RICHMOND, Va. — A $50-million research study spearheaded by Virginia Commonwealth University (VCU) started on Tuesday that will look at the long-term impacts of mild traumatic brain injuries (mTBIs) on active duty military and veterans and innovative ways of treating them.
The research is being funded by a grant by the Department of Defense (DoD) and Veterans Affairs (VA) and will be done by a variety of universities, Veterans Health Administrations hospitals, and the military. Together they make up the Long-term Impact of Military-relevant Brain Injury Consortium (LIMBIC).
The program’s principal investigator Dr. David X. Cifu, the associate dean for Innovation and Systems Integration for VCU School of Medicine and the senior TBI specialist for the U.S. Department of Veterans Affairs, said this five-year program builds off a previous five-year, $62-million program, the Chronic Effects of Neurotrauma (CENC), which was also led by him and VCU.
Dr. Cifu said CENC eventually led to two major research studies. One was an electronic database of the medical records of 2 million veterans.
“So we were able to get get a feel of how they were doing, what kind of healthcare they were getting,” added Dr. Cifu. He said from that data they were able to identify that military service members and veterans who suffered from traumatic brain injuries (TBIs), specifically concussions, were at an elevated risk of long-term effects. “Those effects include dementia, Parkinson’s, suicide risk, chronic pain, opioid use.”
Dr. Cifu said the other major study from CENC was what is called a prospective cohort. Researchers compiled a group of 1,700 service members and veterans who will be tracked for the rest of their lives and compare those with and without TBIs.
Dr. David X. Cifu
Joe Montanari is a part of that cohort and also works for the research program as a coordinator for the other participants.
Montanari served for ten years in the U.S. Army, suffered two mild TBIs while in Iraq, and was eventually medically discharged. He said he still feels these effects of those TBIs.
“Imbalances, constant headaches all the time,” said Montanari. “Just something isn’t really right, from what I’m used to before I went out to combat.”
“For my brothers and sisters in the future, if they do sustain a mild TBI in combat that they would have better treatment, better recovery, faster recovery times, compared to what we’ve gone through before,” said Montanari when asked what his hopes for the research program are.
Dr. Cifu said those two major CENC studies will be carried over to the LIMBIC program, with more participants being added to the prospective cohort.
“Currently 1,700 unique service members who were all in Iraq and Afghanistan. 80% had concussions, 20% had none,” said Dr. Cifu. “We’re going to be adding at least another 1,300 to over 2,500 to that group. So, it will be at least 3,000. We’re hoping as high as 5,000 people that are followed annually for as long as there is funding, hopefully for life.”
Dr. Cifu said CENC/LIMBIC has been and while continue to look at what the driving factors are that lead to the good versus bad outcomes and asking how can they affect those drivers.
“Maybe that’s been unhealthy diet. Maybe that’s not getting good healthcare. Maybe that’s having a mental health disorder on top of concussion, so that you need to better treat, or more intensely treat that,” he said. “Or are there even innovative treatments that we’re not doing now. Because, right now we’re trying to encourage wellness and healthy lifestyle. We’re trying to encourage access to healthcare in the VA system or outside of it. We’re trying to encourage and are pushing good mental health care and good primary care.”
Dr. Cifu said with LIMBIC, researchers will be looking at new, innovative ways to treat those suffering from TBIs that have not gotten relief from current treatment methods. He added that number amounted to about a third of the participants in the initial prospective cohort of 1,700.
“Really begin to shape those treatment interventions. Because, service members, veterans no longer just want to say that there are papers being written about us or that you’re helping, in general. They want treatments,” said Dr. Cifu. “And that’s what this five-year cycle is about. Identifying the population that will benefit from these new, innovative, novel treatments and then perfecting these things.”
Dr. Cifu said they have three proposals already underway, with two more under development. One proposal is a specific type of wellness program for people in the high-risk group.
“It means not just saying eat healthy and exercise, but it means giving them a specific type of diet that’s focused on brain-health, heart-health, et cetera. As well as a specific activity or exercise program…that is focused on elevating the brain’s performance,” explained Dr. Cifu, adding that group would be compared with a group that eats the regular American diet and exercises the regular way. “Why did we choose that? There are large studies that show that that works for dementia.”
Another proposal is heart rate variability or syncing your breathing and heart rate. Dr. Cifu said it is well-known and practiced in the sports and high-performance field, like dancing.
“You teach them to sync their heart rate and their breathing, particularly at night during sleep and it actually helps the brain to restore its performance,” said Dr. Cifu. “There’s some early research that says it actually cleans out some of these negative proteins, or the waster products, that are called tau that are causing this dementia of brain injury, a tauopathy.”
Dr. Cifu said a third proposal will be using immersive virtual reality. He said VCU has two virtual reality labs and there is a third at the Hunter Holmes McGuire VA Medical Center.
“And those experiences can be something like recreating a military environment if you’re trying to treat PTSD or anxiety related to going back to the military,” explained Dr. Cifu. “They can be physical activity. We’ve got one for dodgeball and volleyball, we’ve one for fishing. Where, essentially, you get people who aren’t physical active or think that can’t be, you get them activated by actually moving in space in an immersive environment. Whereas if they went to the gym, they would be in pain.”
Dr. Cifu finished by saying that the benefit of LIMBIC is that it will bring together a nationwide group of experts with decades of experience to help service members and veterans suffering from TBIs and then that research can be transitioned to civilians who have also suffered a TBI.
“The idea is to use the best of the best, bring them all together, which we’ve done now. And then create programs, interventions that can help all Americans,” said Dr. Cifu.
