Warfighter Brain Health (WBH): Late and Long-Term Consequences of Head Impact Exposure and Concussion/Mild Traumatic Brain Injury (mTBI) on Brain Health

The DoD Comprehensive Strategy for Warfighter Brain Health (CSWBH) addresses brain health, brain exposures, to include repetitive head impact exposures, TBI and long-term or late effects, with the goal of optimizing brain health and combating TBI. The DoD’s pursuit of superior lethality, per the National Defense Strategy (2018) hinges on the Warfighter’s optimal neurocognitive abilities, thus detection and management of brain injury at the time it occurs is paramount. One of the objectives of this strategy is to understand the nature and causes of long-term or late effects of single or repetitive head impact exposures and mTBI/concussion. This remains a significant gap that has stymied translatable knowledge or technology to be conveyed for the benefit of the Warfighter. Several gaps in the existing evidence remain related to the extent by which single and repetitive concussions and/or head impact exposures result in static or progressive changes in brain structure or function and performance. Additionally, the need for predictive models to assist in mitigation and prognosis efforts is critical.

The overall objective of the Warfighter Brain Health (WBH) program is to advance both knowledge and technology prototypes (i.e., training, tools, and practice guidelines for assessment, metrics, and interventions) that will reduce or eliminate acute to late and long-term effects from single and repetitive concussion/mTBI. The DoD is seeking Solution Briefs for utilization of an already established and experienced Clinical Research Consortium (CRC) that will follow human subjects who have sustained a single or repeated concussion/mTBI to determine the relationship between concussion/mTBI, head impact exposures and brain health outcomes. The CRC will be expected to interact with a Government Steering Committee with involvement from the USAMRDC and other stakeholders.

The end goal of the program is to deliver translatable processes, knowledge and technology (i.e., training, and practice guidelines for assessment and interventions) to better understand, optimize care for, and treat the immediate, long-term and late effects of repetitive head impact exposure (i.e., jump zones, training activities, shipboard, etc.) and single and repetitive concussions/mTBI in order to maximize WBH. It is expected that outcomes will be transitioned to inform practice guidelines, training and clinical trial endpoints. The research project award recipients were selected from the Offerors who responded to MTEC’s Request for Project Proposals (21-01-WBH).

Characterizing Potential Chronic Brain Health Effects of Concussion and Repetitive Head Impact Exposure: The CARE-SALTOS Integrated (CSI) Study

Project Team: Indiana University

Award Amount: $25.00M (additional cost share = $17.65M)

Project Duration: 62 months

Project Objective: Emerging evidence suggests that concussion/mTBI and head impact exposure (HIE) may result in long-term decrements to brain health and life function, but existing data are confounded by multiple methodological factors. The CARE-SALTOS Integrated (CSI) Study is an integrated military/civilian effort that capitalizes on the previous success of the CSI research team to prospectively evaluate brain health and life function among former military service academy members and student-athletes up to 10 years following their academic or military training/education, as well as a cohort of enlisted personnel at high risk for blast exposure. This project addresses key gaps in brain injury science and directly aligns with the priorities of the Warfighter Brain Health (WBH) initiative and the Defense Health Agency (DHA) TBI-related objectives and will deliver translatable knowledge products to better understand, optimize care for, and treat the long-term effects of concussion/mTBI and HIE to maximize Warfighter brain health.