Back to Top Skip to main content

Emerging technology improves ability to see ‘invisible’ wounds

As well as providing high-resolution clinical imaging capabilities, the 3T Magnetic Resonance Imaging (MRI) scanner used at the NICoE provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging (DTI) and echo planar imaging (EPI) sequences. (Photo courtesy of NICoE) As well as providing high-resolution clinical imaging capabilities, the 3T Magnetic Resonance Imaging (MRI) scanner used at the NICoE provides researchers access to cutting-edge image acquisition methods, such as multiband diffusion tensor imaging (DTI) and echo planar imaging (EPI) sequences. (Photo courtesy of NICoE)

Recommended Content:

Traumatic Brain Injury

The active lifestyle of servicemembers can increase the possibility for concussion or mild TBI because recreation often involves vigorous activities or contact sports, and training can include rigorous physical activity. Deployments also can put warfighters in hazardous situations such as near blasts.

Statistics compiled by the Department of Defense show that servicemembers – both deployed and nondeployed – sustained more than 315,000 mild Tramatic Brain injuries, or mTBI, from the year 2000 through the first quarter of 2018. A recent study of brain injuries in the military republished by the National Institutes of Health noted that the absence of external damage to the head can lead servicemembers to believe they should feel fine. But they don’t.

Fortunately, most mTBI sufferers recover fully under the supervision of a health care professional using a protocol such as the Progressive Return to Activity.

For some, however, symptoms may persist, and can include mood changes, headaches, sleeplessness, and trouble concentrating. With the damage seemingly “invisible,” current methods of looking at bone, blood vessels, and soft tissues in the brain often can’t find a physical cause of these lingering problems. These testing methods include magnetic resonance imaging, known as MRI, or computed tomography X-ray, commonly called CT scans. But a special type of MRI called diffusion tensor imaging or DTI, takes a different approach to examining the brain for traumatic injury. This technology, still in its infancy, may one day serve as a powerful tool for understanding concussions at the molecular level.

“Diffusion tensor imaging is really a way of looking at the connections in the brain,” said Dr. Louis French, deputy director for operations at the National Intrepid Center of Excellence, or NICoE, at Walter Reed National Military Medical Center in Bethesda, Maryland. “Rather than focus solely on the structures there, DTI examines the connections and communication between the various parts of the brain.”

DTI works by observing the flow of water molecules along nerve fibers called axons in the brain, looking for signs of disruption, French explained. Those fibers usually direct water to flow through the brain in one direction, along one of many such channels. In the case of TBI, say after a blast concussion, those fibers and pathways can be deformed or distorted and may even be torn or structurally malformed, causing the water that was flowing along one axis to seep out into other spaces, which can be measured through DTI.

French has been using DTI as one of many evaluation tools in a 15-year, congressionally mandated study of servicemembers with mild to severe TBI. He said most have had multiple concussions or multiple exposures to potentially concussive events. “In that population, we’re really interested in the cumulative brain changes associated with those exposures,” he said. In addition to the study group, researchers also have two control groups: individuals with no injuries and individuals with bodily injuries that don’t involve the head or brain.

DTI is helping to increase understanding of TBI as a process, not an event, French said. “The neuro-imaging that we do, including the MRI with diffusion tensor, enables us to look at the relationship of the changes in the brain as the person recovers.”

“This is a way we can point out to people that, yes, we can see here on the computer screen physically the origin of your complaints,” said French, explaining that the data is objective evidence of subjective complaints.

DTI is available at NICoE, but not widely used across the MHS, partly due to some MRI units unable to run the required software. Additionally, not all MTFs have experts able to evaluate the data produced by DTI. French says the technology is constantly being refined and improved upon, but currently it’s so technically challenging and time consuming, it’s not available for regular use.

He said the MHS is at the forefront of TBI research and care, with abilities that are equal to, or better than, any in the civilian sector. “This isn’t just about treating problems but also understanding wellness,” he added. “We are interested in protecting servicemembers across their lifespan. We want to understand what happens to people when they go through the process of training and deployment and then re-acclamation to society, and this is all part of that effort.”

You also may be interested in...

Progressive Return to Activity After Concussion Video

Video
2/25/2021
DHA Seal

The PRA is an evidence-based, easy-to-use approach to help providers return service members with mild TBIs back to duty safely. TBICoE researchers have found that, if medical providers completed a two-hour, in-person training on the use of the PRA, their patients saw an overall reduction in symptoms after one week, one month, and three months, when compared to patients treated by providers who had not received the training.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Provider Resources | TBI Educators | Traumatic Brain Injury | Brain Injury Awareness Month | TBI Resources | TBI Screening

Sleep and TBI

Video
2/8/2021
DHA Seal

Sleep disturbances are common for service members and veterans following a mild TBI, also known as concussion.

Recommended Content:

Traumatic Brain Injury Center of Excellence | TBI Educators | Patient and Family Resources | Provider Resources | Traumatic Brain Injury

TBI Champion Gary Moran

Video
11/17/2020
TBI Champion Gary Moran

SGM Gary D. Moran shares his TBI recovery story, and tips for talking to kids about TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

TBI Champions Roxana Delgado & Victor Medina

Video
11/17/2020
TBI Champions Roxana Delgado & Victor Medina

While he was deployed, retired Army Sgt. 1st Class Victor Medina was in a vehicle that was hit by an explosive device. He sustained a traumatic brain injury (TBI) that severely impaired some of his physical functions and ability to speak. Medina’s wife, Roxana Delgado, continued her pursuit of a Ph.D. in health sciences and became his caregiver. As they adjusted to a life neither one of them had imagined, their marriage became a new kind of partnership.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Patient and Family Resources | A Head for the Future | Traumatic Brain Injury

Find Your Story: TBI Champions

Video
11/16/2020
Find Your Story: TBI Champions

In this video, A Head for the Future’s TBI Champions share their experiences with traumatic brain injury and resources that helped them through recovery. They can help you too.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | A Head for the Future

TBI Champion Micah Norgard

Video
11/16/2020
TBI Champion Micah Norgard

After 12 years as an infantryman, Norgard's biggest battle was recognizing the cumulative effects of multiple TBIs.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | A Head for the Future

TBI Champion Derek Poor

Video
11/16/2020
TBI Champion Derek Poor

While instructing hand-to-hand combat training, U.S. Army Special Forces veteran Derek Poor slammed his head against a wall and sustained a traumatic brain injury (TBI). Seeing stars and unable to shake his persistent, daily headaches, Poor sought help.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

TBI Champion Dalton Mask

Video
11/16/2020
TBI Champion Dalton Mask

Facing a long road to recovery following his TBI, Dalton remained positive and participated in the 2019 Warrior Games.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

Talking TBI: Going Back to School

Video
11/16/2020
Talking TBI: Going Back to School

Marine Corps veteran Chris shares his experience going back to school following his TBI.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

Talking TBI: Talking to Kids

Video
11/16/2020
Talking TBI: Talking to Kids

While on patrol in Iraq, former U.S. Marine Corps Sgt. Maj. Gary Moran was knocked unconscious by an improvised explosive device, resulting in a traumatic brain injury (TBI). Gary and his son discuss how TBI affected their relationship early on and ultimately brought them closer together.

Recommended Content:

Traumatic Brain Injury | Traumatic Brain Injury Center of Excellence | Patient and Family Resources | A Head for the Future

TBI Champion Beth King

Video
11/16/2020
TBI Champion Beth King

Army veteran Beth King was on a routine mission when her helicopter was struck by an RPG, ultimately resulting in a traumatic brain injury (TBI). In this video, Beth shares the impact of her TBI and how she discovered her new passion along the way — recumbent biking.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Traumatic Brain Injury

Talking TBI: Connect with Others

Video
11/16/2020
Talking TBI: Connect with Others

Navy veteran Amanda Burrill and Army veteran Elana Duffy had a few things in common: They both lived in New York City, experienced traumatic brain injuries (TBI) while in service and were coping with the injuries alone. Until they met each other.

Recommended Content:

Traumatic Brain Injury Center of Excellence | A Head for the Future | Patient and Family Resources | Traumatic Brain Injury

MACE 2 Provider Training Video

Video
9/29/2020
MACE 2 Provider Training Video

This video illustrates how to conduct a MACE 2 training event. This video supports the MACE 2 and its training materials created by the Traumatic Brain Injury Center of Excellence.

Recommended Content:

Traumatic Brain Injury Center of Excellence | Traumatic Brain Injury | Provider Resources

Concussion: Know the Symptoms

Video
3/12/2019
Concussion: Know the Symptoms

A racquetball game goes wrong when one player slips and hits his head. He thinks he's OK and his partner isn’t sure what to do about it.

Recommended Content:

Traumatic Brain Injury

Defense and Veterans Brain Injury Center Celebrates 25 Years

Video
3/12/2018
Defense and Veterans Brain Injury Center Celebrates 25 Years

Katherine Helmick, DVBIC acting national director, discusses DVBIC achievements and goals to advance service members' health care. DVBIC honors 25 years of military health care by continued dedication to research and treatment of traumatic brain injury.

Recommended Content:

Traumatic Brain Injury
<< < 1 2 > >> 
Showing results 1 - 15 Page 1 of 2

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing. Download a PDF Reader or learn more about PDFs.