Health Services Research & Development

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Spotlight: Research into Traumatic Brain Injury

May 2013


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TBI can occur alongside PTSD or depression. If you are a Veteran in crisis, call the VA's Crisis Intervention (24/7) Suicide Prevention Hotline at 1-800-273-8255.

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Traumatic brain injury (TBI) occurs when a significant outside force causes an impact to the head, such as when a head hits a windshield during a car accident, or when a football player is tackled during a game. Traumatic brain injuries can also be caused by pressure waves or shrapnel generated during an explosion. Some of the effects caused by TBI can include:

  • difficulty with concentration and/or memory
  • alteration of the senses (hearing, vision, smell, taste, and touch)
  • difficulty with communication (i.e., expression and understanding)
  • changes in emotion and/or behavior (i.e., depression, anxiety, personality changes)

Because of the prevalence of blast injuries coupled with simultaneous improvements in body armor and field medical care, TBI has become known as the "signature injury" of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). According to a 2012 special report, the Department of Defense estimates that approximately 29,000 1 OEF/OIF service members have some form of TBI, ranging from mild to the severest form in which a foreign body (usually shrapnel) penetrates brain tissue. Further, TBI frequently occurs in combination with other disabling conditions, such as amputation, auditory and visual impairments, spinal cord injury (SCI), post-traumatic stress disorder (PTSD), or other medical conditions that can complicate both diagnosis and treatment.

In addition to VA routinely screening OIF/OEF Veterans for TBI—and referring those who screen positive for diagnostic testing and treatment�—VA's Health Services Research & Development Service (HSR&D) conducts considerable research into TBI. Some of the research efforts that have contributed to the improvement of care for Veterans with TBI include:

  • The Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative (PT/BRI-QUERI) conducts comprehensive research into the health problems, healthcare system challenges, and psychosocial concerns of Veterans who have sustained polytrauma and blast-related injuries, but also maintains a special research focus on Veterans with combat-related TBI that occurred along with other complex injuries.
  • Completed in 2011, this study sought to describe the VA's comprehensive TBI evaluations given to Veterans who screen positive for deployment-related injuries, and to relate the evaluation process to subsequent VA care patterns. Results of the study identified differences in TBI symptom severity by gender and multiple injuries, and provided information that could assist in VA's TBI evaluation process by adding clarifying questions.
  • Family-centered care (involving families in clinical decision-making, care plans, and educational efforts) has been shown to improve patient outcomes. Concluded in 2013, this study looked at outpatient clinician contact and programs associated with family-centered practices in outpatient polytrauma clinics. Results from the study are being used to guide changes in clinical practice that minimize barriers to family-centered care. Results are also being used to foster those clinical practices that engage patients and family members in the plan of care.

  • Vision loss and visual motor dysfunctions affect a high proportion of Veterans with mild TBI (mTBI). In this study, investigators assembled an expert panel of 16 VA optometrists experienced in providing vision and eye movement examinations to look at what patient history elements needed to be included in an optometric screen for visual dysfunctions, and to determine what elements of a vision exam should be used in screening for mTBI. Results provided an evidence-based vision and eye movement screen that was incorporated into the draft clinical practice guidelines.

1 Department of Defense 2013 TBI Special Report, Department of Defense website.