Research on Biomarkers in Diagnosing TBI and PTSD

In response to an Army Small Business Technology Transfer Program RFP requiring university collaboration, Empirical Technologies, Inc. (ETI - an engineering firm) and the University of Virginia (UVA), have partnered to develop tools to differentiate between mild TBI and PTSD, using neurobiologically based biomarkers.   This research project, entitled ‘Non-Invasive Assay to Discriminate between Mild TBI and PTSD’, is a multi-center study under the direction of UVA School of Medicine leader in neuropsychology and concussion, Dr. Jeffrey Barth, at the Defense and Veterans Brain Injury Center (DVBIC) - Charlottesville, and involves former DVBIC-Charlottesville Site Director and current Research Coordinator, Dr. Tina Trudel (Lakeview COO and UVA Asst. Clinical Professor of Psychiatry and Neurobehavioral Sciences).  This research is based on the literature on differences between psychological and concussive issues, wherein the measure of visual tracking was evident in the concussion literature (but not for PTSD), as well as the measure of postural stability wherein imbalance was associated with concussion in athletes, but again was not associated with PTSD.

The engineering group at ETI developed two pieces of technology that can be hardened and taken to the battlefield: A pressure plate connected to a laptop computer that measures balance/postural stability, and goggles that serve as an eye tracking headset with an infrared sensor under each eye that tracks movement and is also fed into the laptop computer.  Prototypes have been built that are reliable and can withstand needed military tolerances.  All of the data on visually tracking targets while wearing the goggles and standing on the pressure plate is sent to the laptop.  The plate may be stationary or moving, and the ocular tracking may be stationary, moving or rotational, the latter of which tends to be most problematic for persons with concussion.  The use of infrared technology versus a camera in the goggle application is a significant benefit due to much lower cost, durability and output of less data to compress for storage and analysis.  Thus, the approach to the study as described will utilize a sensorized platform that assesses center-of-mass sway, which has been shown to be a very sensitive tool to assess postural stability, as well as the optical detection system used to measure eye movement based on discrete element infrared limbus tracking.

The current study, which has just recently received multiple IRB approvals, involves comparison of these postural stability and visual tracking biomarkers as measured through the described devices, along with neuropsychological measures and PTSD screening.  This multi-center effort is a collaboration of ETI, UVA, DVBIC Charlottesville, Fort Lee, Hunter Holmes McGuire Veteran’s Administration Medical Center and Virginia Commonwealth University.  The larger aims of this line of research are to investigate a method of quantitative assessment of mild TBI severity; to develop quantitative assessment to ultimately provide support for a decision regarding clearance for return to duty, stay for temporary management or evacuation to a higher care level; and to provide quantitative assessment of recuperation.  In a passing traumatic injury case, this would provide assessment metrics over the course of days until the subject is cleared.  In more severe cases, the assessment metrics would track the physiological cerebral recovery which would drive the selection of the most effective treatment and drug therapies.  At this point, research team training and initial implementation of the research protocol is commencing. 

This excerpt is from a longer article in the Brain Injury Professional Special Issue on Neurotechnology, published by the North American Brain Injury Society (NABIS).  For more information on this publication, please go to www.nabis.org.  For more information on the Defense and Veterans Brain Injury Center (DVBIC), please visit www.dvbic.org

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