Research at the TBI Center of Excellence

TBICoE supports the MHS and DHA with traumatic brain injury research initiatives, including gap-driven analyses and congressionally directed programs such as the 15-year longitudinal study of TBI and an investigation into the effects of blast exposure on Warfighter Brain Health and Performance.

TBICoE's collaborations allow for clinical innovation and research along the continuum of care of TBI—from initial injury, rehabilitation, and ultimately a return to family, community, and work or continued duty.

Beyond conducting research, TBICoE periodically evaluates available peer-reviewed scientific literature to summarize the state-of-the-science, consensus of medical approaches, as well as existing and new evidence of TBI research. These research reviews, information papers, the CUBIST podcast, and the new clinical pearls resources are available for download.

Research Gaps and Priorities

The TBICoE research portfolio meets DOD TBI clinical and operational research needs by aligning to TBI knowledge gaps. Every two years, TBICoE’s research team reviews, analyzes, and updates a data-driven, actionable list of research gaps and priorities.

TBICoE Publications Catalog

The annual TBICoE Publications Catalog provides an overview of TBICoE's published work. Since 1992, TBICoE has published over 700 peer reviewed manuscripts in collaboration with other institutions. The work aligns and responds to trends, gaps, and priorities of the DHA and broader DOD to inform policy, resource management, and state of the science for warfighters, veterans, their families and caregivers, and health care providers.

The purpose of the catalog is to:

  • Highlight calendar year TBICoE publications
  • Increase awareness of TBICoE research and surveillance initiatives
  • Assist in the planning of future brain health efforts

This catalog is organized by category and contains complete citations and links to the articles on PubMed.

Download the 2024 TBICoE Publications Catalog

Research Reviews & Clinical Pearls

The following TBICoE research reviews are fluid areas of investigation and provide an overview on specific topics of interest related to TBI research. These reviews will be updated as new research emerges.

New in 2023, research reviews will be complemented by a supplemental resource, "Clinical Pearls." Both the research review and clinical pearls products are created for both the researcher and the military clinician.

This research review describes how pain symptoms can interact with other TBI symptoms, such as sleep disturbances, to impact overall quality of life and TBI recovery. The clinical pearls summarize considerations for evaluating and treating chronic pain in individuals with TBI.

This research review describes how excessive drinking can impact service members with TBI. It lists the effects and risk factors of excessive drinking after TBI and provides resources for providers helping patients manage alcohol consumption. The fact sheet is intended to help providers educate patients about alcohol misuse and TBI.

This research review is a detailed summary of clinical research on coexisting mild TBI and PTSD. 

The research review informs the clinical pearls. It is brief with key action items providers can use when treating service members with both mild TBI and PTSD.

People with a history of TBI may be at increased risk of:

  • Another TBI when exposed to less force.
  • Longer recovery from symptoms of that additional TBI. 

Contact sports and military service add risk for more than one TBI. 

Get key action items and a military clinician’s point of view in the clinical pearls.

This research review is a summary of available clinical research on suicide and TBI. It covers:

  • Prevalence
  • Risk factors
  • Evaluation and screening tools
  • Protective factors and treatment

The TBI and suicide clinical pearls provide key actionable items to providers to screen, identify, and treat service members with TBI for suicide risk. 

Revised in March 2023, the research review addresses the current state-of-the-science of CTE, including an in-depth look at available peer-reviewed scientific literature and a bulleted quick-reference summary for clinicians and the operational community. The revised fact sheet is a quick reference for researchers, the operational community, and clinicians to understand what is known, and not known, about CTE.

In cases with confirmed CTE, there is noteworthy overlap of symptomology and comorbid neuropathological conditions. CTE currently cannot be diagnosed in living persons. The clinical syndrome for living persons, Traumatic Encephalopathy Syndrome, is associated with CTE but is not diagnostic of the condition. 

CTE FAQ thumbnail

TBICoE Information Papers

Creatine and TBI [2025]

The purpose of this information paper is to provide a general overview of the current state of the science for using creatine to treat mild TBI and to optimize brain health and performance.

TL;DR: Research to date provides some evidence for the use of creatine supplements to improve outcomes after mild TBI, though both the dose and duration for optimal results remains unknown. Creatine may be useful in environments where warfighters are exposed to acute stressors, such as intense exercise. Given the insufficient evidence, there are no clinical guidelines for using creatine to manage or prevent TBI. Guidance from a healthcare provider or registered performance dietitian is essential before beginning creatine supplements.

Have questions about other supplements? Visit Operation Supplement Safety, DOD's go-to program for dietary supplements. OPSS's mission is to provide the best evidence-based information about dietary supplements to service members, their families, healthcare providers, and leaders to achieve human performance optimization. 

Omega-3 Supplements for Mild Traumatic Brain Injury [2025]

The purpose of this information paper is to provide a general overview of the current state of the science on the use of omega-3 supplements for the prevention and treatment of mild TBI.

Military High-Speed Boat Injuries [2025]

Crew members on military high-speed boats have a higher risk of chronic pain, injuries to the lower back and neck, and head injuries due to hull impacts induced by wave-slamming. Special warfare combatant-craft crewmen are particularly at higher risk. This paper discusses studies on military high-speed boat injuries with a focus on brain health. To learn more on active DOD research in this area, read about the MASHIEN study.

Neurodegenerative Diseases and Traumatic Brain Injury [2025]

The long-term effects of TBI are unknown, but there is concern that there may be an association with neurodegenerative diseases years after the injury. The intention of this information paper is to summarize the available evidence for or against an association of TBI with three of the more common neurodegenerative diseases, Alzheimer’s Disease, Parkinson’s Disease, and Amyotrophic Lateral Sclerosis.

Impact of Mild Traumatic Brain Injury on the Autonomic Nervous System [2023]

The purpose of this information paper is to provide a general overview of the current evidence related to the impact of concussion, or mild TBI, on the autonomic nervous system. This paper will focus on heart rate variability, pupillary light reflex, and hyperhidrosis within the military and civilian populations. Researchers and clinicians can learn about current tools used to measure ANS and their current clinical utility at this time.

Additional Research Resources

Check out the latest resource, "Medical Devices for Assessment of Traumatic Brain Injury."

Learn how the FDA approval process works, get a list of approved devices for assessing TBI, and gain insight to what should be considered before using a device.

Thumbnail image of the downloadable fact sheet on TBI medical devices.

TBICoE Congressional Reporting

Some research activity is directed by Congress by National Defense Authorization Acts. That work and the results are reported to Congress. Those reports are part of the public record.

NDAA FY07 Section 721 Report to Congress: Longitudinal Study on Traumatic Brain Injury Incurred by Members of the Armed Forces in OIF/OEF

This study looks at the health effects related to TBI incurred by members of the Armed Forces in OIF/OEF and their families. The final report will be released in 2025.

NDAA FY18 Section 734 Report to Congress: Longitudinal Medical Study on Blast Pressure Exposure of Members of the Armed Forces

The Section 734 Program includes of the following mandates: NDAA FY18 Section 734, NDAA FY19 Section 253, NDAA FY20 Section 717, and NDAA FY20 Section 742.

NDAA FY19 Report to Congress: Chronic Traumatic Encephalopathy

A study and report on chronic traumatic encephalopathy research in the military.

NDAA FY20 Section 750 Report to Congress: Study and Report on Traumatic Brain Injury Mitigation Efforts

This study assessed 30 unique TBI treatments and summarized the findings.

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