Blast-Related Traumatic Brain Injury: Current Concepts and Research Considerations

Abstract

Traumatic brain injury (TBI) is a well-known consequence of participation in activities such as military combat or collision sports. But the wide variability in eliciting circumstances and injury severities makes the study of TBI as a uniform disease state impossible. Military Service members are under additional, unique threats such as exposure to explosive blast and its unique effects on the body. This review is aimed toward TBI researchers, as it covers important concepts and considerations for studying blast-induced head trauma. These include the comparability of blast-induced head trauma to other mechanisms of TBI, whether blast overpressure induces measureable biomarkers, and whether a biodosimeter can link blast exposure to health outcomes, using acute radiation exposure as a corollary. This examination is contextualized by the understanding of concussive events and their psychological effects throughout the past century’s wars, as well as the variables that predict sustaining a TBI and those that precipitate or exacerbate psychological conditions. Disclaimer: The views expressed in this article are solely the views of the authors and not those of the Department of Defense Blast Injury Research Coordinating Office, US Army Medical Research and Development Command, US Army Futures Command, US Army, or the Department of Defense.

Quality of Psychoeducational Apps for Military Members With Mild Traumatic Brain Injury: An Evaluation Utilizing the Mobile Application Rating Scale

“…Military members are exposed to a variety of physical and psychosocial variables, which either in isolation or in combination can exacerbate the severity, longevity, and dysfunctionality of mTBI symptoms [ 9 - 16 , 43 ]. Psychosocial factors that are prevalent at a higher rate in military populations include increased geographical isolation, alcohol consumption, mental health diagnoses (ie, depression, anxiety, and PTSD), chronic pain, TBI, and sleep disturbances, all of which can exacerbate mTBI symptoms [ 9 - 16 ].…”

“…Blast injuries are also more unique to military populations, with a portion of the mTBI sustained by military members during OEF and OIF being potentially attributable to members being in close proximity to explosions [ 5 , 9 - 13 , 43 ]. A blast mTBI is an injury to the brain leading to dysfunction that is the result of an explosion or a blast [ 13 , 43 ]. Despite differences among mechanisms of injury, no significant variations in mTBI symptoms and PCS caused by blast versus blunt force have been identified apart from a blast mTBI preceding more severe hearing loss [ 13 ].…”

Blast in Context: The Neuropsychological and Neurocognitive Effects of Long-Term Occupational Exposure to Repeated Low-Level Explosives on Canadian Armed Forces' Breaching Instructors and Range Staff

“…These studies used tasks that are laboratory versions of what is tested with BrDI, and support the scientific concept underlying the unique nature of this approach ( 52 – 57 ). Although no previous human studies in military blast have specifically examined this functional measure, a considerable body of work suggests that there is a unique additive value to including tasks that measure cognitive-motor integration in studies of the effects of blast exposure ( 12 , 37 ).…”

“…As part of our battery we also included a measure of clinical posttraumatic stress disorder (PTSD) symptomatology [PCL-5, (32)]. This measure was included because previous studies with service members and veterans have shown that there might be comorbidity between blastinduced TBI and PTSD and/or depression, among other clinical symptoms [e.g., (33)(34)(35)(36), see also (37)]. In the present study we did not expect to see any differences between the two groups on PCL-5, since we had no a priori reason to believe that exposure to breacher training per se is an emotionally traumatic experience.…”

Characteristics and Impact of U.S. Military Blast-Related Mild Traumatic Brain Injury: A Systematic Review

“…The most important limiting factors hampering research and clinical care of blast-related mTBI are determining physiological from pathological changes: lack of a dose response curve defining exposure to primary blast to injury (185), and the current inability to distinguish the contributions of the secondary to quinary effects from the primary blast, in the human.…”