Blast-related mild TBI: LIMBIC-CENC focused review with implications commentary

Issue title: Why Military Neurorehabilitation Research is Relevant to Everyone

Guest editors: David X. Cifu and Sidney R. Hinds

Article type: Review Article

Authors: Miller, Austin R.^a | Martindale, Sarah L.^{b; c; d} | Rowland, Jared A.^{b; c; e} | Walton, Samuel^f | Talmy, Tomer^{g; h} | Walker, William C.^{f; i; *}

Affiliations: [a] Alabama College of Osteopathic Medicine, Dothan, AL, USA | [b] Research and Academic Affairs, W.G. (Bill) Hefner Veterans Affairs Healthcare System, Salisbury, NC, USA | [c] Mid-Atlantic Mental Illness Research Education and Clinical Center, Durham, NC, USA | [d] Department of Physiology and Pharmacology, Wake Forest School of Medicine, Winston-Salem, NC, USA | [e] Department of Neurobiology and Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA | [f] Department of Physical Medicine and Rehabilitation (PM& R), School of Medicine, Virginia Commonwealth University, Richmond, VA, USA | [g] Israel Defense Forces, Medical Corps, Ramat Gan, Israel | [h] Department of Military Medicine, Faculty of Medicine, Hebrew University, Jerusalem, Israel | [i] Richmond Veterans Affairs (VA) Medical Center, Central Virginia VA Health Care System, Richmond, VA, USA

Correspondence: [*] Address for correspondence: William C. Walker, MD., E-mail: william.walker@vcuhealth.org.

Abstract: BACKGROUND:A significant factor for the high prevalence of traumatic brain injury (TBI) among U.S. service members is their exposure to explosive munitions leading to blast-related TBI. Our understanding of the specific clinical effects of mild TBI having a component of blast mechanism remains limited compared to pure blunt mechanisms. OBJECTIVE:The purpose of this review is to provide a synopsis of clinical research findings on the long-term effects of blast-related mild TBI derived to date from the Long-Term Impact of Military-Relevant Brain Injury Consortium - Chronic Effects of Neurotrauma Consortium (LIMBIC-CENC). METHODS:Publications on blast-related mild TBI from LIMBIC-CENC and the LIMBIC-CENC prospective longitudinal study (PLS) cohort were reviewed and their findings summarized. Findings from the broader literature on blast-related mild TBI that evaluate similar outcomes are additionally reviewed for a perspective on the state of the literature. RESULTS:The most consistent and compelling evidence for long-term effects of blast-related TBI is for poorer psychological health, greater healthcare utilization and disability levels, neuroimaging impacts on brain structure and function, and greater headache impact on daily life. To date, evidence for chronic cognitive performance deficits from blast-related mild TBI is limited, but futher research including crucial longitudinal data is needed. CONCLUSION:Commentary is provided on: how LIMBIC-CENC findings assimilate with the broader literature; ongoing research gaps alongside future research needs and priorities; how the scientific community can utilize the LIMBIC-CENC database for independent or collaborative research; and how the evidence from the clinical research should be assimilated into clinical practice.

Keywords: Traumatic brain injury, mild traumatic brain injury, concussion, blast injuries, military medicine, veterans health, outcome studies

DOI: 10.3233/NRE-230268

Journal: NeuroRehabilitation, vol. 55, no. 3, pp. 329-345, 2024