ATLAS: The Impact of Concussions During Military Service

Introduction

Mild traumatic brain injury (mTBI; also known as a concussion) is common among military personnel and can occur due to various causes, such as during missions or deployments, sports activities, or off-duty incidents like traffic accidents. MTBI presents a significant challenge in the military due to its complexity and the risk of long-term symptoms.

The ATLAS study examines mTBI obtained during military service. The study will investigate clinical advice, management practices, and underlying factors that influence mTBI outcomes in the Dutch military. By combining qualitative and quantitative methods, this study aims to have immediate clinical implications while contributing to a broader understanding of mTBI mechanisms.

Study overview

Objective:

ATLAS consists of five sub-studies
1.    Study A: Insight into clinical advice after a concussion, treatment adherence, and protective and/or hindering factors for treatment adherence in the Dutch armed forces. This study is the first in the Netherlands to examine how military personnel experience and follow clinical advice, as well as the barriers and facilitating factors for adherence to recommendations.
2.    Study B: Clinical management of concussion from the perspective of healthcare providers. This qualitative study investigates the consistency of care for concussions within the Dutch armed forces, adherence to guidelines, and barriers, with the aim of improving care.
3.    Study C.1: Relationship between stressful childhood experiences and post-concussion symptoms. This study examines whether stressful childhood experiences influence the severity of post-concussion symptoms in adulthood within the Dutch armed forces.
4.    Study C.2: “Criticality” and EEG patterns in relation to post-concussion symptoms. According to the "criticality" theory, the brain functions best at the boundary between stability and instability. In a stable state, brain signals are not transmitted effectively, whereas in an unstable state, brain signals are transmitted excessively. The precise boundary between stability and instability is referred to as the "critical state." This study investigates whether deviations from the "critical state" in EEG can serve as an objective marker of brain functionality and recovery after a concussion.
5.    Study D: Validation of a short questionnaire for assessing concussions as an alternative to a longer clinical interview.

Target group: 

Dutch (active and non-active) military personnel and veterans who have sustained at least one concussion during their service, regardless of the cause. 

Timeline: 

The study began in May 2025, with an expected duration of three years.

Results: 

The study results are expected by the end of 2028.