Research Advancing Diagnosis & Treatment of Combat-Related Injuries
Mild Traumatic Brain Injury & Blast Injury
The unique nature of injuries resulting from military deployment creates specific challenges for both Canadian Armed Forces (CAF) personnel and the medical community responsible for providing combat casualty treatment and post-deployment care. Research plays a key role in generating the knowledge the military medical community needs to make advancements in this highly-specialized area of treatment and care.
Mild traumatic brain injury (mTBI) and blast injury are both new areas of concern, as there could be CAF personnel suffering from various degrees of neurotrauma - particularly those who have returned from recent combat operations involving frequent explosive attacks. At this stage of progress, in terms of diagnosis and treatment, there are many more puzzle pieces than there are complete pictures.
Defence Research and Development Canada (DRDC)’s Personnel Research program, in concert with our research partners, is concentrated on reducing knowledge gaps both for mBTI and blast injury so that one day treatment of both can be more complete.
Mild Traumatic Brain Injury Research
Researchers are concerned with the long-term physiological, behavioural and cognitive effects of mTBI. This injury, most commonly known as a concussion, is not a new condition; however there is a lack of diagnostic tools and treatment options available. While mBTI symptoms can be diagnosed, there is no definitive diagnosis of the injury itself and no way to assess its severity. DRDC researchers, in cooperation with partners, are trying to change this by using neuroimaging techniques and identifying biomarkers to determine if a definitive diagnosis can be made for mTBI and PTSD. These conditions often coexist and share some similar, overlapping symptoms.
Research for Results
- Neuroimaging for mTBI & PTSD diagnosis:
Seeking objective solutions to diagnose PTSD and mTBI DRDC, the Canadian Forces Health Services (CFHS) and The Hospital for Sick Children (SickKids) successfully demonstrated the use of magnetoencephalography (MEG), a real-time, non-invasive neuroimaging technique capable of showing when and where processing activity occurs in the brain. Results of pilot MEG trials conducted at SickKids demonstrate for the first time that while outward symptoms can be very similar, brain functioning is very different for PTSD and mTBI. With this finding, DRDC is one step closer to understanding brain functioning in PTSD and mTBI patients and moving further ahead in creating an eventual model for diagnosis. The MEG pilot study’s promising results have caught the attention of researchers with the United States Department of Veterans Affairs who are partnering with DRDC to conduct a more definitive trial involving a larger number of patients, with a wider range of clinical conditions and across multiple hospital locations in Canada and the US.
- Biomarker identification for mTBI & PTSD diagnosis:
DRDC’s research in this area is focused on determining whether or not a specific biomarker or biological network can be identified as objectively predicting who will develop mTBI or PTSD, who will recover from these illnesses, who will respond best to treatments and which treatments will be the most effective. Genetic changes, altered blood levels of specific proteins, and brain abnormalities are all possible biomarkers being studied.
Blast Injury Research Program
Treating brain injuries (neurotrauma) is challenging, but particularly when you aren’t able to rule out the events causing the damage in the first place. CAF personnel are surviving explosive attacks and returning home because of advancements made to protective equipment. However, no one knows for certain if blast exposure does cause neurotrauma; therefore, ruling it out or considering it as part of the diagnosis and treatment of CAF patients is currently impossible. Honing in on the possibility of this type of injury, DRDC researchers are conducting research with various partners to discover if and how blast waves damage the brain. The ability to map areas of the brain most affected by blast would be an important discovery and would help determine what steps to take to prevent or treat blast-induced brain injury.
Assessing Neurotrauma, Mission Impossible?
The first focus of DRDC’s Blast Injury Research Program is to construct a valid model of exposure that can be used for diagnosis and treatment of blast-induced brain injury. Through it researchers will be able to produce meaningful research, with the goal to eventually improve blast protection and treatment for the CAF.
The reality is that no such scientifically-validated model currently exists to accurately assess brain injury caused by a primary blast wave. Creating this standardized model is mission one for DRDC and for representatives from nine other nations, selected to be
members of a NATO research task group which is responsible for developing it to prove and measure the extent of blast injury. During his visit to DRDC’s Suffield Research Centre blast injury facility the Task Group’s Chair, Mike Leggieri, Director of the US Department of Defence Blast Injury Research Program, referred to the DRDC model of creating blast waves as “a successful example to follow.”
Research for Results
- Mapping cellular changes:
Using the blast tubes specially engineered by DRDC, researchers have begun to prove that dramatic cell changes and neuron death occur in the brain after exposure to a primary blast. The most dramatic cell changes appear in the hippocampus, the area responsible for learning and memory, while neuron death occurs across all areas of the brain and looks similar to a brain affected by neurodegenerative disease. Research has also shown that after blast a marked decrease in memory, motor function, balance and sleep quality occurs. This is the first step in understanding the damage that blast waves can cause and is a prerequisite to developing protection and treatment options for the CAF.
- Drug testing:
The similarity in brain cell death between blast injury and neurodegenerative diseases has led researchers at DRDC to partner with the University of British Columbia to test a new drug that has effectively decreased glutamate, a neuron-killing substance, in brains affected by Alzheimer’s disease. The hope is that when this drug is used after blast a similar reduction in neuron death will occur – the results of this trial are anticipated in 2015.
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