The Department of Defense continues its research work to improve brain health across all services and operational environments.

As part of a congressionally directed research effort on brain health and blast exposures, DOD Health Affairs and the Defense Health Agency implemented a pilot study that took place at the U.S. Army's Fort Campbell, Kentucky, with 333 members of the 101st Airborne Division and their trainers. The study ran from March 15 to Nov. 24, 2021.

The study evaluated current monitoring capabilities for brain health and blast overpressure, which is the shock wave that occurs from firing weapons or weapon systems, for example.

Presented at the recent Military Health System Research Symposium, the study looked at soldiers outfitted with small wearable blast gauges. The two-part study reviewed the gauge measurements during a single day of supervised training in heavy munitions including additional contextual metavariables and longitudinally during a three- to four-month training period.

The study then surveyed participants, asking troops' perceptions on blast overpressure and brain health.

One goal of the study was for the results to be included in service member medical records. Study participants who believed damage may have occurred to their brains and bodies from blast exposure would have proper documentation in their medical files.

One participant agreed on the need to address brain health and occupational exposure to blast overpressure, stating: "I hope the blast program is able to gather the impact that blasts are having on our bodies and brains, and hopefully use it to protect and innovate."

The next steps of the study included U.S. Marines at the Marine Corps Air Ground Combat Center Twentynine Palms, California, and ran from July 6 to Oct. 28, 2022. The study compared their experiences and supported more broadly applicable recommendations.

Steve Jones, assigned to the DOD Health Affairs, and directly involved with determining how best to implement blast-overpressure monitoring across the DOD, said "similar to other operational and environmental exposures, monitoring blast over-pressure is a very important with regard to the health and readiness of the force, and to mitigating such exposures."

Warfighter Brain Health Initiative

The study is part of the DOD Warfighter Brain Health Initiative that follows a service members' brain condition from joining up to retirement. The idea is to gather data on brain health in training, deployment, garrisons, and off-duty sports.

"We want you in for the long haul, and we want you to have a highly functional and productive life when you leave the military," said Kathy Lee, lead for the WBHI for the office of the Assistant Secretary of Defense for Health Affairs, in a recent interview.

The long-term data will help support the maximum number of healthy service members who are ready for deployment.

"A key part of the plan calls for ensuring that we're monitoring, through time, and having a spot check throughout the rest of a service member's career, to ensure that we're maximizing brain health," Lee explained, adding: "It gives us the opportunity to intervene."

"Marching this plan out, we wanted to ensure that cognition was front and center," Lee said. "Many times, when there's been some decrement in your testing of cognitive abilities, evaluating sleep health, mood, and looking at any lingering TBI symptoms ... can help improve and restore cognitive functioning."

'Culture Change in Leadership'

Lee said there's been a "culture change in leadership" in accepting the brain health concept that varies from the typical warfighter mindset. "I think that the environment has really seen that we've come up with a plan that's cogent; it's doable."

There also has been "more buy-in to the initiative" from listening to the concerns of those in the field across all services, Lee suggested. Many brain health actions and research were already well under way at the DOD on brain health prior to the actual plan published in August.

The Warfighter Brain Health Initiative lays out the action plan for the DOD. These are:

• Enhance health and performance.
• Optimize cognitive and physical performance.
• Identify, monitor, and mitigate brain exposures.
• Prevent, recognize, and minimize the effects of traumatic brain injury.
• Reduce or eliminate long-term/late effects.
• Advance warfighter brain health science.

Lee gave a preview of the Warfighter Brain Health Initiative last year at a speech before trauma nurses.

The military's brain health program "is wide and deep," and "rapid," she said, adding that in the next four years, "our goals and our strategies are to get really meaningful outcomes and changes related to the warfighter brain health plan."