A researcher monitors a soldier as he uses a multi-display driving simulator. The simulator is used in a variety of research applications, to include mild TBI treatment. (U.S. Army photo by Doug LaFon)

The brain is one of the most studied yet least understood parts of the human anatomy, and in many ways, still very much a mystery. That makes understanding traumatic brain injury (TBI) and its effects even more challenging for researchers. And there’s great need for knowledge. Since 2000, more than 300,000 service members have sustained a traumatic brain injury, according to the Defense Department. More than 80 percent occur in a non-deployed environment.

Defense and Veterans Brain Injury Center (DVBIC) supports research along the entire continuum of care, from point of injury to return to duty or reintegration into the community. Investigators hope to unlock some of the mysteries of TBI and expand understanding on all fronts — prevention, diagnosis, treatment and outcomes.

“DVBIC has been conducting high impact research for over two decades, and continues to be at the frontier of new TBI knowledge to improve the care and recovery of service members and veterans with TBI,” said Dr. Felicia Qashu, DVBIC deputy director of research. “It is important for us to stay informed of promising lines of research, so that we can best leverage our position and partnerships within the Defense Department and Department of Veterans Affairs to make sure that medical providers are equipped with clinical and training tools that are based on the most recent available research.”

Here’s a brief look at some innovative ways DVBIC is learning about TBI:

Head to Head
This study compares four computer-based cognitive tests to identify service members who are at risk for brain injury-related problems. The tests measure memory, attention, reaction time and other cognitive skills. They’re usually given to athletes after they’ve had a head injury. The results of this study will help determine which test is best suited for assessing service members who sustain a TBI in the military environment.

Dr. Wesley Cole, DVBIC senior scientific director at Womack Army Medical Center, Fort Bragg, provides support to the Head to Head study.

“Since 2010, I have been involved in research of computerized cognitive assessment tools to potentially use to identify service members at risk for concussion related problems. This research has been exciting to be involved in as it will directly relate to the way we take care of our service members who have sustained concussions,” said Cole. “As a neuropsychologist, my primary interests are in assessment of cognitive functioning, so this line of research ties in perfectly with my clinical interests. It has also been encouraging to see the level of commitment service members have to volunteering for studies in order to help improve the medical care of future service members.”

SCORE
The “Study of Cognitive Rehabilitation Effectiveness” (SCORE) evaluates exercises or therapies to treat memory and attention problems for service members with a history of mild TBI. The study will determine which therapies are most effective and which are associated with better treatment outcomes. The goal of the study is to see if cognitive rehabilitation therapy improves chronic mild TBI symptoms and, if so, which interventions work best, on whom and why.

Dr. Doug Cooper, DVBIC research director in the Department of Neurology at San Antonio Military Medical Center, works on the SCORE study.

“Having worked with service members for many years as a clinician, I feel a personal obligation to serve those who serve our country,” said Cooper. “In my opinion, the SCORE trial has the potential to serve many service members and veterans by determining the most effective treatments for their deployment-related symptoms and creating standardized treatment approaches that can be implemented throughout the [departments of Defense and Veterans Affairs] health care systems.”

iSCORE
The “Imaging Support of Study of Cognitive Rehabilitation Effectiveness” (iSCORE) study collects data from brain scans of SCORE participants. Images of the brain can identify anatomical and functional changes over time associated with treatment. iSCORE will compare brain images with behavioral measures during and following treatment for mild TBI. Researchers expect iSCORE will enhance understanding of mild TBI on a neurobiological level and help predict treatment outcomes.

15 Year Longitudinal Studies
These studies are an integrated collection of research studies that examine the effects of TBI on service members and veterans who served in Iraq and Afghanistan. It also looks at the impact of injury on their families.

• The Natural History Study examines long-term physical and mental health effects of TBI. The study documents natural recovery from TBI for up to 15 years after the injury. It identifies long-term health care, mental health care and rehabilitation needs of study participants.
• The Caregiver Study observes the overall health and well-being of family members caring for a service member with TBI. The goal is to identify factors that can improve caregivers’ quality of life.

“For caregivers, deployment places a strain on the family,” said Dr. Louis French, principal investigator of the 15 Year Longitudinal Study. “The ‘Caregiver Study’ portion of the 15 Year Study will allow us to gain a better understanding of how much additional burden is placed on the family dynamic with an injured loved one: for example, does the family need more medical care themselves or are they in emotional distress? This study will provide valuable input about the need for additional resources, inefficient allocation of resources, or other key information from this under-examined group.”

Visit the DVBIC website for more information on TBI research, including current studies and publications. A contact person is listed for each study if individuals would like to find out more about participating in one of the studies.