The National Research Action Plan for Traumatic Brain Injuries

On August 14th, a group of experts representing both the Department of Defense and the Department of Veterans Affairs met at Fort Lauderdale. The topic of the meeting was to discuss future steps and plans for continuing mental health research at the Military Health System Research Symposium. The list of participants in the discussion is long and distinguished, including a large number of Directors. Dr. Terry Rauch (Director of Medical research at Health Affairs), Dr. Timothy O’Leary (Acting Chief Officer of the VA Office of Research and Development), Dr. Robert Ursano (Director of the Center for the Study of Traumatic Stress at the Uniformed Services University), as well as Colonel Dallas Hack and Katherine Helmick were all attendees at the discussion.


The discussions centered on what is called the “National Research Action Plan”. The NRAP, which was signed into law last year, paves the way for progress in researching many brain-related injuries and ailments that often afflict veterans as they return home from combat situations. The goal of NRAP is to increase access to and quality of mental health care for veterans, servicemembers, and military families. NRAP outlines ways in which the Department of Defense and the Department of Veterans Affairs will collaborate, work with, and share resources and research with the U.S. Department of Health and Human Services and the Department of Education. The first project they will focus on is the DOD-CDC-Brain Trauma Foundation mild TBI/concussion classification project.


The purpose of the classification project is to definitively determine what is known and what is unknown about mild TBI (Traumatic Brain Injuries) and what unknown information needs to be addressed and researched most urgently. Excitement and passion for the project is unanimous among the committee members, and all agree that it is a worthy cause that they are pursuing. Colonel Hack said that NRAP, “…creates a common roadwork for medical leaders to follow…” Dr. Terry Rauch said that NRAP is a representation of the dedication that many people from multiple departments feel towards filling in gaps in research and care.


While war and combat situations are frequently credited with being the cause of most traumatic brain injuries, of the 250,000 reported cases of TBI from returning soldiers between 2000 and 2012, only 20% were combat-related. The remaining 80% were from non-combat related situations, which indicates that even when the nation is not at war, research on TBI’s will be highly valuable.


The National Research Action Plan doesn’t just deal with TBI’s, it also deals with other ailments that often occur alongside TBI’s, such as Post Traumatic Stress Disorder, depression, suicidal behaviors, and drug abuse. Often, abuse of prescription medication is a complicating factor when trying to treat all of those conditions. The NRAP aims at researching more into these issues and discovering better ways to help patients overcome these obstacles.


As part of the NRAP, two consortia are being organized: The Consortium to Alleviate PTSD and the Chronic Effects of Neurotrauma Consortium. As pieces of the first phase of the NRAP, the two consortia will both be created within the next six months and cover much of the preliminary research on PTSD and the chronic effects of neurotrauma. The University of Texas Health Science Center, San Antonio Military Medical Center, and the Boston VA Medical Center are working together on the Consortium to Alleviate PTSD, while Virginia Commonwealth University, the Uniformed Services University of the Health Sciences, and the Richmond VA Medical Center are collaborating on the Chronic Effects of Neurotrauma Consortium.


The first twelve months of the NRAP is primarily focused on developing a procedure and system to diagnose TBI and on standardizing the way that data is recorded by all of the participating organizations. By using standardized data, they will be able to fill in many of the gaps in their research by using the data that others have gathered. The eventual plan leads to analyzing the neural long-term effects of PTSD and TBI, and the effect on brain chemistry and circuitry that treatment for those things has in the long term. While the NRAP only lays out the next five years of steps, those involved feel that this is a life-long process.


“The plan lays out the next five years, but this is really a lifelong commitment,” O’Leary said. “That is the promise we make to our warfighters.”

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