Origins of Brain Injury Center of Excellence Revealed at Science Café

By Lauren Bigge
NMHM Public Affairs Coordinator

Studying the origins of the government's efforts to centralize research and education about traumatic brain injuries affecting military service members helps reveal the level of concern the military has about prevention, diagnosis, and treatment of brain injuries since the mid-20th century, according to contract historian Michael Doidge of the Department of Defense (DoD) Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury. Doidge shared the story of how DoD formed the modern brain injury center of excellence at a Medical Museum Science Café on March 28, at the National Museum of Health and Medicine. NMHM is a Department of Defense museum in Silver Spring, Md.

Doidge started his program by recounting the background of neurologist and Korean War veteran William Caveness. Caveness pioneered traumatic brain injury (TBI) research when he conducted a comparative study of head injuries sustained in World War I, World War II and the Korean War. "He created a registry for his longitudinal study," Doidge explained. That registry, an informational database, was one of the DoD's first important steps in TBI patient care. The need for study and treatment became crucial over time, as 20th century warfare resulted in a dramatic increase in the number of TBI cases.

In 1953, while Caveness was on active duty with the U.S. Navy in Japan, he conducted the government's first longitudinal study of head trauma for the Navy's Bureau of Medicine and Surgery from data recorded in his investigation of 341 Korean War head traumas in 1951 and 1952. Caveness called it the Combat Head Injury Project, and published its results in 1954, concluding that more than 80 percent of head wound survivors returned to normalcy.

Caveness joined the Head Injury Research Project when it was established by the National Institutes of Health in 1965, and then he and fellow researchers worked with the U.S. Army Corps of Engineers to develop a new helmet. In June 1967, he proposed "a definitive study of 1,200 veterans injured in the Korean campaign," which included neurological concerns. In the same proposal, he mentioned a prospective Vietnam War head injury study, with the idea that the NIH would maintain an active registry of the acute data.

In 1974, while Caveness was working at the NIH, he designed a Vietnam head injury registry, which gathered information from 12,021 veterans who sustained head trauma from 1967 to 1970. During his time at NIH, he and other leading neurologists met at professional conferences and discussed ideas for the future. Caveness was interested in how public health and TBI care could work collaboratively, Doidge explained.

"Centers should be established for the study of brains of persons who have survived head injuries," Doidge read, quoting Caveness. "Unique features of combat injuries can furnish information not obtainable in any other way." A federal government information and analysis center "would collect and disseminate information to permit neurologists to maintain the latest standards of care."

"It is recommended, therefore, that consideration be given to the establishment of several centers devoted to head injury investigation," Doidge quoted. Caveness and colleagues had described the Brain Injury Center of Excellence, which would be established decades later – after another pioneer got involved.

Army colonel Andres Salazar, a neurologist, championed the cause in the mid-1980s, after Caveness' death in 1981. As director of the Vietnam Head Injury Study, he wanted to combine registry data with the latest therapies and drug trials so patients with penetrating head wounds would benefit quickly, and with minimal tissue loss, in the clinical practice setting. In 1986, he founded the Army Penetrating Head Injury Project. Systematic care for brain injuries did not yet exist within the DoD or the Department of Veterans Affairs (VA) hospitals, despite some 10,000 peacetime TBI cases that had occurred by the late 1980s.

In 1992, after the Persian Gulf War, Congress allocated $3.2 million to create the Defense and Veterans Head Injury Program. "The program recognized that head trauma's effects may last well beyond a service member's end date of their terms of service," Doidge said.

The Defense and Veterans Brain Injury Center, founded in 2002, expanded the role of the Military Health System beyond research and clinical care, to include an educational component. Since 2007, all VA healthcare facilities have screened all veterans of Operations Enduring Freedom and Iraqi Freedom for potential TBI cases. In 2012, the DoD issued a directive which standardized terminology, systemized medical management, and provided procedures for the management of TBI in deployed settings. The Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, now comprised of DVBIC, the Deployment Health Clinical Center and the National Center for Telehealth and Technology, inform policy and advance the standards of care.

"Upon the establishment of DVBIC in 2002, Caveness and Salazar's vision for a federal traumatic brain center of excellence came into being," Doidge concluded.

Doidge's lecture on the origins of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury culminated Traumatic Brain Injury Awareness Month in the DoD. Earlier in March, NMHM had held its 18th annual Brain Awareness Week program, where middle-school students interact with brain sciences experts as part of a campaign to inspire an interest in the field.

NMHM's Medical Museum Science Cafes are a regular series of informal talks that connect the mission of the Department of Defense museum with the public. NMHM was founded as the Army Medical Museum in 1862 and moved to its current location in Silver Spring, Maryland, in 2012. NMHM is an element of the Defense Health Agency. For more information on upcoming events, please call 301-319-3303 or visit


Caption: Michael Doidge, contract historian for the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury, speaks at the March 28, 2017 Medical Museum Science Café at the National Museum of Health and Medicine in Silver Spring, Md. Doidge's topic was "Learning As We Treat: Building the Department of Defense's Traumatic Brain Injury Center of Excellence."

(National Museum of Health and Medicine photo by Matthew Breitbart / Released)