OEF/OIF Deployment-Related Traumatic Brain Injury

S continued Hoge, C. W., McGurk, D., Thomas, J. l., Cox, A. l., Engel, C. C., &Castro, C. A. (2008). Mild traumatic brain injury in U.S. soldiersreturning from Iraq. New England Journal of Medicine, 358,453-463. We surveyed 2,525 U.S. Army infantry soldiers 3 to 4months after their return from a year-long deployment to Iraq. Of2,525 soldiers, 124 (4.9%) reported injuries with loss of conscious-ness, 260 (10.3%) reported injuries with altered mental status, and435 (17.2%) reported other injuries during deployment. Of thosereporting loss of consciousness, 43.9% met criteria for PTSD, ascompared with 27.3% of those reporting altered mental status,16.2% with other injuries, and 9.1% with no injury. Soldiers withmild TBI, primarily those who had loss of consciousness, weresignificantly more likely to report poor general health, missed work-days, medical visits, and a high number of somatic and postcon-cussive symptoms than were soldiers with other injuries. Afteradjustment for PTSD and depression, mild TBI was no longerassociated with health outcomes or symptoms, except for headache.PTSD and depression are important mediators of the relationshipbetween mild TBI and physical health problems.[abstract adapted] Lew, H. L., Garvert, D. W., Pogoda, T. K., Hsu, P.-T., Devine, J. M.,White, D. K., et al. (2009). Auditory and visual impairments inpatients with blast-related traumatic brain injury: Effect of dualsensory impairment on Functional Independence Measure.Journal of Rehabilitation Research and Development, 46, 819-826.In this preliminary study of 175 patients admitted to a PolytraumaRehabilitation Center, we diagnosed hearing impairment only, visionimpairment only, and both in 19%, 34%, and 32% of patients,respectively. Only 15% of the patients had no sensory impairment.An analysis of variance showed a group difference for the total andmotor functional independence measure (FIM) scores at discharge.Regression analyses demonstrated that dual impairment signifi-cantly contributed to reduced gain in total and motor FIM scores.[abstract adapted] lew, H. l., Otis, J. D., Tun, C., Kerns, R. D., Clark, M. E., & Cifu,D. X. (2009). Prevalence of chronic pain, posttraumatic stressdisorder, and persistent postconcussive symptoms in OIF/OEFveterans: Polytrauma clinical triad. Journal of RehabilitationResearch and Development, 46, 697-702. Analysis of medicalrecords of 340 OIF/OEF veterans seen at a VA Polytrauma NetworkSite indicated high prevalences of chronic pain, PTSD, and persistentpostconcussive symptoms (PPCS) (81.5%, 68.2%, and 66.8%,respectively). Only 12 veterans (3.5%) had no chronic pain, PTSD,or PPCS. The frequency at which these three conditions werepresent in isolation (10.3%, 2.9%, and 5.3%, respectively) wassignificantly lower than the frequency with which they were presentin combination with one another, with 42.1% of the sample beingdiagnosed with all three conditions simultaneously. The mostcommon chronic pain locations were the back (58%) and head(55%). [abstract adapted] Lew, H. L., Poole, J. H., Guillory, S. B., Salerno, R. M., Leskin, G.,& Sigford, B. (2006). Persistent problems after traumatic braininjury: The need for long-term follow-up and coordinated care.Journal of Rehabilitation Research and Development, 43(2), vii-x.To determine the prevalence of problems faced by the TBI patientsadmitted to our Palo Alto VA facility, we performed an extensivechart review on 138 patients who had sustained closed headinjuries. Of these patients, 71% returned for either the 1 or 2 yearfollow-up and 49% returned for both follow-ups. Of TBI patientswho returned for both follow-ups, 90% or more had at least oneproblem in each category at baseline, i.e., during the first week oftheir inpatient admission for acute rehabilitation. During thefollowing 2 years, the frequency of physical problems decreasedfrom 100 to 84%, which indicates gradual but steady improvementin TBI patients’ physical problems over time. Similarly, problemswith community integration decreased in frequency from 90 to77%. Cognitive and emotional issues declined <10% in frequencyover the 2-year period. Of 66 consecutive TBI patients who hadcompleted tours in Iraq or Afghanistan, 38 were wounded in combatand 28 sustained TBI in noncombat situations. Of those patientswho sustained TBI during combat, 74% were victims of blast injury.Of the noncombat-injured soldiers, 71% were injured in motorvehicle accidents outside the war zone. All patients completed a13-item inventory of postconcussive and posttraumatic distresssymptoms. On average, noncombat-injured patients had 3.8symptoms, while combat-injured patients had 5.7 symptoms.[abstract adapted] Nelson, l. A., Yoash-Gantz, R. E., Pickett, T. C., & Campbell, T. A.(2009). Relationship between processing speed and executivefunctioning performance among OEF/OIF veterans: Implicationsfor postdeployment rehabilitation. Journal of Head Trauma Rehabili-tation, 24, 32-40. Comorbid mild traumatic brain injury (mTBI) withPTSD is a common clinical presentation among returning OEF/OIFtroops. This study examined processing speed and executivefunctioning in a sample of OEF/OIF veterans who had sustainedmTBI, a subset of whom also had comorbid PTSD. Fifty-threeOEF/OIF veterans with a history of mTBI completed Wechsler AdultIntelligence Scale-III Symbol Search and Digit Symbol-Codingsubscales, Stroop Word, color and color-word trials, and TrailMaking Test, Parts A and B. Excluding from analysis those whoscored poorly on effort testing, measures of processing speedaccounted for 43% of the variance in performance on the TrailMaking Test, Part B and 50% of the variance in performance onthe Stroop task. Significant differences in processing speed andexecutive functioning were found on the basis of presence ofcomorbid PTSD. Stroop Color and Stroop Color Word scoresdiffered significantly between the groups. Those having comorbidPTSD scored significantly poorer than the mTBI-only group. Implica-tions for treatment of the comorbid conditions are discussed.[abstract adapted] Orrison, W. W., Hanson, E. H., Alamo, T., Watson, D., Sharma, M.,Perkins, T. G., et al. (2009). Traumatic brain injury: A review andhigh-field MRI findings in 100 unarmed combatants using aliterature-based checklist approach. Journal of Neurotrauma, 26,689-701. Seventy-six percent of the unarmed combatants had atleast one finding that may be associated with TBI: 59% hippocampalatrophy, 43% cavum septum pellucidum, 32% dilated perivascularspaces, 29% diffuse axonal injury, 24% cerebral atrophy, 19%increased lateral ventricular size, 14% pituitary gland atrophy, 5%arachnoid cysts, and 2% had contusions. Statistical relationships PAGE 4P T S D R E S E A R C H Q U A R T E R LY