Military traumatic brain injury: A review of key research requirements

Traumatic brain injuries (TBI) are heterogeneous in terms of their mechanisms, pathology, severity and treatment, with widely varying outcomes. Explosive blast injuries are the leading cause of TBI amongst deployed military personnel, with over sixty percent of blast injuries resulting in a TBI, hence TBIs are referred to as the “signature wound” of modern asymmetric warfare. TBI symptoms are broad-spectrum with long-term physical, cognitive, behavioural and emotional consequences. Military injuries result in unique and clinically challenging pathologies, not typically seen in civilian trauma which further complicate patient diagnosis, classification, treatment and rehabilitation. Improved interventions and use of novel technologies and multidisciplinary teams have the potential to address the concerns regarding the diagnosis, treatment and rehabilitation of TBI military veterans for previously un-survivable conditions. This review is aimed at life scientists and engineers with the intent of identifying key research opportunities. Eight key areas and opportunities have been highlighted, including: severity, classification and diagnosis of TBI with progress requiring meaningful definitions; pathologies and mechanisms of TBI; detection and intervention, protection and prevention; co-morbidities and polytrauma. Areas of particular interest are biomarkers, brain imaging and screening techniques, preferably in a deployed setting; evidenced based rehabilitation strategies and the development of meaningful models, and in particular with regards to blast induced neurotrauma (BINT).