October 7, 2021
Henry Mahncke

The war is over now. Our troops have come home, many after years of service across multiple tours of duty. And as they return, their next phase of service begins — to their families, where they are parents to children and caregivers to parents, and to their communities, where they will return to school or launch new careers.

But for far too many, the battle continues. Traumatic brain injuries (TBIs) — considered to be the signature injury of the Iraq and Afghanistan wars — were sustained by more than 430,000 U.S. service members. The most common type of TBI is the somewhat misleadingly named “mild” TBI (mTBI, or concussion), affecting more than 82% of service members diagnosed with TBIs.

Many were able to recover from those injuries, but thousands are plagued by persistent cognitive issues affecting speed, attention and memory — years after their injury — that make it challenging to return to work, school and family roles. People with a history of TBI are also at higher risk for complications from other conditions, notably pre-dementia and dementia.

That’s a burden on those service members and their families — and it’s also a burden on our nation because the talents and experience of these citizens aren’t being used to their fullest potential.

The Department of Defense recognized this problem more than 10 years ago and called for academic and industry researchers to find new kinds of treatments for this new kind of war injury. A number of research groups answered the call. At Posit Science, where I am a scientist and the CEO, we responded with a team including leading clinicians from military hospitals and VA medical centers from around the country with a proposal to put a new kind of computerized brain training to the test.

We recognized we had to solve two problems to help service members with TBI.

First, the brain training program needed to work. Fortunately, we built a brain training program, BrainHQ, shown to improve cognitive function in older adults through multiple studies funded by the National Institutes of Health — we just needed to adapt it for use by younger service members. The brain training exercises in BrainHQ work differently than traditional cognitive training because they are designed to improve the fundamentals of information processing in the brain using brain plasticity — the ability of the brain to rewire itself through learning and experience.

Second, the brain training program needed to reach people where they were. Many active duty service members and veterans don’t have the ability to come into a clinic several times a week for several months for in-person treatments — they’re about to be deployed, or they’re going back to school or work, or they’re located in areas outside of big cities with top clinics. Computerized brain training can be helpful here: Because it’s delivered over the internet, it can reach people in their own homes on their own schedules — wherever they are and whenever they have time.

In the BRAVE Study, which was published this summer in the journal Brain, five U.S. military and veterans hospitals enrolled 83 patients diagnosed with a history of cognitive impairment and mTBI in a double-blind randomized controlled trial. The average participant in the study had experienced persistent cognitive issues for more than seven years before this intervention.

The BRAVE study pitted the intervention of BrainHQ plasticity-based exercises against attention-demanding video games, used as an active control. The researchers found significant improvements in overall cognition among those who used BrainHQ compared to the video game control. While the intervention did not make each patient a genius, it did result in an average gain equal to about 24 percentile points (like moving from the 50th to the 74th percentile). This was the first scalable intervention of any kind to achieve a significant gain in a gold standard study of mTBI.

Those results were confirmed and extended in a second study from NYU, which was recently published in the journal NeuroRehabilitation. That study was of 48 civilians with a mix of mild, moderate and severe TBIs. These researchers found a significant gain in an objective measure of overall cognition in patients using BrainHQ. They also used a self-rated assessment of cognitive function, which showed that the patients noticed a significant improvement in their own cognitive health.

We weren’t the only ones to show success. Several other academic and military research groups using cognitive compensation techniques delivered in person by a trained clinician (notably SMART training, developed at the Center for Brain Health at UT Dallas, and CogSMART training, developed at UCSD and the VA San Diego Healthcare System, showed good results.

But right now, much of this science is sitting on the shelf. Congress and the Department of Defense have spent hundreds of millions of dollars on basic science and clinical trials for TBI — but when I visit military hospitals and VA medical centers, I find dedicated health care providers who are committed to helping people but lacking the staff, space, technology or other resources to put the results of research into practice. We need a concerted effort from the Department of Defense and the Veterans Affairs Administration to move this proven science out of the lab and into the world to help people in need.

As the wars abroad end, we cannot forget our obligation to ensure that our nation’s warriors benefit from the research that’s been done on their behalf. We need to unleash the discoveries of that research so that they — and our entire nation — can benefit from everything they have to offer.