CoChat
Sign Up
Cited by 53Traumatic Brain Injury ResearchOccupational Health and PerformanceAutomotive and Human Injury Biomechanics

Potential Health and Performance Effects of High-Level and Low-Level Blast: A Scoping Review of Two Decades of Research

Open access
Belding, Jennifer N., Englert, Robyn M., Fitzmaurice, Shannon, Jackson, Jourdan R., Koenig, Hannah G., Hunter, Michael A., Thomsen, Cynthia J., da Silva, Uade Olaghere·2021·Frontiers in Neurology
DOI 10.3389/fneur.2021.628782PMC PMC7987950
Open this paper in CoChat — free accountOpen PDF

Abstract

Although blast exposure has been recognized as a significant source of morbidity and mortality in military populations, our understanding of the effects of blast exposure, particularly low-level blast (LLB) exposure, on health outcomes remains limited. This scoping review provides a comprehensive, accessible review of the peer-reviewed literature that has been published on blast exposure over the past two decades, with specific emphasis on LLB. We conducted a comprehensive scoping review of the scientific literature published between January 2000 and 2019 pertaining to the effects of blast injury and/or exposure on human and animal health. A three-level review process with specific inclusion and exclusion criteria was used. A full-text review of all articles pertaining to LLB exposure was conducted and relevant study characteristics were extracted. The research team identified 3,215 blast-relevant articles, approximately half of which (55.4%) studied live humans, 16% studied animals, and the remainder were non-subjects research (e.g., literature reviews). Nearly all (99.49%) of the included studies were conducted by experts in medicine or epidemiology; approximately half of these articles were categorized into more than one medical specialty. Among the 51 articles identified as pertaining to LLB specifically, 45.1% were conducted on animals and 39.2% focused on human subjects. Animal studies of LLB predominately used shock tubes to induce various blast exposures in rats, assessed a variety of outcomes, and clearly demonstrated that LLB exposure is associated with brain injury. In contrast, the majority of LLB studies on humans were conducted among military and law enforcement personnel in training environments and had remarkable variability in the exposures and outcomes assessed. While findings suggest that there is the potential for LLB to harm human populations, findings are mixed and more research is needed. Although it is clear that more research is needed on this rapidly growing topic, this review highlights the detrimental effects of LLB on the health of both animals and humans. Future research would benefit from multidisciplinary collaboration, larger sample sizes, and standardization of terminology, exposures, and outcomes.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.3389/fneur.2021.628782

Cites

2 of 2 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • If there is cumulative brain damage from repetitive, sub-concussive, low-level blast exposures, it was not apparent on the study's cognitive testing.

    “If there is cumulative brain damage from repetitive, sub-concussive, low-level blast exposures as evidence from other evaluation techniques suggests (Belding et al., 2021; Goldstein et al., 2012; Stone et al., 2020; Tate et al., 2013), it was not apparent on our cognitive testing.”

    From Can mild traumatic brain injury alter cognition chronically? A LIMBIC-CENC multicenter study. (2023) · cites this paper as Belding et al., 2021

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 85

  1. [1]Owens BD Kragh JF Wenke JC Macaitis J Wade CE Holcomb JB. Combat wounds in operation Iraqi freedom and operation enduring freedom. J Trauma. (2008) 64: 295– 9. 10.1097/TA.0b013e318163b875 18301189 · DOI
  2. [2]Magnuson J Leonessa F Ling GSF. Neuropathology of explosive blast traumatic brain injury. Curr Neurol Neurosci R. (2012) 12: 570– 9. 10.1007/s11910-012-0303-6 22836523 · DOI
  3. [3]Hoge CW McGurk D Thomas JL Cox AL Engel CC Castro CA. Mild traumatic brain injury in U.S. soldiers returning from Iraq. N Engl J Med. (2008) 358: 453– 63. 10.1056/NEJMoa072972 18234750 · DOI · Paper page
  4. [4]Clark ME Walker RL Gironda RJ Scholten JD. Comparison of pain and emotional symptoms in soldiers with polytrauma: unique aspects of blast exposure. Pain Med. (2009) 10: 447– 55. 10.1111/j.1526-4637.2009.00590.x 19416436 · DOI
  5. [6]Rosenfeld JV McFarlane AC Bragge P Armonda RA Grimes JB Ling GS. Blast-related traumatic brain injury. Lancet Neurol. (2013) 12: 882– 93. 10.1016/S1474-4422(13)70161-3 23884075 · DOI
  6. [7]Kluger Y Nimrod A Biderman P Mayo A Sorkin P. The quinary pattern of blast injury. J Emergency Manage. (2006) 4: 51– 5. 10.5055/jem.2006.0009 18268871 · DOI
  7. [8]Wolf SJ Bebarta VS Bonnett CJ Pons PT Cantrill SV. Blast injuries. Lancet. (2009) 374: 405– 15. 10.1016/S0140-6736(09)60257-9 19631372 · DOI
  8. [9]Cernak I Noble-Haeusslein LJ. Traumatic brain injury: an overview of pathobiology with emphasis on military populations. J Cereb Blood Flow Metab. (2009) 30: 255– 66. 10.1038/jcbfm.2009.203 19809467 PMC2855235 · DOI
  9. [10]Clifford CB Moe JB Jaeger JJ Hess JL. Gastrointestinal lesions in lambs due to multiple low-level blast overpressure exposure. Mil Med. (1984) 149: 491– 5. 10.1093/milmed/149.9.491 6435013 · DOI
  10. [11]Tate CM Wang KKW Eonta SE Zhang Y Carr W Tortella FC. Serum brain biomarker level, neurocognitive performance, and self-reported symptom changes in soldiers repeatedly exposed to low-level blast: a breacher pilot study. J Neurotrauma. (2013) 30: 1620– 30. 10.1089/neu.2012.2683 23687938 · DOI
  11. [12]Ling G Bandak F Armonda R Grant G Ecklund J. Explosive blast neurotrauma. J Neurotrauma. (2009) 26: 815– 25. 10.1089/neu.2007.0484 19397423 · DOI
  12. [13]Cernak I Stein DG Elder GA Ahlers S Curley K DePalma RG. Preclinical modelling of militarily relevant traumatic brain injuries: challenges and recommendations for future directions. Brain Injury. (2017) 31: 1168– 76. 10.1080/02699052.2016.1274779 28981339 PMC9351990 · DOI
  13. [14]Nakagawa A Manley GT Gean AD Ohtani K Armonda R Tsukamoto A. Mechanisms of primary blast-induced traumatic brain injury: Insights from shock-wave research. J Neurotrauma. (2011) 28: 1101– 19. 10.1089/neu.2010.1442 21332411 · DOI
  14. [15]Bull AMJ Clasper J Mahoney PF. Blast Injury Science and Engineering. A Guide for Clinicians and Researchers. Cham: Springer. (2016). 10.1007/978-3-319-21867-0 · DOI
  15. [17]Wiri S Ritter AC Bailie JM Needham C Duckworth JL. Computational modeling of blast exposure associated with recoilless weapons combat training. Shock Waves. (2017) 27: 849– 62. 10.1007/s00193-017-0755-3 · DOI
  16. [18]Bass CR Panzer MB Rafaels KA Wood G Shridharani J. Brain injuries from blast. Ann Biomed Eng. (2012) 40: 185– 202. 10.1007/s10439-011-0424-0 22012085 · DOI
  17. [19]Chalioulias K Sim KT Scott R. Retinal sequelae of primary ocular blast injuries. J R Army Med Corps. (2007) 153: 124. 10.1136/jramc-153-02-11 17896543 · DOI
  18. [20]Morley MG Nguyen JK Heier JS Shingleton BJ Pasternak JF Bower KS. Blast eye injuries: a review for first responders. Disaster Med Public Health Prep. (2010) 4: 154– 60. 10.1001/dmp.v4n2.hra10003 20526138 · DOI
  19. [22]Arksey H O'Malley L. Scoping studies: towards a methodological framework. Int J Soc Res Methodol. (2005) 8: 19– 32. 10.1080/1364557032000119616 · DOI · Paper page
  20. [23]Tricco AC Cogo E Ashoor H Perrier L McKibbon KA Grimshaw JM. Sustainability of knowledge translation interventions in healthcare decision-making: protocol for a scoping review. BMJ Open. (2013) 3: e002970. 10.1136/bmjopen-2013-002970 23674448 PMC3657660 · DOI · Paper page
  21. [24]Cohen J. A coefficient of agreements for nominal scales. Educ Psychol Meas. (1960) 20: 37– 46. 10.1177/001316446002000104 · DOI · Paper page
  22. [25]Landis JR Koch GG. An application of hierachical kappa type statistics in the assessment of majority agreement among multiple observers. Biometrics. (1977) 33: 363– 74. 10.2307/2529786 884196 · DOI · Paper page
  23. [26]Baker AJ Topolovec-Vranic J Michalak A Pollmann-Mudryj M-A Ouchterlony D Cheung B. Controlled blast exposure during forced explosive entry training and mild traumatic brain injury. J Trauma. (2011) 71: S472– 7. 10.1097/TA.0b013e318232e7da 22072006 · DOI
  24. [27]Blennow K Jonsson M Andreasen N Rosengren L Wallin A Hellström PA. No neurochemical evidence of brain injury after blast overpressure by repeated explosions or firing heavy weapons. Acta Neurol Scand. (2011) 123: 245– 51. 10.1111/j.1600-0404.2010.01408.x 20637009 · DOI
  25. [28]Bonnette S Diekfuss JA Kiefer AW Riley MA Barber Foss KD Thomas S. A jugular vein compression collar prevents alterations of endogenous electrocortical dynamics following blast exposure during special weapons and tactical (SWAT) breacher training. Exp Brain Res. (2018) 236: 2691– 701. 10.1007/s00221-018-5328-x 29987537 · DOI
  26. [29]Capo-Aponte JE Jurek GM Walsh DV Temme LA Ahroon WA Riggs DW. Effects of repetitive low-level blast exposure on visual system and ocular structures. J Rehabil Res Dev. (2015) 52: 273– 90. 10.1682/JRRD.2014.09.0204 26237153 · DOI
  27. [30]Carr W Polejaeva E Grome A Crandall B LaValle C Eonta SE. Relation of repeated low-level blast exposure with symptomology similar to concussion. J Head Trauma Rehabil. (2015) 30: 47– 55. 10.1097/HTR.0000000000000064 24901327 · DOI
  28. [31]Carr W Stone JR Walilko T Young LA Snook TL Paggi ME. Repeated low-level blast exposure: a descriptive human subjects study. Mil Med. (2016) 181: 28– 39. 10.7205/MILMED-D-15-00137 27168550 · DOI
  29. [32]Carr W Yarnell AM Ong R Walilko T Kamimori GH da Silva U. Ubiquitin carboxy-terminal hydrolase-L1 as a serum neurotrauma biomarker for exposure to occupational low-level blast. Front Neurol. (2015) 6: 49. 10.3389/fneur.2015.00049 25852633 PMC4360700 · DOI
  30. [33]Gill J Cashion A Osier N Arcurio L Motamedi V Dell KC. Moderate blast exposure alters gene expression and levels of amyloid precursor protein. Neurol Genet. (2017) 3: e186. 10.1212/NXG.0000000000000186 28975156 PMC5618107 · DOI
  31. [34]Gill J Motamedi V Osier N Dell K Arcurio L Carr W. Moderate blast exposure results in increased IL-6 and TNFα in peripheral blood. Brain Behav Immun. (2017) 65: 90– 4. 10.1016/j.bbi.2017.02.015 28232173 PMC5537025 · DOI
  32. [35]Kamimori GH LaValle CR Eonta SE Carr W Tate C Wang KKW. Longitudinal investigation of neurotrauma serum biomarkers, behavioral characterization, and brain imaging in soldiers following repeated low-level blast exposure (New Zealand Breacher Study). Mil Med. (2018) 183: 28– 33. 10.1093/milmed/usx186 29635591 · DOI
  33. [36]Kamimori GH Reilly LA LaValle CR Olaghere Da Silva UB. Occupational overpressure exposure of breachers and military personnel. Shock Waves. (2017) 27: 837– 47. 10.1007/s00193-017-0738-4 · DOI
  34. [37]Kubli LR Pinto RL Burrows HL Littlefield PD Brungart DS. The effects of repeated low-level blast exposure on hearing in marines. Noise Health. (2017) 19: 227– 38. 10.4103/nah.NAH_58_16 28937017 PMC5644382 · DOI
  35. [38]Kulik A Malinowska-Borowska J. Exposure to impulse noise at an explosives company: a case study. Int J Occup Saf Ergon. (2018) 24: 366– 72. 10.1080/10803548.2017.1420583 29353537 · DOI
  36. [39]Littlefield PD Pinto RL Burrows HL Brungart DS. The vestibular effects. J Neurotrauma. (2016) 33: 71– 81. 10.1089/neu.2014.3824 25790248 · DOI
  37. [40]McBride DI Williams S. Air blast circuit breaker noise and hearing loss: a multifactorial model for risk assessment. Occup Med. (2000) 50: 173– 81. 10.1093/occmed/50.3.173 10912360 · DOI
  38. [41]McBride DI Williams S. Audiometric notch as a sign of noise induced hearing loss. Occup Environ Med. (2001) 58: 46– 51. 10.1136/oem.58.1.46 11119634 PMC1740031 · DOI
  39. [42]Rhea CK Kuznetsov NA Ross SE Long B Jakiela JT. Development of a portable tool for screening neuromotor sequelae from repetitive low-level blast exposure. Mil Med. (2017) 182: 147– 54. 10.7205/MILMED-D-16-00140 28291466 · DOI
  40. [43]St Onge P McIlwain DS Hill ME Walilko TJ Bardolf LB. Marine corps breacher training study: auditory and vestibular findings. US Army Med Dep J. (2011) 97– 107. 21805461
  41. [44]Yuan W Foss KDB Dudley J Thomas S Galloway R DiCesare C. Impact of low-level blast exposure on brain function after a one-day tacticle training and the ameliorating effect of a jugular vein compression neck collar device. J Neurotrauma. (2019) 36: 721– 34. 10.1089/neu.2018.5737 30136637 · DOI
  42. [45]Ahlers S Vasserman-Stokes E Shaughness M Hall A Shear D Chavko M. Assessment of the effects of acute and repeated exposure to blast overpressure in rodents: toward a greater understanding of blast and the potential ramification for injury in humans exposed to blast. Front Neurol. (2012) 3: 32. 10.3389/fneur.2012.00032 22403572 PMC3293241 · DOI
  43. [46]Ahmed F Plantman S Cernak I Agoston DV. The temporal patttern of changes in serum biomarker levels reveals complex and dynamically changing pathologies after exposure to a single low-intensity blast in mice. Front Neurol. (2015) 6: 114. 10.3389/fneur.2015.00114 26124743 PMC4464198 · DOI
  44. [47]Chen T Smith K Jiang S Zhang T Gan RZ. Progressive hearing damage after exposure to repeated low-intensity blasts in chinchillas. Hearing Res. (2019) 378: 33– 42. 10.1016/j.heares.2019.01.010 30686544 · DOI
  45. [48]Choi JH Greene WA Johnson AJ Chavko M Cleland JM McCarron RM. Pathophysiology of blast-induced ocular trauma in rats after repeated exposure to low-level blast overpressure. Clin Exp Ophthalmol. (2015) 43: 239– 46. 10.1111/ceo.12407 25112787 · DOI
  46. [49]Elsayed NM Gorbunov NV. Pulmonary biochemical and histological alterations after repeated low-level blast overpressure. Toxicol Sci. (2006) 95: 289– 96. 10.1093/toxsci/kfl138 17060374 · DOI
  47. [50]Hall AA Mendoza MI Zhou H Shaughness M McCarron RM Ahlers ST. Repeated low intensity blast exposure is associated with damaged endothelial glycocalyx and downstream behavioral deficits. Front Behav Neurosci. (2017) 11: 104. 10.3389/fnbeh.2017.00104 28649193 PMC5465256 · DOI
  48. [51]Li Y Yang Z Liu B Valdez C Chavko M Cancio LC. Low-level primary blast induces neuroinflammation and neurodegeneration in rats. Mil Med. (2019) 184: 265– 72. 10.1093/milmed/usy330 30901455 · DOI
  49. [52]Lien S Dickman JD. Vestibular injury after low-intensity blast exposure. Front Neurol. (2018) 9: 297. 10.3389/fneur.2018.00297 29867715 PMC5960675 · DOI
  50. [53]Park E Eisen R Kinio A Baker AJ. Electrophysiological white matter dysfunction and association with neurobehavioral deficits following low-level primary blast trauma. Neurobiol Dis. (2013) 52: 150– 9. 10.1016/j.nbd.2012.12.002 23238347 · DOI
  51. [54]Perez-Garcia G Gama Sosa MA De Gasperi R Lashof-Sullivan M Maudlin-Jeronimo E Stone JR. Exposure to a predator scent induces chronic behavioral changes in rats previously exposed to low-level blast: implications for the relationship of blast-related TBI to PTSD. Front Neurol. (2016) 7: 176. 10.3389/fneur.2016.00176 27803688 PMC5067529 · DOI
  52. [55]Perez-Garcia G Gama Sosa MA De Gasperi R Lashof-Sullivan M Maudlin-Jeronimo E Stone JR. Chronic post-traumatic stress disorder-related traits in a rat model of low-level blast exposure. Behav Brain Res. (2018) 340: 117– 25. 10.1016/j.bbr.2016.09.061 27693852 PMC11181290 · DOI
  53. [56]Por ED Choi J-H Lund BJ. Low-level blast exposure increases transient receptor potential vanilloid 1 (TRPV1) expression in the rat cornea. Curr Eye Res. (2016) 41: 1294– 301. 10.3109/02713683.2015.1122812 27049881 PMC5351794 · DOI
  54. [57]Pun P Kan EM Salim A Li ZH Ng KC Moochhala S. Low level primary blast injury in rodent brain. Front Neurol. (2011) 2: 19. 10.3389/fneur.2011.00019 21541261 PMC3083909 · DOI
  55. [58]Saljo A Arrhen F Bolouri H Mayorga M Hamberger A. Neuropathology and pressure in the pig brain resulting from low-impulse noise exposure. J Neurotrauma. (2008) 25: 1397– 406. 10.1089/neu.2008.0602 19146459 · DOI
  56. [59]Säljö A Bao F Hamberger A Haglid KG Hansson H-A. Exposure to short-lasting impulse noise causes microglial and astroglial cell activation in the adult rat brain. Pathophysiology. (2001) 8: 105– 11. 10.1016/S0928-4680(01)00067-0 11720806 · DOI
  57. [60]Saljo A Bolouri H Mayorga M Svensson B Hamberger A. Low-level blast raises intracranial pressure and impairs cognitive function in rats: propylaxis with processed cereal feed. J Neurotrauma. (2010) 27: 383– 9. 10.1089/neu.2009.1053 19852583 · DOI
  58. [61]Gama Sosa MA De Gasperi R Perez Garcia GS Perez GM Searcy C Vargas D. Low-level blast exposure disrupts gliovascular and neurovascular connections and induces a chronic vascular pathology in rat brain. Acta Neuropathol Commun. (2019) 7: 6. 10.1186/s40478-018-0647-5 30626447 PMC6327415 · DOI
  59. [62]Gama Sosa MA De Gasperi R Perez Garcia GS Sosa H Searcy C Vargas D. Lack of chronic neuroinflammation in the absence of focal hemorrhage in a rat model of low-energy blast-induced TBI. Acta Neuropathol Commun. (2017) 5: 80. 10.1186/s40478-017-0483-z 29126430 PMC6389215 · DOI
  60. [63]Song H Chen M Chen C Cui J Johnson CE Cheng J. Proteomic analysis and biochemical correlates of mitochondrial dysfunction after low-intensity primary blast exposure. J Neurotrauma. (2019) 36: 1591– 605. 10.1089/neu.2018.6114 30484371 PMC6909772 · DOI
  61. [64]Song H Konan LM Cui J Johnson CE Langenderfer M Grant D. Ultrastructural brain abnormalities and associated behavioral changes in mice after low-intensity blast exposure. Behav Brain Res. (2018) 347: 148– 57. 10.1016/j.bbr.2018.03.007 29526786 · DOI
  62. [65]VandeVord PJ Bolander R Sajja VSSS Hay K Bir CA. Mild neurotrauma indicates a range-specific pressure response to low level shock wave exposure. Ann Biomed Eng. (2012) 40: 227– 36. 10.1007/s10439-011-0420-4 21994066 · DOI
  63. [66]Zuckerman A Ram O Ifergane G Matar MA Sagi R Ostfeld I. Controlled low-pressure blast-wave exposure causes distinct behavioral and morphological responses modelling mild traumatic brain injury, post-traumatic stress disorder, and comorbid mild traumatic brain injury–post-traumatic stress disorder. J Neurotrauma. (2017) 34: 145– 64. 10.1089/neu.2015.4310 26885687 · DOI
  64. [67]Carr W Dell KC Yanagi MA Hassan DM LoPresti ML. Perspectives on repeated low-level blast and the measurement of neurotrauma in humans as an occupational exposure risk. Shock Waves. (2017) 27: 829– 36. 10.1007/s00193-017-0766-0 · DOI
  65. [68]Conley YP Diaz-Arrastia R. Genomic links between blast exposure, brain injury, and Alzheimer disease. Neurol Genet. (2017) 3: e196. 10.1212/NXG.0000000000000196 29184914 PMC5640899 · DOI
  66. [69]Dams-O'Connor K Tsao JW. Functional decline 5 years after blast traumatic brain injury: sounding the alarm for a wave of disability? JAMA Neurol. (2017) 7: 763– 4. 10.1001/jamaneurol.2017.0176 28459965 PMC5645802 · DOI
  67. [70]Elder GA Stone JR Ahlers ST. Effects of low-level blast exposure on the nervous system: is there really a controversy? Front Neurol. (2014) 5: 269. 10.3389/fneur.2014.00269 25566175 PMC4271615 · DOI
  68. [71]Säljö A Mayorga M Bolouri H Svensson B Hamberger A. Mechanisms and pathophysiology of the low-level blast brain injury in animal models. Neuroimage. (2011) 54: S83– 8. 10.1016/j.neuroimage.2010.05.050 20580846 · DOI
  69. [72]Suttles ST. Potential of visual sensory screening, diagnostic evaluation, and training for treatment of postconcussive symptoms and performance enhancement for special forces qualified personnel. J Spec Oper Med. (2015) 15: 54– 63. 26125165
  70. [73]Weiner MW Friedl KE Pacifico A Chapman JC Jaffee MS Little DM. Military risk factors for Alzheimer's disease. Alzheimers Dement. (2013) 9: 445– 51. 10.1016/j.jalz.2013.03.005 23809365 PMC5904389 · DOI · Paper page
  71. [74]Galarneau MR Woodruff SI Dye JL Mohrle CR Wade AL. Traumatic brain injury during operation Iraqi freedom: findings from the United States Navy–marine corps combat trauma registry. J Neurosurg. (2008) 108: 950– 7. 10.3171/JNS/2008/108/5/0950 18447712 · DOI
  72. [75]Okie S. Traumatic brain injury in the war zone. N Engl J Med. (2005) 352: 2043– 7. 10.1056/NEJMp058102 15901856 · DOI
  73. [76]Warden D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil. (2006) 21: 398– 402. 10.1097/00001199-200609000-00004 16983225 · DOI
  74. [78]Pugh MJ Finley EP Wang C-P Copeland LA Jaramillo CA Swan AA. A retrospective cohort study of comorbidity trajectories associated with traumatic brain injury in veterans of the Iraq and Afghanistan wars. Brain Inj. (2016) 30: 1481– 90. 10.1080/02699052.2016.1219055 27834535 · DOI
  75. [79]Rogers JM Read CA. Psychiatric comorbidity following traumatic brain injury. Brain Inj. (2007) 21: 1321– 33. 10.1080/02699050701765700 18066935 · DOI
  76. [80]Bauman RA Ling G Tong L Januszkiewicz A Agoston D Delanerolle N. An introductory characterization of a combat-casualty-care relevant swine model of closed head injury resulting from exposure to explosive blast. J Neurotrauma. (2009) 26: 841– 60. 10.1089/neu.2008.0898 19215189 · DOI
  77. [81]Simmons MM Engel CC Hoch E Orr P Anderson B Azhar GS. Neurological Effects of Repeated Exposure to Military Occupational Levels of Blast: A Review of Scientific Literature (RR-2350-A). Santa Monica, CA: RAND Corporation. (2020). p. 64. 10.7249/RR2350 · DOI
  78. [82]Belanger HG Bowling F Yao EF. Low-level blast exposure in humans: a systematic review of acute and chronic effects. J Spec Oper Med. (2020) 20: 87– 93. 32203612
  79. [83]Koliatsos VE Cernak I Xu L Song Y Savonenko A Crain BJ. A mouse model of blast injury to brain: Initial pathological, neuropathological, and behavioral characterization. J Neuropathol Exp Neurol. (2011) 70: 399– 416. 10.1097/NEN.0b013e3182189f06 21487304 · DOI
  80. [84]Belding JN Fitzmaurice S Englert RM Koenig HG Thomsen CJ. Self-reported concussion symptomology during deployment: differences as a function of injury mechanism and low-level blast exposure. J Neurotrauma. (2020) 37: 2219– 26. 10.1089/neu.2020.6997 32368945 · DOI
  81. [85]Belding JN Fitzmaurice S Englert RM Lee I Kowitz B Highfill-McRoy RM. Blast exposure and risk of recurrent occupational overpressure exposure predict deployment TBIs. Mil Med. (2020) 185: e538– 44. 10.1093/milmed/usz289 31665414 · DOI
  82. [86]Eonta SE Kamimori GH Wang KKW Carr W LaValle CR Egnoto MJ. Case study of a breacher investigation of neurotrauma biomarker levels, self-reported symptoms, and functional MRI analysis before and after exposure to measured low-level blast. Mil Med. (2019) 185: e513– 7. 10.1093/milmed/usz185 31429467 · DOI
  83. [87]Sajja VSSS LaValle C Salib JE Misistia AC Ghebremedhin MY Ramos AN. The role of very low level blast overpressure in symptomatology. Front Neurol. (2019) 10: 891. 10.3389/fneur.2019.00891 31555194 PMC6722183 · DOI
  84. [88]Heyburn L Abutarboush R Goodrich S Urioste R Batuure A Statz J. Repeated low-level blast overpressure leads to endovascular disruption and alterations in TDP-43 and Piezo2 in a rat model of blast TBI. Front Neurol. (2019) 10: 766. 10.3389/fneur.2019.00766 31417481 PMC6682625 · DOI
  85. [90]Thiel KJ Dretsch MN Ahroon WA. The Effects of Low-Level Blasts on Neuropsychological Functioning (USAARL 2010-16). Fort Rucker, AL: U.S. Army Aeromedical Research Laboratory (2014). 10.21236/AD1005243 · DOI

Cited by

Sorted by citations

Authors
Belding, J. N., Englert, R. M., Fitzmaurice, S., Jackson, J. R., Koenig, H. G., Hunter, M. A., Thomsen, C. J., & da Silva, U. O.
Affiliations
Naval Health Research Center (US)
Corresponding author
Belding, Jennifer N.
ORCID
Venue
Frontiers in Neurology
Publisher
Frontiers Media SA
Published
2021-03-10
Volume
12
Pages
628782-628782
ISSN
1664-2295 (ISSN-L)
DOI
10.3389/fneur.2021.628782
PMC
PMC7987950
OpenAlex
W3135267821
Cited by
53
References
2
Citations by year
2026: 13 · 2025: 9 · 2024: 13 · 2023: 7 · 2022: 8 · 2021: 3
FWCI
1.19
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Neurology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
Bureau of Medicine and Surgery
Topics
  • Health Sciences › Medicine › Epidemiology › Traumatic Brain Injury Research
  • Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Performance
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Automotive and Human Injury Biomechanics
Keywords
blast injury, military personnel, law enforcement officers, brain injury, training environment, performance effects

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review