraqi Freedom Journal Article
In: Psychiatry Research, vol. 204, pp. 149–154, 2012.
Abstract | BibTeX | Tags: Military
@article{Matthews2012a,
title = {Diffusion tensor imaging evidence of white matter disruption associated with loss versus alteration of consciousness in warfighters exposed to combat in Operations Enduring and Iraqi Freedom},
author = {Matthews, Scott C and Spadoni, Andrea D and Lohr, James B and Strigo, Irina A and Simmons, Alan N},
year = {2012},
date = {2012-01-01},
journal = {Psychiatry Research},
volume = {204},
pages = {149--154},
address = {Veterans Affairs San Diego Healthcare System, La Jolla, CA, USA; Department of Psychiatry, University of California San Diego, 3350 La Jolla Village Drive, Mail code 116-A, La Jolla, CA 92093-0603, USA; VA Center of Excellence for Stress and Mental Health},
abstract = {The effects on the human brain of mild traumatic brain injury (mTBI), which is defined as a brief alteration (AOC) or loss of consciousness (LOC), are incompletely understood. Major psychiatric illnesses such as major depressive disorder (MDD) and posttraumatic stress disorder (PTSD) are common after mTBI. Prior research suggests that individuals who develop MDD after blast-related mTBI versus those who do not show significant white matter disruption and higher rates of LOC, suggesting that LOC might be uniquely associated with brain changes that increase the risk of developing mental illness after neurotrauma. Therefore, the objective of this study was to examine the effects of LOC, MDD, and PTSD on white matter integrity in individuals who reported experiencing mTBI during combat in Operations Enduring and Iraqi Freedom. We hypothesized that LOC would be associated with significant disruption of white matter, above and beyond putative effects of MDD and PTSD. To test this hypothesis, 46 individuals who experienced blast-related mTBI underwent a detailed clinical assessment and diffusion tensor imaging. As hypothesized, LOC versus AOC individuals displayed significantly lower fractional anisotropy (FA) in 14 regions, which included the superior longitudinal fasciculus and corpus callosum. No regions of significant FA difference were identified between individuals with and without PTSD, or between individuals with and without MDD. These preliminary results show that LOC is associated with detectable alterations in brain microstructure and may suggest a brain basis for psychiatric symptoms and mental illness after mTBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Benson, Randall R; Gattu, Ramtilak; Sewick, Bradley; Kou, Zhifeng; Zakariah, Nisrine; Cavanaugh, John M; Haacke, E Mark
Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation Journal Article
In: NeuroRehabilitation, vol. 31, pp. 261–279, 2012.
Abstract | BibTeX | Tags: Military
@article{Benson2012,
title = {Detection of hemorrhagic and axonal pathology in mild traumatic brain injury using advanced MRI: implications for neurorehabilitation},
author = {Benson, Randall R and Gattu, Ramtilak and Sewick, Bradley and Kou, Zhifeng and Zakariah, Nisrine and Cavanaugh, John M and Haacke, E Mark},
year = {2012},
date = {2012-01-01},
journal = {NeuroRehabilitation},
volume = {31},
pages = {261--279},
address = {Center for Neurological Studies, Novi, MI, USA. drbenson@neurologicstudies.com},
abstract = {INTRODUCTION: There is a need to more accurately diagnose milder traumatic brain injuries with increasing awareness of the high prevalence in both military and civilian populations. Magnetic resonance imaging methods may be capable of detecting a number of the pathoanatomical and pathophysiological consequences of focal and diffuse traumatic brain injury. Susceptibility-weighted imaging (SWI) detects heme iron and reveals even small venous microhemorrhages occurring in diffuse vascular injury. Diffusion tensor imaging (DTI) reveals axonal injury by detecting alterations in water flow in and around injured axons. The overarching hypothesis of this paper is that newer, advanced MR imaging generates sensitive biomarkers of regional brain injury which allows for correlation with clinical signs and symptoms. METHODS: Studies involving subjects with a history of traumatic brain injury as well as healthy, non-trauma controls were used. Analysis involved comparison of TBI patients' imaging results with healthy controls as well as correlation of imaging findings with clinical measures of injury severity. An additional animal study of Sprague-Dawley albino rats compared imaging results with histopathological findings after the animals were sacrificed and stained for b-APP. RESULTS: SWI revealed small foci of hemosiderin for some patients while aggregate lesion volume on SWI correlated with clinical injury severity indices. Similarly, DTI showed striking group differences for fractional anisotropy over the white matter globally, while tract and voxel-based regional results colocalized with SWI and FLAIR lesions in some cases and correlated with clinical deficits. For the rats, correlations were seen between imaging findings and staining of axonal injury. DISCUSSION: Animal data gave important tissue correlations with imaging results. SWI and DTI are commercially available sequences that can improve the diagnostic and prognostic ability of the trauma clinician. These biomarkers of regional brain injury which are present in imaging shortly after acute injury and persist indefinitely can inform clinicians and researchers about not only injury severity but also which neurobehavioral systems were injured. Analogous to stroke rehabilitation, having an understanding of the distribution of brain injury should ultimately allow for development of more effective rehabilitation strategies and more efficient clinical interventional trials.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Schmid, K E; Tortella, F C
The diagnosis of traumatic brain injury on the battlefield Journal Article
In: Frontiers in Neurology, vol. 3, pp. 90, 2012.
Abstract | BibTeX | Tags: Military
@article{Schmid2012,
title = {The diagnosis of traumatic brain injury on the battlefield},
author = {Schmid, K E and Tortella, F C},
year = {2012},
date = {2012-01-01},
journal = {Frontiers in Neurology},
volume = {3},
pages = {90},
address = {Schmid,Kara E. Brain Trauma Neuroprotection and Neurorestoration Department, Center for Military Psychiatry and Neuroscience, Walter Reed Army Institute of Research Silver Spring, MD, USA.},
abstract = {The conflicts in Iraq and Afghanistan have placed an increased awareness on traumatic brain injury (TBI). Various publications have estimated the incidence of TBI for our deployed servicemen, however all have been based on extrapolations of data sets or subjective evaluations due to our current method of diagnosing a TBI. Therefore it has been difficult to get an accurate rate and severity of deployment related TBIs, or the incidence of multiple TBIs our service members are experiencing. As such, there is a critical need to develop a rapid objective method to diagnose TBI on the battlefield. Because of the austere environment of the combat theater the ideal diagnostic platform faces numerous logistical constraints not encountered in civilian trauma centers. Consequently, a simple blood test to diagnosis TBI represents a viable option for the military. This perspective will provide information on some of the current options for TBI biomarkers, detail concerning battlefield constraints, and a possible acquisition strategy for the military. The end result is a non-invasive TBI diagnostic platform capable of providing much needed advances in objective triage capabilities and improved clinical management of in-Theater TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ettenhofer, Mark L; Melrose, Rebecca J; Delawalla, Zainab; Castellon, Steven A; Okonek, Anna
Correlates of functional status among OEF/OIF veterans with a history of traumatic brain injury Journal Article
In: Military Medicine, vol. 177, pp. 1272–1278, 2012.
Abstract | BibTeX | Tags: Military
@article{Ettenhofer2012a,
title = {Correlates of functional status among OEF/OIF veterans with a history of traumatic brain injury},
author = {Ettenhofer, Mark L and Melrose, Rebecca J and Delawalla, Zainab and Castellon, Steven A and Okonek, Anna},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {1272--1278},
address = {Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.},
abstract = {This study was conducted to identify factors related to functional status within a clinical sample of Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) with a history of traumatic brain injury (TBI). Medical chart review was conducted for a consecutive group of OEF/OIF Veterans who were referred for neuropsychological evaluation within a Veterans Affairs Medical Center Polytrauma Program related to history of TBI (n = 57). Level of involvement in occupational and academic activity, presence or absence of housing insecurity, and clinician ratings of overall functioning served as indicators of functional status. Reduced functional status was most strongly related to poorer cognitive function, particularly motor function, processing speed, and executive function. Lower levels of functioning were also related to increased severity of postconcussive symptoms, lower levels of education, and ongoing medication treatment for sleep or psychiatric symptoms. Comprehensive evaluation of cognitive, affective, and behavioral functioning among OEF/OIF Veterans with a history of TBI is likely to provide valuable information to inform rehabilitation strategies and identify potential warning signs for poor postdeployment reintegration. Increased awareness of these factors may aid clinicians in identifying patients at risk for poor outcomes and in more effectively targeting symptoms for intervention.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Heltemes, Kevin J; Holbrook, Troy L; Macgregor, Andrew J; Galarneau, Michael R
Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel Journal Article
In: Injury, vol. 43, pp. 1990–1995, 2012.
Abstract | BibTeX | Tags: Military
@article{Heltemes2012,
title = {Blast-related mild traumatic brain injury is associated with a decline in self-rated health amongst US military personnel},
author = {Heltemes, Kevin J and Holbrook, Troy L and Macgregor, Andrew J and Galarneau, Michael R},
year = {2012},
date = {2012-01-01},
journal = {Injury},
volume = {43},
pages = {1990--1995},
address = {Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, 140 Sylvester Road, San Diego, CA 92106, United States. kevin.heltemes@med.navy.mil},
abstract = {INTRODUCTION: Mild traumatic brain injury (MTBI) has emerged as the preeminent injury of combat from the recent conflicts in Iraq and Afghanistan. Very little is known about short- and long-term outcomes after combat-related MTBI. As a measure of outcome after injury, self-rated health is a reliable, widely used measure that assesses perceived health. The primary aim of this study was to determine the effect of combat-related MTBI on self-reported health status after return from deployment. The secondary objective was to examine predictors of a decline in self-reported health status amongst US service members with MTBI, as compared to those service members with other minor non-TBI injuries. PATIENTS AND METHODS: MTBI cases and an injured comparison group were identified from the Expeditionary Medical Encounter Database records of 1129 male, US service members who experienced blast-related injuries in Iraq from March 2004 to March 2008. Self-rated health was assessed from the routinely administered pre- and post-deployment health assessment questionnaires by the following question, "Overall, how would you rate your health during the past month?" Possible responses were "poor", "fair", "good", "very good", or "excellent." A distinction was made between minor and major negative changes in health (i.e., very good to fair) based on these self-rated health outcomes captured post-injury. RESULTS: For all personnel, post-injury levels of self-rated health were statistically significantly worse than pre-injury health rating. At 6months post-injury, service members with MTBI were 5 times more likely to report a major negative change in health as compared to members with other mild injuries. This association was independent of age, rank, branch of service, Injury Severity Score, mental health diagnosis prior to injury, and having been referred to a health care professional. DISCUSSION: Blast-related injuries, specifically MTBI, during deployment have negative consequences on service members' perception of health. Future research is needed to improve our understanding of the overall effects of MTBI on health and quality of life.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Elder, Gregory A; Dorr, Nathan P; De Gasperi, Rita; Gama Sosa, Miguel A; Shaughness, Michael C; Maudlin-Jeronimo, Eric; Hall, Aaron A; McCarron, Richard M; Ahlers, Stephen T
Blast exposure induces post-traumatic stress disorder-related traits in a rat model of mild traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 2564–2575, 2012.
Abstract | BibTeX | Tags: Military
@article{Elder2012,
title = {Blast exposure induces post-traumatic stress disorder-related traits in a rat model of mild traumatic brain injury},
author = {Elder, Gregory A and Dorr, Nathan P and {De Gasperi}, Rita and {Gama Sosa}, Miguel A and Shaughness, Michael C and Maudlin-Jeronimo, Eric and Hall, Aaron A and McCarron, Richard M and Ahlers, Stephen T},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {2564--2575},
address = {1 Neurology Service, James J. Peters Department of Veterans Affairs Medical Center , Bronx, New York.},
abstract = {Abstract Blast related traumatic brain injury (TBI) has been a major cause of injury in the wars in Iraq and Afghanistan. A striking feature of the mild TBI (mTBI) cases has been the prominent association with post-traumatic stress disorder (PTSD). However, because of the overlapping symptoms, distinction between the two disorders has been difficult. We studied a rat model of mTBI in which adult male rats were exposed to repetitive blast injury while under anesthesia. Blast exposure induced a variety of PTSD-related behavioral traits that were present many months after the blast exposure, including increased anxiety, enhanced contextual fear conditioning, and an altered response in a predator scent assay. We also found elevation in the amygdala of the protein stathmin 1, which is known to influence the generation of fear responses. Because the blast overpressure injuries occurred while animals were under general anesthesia, our results suggest that a blast-related mTBI exposure can, in the absence of any psychological stressor, induce PTSD-related traits that are chronic and persistent. These studies have implications for understanding the relationship of PTSD to mTBI in the population of veterans returning from the wars in Iraq and Afghanistan.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Cooper, Douglas B; Chau, Phuong M; Armistead-Jehle, Patrick; Vanderploeg, Rodney D; Bowles, Amy O
Relationship between mechanism of injury and neurocognitive functioning in OEF/OIF service members with mild traumatic brain injuries Journal Article
In: Military Medicine, vol. 177, pp. 1157–1160, 2012.
Abstract | BibTeX | Tags: Military
@article{Cooper2012,
title = {Relationship between mechanism of injury and neurocognitive functioning in OEF/OIF service members with mild traumatic brain injuries},
author = {Cooper, Douglas B and Chau, Phuong M and Armistead-Jehle, Patrick and Vanderploeg, Rodney D and Bowles, Amy O},
year = {2012},
date = {2012-01-01},
journal = {Military Medicine},
volume = {177},
pages = {1157--1160},
address = {Traumatic Brain Injury Service, Department of Orthopedics and Rehabilitation, San Antonio Military Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234 USA.},
abstract = {Military personnel deployed to combat theaters in Iraq and Afghanistan are at risk of sustaining mild traumatic brain injuries (mTBI) from causes such as improvised explosive devices, motor vehicle accidents, and falls. Despite the high incidence of mTBI in deployed personnel, questions remain about the effects of blast-related vs. non-blast-related mTBI on acute and long-term sequelae. This investigation is a retrospective review of service members who presented for evaluation of suspected mTBI and underwent neurocognitive screening evaluation, mTBI diagnosis was made by semistructured clinical interview. Only individuals in whom mechanism of injury could be determined (blast vs. non-blast) were included. Sixty individuals were included in the final sample: 32 with blast mTBI and 28 with non-blast mTBI. There were no differences between the blast-related and non-blast-related mTBI groups on age, time since injury, combat stress symptoms, or headache. Analysis of variance showed no significant between-group differences on any of the neurocognitive performance domains. Although speculation remains that the effects of primary blast exposure are unique, the results of this study are consistent with prior research suggesting that blast-related mTBI does not differ from other mechanisms of injury with respect to cognitive sequelae in the postacute phase.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Balakathiresan, Nagaraja; Bhomia, Manish; Chandran, Raghavendar; Chavko, Mikulas; McCarron, Richard M; Maheshwari, Radha K
MicroRNA let-7i is a promising serum biomarker for blast-induced traumatic brain injury Journal Article
In: Journal of Neurotrauma, vol. 29, pp. 1379–1387, 2012.
Abstract | BibTeX | Tags: Military
@article{Balakathiresan2012,
title = {MicroRNA let-7i is a promising serum biomarker for blast-induced traumatic brain injury},
author = {Balakathiresan, Nagaraja and Bhomia, Manish and Chandran, Raghavendar and Chavko, Mikulas and McCarron, Richard M and Maheshwari, Radha K},
year = {2012},
date = {2012-01-01},
journal = {Journal of Neurotrauma},
volume = {29},
pages = {1379--1387},
address = {Department of Pathology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, USA.},
abstract = {Blast-induced traumatic brain injury (TBI) is of significant concern in soldiers returning from the current conflicts in Iraq and Afghanistan. Incidents of TBI have increased significantly in the current conflicts compared to previous wars, and a majority of these injuries are caused by improvised explosive devices. Currently, no specific technique or biomarker is available for diagnosing TBI when no obvious clinical symptoms are present. Micro-RNAs are small RNA ($sim$ 22nts) molecules that are expressed endogenously and play an important role in regulating gene expression. MicroRNAs have emerged as novel serum diagnostic biomarkers for various diseases. In this study, we studied the effect of blast overpressure injury on the microRNA signatures in the serum of rats. Rats were exposed to three serial 120-kPa blast overpressure exposures through a shockwave tube. Blood and cerebrospinal fluid were collected at various time points after injury, and microRNA modulation was analyzed using real-time PCR. Five microRNAs were significantly modulated in the serum samples of these animals at three time points post-injury. Further, we also found that the levels of microRNA let-7i are also elevated in cerebrospinal fluid post-blast wave exposure. The presence of microRNA in both serum and cerebrospinal fluid immediately after injury makes microRNA let-7i an ideal candidate for further studies of biomarkers in TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Brenner, Lisa A; Bahraini, Nazanin; Hernandez, Theresa D
Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms Journal Article
In: Frontiers in Neurology, vol. 3, pp. 31, 2012.
Abstract | BibTeX | Tags: Military
@article{Brenner2012a,
title = {Perspectives on creating clinically relevant blast models for mild traumatic brain injury and post traumatic stress disorder symptoms},
author = {Brenner, Lisa A and Bahraini, Nazanin and Hernandez, Theresa D},
year = {2012},
date = {2012-01-01},
journal = {Frontiers in Neurology},
volume = {3},
pages = {31},
address = {Veterans Integrated Service Network 19, Mental Illness Research Education and Clinical Center Denver, CO, USA.},
abstract = {Military personnel are returning from Iraq and Afghanistan and reporting non-specific physical (somatic), behavioral, psychological, and cognitive symptoms. Many of these symptoms are frequently associated with mild traumatic brain injury (mTBI) and/or post traumatic stress disorder (PTSD). Despite significant attention and advances in assessment and intervention for these two conditions, challenges persist. To address this, clinically relevant blast models are essential in the full characterization of this type of injury, as well as in the testing and identification of potential treatment strategies. In this publication, existing diagnostic challenges and current treatment practices for mTBI and/or PTSD will be summarized, along with suggestions regarding how what has been learned from existing models of PTSD and traditional mechanism (e.g., non-blast) traumatic brain injury can be used to facilitate the development of clinically relevant blast models.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Nelson, Nathaniel W; Hoelzle, James B; Doane, Bridget M; McGuire, Kathryn A; Ferrier-Auerbach, Amanda G; Charlesworth, Molly J; Lamberty, Gregory J; Polusny, Melissa A; Arbisi, Paul A; Sponheim, Scott R
Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology Journal Article
In: Journal of the International Neuropsychological Society, vol. 18, pp. 845–855, 2012.
Abstract | BibTeX | Tags: Military
@article{Nelson2012,
title = {Neuropsychological outcomes of U.S. Veterans with report of remote blast-related concussion and current psychopathology},
author = {Nelson, Nathaniel W and Hoelzle, James B and Doane, Bridget M and McGuire, Kathryn A and Ferrier-Auerbach, Amanda G and Charlesworth, Molly J and Lamberty, Gregory J and Polusny, Melissa A and Arbisi, Paul A and Sponheim, Scott R},
year = {2012},
date = {2012-01-01},
journal = {Journal of the International Neuropsychological Society},
volume = {18},
pages = {845--855},
address = {Graduate School of Professional Psychology, University of St. Thomas, Minneapolis, Minnesota 55403, USA. nels0600@stthomas.edu},
abstract = {This study explored whether remote blast-related MTBI and/or current Axis I psychopathology contribute to neuropsychological outcomes among OEF/OIF veterans with varied combat histories. OEF/OIF veterans underwent structured interviews to evaluate history of blast-related MTBI and psychopathology and were assigned to MTBI (n = 18), Axis I (n = 24), Co-morbid MTBI/Axis I (n = 34), or post-deployment control (n = 28) groups. A main effect for Axis I diagnosis on overall neuropsychological performance was identified (F(3,100) = 4.81; p = .004), with large effect sizes noted for the Axis I only (d = .98) and Co-morbid MTBI/Axis I (d = .95) groups relative to the control group. The latter groups demonstrated primary limitations on measures of learning/memory and processing speed. The MTBI only group demonstrated performances that were not significantly different from the remaining three groups. These findings suggest that a remote history of blast-related MTBI does not contribute to objective cognitive impairment in the late stage of injury. Impairments, when present, are subtle and most likely attributable to PTSD and other psychological conditions. Implications for clinical neuropsychologists and future research are discussed. (JINS, 2012, 18, 1-11).},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Finkel, Alan
Headaches in soldiers with mild traumatic brain injury--additional data Journal Article
In: Headache, vol. 52, pp. 1320, 2012.
@article{Finkel2012,
title = {Headaches in soldiers with mild traumatic brain injury--additional data},
author = {Finkel, Alan},
year = {2012},
date = {2012-01-01},
journal = {Headache},
volume = {52},
pages = {1320},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Ruff, Robert Louis; Riechers 2nd, Ronald George; Wang, Xiao-Feng; Piero, Traci; Ruff, Suzanne Smith
A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI Journal Article
In: BMJ Open, vol. 2, pp. e000312, 2012.
Abstract | BibTeX | Tags: Military
@article{Ruff2012,
title = {A case-control study examining whether neurological deficits and PTSD in combat veterans are related to episodes of mild TBI},
author = {Ruff, Robert Louis and {Riechers 2nd}, Ronald George and Wang, Xiao-Feng and Piero, Traci and Ruff, Suzanne Smith},
year = {2012},
date = {2012-01-01},
journal = {BMJ Open},
volume = {2},
pages = {e000312},
address = {Neurology Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.},
abstract = {BACKGROUND: Mild traumatic brain injury (mTBI) is a common injury among military personnel serving in Iraq or Afghanistan. The impact of repeated episodes of combat mTBI is unknown. OBJECTIVE: To evaluate relationships among mTBI, post-traumatic stress disorder (PTSD) and neurological deficits (NDs) in US veterans who served in Iraq or Afghanistan. METHODS: This was a case-control study. From 2091 veterans screened for traumatic brain injury, the authors studied 126 who sustained mTBI with one or more episodes of loss of consciousness (LOC) in combat. Comparison groups: 21 combat veterans who had definite or possible episodes of mTBI without LOC and 21 veterans who sustained mTBI with LOC as civilians. RESULTS: Among combat veterans with mTBI, 52% had NDs, 66% had PTSD and 50% had PTSD and an ND. Impaired olfaction was the most common ND, found in 65 veterans. The prevalence of an ND or PTSD correlated with the number of mTBI exposures with LOC. The prevalence of an ND or PTSD was \>90% for more than five episodes of LOC. Severity of PTSD and impairment of olfaction increased with number of LOC episodes. The prevalence of an ND for the 34 combat veterans with one episode of LOC (4/34=11.8%) was similar to that of the 21 veterans of similar age and educational background who sustained civilian mTBI with one episode of LOC (2/21=9.5%, p-NS). CONCLUSIONS: Impaired olfaction was the most frequently recognised ND. Repeated episodes of combat mTBI were associated with increased likelihood of PTSD and an ND. Combat setting may not increase the likelihood of an ND. Two possible connections between mTBI and PTSD are (1) that circumstances leading to combat mTBI likely involve severe psychological trauma and (2) that altered cerebral functioning following mTBI may increase the likelihood that a traumatic event results in PTSD.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Wall, Pamela L Herbig
Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis Journal Article
In: Journal of the American Psychiatric Nurses Association, vol. 18, pp. 278–298, 2012.
Abstract | BibTeX | Tags: Military
@article{Wall2012,
title = {Posttraumatic stress disorder and traumatic brain injury in current military populations: a critical analysis},
author = {Wall, Pamela L Herbig},
year = {2012},
date = {2012-01-01},
journal = {Journal of the American Psychiatric Nurses Association},
volume = {18},
pages = {278--298},
address = {University of Pennsylvania, Philadelphia, PA, USA. luvridley@aol.com},
abstract = {BACKGROUND: The use of unconventional weaponry combined with decreased mortality rates and servicemembers being exposed to intense ground combat during multiple deployments has increased the risk of servicemembers living with the consequences of traumatic brain injuries (TBI) and combat operational stress. OBJECTIVE: The purpose of this article is to perform a critical analysis of the literature to identify current rates of comorbid posttraumatic stress disorder (PTSD) and TBI in military and veteran populations who have served in Iraq or Afghanistan and their combined effects on persistent postconcussive symptoms. DESIGN: A search of the literature with military and veteran populations published after 2001 in Pubmed, OVID/Medline, Cochran Database, Embase, Scopus, CINAHL, and PsychInfo was conducted using keywords. RESULTS: Twenty studies met inclusion criteria. The literature search yielded mixed results for rates of PTSD, TBI, and comorbid conditions. CONCLUSIONS: There is some evidence that comorbid PTSD and TBI result in greater reports of postconcussive symptomology than either condition alone. Limitations include lack of consistency of measurements, sampling biases, and lack of experimental design, and these warrant further exploration. Future research is needed to decrease variability in study findings and elucidate relationships between these disorders and their effects on persistent postconcussive symptomology.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Huang, Ming-Xiong; Nichols, Sharon; Robb, Ashley; Angeles, Annemarie; Drake, Angela; Holland, Martin; Asmussen, Sarah; D'Andrea, John; Chun, Won; Levy, Michael; Cui, Li; Song, Tao; Baker, Dewleen G; Hammer, Paul; McLay, Robert; Theilmann, Rebecca J; Coimbra, Raul; Diwakar, Mithun; Boyd, Cynthia; Neff, John; Liu, Thomas T; Webb-Murphy, Jennifer; Farinpour, Roxanna; Cheung, Catherine; Harrington, Deborah L; Heister, David; Lee, Roland R
An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes Journal Article
In: Neuroimage, vol. 61, pp. 1067–1082, 2012.
Abstract | BibTeX | Tags: Military
@article{Huang2012,
title = {An automatic MEG low-frequency source imaging approach for detecting injuries in mild and moderate TBI patients with blast and non-blast causes},
author = {Huang, Ming-Xiong and Nichols, Sharon and Robb, Ashley and Angeles, Annemarie and Drake, Angela and Holland, Martin and Asmussen, Sarah and D'Andrea, John and Chun, Won and Levy, Michael and Cui, Li and Song, Tao and Baker, Dewleen G and Hammer, Paul and McLay, Robert and Theilmann, Rebecca J and Coimbra, Raul and Diwakar, Mithun and Boyd, Cynthia and Neff, John and Liu, Thomas T and Webb-Murphy, Jennifer and Farinpour, Roxanna and Cheung, Catherine and Harrington, Deborah L and Heister, David and Lee, Roland R},
year = {2012},
date = {2012-01-01},
journal = {Neuroimage},
volume = {61},
pages = {1067--1082},
address = {Radiology, Research, Rehab, and Psychiatry Services, VA San Diego Healthcare System, San Diego, CA, USA. mxhuang@ucsd.edu},
abstract = {Traumatic brain injury (TBI) is a leading cause of sustained impairment in military and civilian populations. However, mild (and some moderate) TBI can be difficult to diagnose because the injuries are often not detectable on conventional MRI or CT. Injured brain tissues in TBI patients generate abnormal low-frequency magnetic activity (ALFMA, peaked at 1-4 Hz) that can be measured and localized by magnetoencephalography (MEG). We developed a new automated MEG low-frequency source imaging method and applied this method in 45 mild TBI (23 from combat-related blasts, and 22 from non-blast causes) and 10 moderate TBI patients (non-blast causes). Seventeen of the patients with mild TBI from blasts had tertiary injuries resulting from the blast. The results show our method detected abnormalities at the rates of 87% for the mild TBI group (blast-induced plus non-blast causes) and 100% for the moderate group. Among the mild TBI patients, the rates of abnormalities were 96% and 77% for the blast and non-blast TBI groups, respectively. The spatial characteristics of abnormal slow-wave generation measured by Z scores in the mild blast TBI group significantly correlated with those in non-blast mild TBI group. Among 96 cortical regions, the likelihood of abnormal slow-wave generation was less in the mild TBI patients with blast than in the mild non-blast TBI patients, suggesting possible protective effects due to the military helmet and armor. Finally, the number of cortical regions that generated abnormal slow-waves correlated significantly with the total post-concussive symptom scores in TBI patients. This study provides a foundation for using MEG low-frequency source imaging to support the clinical diagnosis of TBI.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bogdanova, Y; Verfaellie, M
Cognitive sequelae of blast-induced traumatic brain injury: Recovery and rehabilitation Journal Article
In: Neuropsychology Review, vol. 22, pp. 4–20, 2012, ISSN: 1040-7308.
Abstract | Links | BibTeX | Tags: Military
@article{Bogdanova2012,
title = {Cognitive sequelae of blast-induced traumatic brain injury: Recovery and rehabilitation},
author = {Bogdanova, Y and Verfaellie, M},
doi = {10.1007/s11065-012-9192-3},
issn = {1040-7308},
year = {2012},
date = {2012-01-01},
journal = {Neuropsychology Review},
volume = {22},
pages = {4--20},
abstract = {Blast-related traumatic brain injury (bTBI) poses a significant concern for military personnel engaged in Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF). Given the highly stressful context in which such injury occurs, psychiatric comorbidities are common. This paper provides an overview of mild bTBI and discusses the cognitive sequelae and course of recovery typical of mild TBI (mTBI). Complicating factors that arise in the context of co-morbid posttraumatic stress disorder (PTSD) are considered with regard to diagnosis and treatment. Relatively few studies have evaluated the efficacy of cognitive rehabilitation in civilian mTBI, but we discuss cognitive training approaches that hold promise for addressing mild impairments in executive function and memory, akin to those seen in OEF/OIF veterans with bTBI and PTSD. Further research is needed to address the patient and environmental characteristics associated with optimal treatment outcome.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}
Bass, Cameron R; Panzer, Matthew B; Rafaels, Karen A; Wood, Garrett; Shridharani, Jay; Capehart, Bruce
Brain injuries from blast Journal Article
In: Annals of Biomedical Engineering, vol. 40, pp. 185–202, 2012.
Abstract | BibTeX | Tags: Military
@article{Bass2012,
title = {Brain injuries from blast},
author = {Bass, Cameron R and Panzer, Matthew B and Rafaels, Karen A and Wood, Garrett and Shridharani, Jay and Capehart, Bruce},
year = {2012},
date = {2012-01-01},
journal = {Annals of Biomedical Engineering},
volume = {40},
pages = {185--202},
address = {Department of Biomedical Engineering, Duke University, 136 Hudson Hall, Durham, NC 27708, USA. dale.bass@duke.edu},
abstract = {Traumatic brain injury (TBI) from blast produces a number of conundrums. This review focuses on five fundamental questions including: (1) What are the physical correlates for blast TBI in humans? (2) Why is there limited evidence of traditional pulmonary injury from blast in current military field epidemiology? (3) What are the primary blast brain injury mechanisms in humans? (4) If TBI can present with clinical symptoms similar to those of Post-Traumatic Stress Disorder (PTSD), how do we clinically differentiate blast TBI from PTSD and other psychiatric conditions? (5) How do we scale experimental animal models to human response? The preponderance of the evidence from a combination of clinical practice and experimental models suggests that blast TBI from direct blast exposure occurs on the modern battlefield. Progress has been made in establishing injury risk functions in terms of blast overpressure time histories, and there is strong experimental evidence in animal models that mild brain injuries occur at blast intensities that are similar to the pulmonary injury threshold. Enhanced thoracic protection from ballistic protective body armor likely plays a role in the occurrence of blast TBI by preventing lung injuries at blast intensities that could cause TBI. Principal areas of uncertainty include the need for a more comprehensive injury assessment for mild blast injuries in humans, an improved understanding of blast TBI pathophysiology of blast TBI in animal models and humans, the relationship between clinical manifestations of PTSD and mild TBI from blunt or blast trauma including possible synergistic effects, and scaling between animals models and human exposure to blasts in wartime and terrorist attacks. Experimental methodologies, including location of the animal model relative to the shock or blast source, should be carefully designed to provide a realistic blast experiment with conditions comparable to blasts on humans. If traditional blast scaling is appropriate between species, many reported rodent blast TBI experiments using air shock tubes have blast overpressure conditions that are similar to human long-duration nuclear blasts, not high explosive blasts.},
keywords = {Military},
pubstate = {published},
tppubtype = {article}
}