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Treating Brain Injuries

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 | Los Angeles Times

Last month, when University of Southern California wide receiver Garrett Green bobbled the football on a key play against Washington State, red flags went up among the Trojans' athletic trainers on the sidelines. Only minutes before, Green had tackled an opponent -- hard -- on a kickoff return. His sudden lack of coordination struck team trainer Russ Romano as a pretty likely sign of concussion.


FOR THE RECORD:
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. —

Romano called Green to the sidelines, asked him a few quick questions and got back answers confused enough to take the senior from Chatsworth out of the game. The next day, Green took a battery of cognitive tests to check for concussion symptoms. When they showed some lingering effects of injury, the 19-year-old was ordered to sit out practice for at least a week. After that, Romano told Green, he could be reassessed for a return to the field.

It's a dilemma faced by coaches at all levels and in all kinds of sports, by emergency medical technicians responding to the scene of a car crash, by supervisors called to the site of a workplace accident: This person looks fine on the outside, but has his brain -- lodged in its bony case and far from view -- been hurt?

Every seven seconds across the United States, the answer is yes.

Across Iraq and Afghanistan, U.S. military medics, platoon sergeants and unit commanders urgently ask their troops a battery of questions similar to those that Green got on the sidelines. In the wake of explosions, car bombs and other perils in those countries, they too get confused answers and detect lingering symptoms of concussion from service members, including some who have escaped blasts without so much as a cut.

For these troops, the concussive blast waves rippling outward from an explosion are causing brain injuries that look very much like concussions caused by sports collisions, falls and car wrecks. Deep inside their brains, they are wounded.

Through January 2009, nearly 9,000 U.S. troops in Iraq or Afghanistan had been evaluated or treated for traumatic brain injury, or TBI -- the catch-all medical term for concussions and more severe injuries cause by a forceful blow to the head. But the scope of the problem is almost certainly much larger. A recent assessment by the Rand Corp. estimates that at least 180,000 -- and as many as 360,000 -- U.S. troops serving in those wars may have sustained a head trauma capable of causing brain injury.

That has put the Pentagon and the Veterans Affairs Department, which provides care to those returning from combat, on high alert to an injury that is epidemic among civilians. Their substantial budgets have funded a host of projects that promise to improve the prevention, diagnosis and treatment of traumatic brain injury well beyond the battlefield, brain injury experts say.

For the first time, medical professionals serving on the sidelines of sports and front lines of war are huddling with gadget geeks, neuroscientists and rehabilitation experts at confabs regularly called by the Pentagon.

The results are promising new approaches to curbing the silent epidemic of traumatic brain injury.

Prevention

Better helmets: Until very recently, the helmets worn by soldiers and Marines were designed only to protect the head against penetrating wounds such as bullets or shrapnel, not impact. Newer helmets are making use of impact-absorbing designs widely devised for head protection in collision sports such as football. They include pads made from dense, spongy materials and webbed infrastructures that allow the helmet to absorb a blow without hitting the head.

More ideas may be coming off the fields of athletic battle -- improving protection there in the process. This summer, Major League Baseball began to adopt a batting helmet already in use by high school and youth leagues. Designed to withstand the impact of a 100-mph fastball, the helmet has a composite liner and harder shell.

Youth sports may yield another approach to head protection in combat: A helmet designed by the Boston-based firm Xenith Inc. uses a snug-fitting shell lined with small air bags. The pads surrounding the head adapt to the strength and location of impact. When hit from the outside, the pads inside expel a varying flow of air through tiny holes; the pads closest to the impact point compress to cushion the head, but slowly enough to slow the deceleration of head and brain in a collision.

Developed by a physician who played quarterback for Harvard University, the Xenith design is in use this fall by about 15,000 college, high school and youth league players. Designer Vin Ferrara anticipates that Pentagon grants will enable him and other helmet innovators to adapt some of their designs to the military's needs.

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