Thousands of veterans return home from duty with scars invisible to the naked eye: traumatic brain injury (TBI). Linked to depression, substance abuse and PTSD, and manifesting as memory loss, headaches, dizziness, and confusion, TBI has been called a signature wound of modern warfare.
mTBI: Finding the needle in a haystack.
Nearly two decades since the attacks on 9/11 and TBI remains astonishingly difficult to diagnose. The challenge isn’t diagnosing severe cases like penetrating injuries to the head. Rather, it’s in the subtler ways blows or indirect injuries to the head or face can often go unnoticed. We call these mild TBI, or “mTBI.”
For years, the medical community has gone along with this broader umbrella term because we lacked the tools to quantify the physiological distinctions. Until now. Today, new, more powerful MRIs, coupled with advanced digital-image processing, give us access to nuances that before were impossible to identify. These improved glimpses into brain function are helping doctors to see the finer distinctions between injuries, which in turn are helping to give patients better, more targeted treatments. And that means better outcomes.
A key player in this new research is the Defense Health Agency’s Traumatic Brain Injury Center of Excellence (TBICoE), also known as the Defense and Veterans Brain Injury Center (DVBIC). The TBICoE brings the expertise of nearly 150 neuroscientists, clinical researchers, educators and healthcare providers across a network of 14 military hospitals and two VA medical centers nationwide. Their efforts, along with the collaboration of traumatic brain injury experts at both public and private centers, are helping to cast new light on what we thought we knew about mTBI. Through a vast portfolio of research studies, multiple national presentations and the publication of numerous peer-reviewed research articles, TBICoE is constantly improving the body of science known about mTBI.
One such major advancement is diffusion tensor imaging. By measuring the diffusion of water throughout the brain, doctors are able to see the white matter tracts in greater detail that electrical signals use to travel from one part of the brain to another. By comparing the brains of mTBI sufferers to control groups, we hope to develop standardized measures for determining the extent of a patient’s injuries—along with treatment courses and likely outcomes.
Just like common blood tests, we now foresee one day having a panel of standard neuroimaging tests that can quickly classify brain injuries and indicate the best way to treat them. While there’s still work to be done, for many, there’s a light at the end of the tunnel.
TBI research informs clinical recommendations
The implications go far beyond just the military and veteran communities. From brain damage suffered by professional athletes to head injuries in youth sports, public awareness of TBI is only growing. And our ongoing research and scientific evidence translated into clinical recommendations and education products for both health care providers and patients can help shape this understanding.
TBICoE is studying the effects of brain injuries on vision and hearing, as well as on cognitive rehabilitation. The data from these studies are enhancing our understanding of resilience and how to reduce the impact of these injuries. And in many cases, being added to the Federal Interagency Traumatic Brain Injury Research Repository: a national database and joint venture between the Department of Defense and National Institutes of Health that allows researchers from both the public and private sectors to build on the breakthroughs being made every day.
The importance of service members being ready for any operational environment and the effects of combat on warfighters is why TBICoE’s focus will always be on service members, their caregivers and veterans. Bombs and bullets notwithstanding, even the routine firing of one’s own weapon can come with powerful concussive force, also known as low-level blast exposure. And luckily, we’re beginning to better understand how violent energy affects the brain, and how the right training and treatment can help patients improve.
It’s been a long journey, but for both TBI research and its sufferers’ long-term prognoses, the future is looking bright.