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Female, male service members, veterans recover from concussion differently

At an informal celebration at the AFWERX Vegas Innovation Hub earlier this month, U.S. Air Force personnel took delivery of four helmet designs that may each represent the next generation of fixed-wing aircrew equipment. In just nine months, the AFWERX innovations process generated tangible products for further Air Force testing and development. (U.S. Air Force photo by Nathan Riddle) At an informal celebration at the AFWERX Vegas Innovation Hub earlier this month, U.S. Air Force personnel took delivery of four helmet designs that may each represent the next generation of fixed-wing aircrew equipment. In just nine months, the AFWERX innovations process generated tangible products for further Air Force testing and development. (U.S. Air Force photo by Nathan Riddle)

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Female veterans may have a harder time performing some mental tasks after a mild traumatic brain injury or concussion, according to a recent study supported by the Defense and Veterans Brain Injury Center, a division of the Defense Health Agency Research and Development Directorate.

The study compared male and female veterans who had experienced concussions to more accurately assess whether each gender experienced different symptoms following injury. After adjusting for factors such as marital status, service branch, living situation, and vocation, the results showed female veterans had a harder time performing mental tasks such as difficulty concentrating and forgetfulness, which could slow recovery to normal activities. The study’s authors presented their results at the 2019 annual Military Health System Research Symposium in August.

“TBI is the signature injury experienced by service members and veterans in conflicts since 9/11,” said Navy Captain Scott Pyne, DVBIC division chief. “During this time, women have had the opportunity to serve in more combat related positions associated with increased exposures to potentially concussive events. As a result, there is a need to see whether TBI affects women and men differently.”

According to the latest figures published in Military Medicine in 2019, female service members accounted for 12.6 percent of first-time TBI diagnoses in the U.S. armed forces between 2010 and 2014.

“Women are becoming more prominent in all fields—including the military. If we don’t understand the differences in biology and/or symptomology, it could cause a major burden for society going forward. Individual differences must be analyzed through the lens of gender,” said Maheen Mausoof Adamson, DVBIC senior clinical research director and a neuroscientist at the Stanford University School of Medicine. Adamson is one of the lead scientists on the DVBIC-funded study conducted at the Veteran Affairs Palo Alto Health Care System.

To more accurately assess whether men and women experienced different symptoms following a TBI, the DVBIC-VA Palo Alto study relied on a matching technique where it looked at one male and one female in pairs. The researchers recruited participants, and then formed 49 matched pairs who were similar based on mechanism of injury, time from injury to assessment, and age at assessment. Adamson suggested the study could have long-term implications for susceptibility to dementia if these women could be followed for a number of years.

These findings suggest more research is needed to examine how TBI affects women and men. Such research provides an opportunity to test whether presumed gender differences based on biology are borne out by empirical findings. Continued research may help to realize the possibility that therapy will be tailored to each individual’s unique situation.

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In this lesson we review the six major changes in the TBICoE's revised 2021 Progressive Return to Activity (PRA) Clinical Recommendation that differ from the original recommendation. The changes reflect the latest TBI research, and will make it easier for providers to manage the recovery process and return service members with concussion to full duty as quickly and safely as possible. Each video in the PRA training series is designed to support primary care providers' ability to manage concussion/traumatic brain injury (TBI).

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