This year marks 25 years since a congressional mandate created the Defense and Veterans Head Injury Program in response to the first Gulf War and the need to treat service members with traumatic brain injury (TBI). Service members and veterans impacted by TBI rely on the program, known today as the Defense and Veterans Brain Injury Center (DVBIC), to propel TBI clinical care, groundbreaking research and innovative education.
Over its 25 years, DVBIC has reached a number of pivotal milestones in the advancement of TBI care that continue to impact prevention and treatment today. A snapshot of some key moments in DVBIC history:
- Cognitive Rehabilitation for TBI: A Randomized Trial (1992)
One of the first efforts DVBIC undertook revealed why TBI was a principal cause of death and disability in young adults. The goal of the cognitive rehabilitation study was to evaluate rehabilitation effectiveness for TBI patients. At the time, cognitive rehabilitation didn’t get as much attention as other forms of rehabilitation. Service members were randomly assigned to an eight-week hospital program or limited home care program to compare the differences between them and service members who did not receive cognitive rehab. The outcome showed that regardless of whether it was hospital or home care, cognitive rehab helped. The trial brought needed attention to the necessity of care for moderate and severe TBI patients. The full cognitive rehabilitation study is published in the Journal of the American Medical Association.
- Fort Bragg Paratrooper Study (1998)
DVBIC observed changes in the brain activity of U.S. Army paratroopers before and after jumps in the Fort Bragg Paratrooper Study. Professionals collected data on thousands of paratroopers at Fort Bragg, North Carolina. Their goal: to determine the occurrence and performance impact of TBI among Airborne soldiers. The data they compiled over a 10-year period enabled other studies and helped develop useful tools. Among these, the study demonstrated the feasibility and validity of population-based post-deployment TBI screenings. Also, the Automated Neuropsychological Assessments Metrics, used by the Defense Department for pre-deployment baseline cognitive testing and post-TBI cognitive assessment, was beta-tested in this study.
- Military Acute Concussion Evaluation Tool (2006)
The Military Acute Concussion Evaluation, MACE for short, allows front-line providers to quickly measure four key areas — orientation, immediate memory, concentration and memory recall — to diagnose TBI. Providers use MACE to guide treatment recommendations for service members with TBI. The tool has three components: a directed history and symptom check, a neurologic screening exam and a cognitive screening score. MACE is part of the current VA/DoD Clinical Practice Guideline for the Management of Concussion. MACE wallet cards and MACE pocket cards can be ordered online from DVBIC.
- 15-Year Longitudinal Study of TBI (2009)
This congressionally mandated study examines long-term effects and outcomes of TBI among service members and veterans who served in the conflicts in Iraq and Afghanistan, and the impact on their families. The goal is to better document, understand and develop treatments appropriate for the natural course of TBI in service members and veterans.
Multiple smaller studies comprise the longitudinal study. The first, Exploring the Natural History of Traumatic Brain Injury within a Military Cohort looks to improve understanding of TBI by developing a TBI data repository. The second study, Improved Understanding of Medical and Psychological Needs (IMAP) in Veterans and Service Members with Chronic TBI, examines chronic TBI rehabilitation needs and the impact of related physical and mental health conditions in veterans. The third study, Health Related Quality of Life in Caregivers of Service Members with Military Related Traumatic Brain Injurydocuments the long-term effects of caring for a service member or veteran who experienced a TBI after October 2001, with an additional goal of developing a quality-of-life measure to better assess the needs and outcomes unique to military TBI caregivers.
To date, 62 peer-reviewed publications, 112 published abstracts, 134 conference presentations and two congressional reports have been produced from the study.
- Study of Cognitive Rehabilitation Effectiveness (2010)
The Study of Cognitive Rehabilitation Effectiveness assessed the effectiveness of various forms of cognitive rehab for service members and veterans who sustained concussions during the conflicts in Iraq and Afghanistan. It aimed to improve the quality of life for service members with concussions by developing rehabilitation interventions. The study evaluated various rehabilitation methods over a three-year period. DVBIC created a Cognitive Rehabilitation Effectiveness Study manual for researchers and clinicians, available online
- TBI Pathway of Care (2014)
Since 2014, DVBIC has served as the Defense Department’s leading agency for TBI and collaborates with the Military Health System to manage the TBI Pathway of Care. The pathway delivers an all-inclusive approach to coordinating clinical, research, education and prevention related to TBI care. This system incorporates evidence-based clinical practices with constant monitoring of patient outcomes to help deliver quality TBI care. DVBIC provides TBI care, research, and education and training. It also develops strategic plans, standardized care, standardized reporting and faster, more consistent ways to translate research to care.
These are just some of the many accomplishments of DVBIC through the years. Visit the DVBIC website to learn more about its work or about TBI and find valuable resources for coping with the condition.