TBI Among Military Soldiers

Much has been made of the recent disclosure and discovery regarding the severity and prevalence of traumatic brain injury (TBI) among professional football players. Yet very little attention has been paid to soldiers with battlefield TBI. In both instances, the pathophysiology and disease sequela are not well understood. Yet the consequences of wartime blast traumatic brain injury (bTBI) worsened on most disability measures between one and five-years post injury.

Specific study entrance measurements included specific brain injury diagnosis, pre-injury intelligence, motor strength, verbal fluency, and neurobehavioral symptom severity.

Unfortunately, the five-year outcomes were not favorable. Measurement of overall global disability, life satisfaction, psychiatric symptom severity, neurobehavioral symptom severity and sleep impairment had worsened. In addition, a substantial number of study participants experienced increased severity of post-traumatic stress disorder, depression, anxiety and chronic sleep impairment.

But why?

Research by Shively et al, (2016) analyzed the brains from soldiers who had survived explosive attacks – grenades, mortars, and improvised explosive devices – prior to their death and found that all had astroglial scarring in the subpial glial plate, penetrating cortical blood vessels, grey-white matter junctions and structures lining the ventricles. This may account for the severe neurological and psychiatric symptoms that occur among individuals who sustained numerous, explosive concussive injuries, which we speculate are qualitatively different than a hard knock to the head during a football game.

Why Does This Matter?

The long-term outcomes associated with wartime traumatic brain injury (TBI) and general combat exposure differ substantially from athletes and civilians who suffer concussive injury or TBI. Similar research reveals functional changes during early midlife among military service members who were deployed to Afghanistan or Iraq and suggest that previously held expectations for stable recovery after a sport derived TBI do not generalize to those injured in recent military conflicts in the Middle East.

The high prevalence of serious deficits and disabilities among individuals with deployment related blast mTBI of this magnitude may quickly exceed the services available within the Veterans Affairs health care system. The numbers are staggering.

  • 72% of military personnel who sustained blast traumatic brain injury (TBI) worsened on several disability measures over the five-year study.
  • Deficits and disabilities observed at one year post injury, were predictive of long term deficits and disability.

We must realize, and take to heart, that that progression and severity of post-concussive symptoms flies in the face of our current pedagogy regarding attainment of general stability at six months post injury.

The apparent chronicity of TBI among wartime military personnel and to a lesser extent among some civilians and athletes with repeated concussive injuries will require additional research and clinical resources. A renewed commitment to advancing our knowledge of the etiology and disease sequela of concussive injuries and TBI is now a public health imperative.