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Treating brain injuries on the sports field and battlefield

With traumatic brain injury rampant among troops overseas, the military is taking a page from sports -- discovering ways to better diagnose and treat it.

October 05, 2009|Melissa Healy

Cornell University neurosurgeon Jam Ghajar, executive director of the Brain Trauma Foundation, has devised a test that may detect the cognitive effects of traumatic brain injury without a series of questions. The device is a pair of goggles, strapped around the head, that simultaneously projects a moving tracking ball and gauges the eye movements of the person watching it. The device readily detects what Ghajar argues is a hallmark of brain trauma: a victim's poor performance at anticipating and responding to predictable movement. In the severely concussed, jerky eye movements replace the smooth visual tracking of the projected ball as it changes course. Critics counter the test may be a better measure of fear, anger and attention problems -- all in plentiful supply on the battlefield.

For The Record
Los Angeles Times Wednesday, October 07, 2009 Home Edition Main News Part A Page 4 National Desk 1 inches; 29 words Type of Material: Correction
Concussions: An article in Monday's Health section on new ways to prevent, diagnose and treat concussions said USC wide receiver Garrett Green was 19 years old. He is 21.
For The Record
Los Angeles Times Monday, October 12, 2009 Home Edition Health Part E Page 5 Features Desk 1 inches; 32 words Type of Material: Correction
Concussions: An article in the Oct. 5 Health section on new ways to prevent, diagnose and treat concussions incorrectly said USC wide receiver Garrett Green is 19 years old. He is 21.

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Imaging: With Defense Department funds, Ghajar and others are also exploring better, more sensitive ways of detecting brain injury with new and existing medical imaging technologies. Those include the use of functional Magnetic Resonance Imaging (fMRI), which can detect disruptions in blood flow of an injured person's brain; magnetic resonance spectroscopy, which measures the metabolic changes in the brain that come with trauma; and Diffusion Tensor Imaging, a modification of MRI that zeros in on the brain's white matter -- the dense connections between neurons that tend to rip and tear with concussion.

Such high-tech improvements may help identify where and how severely the brain has been injured in an accident, guiding treatment and rehabilitation. But they are likely to be of greatest use in a specialized trauma center, once a patient has already been identified as having brain injury.

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Biomarkers: Of immediate use on the battlefield, in emergency departments and even on the sidelines of playing fields, says Grant, would be a simple blood test capable of distinguishing brain injury that will likely get better on its own from brain injury requiring immediate medical attention, and possibly surgery. That effort is part of a wide-ranging hunt for "biomarkers," or readily measured physiological changes, that might reveal the presence and severity of TBI.

Already, a test of a protein in the blood called SB-100 is widely used in Europe, though not yet approved for use in the U.S. Last month, Grant presented evidence that a test that included two other biomarkers would reliably identify patients with brain injury that should be transported immediately to a trauma center.

The development of a revealing panel of biomarkers would have a dramatic effect on the diagnosis and care of those hurt in car crashes, falls and sports injuries.

"This is a huge dilemma for ER physicians," says Duke's Laskowitz.While most patients coming to emergency rooms with apparent concussion can safely be allowed to go home and rest, a few will have life-threatening injuries that can progress without aggressive treatment, he says. Physicians already have a rapid blood test capable of revealing whether a person appearing in the ER with chest pains has had a heart attack, "We need the same kinds of tests to help guide those early management decisions in the head-injury arena," Laskowitz says.

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Treatment

For some, it will take more than rest and relaxation to recover from brain injury. Repair and rehabilitation will limit the extent and the persistence of disability, and both represent the final frontier of the Pentagon's efforts.

At a scientific conference in early September called by the Pentagon, Clemson University bioengineering professor Ning Zhang offered an innovative new way to reduce TBI-related disability: by plugging the holes in the brain that trauma can leave behind.

In Zhang's population of lab rats, trauma had killed off vast colonies of brain cells, leaving blank spots in their brains. Many were unable to see, smell, hear or feel stimuli, or to respond to them. With a background in materials science, Zhang and her team injected those holes with a gel made up of both natural and synthetic materials. The gel not only spurred the growth of stem cells to regenerate brain tissue; it provided a structure within which those regenerated cells could grow.

Within 12 weeks, the injured rats were as good as new, said Zhang, who said the strategy of plugging holes could treat head injury caused by car accidents and falls as readily as it would treat head wounds and trauma sustained in combat.

Another treatment prospect being explored by the Defense Department may seem offbeat, but has the strength of several early studies to commend it. In a clinical trial about to begin at the San Antonio Military Medical center, veterans suffering persistent and chronic cognitive symptoms of TBI will spend five sessions a week for six weeks in a hyperbaric oxygen chamber -- the treatment used to cure divers of the "bends" and used with some success on burn victims.

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