A tool that sees what's actually wrong, not just what patients report feeling
Since 2000, more than 492,000 American service members have sustained traumatic brain injuries — wounds that are common yet poorly understood, often recurring, and stubbornly resistant to effective treatment. A research team in San Antonio, backed by a $200,000 grant, is now building a clinical dashboard that draws on biomarkers and neurological data from 3,000 veteran records to move TBI care from symptom-guessing toward physiological precision. It is a quiet but consequential effort to honor the complexity of an injury that has defined a generation of warfare — and to offer those who carry it something closer to a real answer.
- Nearly half a million military TBI cases have accumulated since 2000, yet the medical tools for classifying and treating them remain blunt and often ineffective.
- The core tension is biological: two veterans can suffer the same blast and emerge with entirely different neurological trajectories, yet current systems treat them as roughly the same.
- Researchers at UTSA, VA, and UT Health San Antonio are pooling clinical records, biomarkers, and neurological assessments from 3,000 veterans to map genuinely distinct TBI subtypes.
- A real-time interactive dashboard is being built so clinicians can translate that research into immediate, personalized treatment decisions at the point of care.
- VA clinicians will stress-test the prototype in practice, ensuring the science doesn't stay in the lab — and the team is already eyeing expansion to civilian TBI populations.
Traumatic brain injury has become one of the defining wounds of modern warfare. Since 2000, the U.S. military has documented more than 492,000 cases — many of them involving repeated injuries that compound over time. Yet despite this scale, treatment remains frustratingly imprecise. Two soldiers can survive the same blast and emerge with entirely different symptoms: one loses memory, another develops chronic pain, a third appears fine before neurological problems surface months later. The current classification system, built around obvious surface symptoms, cannot capture that variability — and patients pay the price.
A San Antonio research team is working to change that. Jeffrey Howard of UTSA, Alicia Swan of the VA's rehabilitation research division, and Sara Mithani of UT Health San Antonio's School of Nursing have received a $200,000 grant from the San Antonio Medical Foundation to develop an interactive clinical dashboard for veteran TBI care. Rather than relying on reported symptoms, the tool will integrate medical records, biomarkers, and neurological assessments drawn from 3,000 veteran cases to identify physiologically meaningful TBI subtypes — groupings that reflect what is actually happening inside the brain.
The dashboard is designed for real clinical use: a feedback loop that gives doctors actionable data while sitting across from a patient. Howard envisions it showing which treatment approaches are most likely to work for which physiological profiles. Swan is recruiting VA clinicians to test and refine the prototype, while Mithani keeps the project anchored in practical clinical needs. The San Antonio Medical Foundation funds only five collaborative grants per year, signaling the project's standing among pressing health priorities.
If the tool proves effective for veterans, the team sees a path toward broader application — car accident survivors, athletes, workers whose brains have been damaged by impact or blast. For veterans who have long endured memory loss, chronic pain, and uncertainty about their neurological future, the dashboard represents something beyond a technical upgrade: a recognition that their injuries are measurable, distinct, and deserving of treatment plans built around what is actually wrong.
Traumatic brain injury has become one of the signature wounds of modern warfare. Since 2000, the U.S. military has documented more than 492,000 cases—a staggering number that reflects decades of combat operations in Iraq, Afghanistan, and elsewhere. Many of those veterans have suffered multiple brain injuries, compounding the damage and raising urgent questions about what happens to the brain over time. Yet despite how common TBI has become, doctors still struggle to treat it effectively. The problem is fundamental: brain injuries don't announce themselves in consistent ways. Two soldiers can experience the same blast, and their symptoms might be completely different. One might lose memory. Another might develop chronic pain. A third might seem fine for months before neurological problems emerge. The current medical classification system for TBI is crude—it relies on a handful of obvious symptoms and doesn't account for repeated exposures or varying severity. As a result, treatment plans often miss the mark, and patients fall through gaps in care.
A team of researchers in San Antonio is trying to fix this. Jeffrey Howard, an associate professor of public health at the University of Texas at San Antonio, along with Alicia Swan, the director of rehabilitation research at the U.S. Department of Veterans Affairs, and Sara Mithani, an assistant professor at UT Health San Antonio's School of Nursing, have received a $200,000 grant from the San Antonio Medical Foundation to develop something new: an interactive clinical dashboard that could transform how doctors understand and treat brain injury in veterans. The dashboard won't rely on symptoms alone. Instead, it will pull together medical records, clinical assessments, surveys, and biological data—biomarkers and neurological measurements—to create a more complete picture of what's actually happening inside a patient's brain.
The research team is working with data from 3,000 veterans, a substantial sample that gives them real material to work with. Their goal is to identify distinct subtypes of TBI that have actual physiological meaning, not just surface-level similarities. Once they've mapped out these patterns, they'll build a tool that clinicians can use in real time. Howard describes the vision clearly: an immediate feedback loop that translates research findings into something a doctor can actually use when sitting across from a patient. The dashboard would show useful data trends, helping clinicians see which treatment approaches are likely to work for which patients.
What makes this approach different is its foundation in biology rather than guesswork. Howard explains that recovery from brain injury is wildly variable. Two patients with seemingly identical injuries might recover at completely different rates, experience different symptoms, and face different long-term health risks. The current system doesn't capture that variability. By using biomarkers—measurable biological indicators—and detailed neurological assessments, the team hopes to sort patients into groups that actually reflect how their brains are functioning, not just what they report feeling. This shift from symptom-based to physiology-based classification could mean the difference between a treatment plan that helps and one that misses the problem entirely.
The work is collaborative by design. Howard is leading the development of the dashboard itself. Swan is recruiting a panel of clinicians from the VA who will test the tool and offer feedback on whether it actually works in practice. Mithani is ensuring that the project stays grounded in real clinical needs and that the science translates into something doctors can trust and use. Mithani emphasizes that solving TBI's complexity requires exactly this kind of partnership—combining clinical expertise, research rigor, and data-driven thinking. The San Antonio Medical Foundation awards only five collaborative grants each year, making this one of a select few projects chosen to push forward on major health challenges.
The immediate goal is to refine the dashboard prototype based on clinician feedback. But the team is already thinking bigger. If the tool works for veterans, it could eventually be adapted for the broader population of people living with traumatic brain injury—car accident survivors, athletes, construction workers, anyone whose brain has been damaged by impact or blast. For veterans who have struggled with memory loss, chronic pain, or the fear of neurological decline, this represents something more than a technical advance. It's a recognition that their injuries are real, measurable, and treatable—not something to simply endure. The dashboard won't cure brain injury, but it could mean the difference between a treatment plan tailored to what's actually wrong and one that misses the mark entirely.
Notable Quotes
We want to create that immediate feedback loop to translate these findings to something that can be used by the actual clinicians who are treating these patients.— Jeffrey Howard, associate professor of public health at UTSA
There's so much variability in terms of how patients recover, what their symptoms are and how that translates into subsequent health risks later on.— Jeffrey Howard
The Hearth Conversation Another angle on the story
Why is the current way of classifying brain injuries in veterans falling short?
The system we have now is based on just a few obvious symptoms—memory problems, headaches, that kind of thing. But it doesn't account for the fact that many veterans have been hit multiple times, or that the same injury can affect different people in completely different ways. Two soldiers can have the same blast exposure and end up with totally different long-term problems. The classification system doesn't capture that complexity.
So the dashboard is meant to see the actual biology underneath the symptoms?
Exactly. Instead of just asking a patient what they're experiencing, we're looking at biomarkers—measurable things in the blood or brain—and detailed neurological assessments. That gives us a physiological basis for understanding what's actually happened to someone's brain, not just what they're reporting.
Why does that matter for treatment?
Because if you know what's actually wrong at the biological level, you can match the right treatment to the right patient. Right now, doctors are sometimes prescribing treatments that don't address the real problem. With better classification, you can be much more precise.
The team is working with 3,000 veterans' records. Is that enough to make a real difference?
It's a solid foundation for identifying patterns. But the real test is whether clinicians actually use it and whether it improves outcomes. That's why the VA is recruiting a panel of doctors to test the dashboard and give feedback. You need buy-in from the people who'll actually be using it.
What happens after this grant ends?
The hope is that after refinement, the dashboard could expand beyond veterans to anyone with traumatic brain injury. But first, it has to prove itself in the VA system. That's where the evidence will come from.