The aim: to boost blood flow to brain cells that surround a central injury area and lie dormant following an injury. These idling neurons, sometimes called the "ischemic penumbra," aren't dead, but their low level of activity can cause disabilities that need not be permanent, if they can be coaxed back to life.
The Defense Department has so far invested heavily in the front-end issues of brain trauma -- prevention, detection and acute treatment, says author Michael Paul Mason. "Nobody does it better," he says.
"You'll hear veterans talk about it being like they fell of a cliff. They have this great, great care and then, boom! It's gone," says Mason, who wrote " Head Cases," a book about the challenges faced by those with traumatic brain injury.
The long-term care of those with persistent disabilities from brain injury can be a long and costly commitment -- a fact the U.S. military is just now beginning to face. One Harvard economist has estimated that the lifetime care of each veteran disabled by brain injury could well cost $3.4 million.
It is a burden that many civilian brain trauma victims and their families have shouldered with little or no help from the government.
The Brain Injury Assn. of America, the leading advocacy group for patients and their families, has sought to reframe Americans' understanding of traumatic brain injury as a chronic illness -- rather than an isolated event such as a broken leg. Like those with mental illness or developmental disabilities -- people with whom brain injury victims are often confused -- the brain-injured may have lifelong medical needs and a recognizable disease progression, the BIAA asserts.
That's a view the U.S. government -- with its lifelong commitment to care for veterans' health -- effectively endorses.
As the Pentagon and Veterans Affairs ponder how best and most efficiently to care for thousands of veterans disabled by brain injury, many civilian activists hope the agencies will fund research on practices that work, then help build the capacity to care for disabled veterans in their own communities -- alongside civilians also struggling with brain trauma. Already, a few such programs exist.
"The challenge is bigger than either community has," says Mason, one of only 200 public-sector caseworkers in the U.S. who specialize in assisting the brain-injured.
In April, the Defense Department gathered rehabilitation experts from across the United States and Canada to begin to distill existing lessons from civilians in the field and chart a course for future research.