Back to Top Skip to main content

Emerging technology improves ability to see ‘invisible’ wounds

As well as providing high-resolution clinical imaging capabilities, the 3T Magnetic Resonance Imaging (MRI) scanner used at the NICoE provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging (DTI) and echo planar imaging (EPI) sequences. (Photo courtesy of NICoE) As well as providing high-resolution clinical imaging capabilities, the 3T Magnetic Resonance Imaging (MRI) scanner used at the NICoE provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging (DTI) and echo planar imaging (EPI) sequences. (Photo courtesy of NICoE)

Recommended Content:

Traumatic Brain Injury

The active lifestyle of servicemembers can increase the possibility for concussion or mild TBI because recreation often involves vigorous activities or contact sports, and training can include rigorous physical activity. Deployments also can put warfighters in hazardous situations such as near blasts.

Statistics compiled by the Department of Defense show that servicemembers – both deployed and nondeployed – sustained more than 315,000 mild Tramatic Brain injuries, or mTBI, from the year 2000 through the first quarter of 2018. A recent study of brain injuries in the military republished by the National Institutes of Health noted that the absence of external damage to the head can lead servicemembers to believe they should feel fine. But they don’t.

Fortunately, most mTBI sufferers recover fully under the supervision of a health care professional using a protocol such as the Progressive Return to Activity.

For some, however, symptoms may persist, and can include mood changes, headaches, sleeplessness, and trouble concentrating. With the damage seemingly “invisible,” current methods of looking at bone, blood vessels, and soft tissues in the brain often can’t find a physical cause of these lingering problems. These testing methods include magnetic resonance imaging, known as MRI, or computed tomography X-ray, commonly called CT scans. But a special type of MRI called diffusion tensor imaging or DTI, takes a different approach to examining the brain for traumatic injury. This technology, still in its infancy, may one day serve as a powerful tool for understanding concussions at the molecular level.

“Diffusion tensor imaging is really a way of looking at the connections in the brain,” said Dr. Louis French, deputy director for operations at the National Intrepid Center of Excellence, or NICoE, at Walter Reed National Military Medical Center in Bethesda, Maryland. “Rather than focus solely on the structures there, DTI examines the connections and communication between the various parts of the brain.”

DTI works by observing the flow of water molecules along nerve fibers called axons in the brain, looking for signs of disruption, French explained. Those fibers usually direct water to flow through the brain in one direction, along one of many such channels. In the case of TBI, say after a blast concussion, those fibers and pathways can be deformed or distorted and may even be torn or structurally malformed, causing the water that was flowing along one axis to seep out into other spaces, which can be measured through DTI.

French has been using DTI as one of many evaluation tools in a 15-year, congressionally mandated study of servicemembers with mild to severe TBI. He said most have had multiple concussions or multiple exposures to potentially concussive events. “In that population, we’re really interested in the cumulative brain changes associated with those exposures,” he said. In addition to the study group, researchers also have two control groups: individuals with no injuries and individuals with bodily injuries that don’t involve the head or brain.

DTI is helping to increase understanding of TBI as a process, not an event, French said. “The neuro-imaging that we do, including the MRI with diffusion tensor, enables us to look at the relationship of the changes in the brain as the person recovers.”

“This is a way we can point out to people that, yes, we can see here on the computer screen physically the origin of your complaints,” said French, explaining that the data is objective evidence of subjective complaints.

DTI is available at NICoE, but not widely used across the MHS, partly due to some MRI units unable to run the required software. Additionally, not all MTFs have experts able to evaluate the data produced by DTI. French says the technology is constantly being refined and improved upon, but currently it’s so technically challenging and time consuming, it’s not available for regular use.

He said the MHS is at the forefront of TBI research and care, with abilities that are equal to, or better than, any in the civilian sector. “This isn’t just about treating problems but also understanding wellness,” he added. “We are interested in protecting servicemembers across their lifespan. We want to understand what happens to people when they go through the process of training and deployment and then re-acclamation to society, and this is all part of that effort.”

You also may be interested in...

March is Brain Injury Awareness Month; TBICoE’s mission lasts all year

Article
3/2/2021
Military health personnel performing a balance test on a patient

Staying a-head of TBI

Recommended Content:

Traumatic Brain Injury Center of Excellence | Brain Injury Awareness | A Head for the Future | March Toolkit | Traumatic Brain Injury | Brain Injury Awareness Month

Progressive Return to Activity After Concussion Video

Video
2/25/2021
DHA Seal

The PRA is an evidence-based, easy-to-use approach to help providers return service members with mild TBIs back to duty safely. TBICoE researchers have found that, if medical providers completed a two-hour, in-person training on the use of the PRA, their patients saw an overall reduction in symptoms after one week, one month, and three months, when compared to patients treated by providers who had not received the training.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators | Traumatic Brain Injury | Brain Injury Awareness Month | TBI Resources | TBI Screening

Brain Injury Awareness Month "Be TBI Ready" Infographic

Infographic
2/24/2021
March is Brain Injury Awareness Month. Be TBI Ready. A traumatic brain injury—or TBI—is a blow or jolt to the head that disrupts the normal function of the brain. The severity of the TBI is determined at the time of the injury and may be classified as: mild, moderate, severe, or penetrating.

During Brain Injury Awareness Month, TBICoE and the MHS will promote the theme “Be TBI Ready” — recognizing that health care providers and others in the military community need to be aware of the latest educational trainings, research, fact sheets, and other available resources to prevent, diagnose, and treat TBI.

Recommended Content:

Brain Injury Awareness Month | Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | TBI Educators

Returning to Duty After Concussion

Infographic
2/24/2021
What's the best way to recover from a concussion? Returning to duty too soon after a concussion can lead to prolonged symptoms, decreased readiness, poor marksmanship, accidents and falls, and increased risk of more concussions. Progressively increasing activity in a step-wise manner can help you resolve your symptoms and return to duty safely. Ask your primary health care provider about TBICoE's Progressive Return to Activity to help you return to duty as quickly and safely as possible. Visit health.mil/TBICoE.

This TBICoE infographic gives an overview of the risks of returning to duty too soon after a concussion and explains how a progressive increase in activity can help get you back to duty safely. Returning to duty too soon after concussion can lead to prolonged symptoms, poor marksmanship, decreased readiness, accidents and falls, and increased risk of more concussions.

Recommended Content:

Traumatic Brain Injury | Brain Injury Awareness Month | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | TBI Educators | Provider Resources

Progressive Return to Activity Following Acute Concussion/Mild TBI

Publication
2/23/2021

The 2021 Progressive Return to Activity (PRA) Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation is an evidence-based return to activity protocol for primary care managers and concussion/traumatic brain injury (TBI) clinic providers. The PRA is a six-step approach that begins after the provider performs the Military Acute Concussion Evaluation 2 (MACE 2) and diagnoses the patient with a concussion/TBI. The PRA stages start with relative rest and allow service members to gradually increase activities until they receive clearance for return to full duty or activity. In each stage, it offers general and military specific activities and options to help providers manage their patients’ primary symptom clusters. The PRA also offers recommendations on specialty referrals and handouts are available for providers to give patients and leadership.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | Traumatic Brain Injury | TBI Resources

Progressive Return to Activity Following Acute Concussion/Mild TBI Provider Training

Publication
2/23/2021

The TBICoE revised the Progressive Return to Activity Following Acute Concussion/Mild Traumatic Brain Injury Clinical Recommendation (PRA) and this updated provider training slide deck. The trainings objectives will help providers to identify the key changes to the updated 2021 PRA; explain the rationale for using a PRA protocol for service members post-concussion; understand the criteria for progression following a concussion or mild traumatic brain injury; identify appropriate activities at each stage of progression; understand how to apply primary care management strategies and specialty referral considerations to treat concussed service members who are not progressing as expected; utilize the Tri-Service Workflow mild TBI Alternate Input Method Form to document the PRA in the Armed Forces Health Longitudinal Application.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Education | Provider Resources | TBI Educators | Traumatic Brain Injury | TBI Education and Training Events

March 2021 Toolkit

Publication
2/22/2021

March is nationally recognized as Brain Injury Awareness Month, with the goal of increasing traumatic brain injury (TBI) awareness and improve health care providers’ ability to identify, care for, and treat all those who are affected by TBI. A TBI is a blow or jolt to the head that disrupts the normal function of the brain. According to the Defense Health Agency Traumatic Brain Injury Center of Excellence, 430,720 service members have been diagnosed with a first-time TBI since 2000. The toolkit also contains information on patient Safety Awareness Week, National Nutrition Month and many other graphics and messages you can use for holidays and observances during March.

Recommended Content:

March Toolkit | Total Force Fitness | Traumatic Brain Injury | Brain Injury Awareness Month

Sleep and TBI

Video
2/8/2021
DHA Seal

Sleep disturbances are common for service members and veterans following a mild TBI, also known as concussion.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | Traumatic Brain Injury

Caregivers share their stories of support for TBI recovery

Article
11/23/2020
Group of people walking and on wheelchairs through the forest

"Recovery is possible to help lead a normal life."

Recommended Content:

November Toolkit | Warrior Care Month | National Family Caregivers Month | Traumatic Brain Injury

NICoE & ISC Network maintain TBI care during COVID-19

Article
11/19/2020
Image of United States map with locations noted

The Network leveraged their geographic distribution to help each other quickly adapt to changing times.

Recommended Content:

Coronavirus | Traumatic Brain Injury

Sleep After mTBI

Infographic
11/19/2020
Sleep After mTBI

"Sleep After mTBI" is intended for providers to show the importance of screening and treating service members affected by sleep issues following mTBI.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Provider Resources

TBI Champions Roxana Delgado & Victor Medina

Video
11/17/2020
TBI Champions Roxana Delgado & Victor Medina

While he was deployed, retired Army Sgt. 1st Class Victor Medina was in a vehicle that was hit by an explosive device. He sustained a traumatic brain injury (TBI) that severely impaired some of his physical functions and ability to speak. Medina’s wife, Roxana Delgado, continued her pursuit of a Ph.D. in health sciences and became his caregiver. As they adjusted to a life neither one of them had imagined, their marriage became a new kind of partnership.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | A Head for the Future | Traumatic Brain Injury

TBI Champion Gary Moran

Video
11/17/2020
TBI Champion Gary Moran

SGM Gary D. Moran shares his TBI recovery story, and tips for talking to kids about TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

TBI Champion Micah Norgard

Video
11/16/2020
TBI Champion Micah Norgard

After 12 years as an infantryman, Norgard's biggest battle was recognizing the cumulative effects of multiple TBIs.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | A Head for the Future

TBI Champion Beth King

Video
11/16/2020
TBI Champion Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way — recumbent biking.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury
<< < 1 2 3 4 5  ... > >> 
Showing results 1 - 15 Page 1 of 13

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.