family members is that substantial long-term effects have been associated with TBI (IOM, 2009). In some cases a TBI can go undetected until the service member returns home and can no longer function as he or she did before deployment; this can result in frustration and problems for both service member and family alike (Zeitzer and Brooks, 2008). A recent Institute of Medicine (IOM) report (2009) noted that numerous adverse long-term outcomes are related to TBI. Although some acute outcomes, such as some neurocognitive and psychosocial dysfunction, resolve or lessen over time, other sequelae, such as psychiatric outcomes, become more apparent several years after injury. Many studies have found a dose–response relationship with regard to TBI severity and outcome: generally, the more severe the TBI, the more severe the outcome. However, the IOM report identified several outcomes that can persist even after mild TBI, including unprovoked seizures, depression, aggression, and postconcussive symptoms, such as memory problems, dizziness, and irritability. TBI can cause life-long impairments, and rehabilitation and recovery might take many years.
One common complication of TBI is pain (Nampiaparampil, 2008), particularly headache, and there is growing evidence that it can be a long-term problem (Gironda et al., 2009). A study of OEF and OIF veterans diagnosed with TBI found that those with neurocognitive impairments were more likely to have headache, migraine-like headache, more severe pain, and more frequent headache than veterans without neurocognitive impairment (Ruff et al., 2008). Similarly, a recent study (Theeler and Erickson, 2009) found an association between a history of mild head trauma, usually caused by blast exposure, and onset or worsening of headache in combat troops; it was also noted that the soldiers diagnosed with TBI usually experienced migraine-type headaches.
There is clear evidence of increased mortality in the acute phase after moderate to severe TBI and for some time following in both military and civilian populations (Baguley et al., 2000; Brown et al., 2004; Corkin et al., 1984; Harrison-Felix et al., 2004; Lewin et al., 1979; Ratcliff et al., 2005; Rish et al., 1983; Selassie et al., 2005; Shavelle and Strauss, 2000; Walker et al., 1971; Weiss et al., 1982). In the military literature, posttraumatic epilepsy in patients who initially survive penetrating head injury is associated with an increased risk of death and about a 5-year decrease in life expectancy (Corkin et al., 1984; Walker et al., 1971; Weiss et al., 1982). Studies of the subset of more severely injured patients who survive initial hospitalization and require inpatient rehabilitation have shown a worse prognosis that is consistent with the greater degree of residual compromise: mortality some 2–7 times as high as that in age- and sex-matched comparison populations (Brown et al., 2004; Harrison-Felix et al., 2004; Ratcliff et al., 2005; Selassie et al., 2005).
TBI can also lead to disruptions in higher-level functions of everyday life, including social relationships, independent living, and employment. Numerous studies have documented that penetrating brain injuries have adverse consequences for long-term employment outcomes (Dikmen et al., 1994; Doctor et al., 2005; McLeod et al., 2004; Schwab et al., 1993). Moreover, although some impairments might be related to injuries to other parts of the body sustained at the time of TBI, moderate to severe TBI leads to more functional impairment than do injuries to other parts of the body alone (Dikmen et al., 1995; Gerberich et al., 1997; McLeod et al., 2004; Oddy et al., 1978; Ommaya, 1996). The adverse effects of TBI on leisure and recreation, social relationships, functional status, quality of life, and independent living clearly affect readjustment and family life and relationships. By one year after injury, psychosocial problems appear to be greater than problems in basic activities of daily living (IOM, 2009).