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Neuropsychological Outcome from Blast versus Non-blast: Mild Traumatic Brain Injury in U.S. Military Service Members

Published online by Cambridge University Press:  30 March 2012

Rael T. Lange ,
Sonal Pancholi ,
Tracey A. Brickell ,
Sara Sakura ,
Aditya Bhagwat ,
Victoria Merritt  and
Louis M. French
Rael T. Lange*
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland Department of Psychiatry, University of British Columbia, Vancouver, British Columbia
Sonal Pancholi
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Fort Belvoir Community Hospital, Fort Belvoir, Virginia
Tracey A. Brickell
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
Sara Sakura
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland
Aditya Bhagwat
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland United States Public Health Service, Bethesda, Maryland
Victoria Merritt
Affiliation:
Department of Psychology, Pennsylvania State University, State College, Pennsylvania
Louis M. French
Affiliation:
Department of Research, Defense and Veterans Brain Injury Center, North Bethesda, Maryland Department of Orthopaedics and Rehabilitation, Walter Reed National Military Medical Center, Bethesda, Maryland Department of Neurology, Uniformed Services University of the Health Sciences, Bethesda, Maryland
*
Correspondence and reprint requests to: Rael T. Lange, Defense and Veterans Brain Injury Center, 11300 Rockville Pike, Suite 1100, North Bethesda, MD 20852. E-mail: [email protected]
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Abstract

The purpose of this study was to compare the neuropsychological outcome from blast-related versus non-blast related mild traumatic brain injury (MTBI). Participants were 56 U.S. military service members who sustained an MTBI, divided into two groups based on mechanism of injury: (a) non-blast related (Non-blast; n = 21), and (b) blast plus secondary blunt trauma (Blast Plus; n = 35). All participants had sustained their injury in theatre whilst deployed during Operation Iraqi Freedom or Operation Enduring Freedom. Patients had been seen for neuropsychological evaluation at Walter Reed Army Medical Center on average 4.4 months (SD = 4.1) post-injury. Measures included 14 clinical scales from the Personality Assessment Inventory (PAI) and 12 common neurocognitive measures. For the PAI, there were no significant differences between groups on all scales (p > .05). However, medium effect sizes were found for the Depression (d = .49) and Stress (d = .47) scales (i.e., Blast Plus > Non-blast). On the neurocognitive measures, after controlling for the influence of psychological distress (i.e., Depression, Stress), there were no differences between the Non-blast and Blast Plus groups on all measures. These findings provide little evidence to suggest that blast exposure plus secondary blunt trauma results in worse cognitive or psychological recovery than blunt trauma alone. (JINS, 2012, 18, 595–605)

Keywords

Mild traumatic brain injuryBlast injuryMilitaryService membersNeurocognitivePsychological outcome
Type
Research Articles
Information
Journal of the International Neuropsychological Society , Volume 18 , Issue 3 , May 2012 , pp. 595 - 605
Copyright
Copyright © The International Neuropsychological Society 2012

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References

Alley, M.D., Schimizze, B.R., Son, S.F. (2010). Experimental modeling of explosive blast-related traumatic brain injuries. Neuroimage, 54(Suppl 1), S45–S54.CrossRefGoogle ScholarPubMed
Anderson-Barnes, V., Lange, R.T., Pancholi, S., Brickell, T.A., Bhagwat, A., Iverson, G.I., French, L.M. (2011). Comparison of neuropsychological outcome from uncomplicated mild TBI, complicated mild TBI, and moderate TBI in U.S. military personnel. The Clinical Neuropsychologist, 25(4), 517.Google Scholar
Belanger, H.G., Kretzmer, T., Yoash-Gantz, R., Pickett, T., Tupler, L.A. (2009). Cognitive sequelae of blast-related versus other mechanisms of brain trauma. Journal of the International Neuropsychological Society, 15(1), 1–8.CrossRefGoogle ScholarPubMed
Belanger, H.G., Proctor-Weber, Z., Kretzmer, T., Kim, M., French, L.M., Vanderploeg, R.D. (2011). Symptom complaints following reports of blast versus non-blast mild TBI: Does mechanism of injury matter? Clinical Neuropsychology, 25, 702–714.CrossRefGoogle ScholarPubMed
Bochicchio, G.V., Lumpkins, K., O'Connor, J., Simard, M., Schaub, S., Conway, A., Scalea, T.M. (2008). Blast injury in a civilian trauma setting is associated with a delay in diagnosis of traumatic brain injury. The American Surgeon, 74(3), 267–270.CrossRefGoogle Scholar
Brenner, L.A., Vanderploeg, R.D., Terrio, H. (2009). Assessment and diagnosis of mild traumatic brain injury, posttraumatic stress disorder, and other polytrauma conditions: Burden of adversity hypothesis. Rehabilitation Psychology, 54(3), 239–246.CrossRefGoogle ScholarPubMed
Carroll, L.J., Cassidy, J.D., Holm, L., Kraus, J., Coronado, V.G. (2004). Methodological issues and research recommendations for mild traumatic brain injury: The WHO Collaborating Centre Task Force on Mild Traumatic Brain Injury. Journal of Rehabilitation Medicine, 43(Suppl), 113–125.CrossRefGoogle Scholar
Cernak, I., Wang, Z.G., Jiang, J.X., Bian, X.W., Savic, J. (2001). Ultrastructural and functional characteristics of blast injury-induced neurotrauma. Journal of Trauma-Injury Infection and Critical Care, 50(4), 695–706.CrossRefGoogle ScholarPubMed
Chafi, M.S., Karami, G., Ziejewski, M. (2010). Biomechanical assessment of brain dynamic responses due to blast pressure waves. Annals of Biomedical Engineering, 38(2), 490–504.CrossRefGoogle ScholarPubMed
Cheng, J., Gu, J., Ma, Y., Yang, T., Kuang, Y., Li, B., Kang, J. (2010). Development of rat model for studying blast-induced traumatic brain injury. Journal of Neurological Sciences, 294, 23–28.CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.Google Scholar
Conners, K. (2002). Conner's continuous performance test II (CPT II). Toronto, ON: Multi-Health Systems Inc.Google Scholar
Courtney, M.W., Courtney, A.C. (2011). Working toward exposure thresholds for blast-induced traumatic brain injury: Thoracic and acceleration mechanisms. Neuroimage, 54(Suppl 1), S55–S61.CrossRefGoogle ScholarPubMed
Delis, D.C., Kramer, J.H., Kaplan, E., Ober, B.A. (2000). The California Verbal Learning Test Manual, second edition. New York: The Psychological Corporation.Google Scholar
Desmoulin, G.T., Dionne, J.P. (2009). Blast-induced neurotrauma: Surrogate use, loading mechanisms, and cellular responses. Journal of Trauma, 67(5), 1113–1122.Google ScholarPubMed
Dikmen, S.S., Corrigan, J.D., Levin, H.S., Machamer, J., Stiers, W., Weisskopf, M.G. (2009). Cognitive outcome following traumatic brain injury. Journal of Head Trauma Rehabilitation, 24(6), 430–438.CrossRefGoogle ScholarPubMed
Green, P. (2003). Green's word memory test: User manual. Edmonton, Canada: Green's Publishing.Google Scholar
Heaton, R.K., Miller, S.W., Taylor, M.J., Grant, I. (2004). Revised comprehensive norms for an expanded Halstead-Reitan Battery: Demographically adjusted neuropsychological norms for African American and Caucasian adults professional manual. Lutz, FL: Psychological Assessment Resources.Google Scholar
Iverson, G.L., Lange, R.T., Gaetz, M., Zasler, N.D. (2007). Mild TBI. In N. D. Zasler, D. Katz, R. D. Zafonte (Eds.), Brain injury medicine (pp. 333–371). New York, NY: Demos Medical Publishing, Inc.Google Scholar
Jaffee, M.S., Meyer, K.S. (2009). A brief overview of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) within the Department of Defense. The Clinical Neuropsychologist, 23(8), 1291–1298.CrossRefGoogle ScholarPubMed
Kennedy, J.E., Leal, F.O., Lewis, J.D., Cullen, M.A., Amador, R.R. (2010). Posttraumatic stress symptoms in OIF/OEF service members with blast-related and non-blast-related mild TBI. Neurorehabilitation, 26(3), 223–231.CrossRefGoogle ScholarPubMed
Lew, H.L., Otis, J.D., Tun, C., Kerns, R.D., Clark, M.E., Cifu, D.X. (2009). Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF/OEF veterans: Polytrauma clinical triad. Journal of Rehabilation Research and Development, 46(6), 697–702.CrossRefGoogle ScholarPubMed
Lippa, S.M., Pastorek, N.J., Benge, J.F., Thornton, G.M. (2010). Postconcussive symptoms after blast and nonblast-related mild traumatic brain injuries in Afghanistan and Iraq war veterans. Journal of the International Neuropsychological Society, 16(5), 856–866.CrossRefGoogle ScholarPubMed
Lockhart, P., Cronin, D., William, K., Ouellet, S. (2010). Investigation of head response to blast loading. Journal of Trauma, 70(2), E29–E36.Google Scholar
Long, J.B., Bentley, T.L., Wessner, K.A., Cerone, C., Sweeney, S., Bauman, R.A. (2009). Blast overpressure in rats: Recreating a battlefield injury in the laboratory. Journal of Neurotrauma, 26(6), 827–840.CrossRefGoogle ScholarPubMed
Luethcke, C.A., Bryan, C.J., Morrow, C.E., Isler, W.C. (2011). Comparison of concussive symptoms, cognitive performance, and psychological symptoms between acute blast-versus nonblast-induced mild traumatic brain injury. Journal of the International Neuropsychological Society, 17(1), 36–45.CrossRefGoogle ScholarPubMed
Managment of Concussion/nTBI Working Group. (2009). VA/DoD clinical practice guidline for managment of concussion/mild traumatic brain injury. Washington, DC: Department of Veterans Affairs/Department of Defense.Google Scholar
Mild Traumatic Brain Injury Committee, American Congress of Rehabilitation Medicine & Head Injury Interdisciplinary Special Interest Group. (1993). Definition of mild traumatic brain injury. Journal of Head Trauma Rehabilitation, 8(3), 86–87.CrossRefGoogle Scholar
Morey, L.C. (1991). Personality assessment inventory: Professional manual. Odessa, FL: Psychological Assessment Resources.Google Scholar
Owens, B.D., KraghJ.F., Jr. J.F., Jr., Wenke, J.C., Macaitis, J., Wade, C.E., Holcomb, J.B. (2008). Combat wounds in operation Iraqi Freedom and operation Enduring Freedom. Journal of Trauma, 64(2), 295–299.Google ScholarPubMed
Readnower, R.D., Chavko, M., Adeeb, S., Conroy, M.D., Pauly, J.R., McCarron, R.M., Sullivan, P.G. (2010). Increase in blood-brain barrier permeability, oxidative stress, and activated microglia in a rat model of blast-induced traumatic brain injury. Journal of Neuroscience Research, 88(16), 2530–2539.CrossRefGoogle Scholar
Reitan, R.M. (1992). Trail making test: Manual for administration and scoring. South Tucson, AZ: Reitan Neuropsychological Laboratory.Google Scholar
Salijo, A., Bolouri, H., Mayorga, M., Svensson, B., Hamberger, A. (2010). Low-level blast raises intracranial pressure and impairs cognitive function in rats: Prophylaxis with processed cereal feed. Journal of Neurotrauma, 27(2), 283–289.Google Scholar
Salijo, A. Mayorga, M., Bolouri, H., Svensson, B., Hamberger, A. (2010). Mechanisms and pathophysiology of the low-level blast brain injury in animal models. Neuroimage, 54(Suppl 1), S83–S88.CrossRefGoogle Scholar
Sayer, N.A., Chiros, C.E., Sigford, B., Scott, S., Clothier, B., Pickett, T., Lew, H.L. (2008). Characteristics and rehabilitation outcomes among patients with blast and other injuries sustained during the Global War on Terror. Archives of Physical Medicine and Rehabilitation, 89(1), 163–170.CrossRefGoogle ScholarPubMed
Schretlen, D.J., Shapiro, A.M. (2003). A quantitative review of the effects of traumatic brain injury on cognitive functioning. International Review of Psychiatry, 15(4), 341–349.CrossRefGoogle ScholarPubMed
Snell, F.I., Halter, M.J. (2010). A signature wound of war: Mild traumatic brain injury. Journal of Psychosocial Nursing and Mental Health Services, 48(2), 22–28.CrossRefGoogle ScholarPubMed
Svetlov, S.I., Prima, V., Kirk, D.R., Gutierrez, H., Curley, K.C., Hayes, R.L., Wang, K.K. (2010). Morphologic and biochemical characterization of brain injury in a model of controlled blast overpressure exposure. Journal of Trauma, 69(4), 795–804.Google Scholar
Taylor, P.A., Ford, C.C. (2009). Simulation of blast-induced early-time intracranial wave physics leading to traumatic brain injury. Journal of Biomechanical Engineering, 131(6), 061007.CrossRefGoogle ScholarPubMed
The Psychological Corporation. (2001). Wechsler test of adult reading manual. San Antonio, TX: Author.Google Scholar
Wallace, D. (2009). Improvised explosive devices and traumatic brain injury: The military experience in Iraq and Afghanistan. Australasian Psychiatry, 17(3), 218–224.CrossRefGoogle ScholarPubMed
Warden, D.L., French, L.M., Shupenko, L., Fargus, J., Riedy, G., Erickson, M.E., Moore, D.F. (2009). Case report of a soldier with primary blast brain injury. Neuroimage, 47(Suppl 2), T152–T153.CrossRefGoogle ScholarPubMed
Wechsler, D. (1987). Wechsler memory scale-revised. San Antonio, TX: The Psychological Corporation.Google Scholar
Wechsler, D. (1997). Wechsler adult intelligence scale 3rd edition. San Antonio, TX: Psychological Corporation.Google Scholar
Wilk, J.E., Thomas, J.L., McGurk, D.M., Riviere, L.A., Castro, C.A., Hoge, C.W. (2010). Mild traumatic brain injury (concussion) during combat: Lack of association of blast mechanism with persistent postconcussive symptoms. Journal of Head Trauma Rehabilitation, 25(1), 9–14.CrossRefGoogle ScholarPubMed
Yilmaz, S., Pekdemir, M. (2007). An unusual primary blast injury Traumatic brain injury due to primary blast injury. American Journal of Emergency Medicine, 25(1), 97–98.CrossRefGoogle ScholarPubMed