1. Determine the cumulative effects of multiple concussive or sub-concussive exposures or events, on acute and long-term physical, psychological, and cognitive outcomes.
2. Determine the prevalence of brain injuries within the military and identify environmental risk factors and variables in various settings (operations, weapons training, combatives, parachute training, etc.).
3. Determine the relationship(s) between adverse brain health outcomes resulting from brain injury and/or brain exposures (e.g. blast, blunt, accelerative, and directed energy) and potential co-occurring/influential individual factors, including (but not limited to): health conditions, genetic factors, psychological factors, stress, chronic pain, and substance overuse/dependence.
4. Define the chronic/long-term effects which result from brain injury and/or exposure(s) that mayor may not lead to a clinical diagnosis that may influence occupational performance and military readiness in warfighters. This includes the dose/response relationship between exposure(s) and these long-term outcomes and age-related decline or neurodegenerative diseases.
5. Determine the mechanisms underlying neuroprotection and cognitive enhancement following brain exposure(s) or brain injury and adapt or refine the use of cognitive performance improvement tools, capabilities, and supplements for the warfighter.
6. Evaluate neurocognitive assessment tools and validated metrics that enable an accurate understanding of a warfighter’s cognitive readiness for military activities and readiness requirements.
7. Determine the utility and effectiveness of novel TBI treatments, assessments, diagnostic and clinical decision-support tools, and technologies based on objective measures (e.g., biomarkers, sensory system status, neuroimaging changes, and neurocognitive status), all with the aim of supporting care in any environment, including future operations.
8. Reliably predict symptom trajectory and variables associated with treatment response for mild TBI patients with common co-occurring conditions (e.g., PTSD, depression, insomnia, etc.).
9. Define and mitigate the acute effects of brain injury or exposures that can prevent warfighters from returning to optimal brain health required for military service.
10. Evaluate and prioritize novel treatments for TBI, and determine optimal categorization of treatment courses based on symptom subgroups/clusters (e.g., vestibular, headache, PTSD, and psychological health or cognitive).

Prior history of TBI may predispose an individual to increased risk of subsequent TBI when exposed to less force, and may engender lengthier recovery from postinjury symptoms. Activities such as contact sports and military service carry particular risk for multiple TBI. In addition to acute postinjury difficulties, cumulative TBI may increase the risk of chronic cognitive and functional impairment. Conservative management of postinjury symptoms as part of a medically monitored, progressive plan for returning to activities is recommended for individuals with a history of TBI.

• Multiple TBI/Multiple Concussion Research Review

This research review provides an overview of the topic of comorbid mild TBI and posttraumatic stress disorder (PTSD). The symptoms, diagnosis, and treatment of PTSD and mild TBI symptoms in patients with mild TBI history will be discussed. While it can be difficult to differentiate symptoms of mild TBI from PTSD symptoms, especially months or years after the injury event, this review aims to present information relevant to understanding these often complex cases.

• Mild Traumatic Brain Injury and Posttraumatic Stress Disorder

An understanding of the neuropathological and clinical presentation of chronic traumatic encephalopathy (CTE) is critical for determining if there are clinical and pathological stages of progression, relating pathology to clinical symptoms, identifying risk factors, and developing interventions to prevent onset or spread of symptoms and pathology. The purpose of this research review is to summarize the available peer-reviewed scientific literature regarding the definition, epidemiology, risk factors, pathology and clinical manifestations for CTE. A list of specific gaps in our understanding of the disease is provided that, if addressed, could inform the most appropriate prevention recommendations and allow clinicians to more effectively diagnose, manage and treat CTE.

• Chronic Traumatic Encephalopathy Research Review
• Chronic Traumatic Encephalopathy Frequently Asked Questions Flier

• TBICoE Publications 2021
• TBICoE Publications 2020
• TBICoE Publications 2019
• TBICoE Publications 1992-2018