Traumatic Brain Injury: Remembering Our Soldiers With Hidden Wounds

On Memorial Day, at dawn, the American flag is raised to half-staff to remember the one million–plus men and women who have died in the service of their country. At noon, the flag is raised to full height to honor their memory and to remind Americans not to let their sacrifices be in vain, but rather to keep their country committed to the pursuit of “liberty and justice for all.”

The current men and women of the United States Armed Forces face this resolve with a greater personal risk than most, and we thank them for their continued service. This risk is often obvious, with frequently posted pictures of military and civilians with lost limbs or unconscious bodies. But a large number—much larger than what we see—will suffer from injuries that leave no visible, external scars.

Traumatic brain injury (TBI) is an unfortunate fact of everyday life; people fall, motor vehicle accidents happen, heads collide in various sports (more violently in some sports than in others). Military members face the additional risk of head injury caused by explosive devices. While the majority of head injuries are suffered by men and women in non-combat situations, roughly 20 percent occur during deployment. Between 2000 and 2014, the Department of Defense reported 320,334 total head injuries, approximately 64,000 of which occurred in active duty. The majority (60 percent) of these injuries are related to explosive blasts, the most well-reported of which would be due to the use of improvised explosive devices, or IEDs.


In an explosive blast, there are generally three sources of injury: (1) generated energy disbursing outward in a shock wave of over-pressurized air; (2) shrapnel from the explosion hitting the head and body; and (3) the body being thrown into other objects and the ground. All three of these forces can cause either direct injury to the brain (as from a penetrating injury) or an indirect concussive injury (from the brain’s moving forcefully within the head).

As in a more traditional concussion, such as when two football players collide, the sudden and often violent movement of the brain due to explosive forces can cause shearing injury to the nerve cells throughout the brain. Many of these injuries do not show up on a traditional MRI or CT scan, since there isn’t significant bleeding or swelling; but they can still cause significant short—and even long-term—symptoms and disability.

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