MILD TRAUMATIC BRAIN INJURY FACTS
What is mild traumatic brain injury?
Mild Traumatic Brain Injury (mTBI) is commonly called concussion. The effects are typically transient, with headache, cognitive, behavioral, balance, and sleep symptoms most often seen in the first 1 to 3 months post-injury. In a small percentage of individuals however, these difficulties persist and even lead to lifelong disability. In these individuals, additional chronic effects, including neuroendocrinologic abnormalities, seizures and seizure-like disorders, fatigue, vision and hearing abnormalities, and numerous other somatic symptoms are more common over time. The long-term effects from these single or repeated TBIs on the persistence of these symptoms, on combat and trauma-related comorbidities, and on long-term brain functioning are unknown. Increasing evidence supports the linkage between both concussions and combat-related trauma with a degenerative neurologic disorder known as chronic traumatic encephalopathy (CTE), which results in progressive cognitive and behavioral decline in sub-populations that are 5 to 50 years out from repeated or cumulative exposures [Gavett 2011; Guskiewicz 2005; Omalu 2005].
How common is mTBI and what causes it?
Nearly 20% of the more than 2.5 million Service members (SMs) deployed since 2003 to Operation Enduring Freedom, Operation Iraqi Freedom and Operation New Dawn (OEF/OIF/OND) have sustained at least one traumatic brain injury, predominantly mTBI [Warden 2006; www.dvbic.org/tbi-numbers.aspx], and almost 8% of all OEF/OIF/OND Veterans demonstrate persistent post-TBI symptoms more than 6 months post-injury [Scholten 2012; Taylor 2012]. The incidence is likely even significantly higher than reported, as many mTBIs may go unrecognized during and even after deployment because of more visible concomitant injuries capturing greater attention, clinicians’ limited awareness of the often subtle initial findings, and patients’ reduced subjective awareness related to cognitive deficits in the acute period [Jordan 2000]. During deployment explosive munitions, predominantly improvised explosive devices (IEDs), have caused the overwhelming majority of these identified cases. Additionally, there are more than 3.5 million mTBIs, or concussions, that U.S. civilians experience annually from motor vehicle collisions, sports, falls, and violent trauma [Coronado 2012].
How is mTBI treated?
For individuals who sustain mTBI, treatment may be sort immediately or at any time in the future. Current treatment includes intensive care unit, acute rehabilitation, post-acute rehabilitation, sub-acute rehabilitation, day treatment (day rehabilitation or day hospital), outpatient, home health services, community re-entry and/or independent living programs.
Why is the CENC consortium needed and how will it help advance mTBI prevention and treatment?
Current mTBI treatment is limited to improving dysfunctions observed acutely after TBI, although the effects from single or repeated TBIs on long-term brain functioning are unknown and therefore currently untreatable. The mission of the CENC is to fill the gaps in knowledge about the basic science of mTBI, to determine its effects on late-life outcomes and neurodegeneration, to identify Service members most susceptible to these effects, and to identify the most effective treatment strategies. The CENC is a multi-center collaboration linking premier basic science, translational, and clinical neuroscience researchers from the DoD, VA, academic universities, and private research institutes to effectively address the scientific, diagnostic, and therapeutic ramifications of mild TBI and its long-term effects. The consortium serves as the comprehensive research network for DoD and VA that focuses on the long-term effects of combat-related and military-relevant TBI, and is designed to conduct research that provides clinically relevant answers and interventions for current Service members and Veterans and to develop the long-term solutions to the chronic effects of TBI. The CENC is identifying and characterizing the anatomic, molecular, and physiological mechanisms of chronic injury from TBI and potential neurodegeneration, investigating the relationship of comorbidities (psychological, neurological, sensory, motor, pain, cognitive, neuroendocrine) of trauma and combat-exposure to TBI with neurodegeneration. CENC is also assessing the efficacy of existing and novel treatment and rehabilitation strategies for chronic effects and neurodegeneration following TBI.
- Coronado V, McGuire L, Sarmiento K, et al. Trends in Traumatic Brain Injury in the U.S. and the public health response: 1995-2009. J Saf Res. 2012; 43:299-307.
- Gavett B, Stern R, McKee A. Chronic traumatic encephalopathy: A potential late effect of sport-related concussive and subconcussive head trauma. Clin Sports Medicine 2011; 30(1): 179-88.
- Guskiewicz KM, Marshall SW, Bailes J, et al. Association between recurrent concussion and late-life cognitive impairment in retired professional football players. Neurosurgery 2005; 57 (4): 719-26.
- Omalu BI, DeKosky ST, Minster RL, Kamboh MI, Hamilton RL, Wecht CH: Chronic traumatic encephalopathy in a National Football League player. Neurosurgery 2005 Jul; 57(1):128-34; discussion 128-34.
- Scholten JD, Sayer NA, Vanderploeg RD, Bidelspach DE, Cifu DX. Analysis of US Veterans Health Administration comprehensive evaluations for traumatic brain injury in Operation Enduring Freedom and Operation Iraqi Freedom Veterans. Brain Inj. 2012; 26(10):1177-1184.
- Taylor BC, Hagel EM, Carlson KF, Cifu DX, Cutting A, Bidelspach DE, Sayer NA: Prevalence and costs of co-occurring traumatic brain injury with and without psychiatric disturbance and pain among Afghanistan and Iraq war Veteran VA users.Med Care 2012; 50(4):342-6.
- Warden D. Military TBI during the Iraq and Afghanistan wars. J Head Trauma Rehabil. 2006; 21 (5): 398-402.