Concussions and the military: issues specific to service members.

Since October 2001, more than 1.6 million American military service members have deployed to Iraq and Afghanistan in the Global War on Terrorism. It is estimated that between 5% and 35% of them have sustained a concussion, also called mild traumatic brain injury (mTBI), during their deployment. Up to 80% of the concussions experienced in theater are secondary to blast exposures. The unique circumstances and consequences of sustaining a concussion in combat demands a unique understanding and treatment plan. The current literature was reviewed and revealed a paucity of pathophysiological explanations on the nature of the injury and informed treatment plans. However, through observation and experience, a theoretical but scientifically plausible model for why and how blast injuries experienced in combat give rise to the symptoms that affect day-to-day function of service members who have been concussed has been developed. We also are able to offer treatment strategies based on our evaluation of the current literature and experience to help palliate postconcussive symptoms. The purpose of this review is to elucidate common physical, cognitive, emotional, and situational challenges, and possible solutions for this special population of patients who will be transitioning into the civilian sector and interfacing with health professionals. There is a need for further investigation and testing of these strategies.