Department of Veterans Affairs Rehabilitation Research & Development Service Translational Research Center for Traumatic Brain Injury and Stress Disorders [TRACTS] A Rehabilitation Research and Development Center of Excellence VA Boston Healthcare System Melissa Amick, Investigator Regina McGlinchey, PhD, Director William Milberg, PhD, Co-Director

Prevalence and Incidence of TBI

• • • • 1.4 million TBI’s in the United States per year 80% mild, 10% moderate, 10% severe 50,000 fatalities annually 5.3 million Americans - 2% of the US population - live with disabilities resulting from TBI

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Why is there an epidemic of TBI in OEF/OIF?

Improved armor has made combatants more likely to survive injuries that would have been fatal in previous wars.

• Improved field treatment and rapid transport to state-of the-art medical facilities.

• 90% survival of wounded who have been transported to these facilities.

• Weapons have changed: IED are the primary weapon. DOD reports that 73 % of all military casualties are caused by explosive weaponry.

• Blasts can cause concussion or mild TBI.

COMBAT TBI SPECIFIC BRAIN TRAUMA EVENT(S)

BLAST

PTSD Vasterling et al. 2010

Overlapping mTBI & PTSD Symptoms

PTSD •Re experiencing •Shame •Guilt ++ •Depression/ Anxiety •Insomnia •Irritability/Anger •Trouble Concentrating •Fatigue •Hyperarousal •Avoidance mTBI •Headache •Sensitivity to Light •Memory Deficit •Dizziness Stein & McAllister (2009)

Mission Statement

The mission of the Boston Translational Research Center for TBI and Stress Disorders (TRACTS) is to understand the modifying impact of traumatic brain injury on the effects of stress-related emotional disorders on brain structure and function so that we may maximize cognitive and behavioral recovery through the development of informed therapeutic techniques.

Translational Research Center for TBI and Stress Disorders Organizational Chart

Core A: Administrative Core Neuro-Imaging Personality Neuropsychology Medical Core B: Human Characterization Core Core C: Database Management & Informatics Core Bioinformatics Statistics Associative Learning Year 1 & Cognition Cognitive Project 1: Rehabilitation of Attention Year 2 Experimental Treatment of Memory and Executive Function Impairment Project 2: Cognitive Behavioral Therapy Year 3 fMRI Predictors of CPT-C Outcomes Year 4 Integrated Treatment for Veterans with Comorbid Pain, PTSD, and PPCS Project 3: Structural and Functional Neuroimaging Year 5 To be determined

Preliminary Findings

TRACTS Participants Have Complex TBI Histories

Multiple Blast Exposure is common in the TRACTS Sample

Uncomplicated mTBI Rare in the TRACTS Sample

Thanks to: The Department of Veterans Affairs Rehabilitation Research & Development Service TRACTS Scientists and Professional Staff Regina McGlinchey, Director William Milberg, Co-Director Melissa Amick Marge Ahlquist Mike Esterman Colleen Barber Catherine Fortier Alex Kenna Elizabeth Lertiz John Otis Ann Rasmusson Rachael Dayton Vitaly Dobomyslin Patrick Kilduff Lindsay Morra David Salat Wally Musto Jennifer Vasterling Jon Venne Mieke Verfaellie David Zade