Editorial: Innovations in the assessment and treatment of TBI and co-occurring conditions in military connected populations

Treatment for the consequences of head injuries dates to the ;me of Hippocrates (Hippocrates, 1928/400 B.C.E.), when the prac;ce of trephina;on of the skull was likely considered an innova;ve treatment. Ganz (2013) observes that the evolu;on of head injury treatment did not occur un;l the 1700s, when the brain was recognized as the source of symptoms a_er injury, leading to improvements in neurosurgical interven;ons. In the United States, engagement in wars from the Civil War to recent conflicts has prompted the advancement of assessment and rehabilita;on strategies (Cifu et al., 2013), which is the core theme of this special topic. This research topic highlights innova;ons and new developments in the assessment, treatment, and neurorehabilita;on of military service members and veterans with trauma;c brain injury (TBI) and common co-occurring disorders. The goal is to s;mulate discussion and further research into effec;ve means of enhancing the quality of life and healthcare outcomes in military-connected popula;ons. Our special topics issue represents ar;cles in the areas of family wellness, biomarkers, interven;ons, and crea;ve arts therapy.While rehabilita;on efforts following TBI have historically centered around interven;ons focused on the pa;ent, increasing aOen;on has shi_ed to include research into the impact of social support and family func;oning on long-term rehabilita;on outcomes for service members following injury. This shi_ in focus is highlighted within this special topic through a set of manuscripts (hOps://www.fron;ersin.org/journals/healthservices/ar;cles/10.3389/frhs.2025.1575781/full) describing the work of the Caregiver and Family Member Study of the United States Defense and Veterans Brain Injury Center-Trauma;c Brain Injury Center of Excellence (DVBIC-TBICoE) 15-Year Longitudinal TBI Study. Building upon their previous work, Brickell and colleagues (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1475098/full) provide evidence that following TBI, service members living in unhealthy family environments report worse health-related quality of life outcomes compared to those living in healthy family environments. Furthermore, using a dyadic approach (hOps://www.fron;ersin.org/journals/psychiatry/ar;cles/10.3389/fpsyt.2025.1465801/full) they show that both service members and in;mate partners who are dissa;sfied in their rela;onship report worse health outcomes compared to their sa;sfied counterparts. Finally, they describe their work to translate their research findings into a clinical Family Wellness Program that is in the ini;al stages of implementa;on at the Na;onal Intrepid Center of Excellence and planned expansion across the Defense Intrepid Network for TBI and Brain Health. This work paves the way for "[f]amily wellness to become a long-term component of DoD TBI treatment programs, promo;ng a holis;c, family-centered interdisciplinary model of care that supports service member brain health, return to duty following a TBI, and the development of healthy, resilient, and mission-ready military families." (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1569003/full), olfactory iden;fica;on performance was hypothesized to dis;nguish the effects of TBI from posOrauma;c stress disorder (PTSD) in post-deployed service members and veterans. Using the University of Pennsylvania Smell Iden;fica;on Test, they found that individuals with a history of moderate/severe TBI showed reduced olfactory abili;es. In contrast, PTSD symptoms and symptom clusters did not meaningfully relate to olfactory performance. Overall, the study suggests that reduced smell iden;fica;on is linked to TBI but not PTSD, indica;ng poten;al clinical u;lity for assessing TBI-related impairment.There con;nues to be a great need for cost-effec;ve interven;on op;ons for the treatment of TBI and co-occurring condi;ons in military-connected popula;ons. This issue includes several novel approaches in varying degrees of development. Fann et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1594748/full) describe an analysis of a telehealth interven;on that was built on a problem-solving framework and used brief modules tailored to target specific common co-occurring condi;ons among ac;ve-duty service members with a history of mild TBI. This approach was found to be feasible and acceptable to service members while being effec;ve in decreasing symptoms. Specifically, they report that the overall number of significant comorbidi;es and symptoms of PTSD, depression, anxiety, and sleep were significantly improved from baseline to 6 months, compared to an educa;on control. While encouraging, improvements were not sustained at 12 months, sugges;ng that maintenance strategies need to be further developed and tested. In a series of retrospec;ve chart reviews, Frueh et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1495034/full) report that alpha-guided repe;;ve transcranial magne;c s;mula;on (alpha-rTMS) was beneficial and well-tolerated in reducing postconcussive and PTSD symptoms in special operators with comorbid TBI and PTSD.It is well-documented that treatment effec;veness and adherence with symptom repor;ng are common challenges among service members and veterans with TBI. These issues are par;cularly problema;c in the ac;ve-duty senng, where return to duty is a priority. Mon; et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1564657/full) showed that microinterac;on ecological momentary assessment (mEMA) to collect symptom and treatment engagement informa;on delivered via smartwatch is feasible and acceptable among service members with a history of TBI, including those undergoing cogni;ve rehabilita;on for cogni;ve impairment. In a randomized controlled trial comparing a novel advanced reasoning training interven;on (SMART) to a tradi;onal cogni;ve rehabilita;on program in service members with mild TBI, Darr et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1541894/full) found that SMART was similarly effec;ve and more cost-and ;me-efficient in reducing cogni;ve deficits and postconcussive symptoms. By using meta-cogni;ve strategies that focus on advanced reasoning skills, SMART offers an alterna;ve to tradi;onal compensatory-based approaches. Dieterich-Hartwell et al.'s (hOps://www.fron;ersin.org/journals/psychiatry/ar;cles/10.3389/fpsyt.2025.1568876/full) detailed case report in this issue highlights the benefit and poten;al rapid improvement in symptoms from an intensive, tailored, outpa;ent interdisciplinary team approach delivered to pa;ents with TBI and a complex constella;on of comorbidi;es.The field of crea;ve arts therapies is emerging as a poten;ally effec;ve interven;on in military-connected popula;ons with TBI and co-occurring condi;ons. These therapies are generally well-accepted by pa;ents with a favorable safety profile, thus being a good fit for this popula;on with cogni;ve and behavioral health co-occurring symptoms.(hOps://www.fron;ersin.org/journals/psychiatry/ar;cles/10.3389/fpsyt.2025.1512565/full) present a retrospec;ve case study showing that culturally informed art therapy helped an African American female combat veteran with mild TBI and PTSD express emo;ons, communicate needs, and explore cultural iden;ty through thema;c analysis and standardized emo;on-regula;on measures. Introduced by Vetro-Kalseth et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1642056/full), the Auditory Cogni;on Lab is a collabora;ve music therapy and speech-language pathology program designed for military-connected individuals with TBI, demonstra;ng preliminary improvements in auditory processing, cogni;on, language, aOen;on, and self-efficacy, while outlining a framework for future feasibility research. Story et al. (hOps://www.fron;ersin.org/journals/neurology/ar;cles/10.3389/fneur.2025.1613220/full) examine veterans' experiences in the Feasibility and Acceptability of Music Imagery and Listening Interven;ons for Analgesia (FAMILIA) project, a telehealth-delivered music-listening and music imagery interven;on for chronic pain, finding that par;cipants viewed both approaches as acceptable, mo;va;ng, and beneficial for managing pain and psychological symptoms despite some logis;cal challenges. Finally, Gooding et al. (hOps://www.fron;ersin.org/journals/psychiatry/ar;cles/10.3389/fpsyt.2025.1581291/full) evaluate a community-based music therapy program delivered in suppor;ve housing for veterans experiencing homelessness, TBI, and co-occurring condi;ons. Their findings iden;fy preferred music styles, common interven;on strategies, and themes of self-expression, rapport, and group cohesion, with results indica;ng that onsite, collabora;ve music programming can foster trust, connec;on, and improved well-being among this marginalized popula;on.Many promising avenues for evalua;ng and trea;ng individuals with TBI and cooccurring condi;ons such as PTSD have yet to be fully explored. Emerging assessment technologies are likely to integrate self-report, clinician ra;ngs, physiological monitoring, and validated neuroimaging and blood biomarkers to create a more complete and dynamic picture of military service members and veterans with complex post-TBI presenta;ons. Developing this holis;c, data-rich understanding of each pa;ent will help bridge the gap between assessment and targeted interven;on, advancing us toward truly personalized and precision-based care.Military service is associated with addi;onal occupa;onal risk factors that impact both short-and long-term health outcomes, such as repe;;ve low-level blast exposure, extreme psychological and physiological stress and trauma, chemical exposures, disrupted sleep paOerns, as well as the impacts of training and deployment cycles on social rela;onships. The recently introduced concept of the exposome (see Vineis, et al., 2020), which is used to describe how internal and external environmental exposures experienced throughout life impact health, is especially relevant to this popula;on and the conceptualiza;on of TBI as a chronic health condi;on (Wilson et al., 2017). Therefore, future research in this area requires an integrated approach to incorporate the individual and combined impacts of TBI and military-specific occupa;onal exposures in the development and evalua;on of targeted interven;ons.A forward-looking research agenda for military service members and veterans must extend beyond improving proximal clinical outcomes alone. To be truly impactful, innovative assessment and treatment strategies should explicitly connect near-term clinical gains to the distal outcomes that matter most for each population. For active-duty service members, this means designing and evaluating interventions that not only reduce symptoms but also strengthen resilience and military readiness. For veterans, research must link clinical improvements to meaningful participation in everyday activities and life roles, as articulated within the International Classification of Functioning (ICF). By anchoring proximal outcomes to these longer-term, population-specific goals, future research can better support recovery, reintegration, and sustained well-being.