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Promoting better understanding, treatment of traumatic brain injury

Marine Corps Staff Sgt. Anthony Mannino performs Art Therapy as part of his Traumatic Brain Injury (TBI) treatment and recovery. Art Therapy Interns, Adrienne Stamper (left) and Nancy Parfitt instruct and work with Mannino as he receives his art therapy. The therapy is conducted at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center located in Bethesda, Maryland. (Department of Defense photo by Marvin Lynchard) Marine Corps Staff Sgt. Anthony Mannino performs Art Therapy as part of his Traumatic Brain Injury (TBI) treatment and recovery. Art Therapy Interns, Adrienne Stamper (left) and Nancy Parfitt instruct and work with Mannino as he receives his art therapy. The therapy is conducted at the National Intrepid Center of Excellence, Walter Reed National Military Medical Center located in Bethesda, Maryland. (Department of Defense photo by Marvin Lynchard)

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Traumatic Brain Injury

Traumatic brain injuries continue to be a top focus in the Defense Health Agency. According to the Defense and Veterans Brain Injury Center, or DVBIC, more than 380,000 service members have been diagnosed with a TBI since 2000. The majority of the incidents have occurred in noncombat events including training accidents, falls, motor vehicle collisions, and sports-related activities.

TBIs are categorized as mild, moderate, severe, or penetrating. They occur when a blow or jolt to the head disrupts normal brain functioning. Mild TBIs or mTBI, also known as concussions, are the most common TBI among military members, DVBIC says. Full recovery is usually expected within days or weeks, but mTBIs can cause cognitive and emotional issues, such as temporary memory gaps, slowed thinking, irritability, and depression.

Further, research has shown that repeated head trauma may increase the risk of developing Alzheimer's disease and Parkinson's disease, and also may lead to brain degeneration known as chronic traumatic encephalopathy.

Here's a look at some activities this year that were related to promoting better understanding and treatment of TBI:

The U.S. Army Medical Research and Materiel Command began limited user testing of a blood test for brain trauma. The Army and the Department of Defense funded the research that led to the development of the test, called a brain trauma indicator. The BTI identifies two brain-specific protein markers that rapidly appear in the blood and are elevated 12 hours after a head injury occurs.

"When these proteins are elevated, there may be blood in the brain,” said Kathy Helmick, DVBIC deputy director. This could be an indication of a more serious brain injury, she said, and would require rapid intervention, such as neurosurgery to remove a blood clot.

The Air Force opened its first Invisible Wounds Center at Eglin Air Force Base, Florida. The facility serves as a regional treatment center for TBI as well as associated pain conditions and psychological injuries. With a team of 18 specialties under one roof, the center combines conventional and complementary therapies to provide treatment that's individually tailored to each patient as well as holistic and integrated.

“The center is ready to treat retirees, Guard, Reserve, and active duty members from our sister services who carry the weight of invisible wounds,” said Lt. Gen. Dorothy Hogg, the Air Force surgeon general. “Our goal is to eliminate barriers to care. We want to treat our service members with dignity through every phase of their recovery.”

During this year's Military Health System Research Symposium, a researcher at Indiana University was recognized for his work advancing the biological understanding of head impacts that don't produce clinical symptoms of mTBI. Keisuke Kawata, Ph.D., of the Department of Kinesiology, School of Public Health, Indiana University, received the first-place award in the Young Investigator Competition for his study, “Association of Increased Serum S100B Levels with High School Football Subconcussive Head Impacts.”

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Defense and Veterans Brain Injury Center Celebrates 25 Years

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Defense and Veterans Brain Injury Center Celebrates 25 Years

Katherine Helmick, DVBIC acting national director, discusses DVBIC achievements and goals to advance service members' health care. DVBIC honors 25 years of military health care by continued dedication to research and treatment of traumatic brain injury.

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Diagnoses of Traumatic Brain Injury Not Clearly Associated with Deployment, Active Component, U.S. Armed Forces, 2001 – 2016

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Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force.  TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment). Categorization of person time during surveillance period included four categories: Group 1 (Never deployed/TBI before first-ever deployment), Group 2 (Currently deployed or within 30 days of return), Group 3 (previously deployed but not currently deployed nor within 30 days of return) and Censored after Diagnosis of TBI. From 2001-2016, 276,858 active component service members received first-time diagnoses of TBI. The crude overall incidence rate of TBI among deployed service members was 1.5 times that of service members assigned to Group 1 and 1.2 times that of service members in Group 3 during the surveillance period.  Total TBI cases by group were Group 1 42.8%, Group 2 13.2% and Group 3 44.0%. Incidence rates by group (per 100,000 person-years) were Group 1 1,141.3, Group 2 1,690.5, and Group 3 1,451.2. Learn more at www.Health.mil/MSMR and see fact sheets at www.Health.mil/AFHSB

Traumatic Brain Injury (TBI) is structural alteration of the brain or physiological disruption of brain function caused by an external force. TBI, particularly mild TBI or concussion, is the most common traumatic injury in the U.S. military. This analysis provides the estimated rates of incident TBIs among service members before their first-ever deployment as well as separately among service members during deployments/ after deployments. It also mentions factors that may explain why the TBI incidence rates among the previously deployed were higher than those of the never-deployed group. Moreover, it describes the demographic and military traits of service members diagnosed as TBI cases (before/after deployment).

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Exiting an A-10C Thunderbolt

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9/30/2016
U.S. Air Force Senior Airman Judith Bulkley, an electrical and environmental systems specialist deployed from the 23rd Aircraft Maintenance Squadron, Moody Air Force Base, Ga., exits an A-10C Thunderbolt II after performing an external power operations check on the aircraft at Kandahar Airfield, Afghanistan. Because service members in particular are often exposed to high noise levels, hearing protection is crucial, especially with a TBI. (U.S. Air Force photo by Tech. Sgt. Stephen Schester)

U.S. Air Force Senior Airman Judith Bulkley, an electrical and environmental systems specialist deployed from the 23rd Aircraft Maintenance Squadron, Moody Air Force Base, Ga., exits an A-10C Thunderbolt II after performing an external power operations check on the aircraft at Kandahar Airfield, Afghanistan. Because service members in particular are often exposed to high noise levels, hearing protection is crucial, especially with a TBI. (U.S. Air Force photo by Tech. Sgt. Stephen Schester)

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A soldier at Joint Base Elmendorf-Richardson’s traumatic brain injury clinic in Alaska takes a cognitive hand-eye coordination test on a driving stimulator.

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Public Health Service Cmdr. Robin Toblin speaks at TBI Summit

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9/21/2016
Public Health Service Cmdr. Robin Toblin with the Walter Reed Army Institute of Research was one of the more than 1,700 health care providers and policy makers from the Military Health System, the Department of Veterans Affairs, academia and commercial research companies who met in person and virtually during the recent Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury Summit held at the Defense Health Headquarters in Falls Church, Virginia. (DCoE photo by Terry Welch)

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Technician Discusses TBI Research

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5/20/2016
Photo of an Edgerton Shadowgraph, a technique which allows researchers to visualize shockwaves in a transparent medium so they can see the shockwaves in the air. Upon visualizing the shockwaves, researchers can measure their locations and use the timing from high-speed video cameras to determine a velocity, which is critical in indicating the shockwave’s pressure. Once researchers have all this information, they can tell the pressure impacted on the test subject. (DoD photo)

Richard Benjamin, lead physical science technician at the Army Research Laboratory at Aberdeen Proving Ground, Md., discusses using technology to better understand traumatic brain injuries.

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A Head for the Future: Randy Gross

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When he was 23, Randy Gross was riding in a car with his seat belt off. The former Army staff sergeant sustained a TBI when the vehicle crashed. He sought help immediately, making a full recovery from his TBI and continuing to serve in the Army until 2006. Now, Gross helps those in the military with TBI as a regional education coordinator for DVBIC.

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DoD Instruction 6490.13: Comprehensive Policy on Traumatic Brain Injury-Related Neurocognitive Assessments by the Military Services

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