Research

OVERVIEW

The Defense and Veterans Brain Injury Center (DVBIC) conducts and collaborates with many organizations to advance research on traumatic brain injury (TBI), including the Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), TBI Model Systems, and others. A major focus of the DVBIC clinical research program is to evaluate the quality, timeliness, and cost-effectiveness of treatment delivered to military personnel and veterans.

DVBIC conducts research on a range of other topics related to TBI, including studies on safety and prevention of TBI. There are a number of studies examining how diagnosis of TBI, particularly concussion/mild TBI (mTBI), can be improved by using new imaging modalities and new screening instruments. DVBIC has developed a number of ongoing research studies to better understand the effects of blast exposure on the brain from a neurobiological perspective.

Finally, DVBIC has a number of ongoing research studies examining many aspects of outcome following TBI, including return to work or duty and long term needs. As a result of the unique system of TBI centers developed by DVBIC, there is a potential for both single and multi-center TBI studies, examining different issues specific to TBI in both active duty military and veteran groups.

CLINICAL RESEARCH GOALS AND OBJECTIVES:

• Investigate the usefulness of a variety of medications, supplements, and treatment interventions in treating the effects of TBI.
• Evaluate the usefulness and costs of rehabilitation strategies after TBI.
• Conduct research across the entire range of severity levels from mild to moderate to severe TBI in the military and veteran populations. These studies focus on all phases of TBI, from acute care and evaluation to treatment studies, with a major goal of DVBIC research to assist with the development of evidence based guidelines to help improve return to community, work and/duty recommendations for the wounded warriors.
• Develop and conduct survey studies to answer questions regarding the incidence of TBI, as well as unmet medical needs of TBI survivors; a battlefield survey will be established to monitor the incidence and type of brain injuries experienced during war-time operations.
• Conduct imaging studies utilizing new technology for physiological/biological information including: Diffusion Tensor Imaging (DTI); functional Magnetic Resonance Imaging (fMRI); Magnetoencephalography (MEG); and Positron emission tomography (PET).

SECTIONS WITHIN THE DIVISION OF RESEARCH

Clinical Trials

The Section of Clinical Trials develops develops clinical research protocols using randomized control trial (RCT) design and strategies for the investigation of treatment of military-related TBI. This section has performed a number of high profile RCTs leading to Class I evidence. Of particular note was the first RCT performed in rehabilitation medicine published in JAMA (Salazar et al. 2001). The Section of Clinical Trials is currently in the process of developing a RCT examining the effectiveness of methylphenidate therapy in improving outcome following moderate to severe TBI.

Epidemiology and Statistics

The Section of Epidemiology and Statistics develops and analyzes survey-based data related to the military occurrence of TBI. The activities of the section and of the satellite program at Fort Bragg and Fort Carson, together with the DVBIC network of 19 sites, provide the field epidemiology basis of DVBIC and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE). The goal of the section is to ensure that all military and Department of Veterans Affairs (VA) patients with TBI receive TBI-specific screening, treatment and follow-up, while at the same time collecting standardized patient outcome data.

Translational Research and Neuroimaging

The Section of Translational Research and Neuroimaging develops clinical research protocols  using current imaging (Nuclear magnetic resonance [NMR] spectroscopy, PET, MEG), genetic, bio-informatic and computational biology strategies for the investigation of military-related TBI.

The goal of this section is to answer questions related to and contributing to force health and readiness in terms of mitigation and treatment of TBI. Eleven studies are currently in process ranging from helmet-mounted sensors and blast-related TBI, to those involving PET, Proteomics, gene expression, as well as neuroanatomical and functional abnormalities.

Together, these programs allow the key translation of information and linking of pre-clinical research to strategies for the mitigation, acute treatment and rehabilitation of combat-related TBI, as well as other causes of TBI (e.g. motor vehicle-related TBI).