This study examined the impact of service member/veteran (SMV) combat deployment and traumatic brain injury (TBI) on the health and behavior of his or her children. Participants were 104 female spouse caregivers of US SMVs who had sustained a mild, severe, or penetrating TBI. Participants completed the Children’s Health and Behavior Questionnaire (CHBQ; r = .758 to .881) that evaluates school grades, behavior, medical health, emotional health, and social participation: (a) prior to the first combat deployment, (b) in the month prior to the TBI, (c) within 2 years after the TBI, and (d) 2 or more years after the TBI. A substantial number of children experienced a decline in health and behavior following the TBI (41.7%–79.1%). Of those who declined (a) 68.8%–75.5% declined within the first 2 years post-injury, followed by improvement or stabilization; (b) 6.7%–15.6% declined only after 2 or more years post-injury; (c) 15.6%–25.0% declined within the first 2 years post-injury and then again 2 or more years post-injury; and (d) 16.9%–26.5% experienced a decline as a result of deployment, followed by an additional decline after the SMV’s TBI. Services are required for children of SMVs following TBI and deployment, particularly children at risk for poor outcome.
1. Wojcik BE, Stein CR, Bagg K, Humphrey RJ, Orosco J. Traumatic brain injury hospitalizations of U.S. army soldiers deployed to Afghanistan and Iraq. Am J Prev Med. 2010;38(1 suppl):S108–16.[PubMed]
2. Hoge CW, McGurk D, Thomas JL, Cox AL, Engel CC, Castro CA. Mild traumatic brain injury in U.S. Soldiers returning from Iraq. N Engl J Med. 2008;358:453–63.[PubMed]
3. Bell RS, Vo AH, Neal CJ, Tigno J, Roberts R, Mossop C, et al. Military traumatic brain and spinal column injury: a 5-year study of the impact blast and other military grade weaponry on the central nervous system. J Trauma. 2009;66(4 suppl):S104–11.[PubMed]
4. Terrio H, Brenner LA, Ivins BJ, Cho JM, Helmick K, Schwab K, et al. Traumatic brain injury screening: Preliminary findings in a US Army Brigade Combat Team. J Head Trauma Rehabil. 2009;24:14–23.[PubMed]
5. Mott FW. The effects of high explosives upon the central nervous system, lecture I. Lancet. 1916;48:331–8.
6. Mott FW. The effects of high explosives upon the central nervous system, lecture II. Lancet. 1916;48:441–9.
7. Shively S, Scher AI, Perl DP, Diaz-Arrastia R. Dementia resulting from traumatic brain injury: What is the pathology? Arch Neurol. 2012;69:1245–51.[PMC free article][PubMed]
8. Martland HS. Punch drunk. JAMA. 1928;91:1103–7.
9. Winterstein CE. Head injuries attributable to boxing. Lancet. 1937;230:719–22.
10. Johnson J. Organic psychosyndromes due to boxing. Br J Psychiatry. 1969;115:45–53.[PubMed]
11. Critchley M. In: Punch-drunk syndromes: The chronic traumatic encephalopathy of boxers. Vincent HC, editor. Maloine; 1949.
12. Critchley M. Medical aspects of boxing, particularly from a neurological standpoint. Br Med J. 1957;1:357–62.[PMC free article][PubMed]
13. Corsellis JA, Bruton CJ, Freeman-Browne D. The aftermath of boxing. Psychol Med. 1973;3:270–303.[PubMed]
14. McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte ET, Gavett BE, Budson AE, et al. Chronic traumatic encephalopathy in athletes: progressive tauopathy after repetitive head injury. J Neuropathol Exp Neurol. 2009;68:709–35.[PMC free article][PubMed]
15. Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH. Chronic traumatic encephalopathy in a National Football League player. Neurosurgery. 2005;57:128–34.[PubMed]
16. Omalu BI, DeKosky ST, Hamilton RL, Minster RL, Kamboh MI, Shakir AM, et al. Chronic traumatic encephalopathy in a National Football League player: Part II. Neurosurgery. 2006;59:1086–92. discussion 92-3. [PubMed]
17. McKee AC, Stein TD, Nowinski CJ, Stern RA, Daneshvar DH, Alvarez VE, et al. The spectrum of disease in chronic traumatic encephalopathy. Brain. 2013;136:43–64.[PMC free article][PubMed]
18. McKee AC, Daneshvar DH, Alvarez VE, Stein TD. The neuropathology of sport. Acta Neuropathol. 2014;127:29–51.[PMC free article][PubMed]
19. Omalu B, Hammers JL, Bailes J, Hamilton RL, Kamboh MI, Webster G, et al. Chronic traumatic encephalopathy in an Iraqi war veteran with posttraumatic stress disorder who committed suicide. Neurosurg Focus. 2011;31:E3.[PubMed]
20. Goldstein LE, Fisher AM, Tagge CA, Zhang XL, Velisek L, Sullivan JA, et al. Chronic traumatic encephalopathy in blast-exposed military veterans and a blast neurotrauma mouse model. Sci Transl Med. 2012;4:134ra60.[PMC free article][PubMed]
21. Concussion (mild traumatic brain injury) and the team physician: A consensus statement. Med Sci Sports Exerc. 2006;38:395–9.[PubMed]
22. McCrory P, Meeuwisse WH, Aubry M, Cantu B, Dvorak J, Echemendia RJ, et al. Consensus statement on concussion in sport: The 4th International Conference on Concussion in Sport held in Zurich, November 2012. Br J Sports Med. 2013;47:250–8.[PubMed]
23. Defense and Veterans Brain Injury Center Sports concussion vs. military concussion. http://dvbic.dcoe.mil/about-traumatic-brain-injury/article/sports-concussion-vs-military-concussion.
24. Walker KR, Tesco G. Molecular mechanisms of cognitive dysfunction following traumatic brain injury. Front Aging Neurosci. 2013;5:29.[PMC free article][PubMed]
25. Gysland SM, Mihalik JP, Register-Mihalik JK, Trulock SC, Shields EW, Guskiewicz KM. The relationship between subconcussive impacts and concussion history on clinical measures of neurologic function in collegiate football players. Ann Biomed Eng. 2012;40:14–22.[PubMed]
26. Talavage TM, Nauman EA, Breedlove EL, Yoruk U, Dye AE, Morigaki KE, et al. Functionally-detected cognitive impairment in high school football players without clinically-diagnosed concussion. J Neurotrauma. 2014;31:327–38.[PMC free article][PubMed]
27. Meaney DF, Smith DH, Shreiber DI, Bain AC, Miller RT, Ross DT, et al. Biomechanical analysis of experimental diffuse axonal injury. J Neurotrauma. 1995;12:689–94.[PubMed]
28. Korn A, Golan H, Melamed I, Pascual-Marqui R, Friedman A. Focal cortical dysfunction and blood-brain barrier disruption in patients with postconcussion syndrome. J Clin Neurophysiol. 2005;22:1–9.[PubMed]
29. Iwata A, Stys PK, Wolf JA, Chen XH, Taylor AG, Meaney DF, et al. Traumatic axonal injury induces proteolytic cleavage of the voltage-gated sodium channels modulated by tetrodotoxin and protease inhibitors. J Neurosci. 2004;24:4605–13.[PubMed]
30. Giza CC, Hovda DA. The neurometabolic cascade of concussion. J Athl Train. 2001;36:228–35.[PMC free article][PubMed]
31. Oppenheimer DR. Microscopic lesions in the brain following head injury. J Neurol Neurosurg Psychiatry. 1968;31:299–306.[PMC free article][PubMed]
32. Blumbergs PC, Scott G, Manavis J, Wainwright H, Simpson DA, McLean AJ. Staining of amyloid precursor protein to study axonal damage in mild head injury. Lancet. 1994;344:1055–6.[PubMed]
33. Povlishock JT, Katz DI. Update of neuropathology and neurological recovery after traumatic brain injury. J Head Trauma Rehabil. 2005;20:76–94.[PubMed]
34. Povlishock JT, Erb DE, Astruc J. Axonal response to traumatic brain injury: Reactive axonal change, deafferentation, and neuroplasticity. J Neurotrauma. 1992;9(suppl 1):S189–200.[PubMed]
35. Erb DE, Povlishock JT. Neuroplasticity following traumatic brain injury: A study of GABAergic terminal loss and recovery in the cat dorsal lateral vestibular nucleus. Exp Brain Res. 1991;83:253–67.[PubMed]
36. Breedlove EL, Robinson ME, Talavage TM, Morigaki KE, Yoruk U, O'Keefe K, et al. Biomechanical correlates of symptomatic and asymptomatic neurophysiological impairment in high school football. J Biomechanics. 2012;45:1265–72.[PubMed]
37. Bazarian JJ, Zhu T, Blyth B, Borrino A, Zhong J. Subject-specific changes in brain white matter on diffusion tensor imaging after sports-related concussion. Magn Reson Imaging. 2012;30:171–80.[PMC free article][PubMed]
38. Lipton ML, Kim N, Zimmerman ME, Kim M, Stewart WF, Branch CA, et al. Soccer heading is associated with white matter microstructural and cognitive abnormalities. Radiology. 2013;268:850–7.[PMC free article][PubMed]
39. Koerte IK, Kaufmann D, Hartl E, Bouix S, Pasternak O, Kubicki M, et al. A prospective study of physician-observed concussion during a varsity university hockey season: White matter integrity in ice hockey players. Part 3 of 4. Neurosurg Focus. 2012;33:1–7.[PMC free article][PubMed]
40. Koerte IK, Ertl-Wagner B, Reiser M, Zafonte R, Shenton ME. White matter integrity in the brains of professional soccer players without a symptomatic concussion. JAMA. 2012;308:1859–61.[PMC free article][PubMed]
41. Taber KH, Hurley RA, Haswell CC, Rowland JA, Hurt SD, Lamar CD, et al. White matter compromise in veterans exposed to primary blast forces. J Head Trauma Rehabil. 2014 [e-pub ahead of print] [PMC free article][PubMed]
42. Duckworth JL, Grimes J, Ling GS. Pathophysiology of battlefield associated traumatic brain injury. Pathophysiology. 2013;20:23–30.[PubMed]
43. Kaur C, Singh J, Lim MK, Ng BL, Yap EP, Ling EA. The response of neurons and microglia to blast injury in the rat brain. Neuropathol Appl Neurobiol. 1995;21:369–77.[PubMed]
44. Ahlers ST, Vasserman-Stokes E, Shaughness MC, Hall AA, Shear DA, Chavko M, et al. Assessment of the effects of acute and repeated exposure to blast overpressure in rodents: Toward a greater understanding of blast and the potential ramifications for injury in humans exposed to blast. Front Neurol. 2012;3:32.[PMC free article][PubMed]
45. Bauman RA, Ling G, Tong L, Januszkiewicz A, Agoston D, Delanerolle N, et al. An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast. J Neurotrauma. 2009;26:841–60.[PubMed]
46. Knudsen SK, Oen EO. Blast-induced neurotrauma in whales. Neurosci Res. 2003;46:377–86.[PubMed]
47. Kocsis JD, Tessler A. Pathology of blast-related brain injury. J Rehabil Res Dev. 2009;46:667–72.[PubMed]
48. Saljo A, Arrhen F, Bolouri H, Mayorga M, Hamberger A. Neuropathology and pressure in the pig brain resulting from low-impulse noise exposure. J Neurotrauma. 2008;25:1397–406.[PubMed]
49. Ling G, Bandak F, Armonda R, Grant G, Ecklund J. Explosive blast neurotrauma. J Neurotrauma. 2009;26:815–25.[PubMed]