A ‘huge leap forward’ for brain injury care in first responders

Consensus reached on approaches to recognition, recovery, return to duty

Ohio State University

Facebook

XLinkedInWeChat
WhatsAppEmail

COLUMBUS, Ohio – Over 50 experts – clinicians, researchers, policymakers, first responders and representatives from agencies that employ and advocate for them – have reached consensus on the first-ever recommendations for the recognition, diagnosis and management of traumatic brain injury in first responders.

Publishing today (Oct. 16, 2026) in The Journal of Head Trauma Rehabilitation, the 52 authors agreed to 28 recommendations designed to help first responders, healthcare professionals and agencies work toward five primary goals: timely recognition of traumatic brain injury (TBI), safe recovery, operational readiness, reduced stigma and first responder-centered care.

Researchers and clinicians at The Ohio State University assembled the team that developed the guidelines, which apply to law enforcement officers, corrections personnel, firefighters and emergency medical technicians (EMTs) – a group of professionals at high risk for violent interactions, falls and car crashes working in a demanding culture that makes it tough to seek help.

While addressing injury prevention, treatment and return to duty, the recommendations also recognize that better outcomes will require education, supportive reporting practices and organizational cultures that enable first responders to identify injuries and access appropriate care. The authors wrote in the paper that management of traumatic brain injuries in first responders “must shift from an individual burden to an organizational responsibility.”

“The first step is recognizing that TBI is a problem in first responders. I think everybody thinks of it as a sports problem, but there are a lot of other populations that TBI impacts, and, clearly, first responders is one of them,” said lead author Jaclyn Caccese, associate professor in the School of Health and Rehabilitation Sciences at Ohio State.

“We don’t have to start from scratch. There is a lot we can learn from sports and the military, but those approaches have to be adapted with first responders to reflect the realities of their work. That partnership is really important if we want the recommendations to be practical, trusted and ultimately useful.”

The authors convened at Ohio State last spring to pursue consensus on protocols surrounding six frameworks that they had been discussing in smaller groups for months before they met.

• workplace policies
• injury prevention measures
• challenges of recognizing injuries
• diagnosis and treatment of the injury
• mental health monitoring
• steps needed to get a concussed first responder back to work 

Though concussion research on athletes and military personnel has informed this work, the complex nature of first responders’ responsibilities brings a different set of challenges after a TBI: Symptoms can interfere with duties that require making split-second decisions, while driving at high speed with lights and sirens can provoke symptoms. Shift work disrupts sleep, which is essential to repairing the brain. An additional strike to the head could set back the recovery process.

The recommendations emphasize shared organizational responsibility, supportive and non-punitive reporting and referral processes, clinician-guided care, occupation-specific return to duty progression and continued research partnerships with first responder communities.

Two recently published studies led by Caccese and colleagues provided new details on the size of the problem of TBIs in first responders.

In a statewide survey of Ohio law enforcement and corrections officers, 64.1% of respondents reported at least one lifetime TBI, and 28.3% reported duty-related TBI. Nearly three-quarters of the duty-related injuries had never been diagnosed or treated.

A review of 23 studies of TBI occurrence in first responders showed the prevalence of a lifetime TBI in this population was 58.8%. The research also showed there is a high risk for TBI in firefighters and revealed that head injuries in EMTs have barely been studied at all.

New federal funding will support an investigation into symptoms and recovery timing in first responders. The National Institute for Occupational Safety and Health awarded Ohio State $1.9 million to fund a project adapting the sideline assessment and repeated testing of injured athletes as closely as possible to the law enforcement environment. Personnel with a head injury will be compared to uninjured controls on a range of symptoms 72 hours after the TBI, once symptoms have resolved, when they’re cleared for unrestricted work and six months later.

“The idea is to look at what are the common mechanisms of injury, how long does it take officers on average to hit those milestones, and what do their trajectories look like?” said Caccese, who is the principal investigator on the grant. “And we’ll also look at the risk factors for persisting symptoms – for officers who do take longer to recover, why do they take longer to recover?”

Many other consensus statement authors are working to shrink the gap of research on TBI in first responders and helping spread the word about the recommendations and the collaborative process that led to them. A major next step is working with first responder organizations to determine how the recommendations can be implemented across different agencies and occupational settings. Caccese and colleagues are presenting the consensus statement at the International Association of Chiefs of Police in late October.

Though there is a lot more work to be done, Caccese said publication of the recommendations is a significant milestone in the effort to build more consistent, evidence-informed systems of TBI care with and for first responders, whose workplace safety and well-being “really affects everyone.”

“A first responder should not have to recognize a TBI alone, decide whether reporting it could threaten a career, find a clinician who understands the demands of the job, negotiate appropriate work restrictions, and determine when it is safe to resume a high-risk duty,” she and colleagues wrote in a preface to the topical issue of the journal. “Yet in many settings, there is no clear system to guide that process. The consensus statement offers a framework for beginning to build one.”

This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense through the Traumatic Brain Injury and Psychological Health Research Program, and by Ohio State’s School of Health and Rehabilitation Sciences and Center for Brain Injury Recovery & Discovery.

Additional Ohio State co-authors are James Oñate, Nathan Edwards, Andrew Sas, Carly Smith, Thomas Beach, Laura Boxley, Michael Guthrie, Jacek Kolacz, Patrick McKenna, Ashish R. Panchal, Bryant Walrod and Jeffrey J. Wing.

#

Contact: Jaclyn Caccese, Jaclyn.Caccese@osumc.edu

Written by Emily Caldwell, Caldwell.151@osu.edu

 

---

Journal

Journal of Head Trauma Rehabilitation

DOI

10.1097/HTR.0000000000001221

Article Title

Consensus Statement on Traumatic Brain Injury in First Responders: The 1st International Conference on TBI in First Responders

Article Publication Date

16-Oct-2026

 

Mental health, sleep disorders among risk factors for long-term concussion symptoms

A new study has found almost half of people who experience a concussion still experience problems a year later, while also revealing which factors put patients most at risk of long-term symptoms

Curtin University

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

A new Curtin University study has found almost half of people who experience a concussion still experience problems a year later, while also revealing which factors put patients most at risk of long-term symptoms.

 

The Concussion Recovery Study followed 232 adults aged 18-65 who had sustained a concussion and found 45.6 per cent still reported symptoms 12 months after their injury.

 

Ongoing effects included fatigue, difficulty concentrating, headaches, dizziness, memory problems, sensitivity to noise and light, balance issues, irritability and more.

 

Published in PLOS One, the research identified the strongest predictors of long-term symptoms, while also challenging commonly held assumptions about what leads to prolonged issues.

 

Study author Dr Jacinta Thorne, from the Curtin Medical Research Institute, said participants who reported severe symptoms in the days after their concussion were almost three times more likely to still be experiencing symptoms a year later.

 

"Feeling slow, mentally foggy or nervous in the days immediately following injury were important warning signs that someone may need closer monitoring and support during recovery," Dr Thorne said.

 

However, researchers also found initial indicators of injury severity don’t necessarily lead to a longer recovery.

 

"We found no evidence that loss of consciousness, post-traumatic amnesia or whether a patient received a CT scan predicted who would experience persistent symptoms a year later," Dr Thorne said.

 

"That tells us it's not always the injury that appears most serious at the time that leads to the poorest recovery.

 

"Instead, what people are feeling and experiencing in the days immediately after the injury appears to be far more important than traditional markers of injury severity."

 

The study also revealed other risk factors for long-term recovery in people with:

 

• History of mental health conditions - 2.6 times more likely to experience symptoms after 12 months
• Pre-existing sleep disorders - 5.1 times more likely at 12 months
• Concussion from a non-sport injury - 2.5 times more likely at 12 months

Dr Thorne said this showed recovery was about much more than the initial injury.

 

“People who already live with sleep difficulties or mental health challenges may have fewer reserves to draw on during recovery, while non-sport injuries are often associated with events such as falls, assaults and vehicle crashes that can bring additional physical or psychological stress,” Dr Thorne said.

 

Researchers found despite the high numbers of participants who still experienced symptoms after 12 months, 97 per cent had returned to work within a year of their injury.

 

Co-author Dr Jemma Keeves, also from Curtin Medical Research Institute, said this showed returning to work didn’t mean someone had recovered.

 

"Our findings suggest many people continue working despite ongoing fatigue, concentration difficulties and other symptoms,” Dr Keeves said.

 

“The good news is that identifying all of these risk factors early gives clinicians an opportunity to provide more targeted follow-up and support for the people most likely to experience ongoing symptoms and help them maintain a better quality of life.”

 

Connectivity Traumatic Brain Injury Australia CEO Naomi Fuller said the study highlighted why concussion research was so important.

 

“This work shows that many Australians are living with symptoms long after they sustain a concussion,” Ms Fuller said.

 

“Concussion recovery can look different for everyone and we are increasingly understanding the effects that these long-term symptoms have on different aspects of people’s lives.

 

“We hear a lot about sports concussion in the media, but as this study showed, concussion from non-sporting causes is also prevalent within the community and can have long-term consequences.”

 

The paper, Predicting recovery outcomes following mild traumatic brain injury in an Australian community cohort: Results from the Concussion Recovery Study (CREST), was published in PLOS One.

---

Journal

PLOS One

DOI

10.1371/journal.pone.0339248

Method of Research

Survey

Subject of Research

People

Article Title

Predicting recovery outcomes following mild traumatic brain injury in an Australian community cohort: results from the Concussion Recovery Study (CREST)

Article Publication Date

7-Oct-2026

COI Statement

Prof. Melinda Fitzgerald declares her role as CEO of Connectivity Traumatic Brain Injury Australia Ltd. All other authors of this manuscript have no conflicts of interest associated with this publication.

 

Engineers develop a smart shoe that could help track changes in how people walk

A Rutgers prototype, which needs no batteries, counts steps, estimates calories burned, and tracks movement with 95.4% accuracy

Rutgers University

Facebook

XLinkedInWeChatBlueskyMessageWhatsAppEmail

image: 

A Rutgers smart shoe prototype analyzes movement and could one day help track changes in how people walk.

view more 

Credit: Veronica Mendez/Rutgers University

Rutgers engineers have developed a smart shoe that automatically analyzes how a person walks, a technology that someday could help monitor people with Parkinson’s disease, spinal cord injuries, traumatic brain injuries, and other movement disorders.

The prototype analyzes movement with 95.4% accuracy while counting steps and estimating calories burned.

The research, led by Simiao Niu, a biomedical engineer at Rutgers University-New Brunswick, was published in Science Advances.

What makes the shoe unusual is that it powers the analysis with energy generated from the wearer’s footsteps. It has no battery to recharge.

“When you are walking or running, you automatically have biomechanical energy available, so you can harvest this energy,” said Niu, an assistant professor in the Department of Biomedical Engineering in the Rutgers School of Engineering.

 A shoe was a natural target, he said, because walking produces the information the researchers want to analyze and the energy needed to study it.

“When you sit down, there is no energy available, but you don’t need gait monitoring,” Niu said.

A device embedded in the sole produces electricity from the pressure and friction of each step. The process, known as the triboelectric effect, is related to the static electricity created when different materials rub together.

The electricity arrives in irregular bursts that the electronics cannot use directly. The researchers designed a power-management circuit that converts it into a useful form, increasing the usable energy by as much as 120 times compared with a conventional method.

When studying walking information, scientists use “gait” to describe a person’s pattern of walking, including balance, speed, stride, and rhythm. Changes can offer clues about disease progression, fall risk or rehabilitation.

“Gait is one of the most significant biomarkers for a lot of diseases,” said Niu.

Doctors often evaluate gait by watching a patient walk briefly in a clinic or laboratory. A wearable device could eventually measure movement over longer periods as people go about their daily lives.

“If you are able to use what I call the ‘worry-free shoes’ we’ve developed, patients can just wear them, and the shoes can automatically collect their gait pattern,” Niu said.

With further development and clinical testing, similar shoes might one day assess fall risk, detect unusual walking patterns or follow recovery after a brain or spinal cord injury. The design also might be adapted to monitor heart activity, biochemical signals or other aspects of health.

The white athletic shoes conceal electronics in the heels. The current version is an early prototype, not a medical device, Niu said. It cannot yet diagnose disease, predict a fall, or determine whether a treatment is working, but it shows basic walking patterns can be analyzed without a rechargeable battery.

That could address a weakness in existing health wearables, he said. Smartwatches and other devices can gather large amounts of information, and artificial intelligence (AI) can turn those measurements into useful findings. But AI requires energy. As wearables become more intelligent, they may drain their batteries faster.

Niu calls this problem the “energy-intelligence bottleneck.”

“We want to solve the fundamental bottleneck in current wearable devices,” Niu said. “We are developing a smart wearable with integrated AI functionality that can harvest energy on its own, so you don’t need to worry about charging.”

Niu encountered the problem while working at Apple, where he helped develop an electrocardiogram sensor for the Apple Watch. Monitoring stops when a health device is removed for charging, and users may forget to put it back on.

“Once you put it onto the charger, you typically forget about it, and then you don’t wear it,” Niu said. “Those wearables cannot monitor your health if you just leave them in your drawer.”

An accelerometer measures the foot’s movement along three axes, labeled x, y and z. A tiny processor uses AI to analyze patterns in those measurements and classifies each 15-second segment as one of four activities: slow walking, fast walking, running, or climbing stairs. It displays the results on a screen attached to the shoe.

The analysis occurs inside the wearable, an approach known as “edge AI.” Because the shoe doesn’t continuously send raw information to a phone, computer, or cloud server, it requires significantly less energy.

Making the AI algorithm small enough to fit the tiny processor’s limited memory was another challenge. The original model examined 21 characteristics of movement and achieved 98.1% accuracy, but required more memory than the shoe’s processor could hold.

The team found that the variation in movement along the three axes provided most of the information the AI algorithm needed. The smaller model achieved 95.4% accuracy while running about 15 times faster and using about one-sixth as much current.

The sensor and AI algorithm together consume 86 microwatts, a fraction of the power used by many wearable AI systems. In laboratory tests, even slow walking generated enough electricity to keep the complete system operating.

Fuying Dong, a Rutgers biomedical engineering doctoral student and the first author of the study, said the project required the team to treat the shoe as one connected system.

“The idea of how to co-design the whole system is the best thing I learned from this project,” Dong said. “You break a huge project into smaller pieces, finish them one by one, and try to figure out what’s the biggest story behind it.”

The prototype was developed using data from four healthy volunteers ages 23 to 26. So far, the AI algorithm has been trained and tested only on the activities included in the study. It hasn’t been tested in older adults, people with movement disorders, or patients undergoing rehabilitation.

Niu, Dong, and Chi Han are inventors on a Rutgers provisional patent application related to the technology.

Explore more of the ways Rutgers research is shaping the future.

Simiao Niu, an assistant professor of biomedical engineering in the Rutgers School of Engineering (at right), and doctoral student Fuying Dong work in the lab on a smart shoe powered by the wearer’s footsteps.

Credit

Veronica Mendez/Rutgers University

---

Journal

Science Advances

DOI

10.1126/sciadv.aeh9625

Method of Research

Data/statistical analysis

Subject of Research

People

Article Title

A biomimetic, ultralow-power edge-AI-empowered and self-sustaining gait analysis system

Article Publication Date

19-Aug-2026

COI Statement

S.N., F.D., and C.H. are inventors on a U.S. provisional patent application related to this work, titled “Wearable Gait Analysis System and Method” (U.S. Provisional Application No. 63/897,241; filed 10 October, 2025; Rutgers Reference No. P2025–279-01). The current assignee is Rutgers, The State University of New Jersey. All other authors declare that they have no competing interests.

 

Cognitive impairment is common in people experiencing homelessness

Canadian Medical Association Journal

Facebook

XLinkedInWeChat
WhatsAppEmail

“Chronic homelessness in Canada is a human tragedy and a public policy failure,” writes Dr. Sumantra Monty Ghosh, an addiction medicine specialist and associate professor at the University of Alberta, Edmonton, Alberta. “An important reason for the latter is insufficient recognition that many people who are homeless have cognitive dysfunction severe enough to limit their ability to live independently.”

People experiencing homelessness are often exposed to several causes of cognitive impairment, including fetal alcohol syndrome disorder, negative childhood experiences, traumatic brain injury, injuries from substance use disorders, and mental health conditions that can affect memory, executive function, and comprehension.

Rather than using a blanket approach, Dr. Ghosh argues that care for people with cognitive impairment experiencing homelessness should include a similar level of support as that offered to people with dementia: 24-hour supervision and safety monitoring, brain rehabilitation, and structure that goes beyond conventional interventions like Housing First. Routine screening is important to help identify people with cognitive impairment and to provide appropriate care and support for this group with complex needs.

“Reframing chronic homelessness as a cognitive impairment crisis is essential. If this foundational driver remains unaddressed, most conventional responses to Canada’s homelessness crisis will continue to fail. By focusing on the estimated half of people experiencing chronic homelessness and who have substantial brain injuries, outcomes for both vulnerable unhoused people and wider communities could be meaningfully improved in Canada,” Dr. Ghosh concludes.

“High rates of cognitive impairment in people experiencing homelessness demand radical policy change” is published September 21, 2026.

---

Journal

Canadian Medical Association Journal

DOI

10.1503/cmaj.252022

Method of Research

Commentary/editorial

Subject of Research

People

Article Title

High rates of cognitive impairment in people experiencing homelessness demand radical policy change

 

Study finds irritability long after concussions in veterans is linked to PTSD, chronic pain and hearing difficulties

CU Anschutz research suggests post-concussion irritability reflects combined effects of brain function changes, emotional health and difficulty understanding speech in noisy environments rather than a single psychological cause

University of Colorado Anschutz

LinkedIn
MessageWhatsAppEmail

New research from the  CU Anschutz Marcus Institute for Brain Health shows that irritability is strongly associated with post-traumatic stress disorder (PTSD) symptoms, chronic pain and difficulty understanding speech in noisy environments among military veterans with chronic mild traumatic brain injury (mTBI), or concussion.

Published today in the Journal of Neuropsychiatry and Clinical Neurosciences, the study suggests that post-concussion irritability may reflect a combination of changes in brain function, emotional health and sensory processing rather than a single psychological cause.

Irritability is one of the most reported long-term symptoms after concussion, particularly in veterans with chronic mTBI. It can significantly disrupt work, relationships and social functioning.

“Our findings suggest irritability years after multipleconcussions is not simply a psychologically-driven emotional reaction,” said the study’s lead investigator Jeffrey Hebert, PhD, PT, associate professor at the CU Anschutz School of Medicine and director of research for the University of Colorado Anschutz Marcus Institute for Brain Health. “It reflects difficulties managing both psychological and sensory system factors that can persist for years after injury.”

The study included 124 military veterans, consisting of 61 with chronic mTBI and 63 without any history of brain injury. Participants completed standardized assessments measuring irritability, PTSD symptoms, chronic pain, balance and auditory processing, including speech in noise comprehension.

Veterans with chronic mTBI reported higher levels of irritability, more severe PTSD symptoms, greater chronic pain, worse balance and increased difficulty understanding speech in noisy settings compared with those without brain injury.

Researchers found that PTSD symptoms had the strongest association with irritability, followed by chronic pain. Difficulty understanding speech in challenging listening environments also contributed independently, suggesting that sensory strain plays a role in emotional regulation.

The findings are among the first to show that difficulty following conversations in noisy environments may independently contribute to irritability after chronic mTBI.

“When the brain must work harder to understand speech in noisy environments, it increases mental effort and fatigue. Over time, that can reduce stress tolerance and contribute to emotional overload and irritability,” said Hebert.

The results also highlight how everyday environments such as restaurants, social gatherings and crowded public spaces may be especially challenging for individuals living with chronic mTBI.

Overall, the study emphasizes that irritability after concussion likely involves multiple interacting systems in the brain and body.

“This work shows the issue cannot be understood through a single lens. Effective care may require addressing PTSD symptoms, chronic pain and sensory processing difficulties together rather than in isolation,” said Hebert.

Future research will explore whether improving functional hearing and sensory processing could reduce irritability and enhance quality of life after concussion.

Key Findings

• Irritability after concussion was most strongly linked to PTSD symptoms and chronic pain
• Difficulty understanding speech in noisy environments also contributed to irritability
• Veterans with chronic mTBI experienced higher emotional, physical, and sensory symptoms
• Findings support more integrated screening and treatment approaches

Why the Research Matters

Long term symptoms after concussion are common in military veterans and can affect daily life, including work and relationships. Irritability is one of the most disruptive symptoms, but is often viewed only as behavioral or psychological. This study suggests it may instead reflect changes in brain function, sensory processing, and emotional regulation, supporting more comprehensive approaches to care.

Clinical Implications

Clinicians treating patients with chronic mTBI may improve outcomes by screening for PTSD symptoms, chronic pain, and difficulty understanding speech in noisy environments when irritability is present.

About Mild Traumatic Brain Injury (mTBI)

Mild traumatic brain injury (mTBI), commonly called concussion, can result from blasts, falls, sports injuries, or vehicle accidents. Although considered “mild,” symptoms may persist long after injury and can include headaches, fatigue, memory problems, sleep disruption, mood changes, and sensitivity to sensory stimuli.

About the Study

The study examined relationships between irritability, PTSD symptoms, chronic pain, balance and auditory processing, including difficulty understanding speech in noisy environments, in military veterans with and without chronic mild traumatic brain injury.

About the University of Colorado Anschutz
The University of Colorado Anschutz is a world-class academic medical campus leading transformative advances in science, medicine, education and patient care. The campus includes the University of Colorado’s health professional schools, more than 60 centers and institutes, and two nationally ranked independent hospitals - UCHealth University of Colorado Hospital and Children's Hospital Colorado - which see nearly three million adult and pediatric patient visits each year. Innovative, interconnected and highly collaborative, CU Anschutz delivers life-changing treatments, exceptional patient care and top-tier professional training. The campus conducts world-renowned research supported by $890 million in funding, including $762 million in sponsored awards and $128 million in philanthropic gifts for research.

---

Journal

Journal of Neuropsychiatry