Assessing head injury risk and neuroprotective effect of ketone monoester supplementation in military airborne training.

Head strike incidence during Improved Swing Landing Trainer training was approximately 35% of participants.

• 354 active-duty male and female service members were enrolled; n=318 completed ISLT and assessments (PLA=157, 142M/15F; KME=161, 144M/18F)
• N=112 (35.2%) experienced head strikes, defined as whiplash or helmet-to-ground impact
• Head strike incidence was similar between groups: 35.7% in PLA and 34.8% in KME
• The study was conducted during US Army Basic Airborne Course's ISLT training

KME supplementation showed a protective effect on Simple Reaction Time performance following head strikes.

• One ANAM-4 measure (Simple Reaction Time-Repeat) demonstrated a significant HS × Time × Treatment interaction (p=0.024)
• Performance decrements in HS+PLA were not observed in HS+KME
• The study was a double-blind, randomized, placebo-controlled trial with 1:1 randomization to placebo or KME

KME supplementation showed a protective effect on single-leg balance performance following head strikes.

• One SWAY measure (Single Leg Right) demonstrated a significant HS × Time × Treatment interaction (p=0.014)
• Balance decrements observed in HS+PLA were not observed in HS+KME
• SWAY balance testing was used to assess balance outcomes alongside ANAM-4 neuropsychological assessment

Head strikes were associated with cognitive and balance decline independent of treatment.

• Several HS × Time interactions were observed for ANAM-4 and SWAY variables
• These interactions indicated HS-induced cognitive and balance decline
• Assessments included the Automated Neuropsychological Assessment Metric (ANAM-4) and SWAY balance testing

No relevant blood-based biomarker patterns were associated with head strikes or KME supplementation.

• Plasma biomarkers were assessed as part of the study protocol
• No relevant blood-based biomarker patterns were associated with HS or KME
• The absence of biomarker changes occurred despite observed cognitive and balance performance differences

Predictive modeling identified variables associated with head strike risk with moderate accuracy.

• Predictive modeling was performed to identify variables associated with HS risk
• The modeling achieved moderate accuracy in predicting head strike occurrence
• Specific variables identified in the predictive model were associated with HS risk