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July 31, 2018
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Tens of thousands of veterans returned from the Afghanistan and Iraq wars with a real yet invisible scar from traumatic brain injury. TBI has been called a signature wound of these wars. It manifests in headaches, dizziness, memory inefficiencies and confusion and has been linked to depression, substance abuse and posttraumatic stress disorder.

Nearly two decades after 9/11, TBI remains astonishingly difficult to diagnose conclusively. The challenge is not with the most severe cases – those characterized by blows that leave individuals unconscious for 30 minutes or more.

Rather, the challenge is in the wide range of more subtle injuries falling in the broad category we call “Mild TBI.”

The medical community accepted this broad definition largely because we lacked a scientific way to quantify the physiological distinctions between different levels of mTBI.

That is no longer the case.

New, more powerful magnetic resonance imaging systems, coupled with advanced digital image processing, now allow us to see nuances never before possible with conventional MRIs. These clearer images of brain function are helping us recognize finer distinctions between injuries. These, in turn, will lead to better, more targeted treatment plans for patients and, eventually, improved outcomes.

The Defense and Veterans Brain Injury Center, funded by Congress since 1992 and representing a joint effort between the Department of Defense and the Department of Veterans Affairs, is playing a critical role in this research. DVBIC brings to bear the expertise of some 500 professional staff members at 17 military hospitals and five VA medical centers nationwide to develop a better understanding of brain injuries and treatment in the nation’s military and veteran populations. In coordination with experts at other public and private research centers, DVBIC is helping to open up a whole new area of understanding about mTBI.

One key technical advance that makes this possible is diffusion tensor imaging, a technique that measures the diffusion of water through brain tissue. This technique enables doctors to see in refined detail the integrity of white matter tracks through which signals travel from one part of the brain to another.

By comparing scans of those suffering mTBI with scans of individuals in control groups (people of similar age and gender without mTBI), we hope to develop standardized measures for determining the extent of injuries along with likely outcomes and courses of treatment.

We can now imagine someday having a panel of standard neuroimaging tests that could work like a blood test panel to classify brain injuries and indicate courses of treatment.

While much work remains to standardize methodologies and further enhance post-processing of diffusion tensor imaging data to enhance visualizations, the essential groundwork has been laid. We can see the path forward.

This has implications far beyond the military and veteran community. Public awareness about brain injuries has never been greater, fueled by growing reports of long-term damage suffered by professional athletes and the risks of head injuries in youth sports. Our research contributes scientific evidence to shape this public understanding.

Our focus at DVBIC however, is always ultimately on service members and veterans. We are studying the effects of brain injuries on vision, hearing and emotional disturbances and enhancing our understanding of resilience and other factors and treatments that can reduce some of the harmful effects of injury. Data from many of these studies are being placed in the Federal Interagency Traumatic Brain Injury Research Repository, a national database of brain injury information, representing a joint venture between the NIH and DoD, that allows researchers from other agencies and the civilian sector to build on what we are learning every day.

Combat inflicts great stresses on our warfighters. Aside from bombs and bullets, even firing one’s own weapons can pack powerful concussive forces. Through DVBIC, we are gaining a deeper and more nuanced understanding of how that violent energy affects the brain – and how to manage those effects through training and appropriate treatment, improving the long-term prognosis for many service members and veterans.

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Jan E. Kennedy is the senior principal scientist for DVBIC at Brooke Army Medical Center. A PhD neuropsychologist, she is employed by General Dynamics Information Technology, which manages the DVBIC program for its two funding departments, the Department of Defense and the Department of Veterans Affairs. The comments above are her personal opinion and do not reflect the official position of the Defense and Veterans Brain Injury Center, the Defense Health Agency or the Department of Defense.