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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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This memorandum updates the DoD definition of TBI, severity of brain injury stratification, and method of data collection.

DoD Instruction Number 6490.11: DoD Policy Guidance for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Setting

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This instruction establishes policy, assigns responsibilities, and provides procedures on the management of mild traumatic brain injury (mTBI), also known as concussion, in the deployed setting.

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