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The Invisible Injury: Signs of Overpressure Traumatic Brain Injuries in Military Members

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By Jennifer Bucholtz
Criminal Justice Faculty at American Military University

Recently, Americans have witnessed a drastic increase in publicity regarding the long-reaching effects of concussions, particularly in professional football players. This increased awareness has, no doubt, provided support for multiple neurological studies, with the goal of pinpointing physical damage to players’ brains and identifying the long-term physical and emotional effects of this damage. Though these brain injuries are serious no matter the patient’s profession, they affect an even larger sub-section of our society: our military members.

Traumatic Brain Injuries (TBIs) are considered the “invisible injury” of our men and women engaged in operations in Iraq and Afghanistan. Though the physical damage that results from a TBI is not always apparent, the manifestation of other side effects is quite obvious. Unfortunately, countless military members who suffer one or more TBIs, while in combat, return stateside a distant variation of their former selves. Some, having been previously law-abiding citizens, turn to criminal behavior upon their return.

When most hear the word “concussion”, thoughts of one’s head hitting a stationary object often come to mind. For football players, this is the common method of injury. Concussions these athletes endure are often a result of their head coming into contact with the ground, or another player, at a high rate of speed. This is a considered a “traditional” concussion or brain injury. The terms “concussion” and “TBI” are nearly interchangeable. They both share the same symptoms and have varying levels of severity, from mild to severe.

Other Type of Brain Injury Often Overlooked

In conducting research for my graduate thesis, I discovered the existence of another kind of traumatic brain injury, called an “Overpressure TBI” with the same symptoms, but different underlying cause. Recent research (Moss, King & Blackman, 2009; Kocsis & Tessler, 2009) has revealed that the concussive shockwave from the blast of an explosion results in the same types of brain injury as a traditional concussion (in which the head hits a stationary object).

When exposed to a blast wave, the human skull experiences a rippling effect, called “skull flexure”, causing over-pressurization in the brain, leading to damage. This revelation has long-reaching consequences, considering how many military members have been in close proximity to an explosion while serving in a combat zone. The unfortunate downside of this medical finding is that it was not discovered until several years into our wars in Iraq and Afghanistan. Consequently, countless military members and veterans likely suffered TBIs, while serving in Iraq and Afghanistan, but their injuries went undetected. The number affected and the severity of injuries is now impossible to ascertain.

In the early years of these two wars, it was assumed that the Kevlar helmet, issued to all deploying troops, provided adequate protection of the brain in most circumstances. It is now known that this assumption was incorrect. The blast wave from an explosion travels easily through the helmet and brain, leaving devastating injuries that are not always immediately apparent. Soldiers who have experienced a blast shockwave often report feelings of dizziness, confusion and short-term memory loss. However, these symptoms typically wear off within minutes and the soldier feels and appears generally “normal” again. It often takes weeks, months or even years for other long-term and sometimes permanent, side effects to manifest. Many of these changes are behavioral in nature and affect a person’s ability to make decisions, react properly to stressful situations and display appropriate emotional responses towards others. As a result, the person may misperceive situational elements and make poor social judgments which can lead to (sometimes involuntary) participation in anti-social and even criminal behavior. The frontal lobe area of the brain is responsible for critical thinking, decision-making, impulse control and consideration of consequences, making it the area most negatively affected by a TBI.

Indicators of a Traumatic Brain Injury

Family members of those affected by a TBI often report their loved one(s) as having emotional and angry outbursts, which would have been uncharacteristic for the person prior to the brain injury. The sufferers also tend to experience mood swings they cannot explain and a lack of interest and motivation for everyday activities. Some believe these types of behavioral changes to be a result of Post-Traumatic Stress Disorder (PTSD) and it is unfortunate that the symptoms of PTSD can overlap with those of a brain injury. This commonality in symptoms presents additional challenges to medical personnel charged with treating combat veterans.

Researchers and engineers (Blackman et al, 2011) are currently striving to develop protective gear that will better defend the brain from the effects of blast shockwaves. According to Blackman (2011), the need for elastic, cushioning, absorbing pads inside the combat helmet are necessary in order to deflect a blast wave away from the human skull and brain. None of these enhancements have been adopted yet by our military, but it is expected they will be in the near future, after further testing.

From my own research, I prepared several recommendations about how the military and Department of Veteran’s Affairs can better treat and prepare our military members, with regards to TBIs:

1. Institution of pre- and post-deployment brain scans in soldiers. This practice will provide a method of comparison (before and after deployment) and assist medical personnel in detecting brain damage that may have previously gone unnoticed.

2. Mandatory briefings for military members and their family members, to assist in recognizing and identifying symptoms of TBIs.

3. Access for family members to report TBI-related symptoms noticed in their loved one(s). Doctors should not rely only on self-reporting by the military member because many do not report their symptoms.

4. Specific training for military members in leadership positions to conduct informal, on-the-battlefield evaluations of their peers and subordinates, following a blast incident. This ability will assist in the immediate detection of brain injuries.

5. Immediate removal of military members, exposed to a blast incident, from field duty for an appropriate amount of time (as determined by medical personnel). This will allow for proper rest of the brain and expedite the healing process.

About The Author
Jennifer Bucholtz is a former U.S. Army Counterintelligence Agent and decorated veteran of the Iraq and Afghanistan wars. She holds a bachelor of science in criminal justice, MA in criminal justice and MS in forensic sciences. Jennifer has an extensive background in U.S. military and Department of Defense Counterintelligence operations. While on active duty, she served as the Special Agent in Charge for her unit in South Korea and Assistant Special Agent in Charge at stateside duty stations. Jennifer has also worked for the Arizona Department of Corrections and Office of the Chief Medical Examiner in New York City. Jennifer is currently an adjunct faculty member at American Military University and teaches courses in criminal justice and forensic sciences, within the School of Public Service and Health. You can contact her at

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