Mild traumatic brain injury in translation

Abstract

This Introduction to a Special Issue on Mild Traumatic Brain Injury (mTBI) highlights the methodological challenges in outcome studies and clinical trials involving patients who sustain mTBI. Recent advances in brain imaging and portable, computerized cognitive tasks have contributed to protocols that are sensitive to the effects of mTBI and efficient in time for completion. Investigation of civilian mTBI has been extended to single and repeated injuries in athletes and blast-related mTBI in service members and veterans. Despite differences in mechanism of injury, there is evidence for similar effects of acceleration-deceleration and blast mechanisms of mTBI on cognition. Investigation of repetitive mTBI suggests that the effects may be cumulative and that repeated mTBI and repeated subconcussive head trauma may lead to neurodegenerative conditions. Although animal models of mTBI using cortical impact and fluid percussion injury in rodents have been able to reproduce some of the cognitive deficits frequently exhibited by patients after mTBI, modeling post-concussion symptoms is difficult. Recent use of closed head and blast injury animal models may more closely approximate clinical mTBI. Translation of interventions that are developed in animal models to patients with mTBI is a priority for the research agenda. This Special Issue on mTBI integrates basic neuroscience studies using animal models with studies of human mTBI, including the cognitive sequelae, persisting symptoms, brain imaging, and host factors that facilitate recovery.

FIG. 1.

Conceptual model of mTBI in humans, including pre-injury host factors, moderating effects of environment, injury mechanism and number of injuries, associated trauma exposure, and concomitant injuries. Co-morbid conditions exacerbate the effects of mTBI, whereas a supportive post-injury environment and intervention may mitigate the effects of mTBI. Host factors, including age, genotype, cognitive and brain reserve, may also moderate the effects of mTBI. Adapted from a figure provided by Randall Scheibel, PhD, and Elisabeth Wilde, PhD.