Since October 2001, more than 1.6 million American military service members have deployed to Iraq and Afghanistan in the Global War on Terrorism. It is estimated that between 5% and 35% of them have sustained a concussion, also called mild traumatic brain injury (mTBI), during their deployment. Up to 80% of the concussions experienced in theater are secondary to blast exposures. The unique circumstances and consequences of sustaining a concussion in combat demands a unique understanding and treatment plan. The current literature was reviewed and revealed a paucity of pathophysiological explanations on the nature of the injury and informed treatment plans. However, through observation and experience, a theoretical but scientifically plausible model for why and how blast injuries experienced in combat give rise to the symptoms that affect day-to-day function of service members who have been concussed has been developed. We also are able to offer treatment strategies based on our evaluation of the current literature and experience to help palliate postconcussive symptoms. The purpose of this review is to elucidate common physical, cognitive, emotional, and situational challenges, and possible solutions for this special population of patients who will be transitioning into the civilian sector and interfacing with health professionals. There is a need for further investigation and testing of these strategies.

Active duty U.S. Army Service Members previously diagnosed with post-traumatic stress disorder (PTSD) were selected from review of patient records in the Traumatic Brain Injury Clinic at the Department of Defense Eisenhower Army Medical Center at Fort Gordon in Augusta, Georgia. Patients agreed to practice the Transcendental Meditation (TM) technique for 20 minutes twice a day for the duration of a 2-month follow-up period. Three cases are presented with results that show the feasibility of providing TM training to active duty soldiers with PTSD in a Department of Defense medical facility. Further investigation is suggested to determine if a TM program could be used as an adjunct for treatment of PTSD. Impact of this report is expected to expand the complementary and alternative evidence base for clinical care of PTSD.

The purpose of the study was to determine whether the regular practice of Transcendental Meditation (TM) decreased the need for psychotropic medications required for anxiety and post-traumatic stress disorder (PTSD) management and increased psychological wellbeing. The sample included 74 military Service Members with documented PTSD or anxiety disorder not otherwise specified (ADNOS), 37 that practiced TM and 37 that did not. At 1 month, 83.7% of the TM group stabilized, decreased, or ceased medications and 10.8% increased medication dosage; compared with 59.4% of controls that showed stabilizations, decreases, or cessations; and 40.5% that increased medications (p < 0.03). A similar pattern was observed after 2 (p < 0.27), 3 (p < 0.002), and 6 months (p < 0.34). Notably, there was a 20.5% difference between groups in severity of psychological symptoms after 6 months, that is, the control group experienced an increase in symptom severity compared with the group practicing TM. These findings provide insight into the benefits of TM as a viable treatment modality in military treatment facilities for reducing PTSD and ADNOS psychological symptoms and associated medication use.

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Each year, 1.4 million people in the United States are seen in a hospital for a traumatic brain injury. Those with moderate-to-severe traumatic brain injury frequently go through a course of inpatient neurorehabilitation prior to discharge back into the community. A broad overview of neurorehabilitation is presented, including the standards for admission to inpatient rehabilitation and the members and roles of the neurorehabilitation team. Common medical complications that are managed after moderate-to-severe traumatic brain injury are reviewed. The spectrum of arousal issues is summarized. The evidence regarding neurorehabilitation is then reviewed. Future studies that are underway to better understand the utility of neurorehabilitation are then discussed.