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

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.

SPECIFIC BRAIN TRAUMA EVENT(S) COMBAT PTSD SPECIFIC BRAIN TRAUMA EVENT(S) BLAST TBI Vasterling et al. 2010

Overlapping mTBI & PTSD Symptoms Re-experiencing Shame Guilt Headache Sensitivity to Light Memory Deficit Dizziness ++ Depression/ Anxiety Insomnia Irritability/Anger Trouble Concentrating Fatigue Hyperarousal Avoidance 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 Project 1: Associative Learning & Cognition Core A: Administrative Core Project 2: Cognitive Behavioral Therapy Project 3: Structural and Functional Neuroimaging Core B: Human Characterization Core Core C: Database Management & Informatics Core Year 1 Cognitive Rehabilitation of Attention Year 2 Experimental Treatment of Memory and Executive Function Impairment Year 3 fMRI Predictors of CPT-C Outcomes Year 4 Integrated Treatment for Veterans with Comorbid Pain, PTSD, and PPCS Year 5 To be determined Neuro-Imaging Personality Neuropsychology Medical Bioinformatics Statistics We retain the basic structure. Go through the structure

Preliminary Findings

TRACTS Participants Have Complex TBI Histories

Multiple Blast Exposure is common in the TRACTS Sample

Uncomplicated mTBI Rare in the TRACTS Sample

TRACTS Scientists and Professional Staff 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 Mike Esterman Catherine Fortier Alex Kenna Elizabeth Lertiz John Otis Ann Rasmusson David Salat Jennifer Vasterling Mieke Verfaellie Marge Ahlquist Colleen Barber Rachael Dayton Vitaly Dobomyslin Patrick Kilduff Lindsay Morra Wally Musto Jon Venne David Zade