The Chaos of Combat: An Overview of Challenges in Military Mild Traumatic Brain Injury Research.

Nicholas D Davenport

doi:10.3389/fpsyt.2016.00085

Abstract

Mild traumatic brain injury (mTBI), or concussion, is among the most common injuries affecting Veterans of recent combat deployments. Military mTBI differs from civilian mTBI in fundamental ways that make assessment and diagnosis difficult, including a reliance on retrospective self-report and the potential influence of comorbid psychopathology. These unique features and their implications for research and clinical practice are summarized, and neuroimaging studies are discussed in the context of these complicating factors.

Highlights

Mild traumatic brain injury, or concussion, has been deemed the “signature injury” of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) affecting 15–25% of American military service members deployed to these recent conflicts [1,2,3]
According to the definition established by the American Congress of Rehabilitation Medicine [8], Mild traumatic brain injury (mTBI) is characterized by a blow to the head accompanied by evidence of physiological disruption of brain function [i.e., loss of consciousness (LOC) less than 30 min, altered mental state (AMS), posttraumatic amnesia (PTA) less than 24 h, and neurological deficits]
While the major diagnostic symptoms of LOC, AMS, and PTA are generally limited in duration to the mTBI event itself, some physical, behavioral, and cognitive symptoms can persist for several days or weeks

Summary

INTRODUCTION

Mild traumatic brain injury (mTBI), or concussion, has been deemed the “signature injury” of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) affecting 15–25% of American military service members deployed to these recent conflicts [1,2,3]. There has been substantial interest recently, both from clinical and scientific perspectives, in the identification of Service Members who have sustained mTBI to determine whether there are long-term effects. These efforts have been complicated by several unique features of military mTBI, such as reliance on retrospective self-report, overlap with symptoms of posttraumatic stress disorder (PTSD) and depression, and variability in assessment approaches. This manuscript presents an overview of some of these considerations, with brief discussions of their impact on clinical care and neuroimaging research

MILD TRAUMATIC BRAIN INJURY

Challenges in Military mTBI Research

Involvement of trauma

LOSS OF CONSCIOUSNESS AND BLAST EXPOSURE

Findings

CONCLUSION