Spotlight on VA Research

VA's research related to traumatic brain injury (TBI) is wide-ranging. Among its goals: shedding light on the brain changes in TBI; improving screening methods and refining tools for diagnosing the condition; developing drugs to treat brain injury or limit its severity when it first occurs; designing improved methods for assessing treatment effectiveness; helping Veterans with TBI to reintegrate into their communities; and learning the best ways to help family members cope and provide support.

Important areas of VA research in TBI include:

• Characterizing Brain Changes
  TBI can result in sometimes-subtle brain damage with changes in memory, attention, thinking, personality, and behavior that are currently difficult to diagnose and treat. VA researchers are refining ways to reliably diagnose TBI and predict patients' outcomes and care needs. In one example of this work, a VA research team is combining two new brain-scan technologies to help in detection of subtle brain injuries. One method records magnetic signals that brain cells give off as they communicate with each other. The second method tracks the movement of water molecules through brain tissue. At another site, VA researchers are studying brain cells that have been exposed to extreme pressure inside a lab device called a barochamber. The investigators are using the device, which simulates the effects of explosions, to help them understand how cells in the brain respond. The study could support the development of therapies that troops would receive while in a combat zone—either before they go out on patrol, as a preventive measure; or after a blast has occurred, to limit damage to the brain.
• Regenerating Nerve Cells
  VA investigators are working to identify ways to repair the nervous system by supporting regrowth of nerve cells. Strategies being explored include gene therapy, tissue engineering, and adult stem cell transplantation. Advances in this area hold promise not only for TBI, but also for conditions such as spinal cord injury, multiple sclerosis, and Alzheimer's disease. In one example of recent research in this area, VA lab investigators demonstrated promising methods for coaxing adult stem cells within the hippocampus—the brain's memory and learning center—to develop into new brain cells.
• Using Medications for TBI Symptoms
  The Defense and Veterans Brain Injury Center, a collaboration between VA and the Department of Defense (DoD), is studying the effectiveness of various drugs for treating TBI symptoms such as headaches, anxiety, and mood swings.
• Advancing Personalized Medicine
  Because genetic factors may play a role in how TBI develops after an injury and how patients respond to treatment, a new VA registry will allow for anonymous analysis of DNA samples from Veterans who served in Afghanistan and Iraq. The goal is to learn how to use individuals' genetic information to optimize care and treatment for TBI.
• Treating Blast-Related Sensory Loss  VA Research is increasing its focus on the hearing and vision loss that often occurs as part of TBI. For example, investigators at VA's National Center for Rehabilitative Auditory Research are partnering with audiologists at Walter Reed Army Medical Center to study central auditory processing-how the brain interprets incoming sounds—in service members who have been exposed to blasts. Other teams of VA investigators are studying the prevalence and nature of vision problems among Veterans with TBI. Their findings point to the need for more comprehensive evaluations that include, for example, binocular function tests, which may detect subtle but distressing vision problems that may be missed in standard eye exams.
• Supporting Reintegration
  VA investigators are examining ways to help Veterans with TBI achieve a smooth transition back into daily life, including family, school, and work roles. To restore independence to Veterans with TBI, investigators are looking at such innovative techniques as robotic movement therapy and driving simulators for assessment and training. Researchers are also focusing on supporting caregivers, by assessing their needs and the resources currently available to them.
• Promoting Best Practices
  VA's Quality Enhancement Research Initiative (QUERI) focuses on rapidly translating research findings into patient care. A Polytrauma and Blast-Related Injury QUERI coordinating center has been established to promote evidence based "best practices" in care and thereby support the rehabilitation, psychological adjustment, and community reintegration of Veterans affected by TBI and other injuries.

Plans for Further Research

In an effort to maximize the benefits from traumatic brain injury research, VA's Office of Research and Development recently held a conference titled "Research to Improve the Lives of Veterans: Approaches to Traumatic Brain Injury Screening, Treatment, Management, and Rehabilitation."

Recommendations from the conference included calls for enhanced access to TBI data through a central database, increased recruitment of TBI researchers into the VA system, and additional support for TBI clinical trials. VA has already acted on recommendations from the TBI conference and issued a request for new study proposals reflecting priorities discussed.

Team Approach to TBI Care

Because TBI often occurs along with other severe injuries, some patients with TBI receive care through regional VA polytrauma teams. Polytrauma refers to multiple, complex injuries, often including limb loss, spinal cord injury, vision or hearing loss, burns, and related medical complications. Those needing the most intensive care are treated at one of VA's four main polytrauma centers, in Minneapolis, Tampa, Richmond, and Palo Alto. Initially established as TBI clinics in the early 1990s, these sites now provide comprehensive care for polytrauma. VA is building a fifth polytrauma center in San Antonio. (http://www.polytrauma.va.gov)