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Objective Traumatic Brain Injury (TBI) has been identified as a risk factor for later developing neurodegenerative disorders, and there has been significant attention on this association in forensic settings. As a result, forensic neuropsychologists are frequently asked to comment on risk for dementia after an alleged TBI in litigation and criminal cases. This article provides an evidence-based foundation to aid forensic practice by synthesizing comprehensive information pertaining to: (i) the role of the neuropsychologist in TBI-related litigation, (ii) the complexities associated with identifying TBIs in forensic cases, (iii) the science of TBI in relation to incident dementia, and (iv) current scientific evidence for chronic traumatic encephalopathy. Results Developing a neurodegenerative disorder after TBI is the exception rather than the rule. Prevalence rates suggest that only a small subset (< 5%) of individuals with moderate-to-severe TBI, and even fewer (< 1%) with mild TBI (mTBI), appear to develop certain neurodegenerative diseases, and the characteristics that place some at risk remain unclear. The literature is mixed in terms of identifying a relationship between mTBI and later-in-life dementia risk. Also, the quality of positive evidence for risk of dementia after mTBI is weak and mostly consists of observational studies characterized by methodological limitations. Conclusions Methods used to establish the likely occurrence of a TBI in a forensic context are typically more extensive than those used in a routine clinical evaluation. Research methodology to define TBI is often even more rudimentary and inconsistent. Applying clinical research results of TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote head hits or concussion in a causal manner to dementia is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.
Objective Traumatic Brain Injury (TBI) has been identified as a risk factor for later developing neurodegenerative disorders, and there has been significant attention on this association in forensic settings. As a result, forensic neuropsychologists are frequently asked to comment on risk for dementia after an alleged TBI in litigation and criminal cases. This article provides an evidence-based foundation to aid forensic practice by synthesizing comprehensive information pertaining to: (i) the role of the neuropsychologist in TBI-related litigation, (ii) the complexities associated with identifying TBIs in forensic cases, (iii) the science of TBI in relation to incident dementia, and (iv) current scientific evidence for chronic traumatic encephalopathy. Results Developing a neurodegenerative disorder after TBI is the exception rather than the rule. Prevalence rates suggest that only a small subset (< 5%) of individuals with moderate-to-severe TBI, and even fewer (< 1%) with mild TBI (mTBI), appear to develop certain neurodegenerative diseases, and the characteristics that place some at risk remain unclear. The literature is mixed in terms of identifying a relationship between mTBI and later-in-life dementia risk. Also, the quality of positive evidence for risk of dementia after mTBI is weak and mostly consists of observational studies characterized by methodological limitations. Conclusions Methods used to establish the likely occurrence of a TBI in a forensic context are typically more extensive than those used in a routine clinical evaluation. Research methodology to define TBI is often even more rudimentary and inconsistent. Applying clinical research results of TBI and dementia outcomes to forensic cases at an individual level carries significant limitations. Estimating the contribution of remote head hits or concussion in a causal manner to dementia is a challenge forensic experts sometimes face, yet at present, the task is impossible beyond correlations and speculation.
The article reveals the essence of medical rehabilitation of combatants as an important aspect of military medicine aimed at restoring or improving the physical, psychological, and social functioning of defenders with various types of combat trauma. The author emphasizes the growing number of disabled combatants in Ukraine, which has serious consequences for the healthcare system in the form of increased demand for medical services and budget constraints. The author analyzes various types of rehabilitation strategies (early start, implementation of modern technologies, individual approach, social and psychological adaptation, etc.) that can increase the efficiency and cost-effectiveness of the recovery process. The article describes the positive socioeconomic impact of medical rehabilitation of combatants, including those with disabilities, which reduces military healthcare costs, speeds up recovery, increases combat capability, promotes reintegration into society, job creation and financial independence of veterans, and provides overall economic benefits. The article shows that investment in rehabilitation services for military personnel not only improves outcomes for individual patients but also contributes to the economic well-being of society as a whole. The socio-economic benefits of different approaches to medical rehabilitation and the appropriate allocation of financial resources are emphasized, which will ensure that combatants have access to timely and appropriate rehabilitation services. In order to increase the socio-economic effectiveness of comprehensive rehabilitation of combatants in Ukraine, the article suggests focusing on reducing the cost of rehabilitation services by introducing effective modern technologies and individualized approaches; expanding access to medical rehabilitation, ensuring its availability and quality in all regions of the country; and creating an effective system for monitoring and evaluating the effectiveness of rehabilitation measures.
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