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Jack Sisson's TBI Blog

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We all know by now that Traumatic Brain Injury is the signature wound of the Iraq War. Explosions that would have killed soldiers in previous wars are now less often fatal, due to the improved protective qualities of military helmets. What happens, however, is that the brain is knocked around inside the skull, as the head forcibly hits the helmet during the explosion. The result is less fatalities, but more brain injuries. According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009. The military has planned clinical trials using pure oxygen in a pressurized chamber to determine if the technique can help brain-injury sufferers heal.

From The Associated Press:
The U.S. military plans clinical trials next year to see whether breathing pure oxygen in a pressurized chamber might help thousands of Iraq and Afghanistan war veterans suffering from traumatic brain injuries.

About 300 service members with mild to moderate damage will participate in the trials of hyperbaric oxygen therapy to help determine whether it can help them heal, or at least ease the headaches, mood swings or other symptoms linked to brain injury.

Some will spend a total of 40 hours over 10 weeks breathing pure oxygen in a hyperbaric chamber, where the atmospheric pressure is increased to a level similar to what they would experience about 20 feet under water.

According to the Defense Department, more than 134,000 service men and women suffered traumatic brain injuries from 2003 through 2009.

Read the story here.

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From the Navy Times, Kelly Kennedy - Staff writer, Friday Feb 22, 2008:
After months of military officials and medical personnel lamenting the lack of an immediate, unequivocal, physical proof of mild traumatic brain injury, an anesthesiologist thinks he has found a solution.

And it may be as simple as two sensors and a BlackBerry.

Dr. Richard Dutton heads up trauma anesthesiology at the R. Adams Cowley Shock Trauma Center at the University of Maryland and sees about 4,000 people a year who doctors believe have a brain injury. But without a CT scan or an MRI, it’s hard to immediately tell for sure — especially if, as is the case in most trauma situations, doctors are also worried about broken bones, ruptured organs or heavy bleeding. And about 3,000 of those cases are mild TBI, which doesn’t show up on a scan.

So Dutton and a team of engineers decided to see if they could use sonar to “listen” for differences in healthy brains and injured brains. They used a headband with sensors to pick up the sound transmitted through the brain with sonar and then analyzed the data fed back into a computer. The Air Force paid for the research.

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Doctors typically can’t see mild TBI, even with a scan. But they know it’s important not to send a service member back out on patrol with a mild TBI because injuries caused by mild TBI are cumulative; even a slight second head injury can cause death for someone with an already damaged brain, and no one wants to go on patrol with someone whose vision is blurry or who has short-term memory loss.

When Dutton and the engineers tried out their equipment on people they believed to have mild TBIs, they found turbulent blood flow — or irregular bandwidths — on the Brain Acoustic Monitor.

“You hit your head, your BAM becomes abnormal,” Dutton said. “We think we may have an objective marker for brain injury. This is pretty exciting stuff.”

And it’s completely portable, which could be good news for troops in Iraq and Afghanistan. In Iraq, there’s one CT scan — in Balad — and no MRI machine. Medics don’t have access to the heavy, expensive equipment.

Read the entire article. This could be a huge diagnostic breakthrough for TBI's.

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We've posted a lot about TBI injuries in the military over the past year or so, sadly because it's the sheer number of TBIs suffered in the Iraq War that has drawn so much needed attention to this once silent epidemic.

Well, it's silent no more. Congress and the military have gotten heavily involved. The Centers for Disease Control in Atlanta are sponsoring studies of TBI in prisons. Others are beefing up studies of TBI in homeless populations. In fact, Jack is meeting this month with a representative from Harvard to discuss studying TBI's impact on the homeless. The NFL has completed intensive studies on TBI in professional football. For a topic that rarely saw the light of day, it would now be hard to find someone who had NOT heard about TBI in the past year.

And speaking of the past year, the Surgeon General has just praised the improvements in the way Army medicine assists and transitions its wounded and ill. If you'll remember, it was not so long ago that the Army was on the receiving end of a lot of criticism in this very area.

Coupled with those improvements,
Col. Loree Sutton, head of the Defense Center of Excellence for Psychological Health and Traumatic Brain Injury, spoke at the [same] media roundtable about improvements in mental health and brain injury research and treatment.

"There have been numerous advancements in the last few months with respect to mild traumatic brain injuries, Post Traumatic Stress Disorder, depression and anxiety," she said. Mental health professionals, both Army and civilian, will continue to cooperate and share information regarding mental health and brain injuries and the risks associated with them.

Sutton added that a scientific working group would convene later this month to review all areas and discuss ways to better serve affected Soldiers and their families.

"We are looking to take a holistic approach (when dealing with) injury and trauma," she said.
Read more about the roundtable here.

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$1.7 million NIH grant to UC Scientists

Cincinnati Business Courier - July 6, 2007, The National Institutes of Health has awarded $1.7 million to a University of Cincinnati scientist to do molecular research that could lead to better treatments for brain injury patients.

Kenneth Strauss will study two types of molecules known as eicosanoids, which are created by injured brain cells, to confirm that they can protect healthy brain cells from further damage.

If successful, Strauss's research could lead to a new class of drugs designed to enhance the levels of these helpful molecules, and thereby improve outcomes in patients who have suffered traumatic brain injury.

Traumatic brain injury is the leading cause of death and disability among people aged 16 to 45.

Read it here.


Diagnoses, treatments have changed
for some veterans' health problems


The Herald-Mail Online, Monday July 9, 2007,
Of approximately 686,000 troops who had returned from Iraq and Afghanistan and left the military, about 229,000 had gone to Veterans Affairs facilities as of April for health care, whether it was a veteran getting a flu shot or a quadriplegic receiving perpetual care, said VA spokesman Phil Budahn in Washington, D.C.

Budahn said he didn't have specific statistics for injuries caused by IEDs, but the VA was treating about 400 people for traumatic brain injuries. Such injuries could range from subtle symptoms such as loss of concentration all the way up to extreme personality changes and short-term memory loss.

In the past, everyone thought they understood the risks of traumatic brain injury to be obvious physical injury such as shrapnel, so traumatic brain injury wasn't always properly diagnosed, Budahn said.

But in 2003, a study out of the Tampa, Fla., VA hospital pointed out that people could experience a closed head trauma, or concussion, with no visible wounds, just from being close to a bomb going off, said Dr. John Sentell, chief of Mental Health Service at the Martinsburg VA Medical Center.

The brain can get injured from an IED blast without visible blood; even from the brain being jostled in the skull from the blast, Sentell said. These less obvious traumatic brain injuries are more common in today's wars and often make diagnosis difficult.

Read it here.


Illinois program first in the nation to provide
TBI screening for state’s returning Iraq and Afghanistan Veterans


July 3, 2007 -- CHICAGO – On the eve of Independence Day, Illinois Governor Rod R. Blagojevich was joined by Tammy Duckworth, Director of the Illinois Department of Veterans’ Affairs (IDVA) to announce a first-of-its-kind program to screen every returning Illinois National Guard member for traumatic brain injury (TBI), offer TBI screening to Illinois Veterans, and 24-hour toll-free psychological assistance for Veterans suffering from PTSD. The program increases health care benefits for Veterans and will later become part of the Governor’s Illinois Covered insurance plan.

The program will work in two parts: The TBI portion will mandate screening for all Illinois National Guard members returning from deployment and offer free screening to all Illinois Veterans, especially those returning from Operation Enduring Freedom and Operation Iraqi Freedom. The PTSD portion will offer 24-hour, toll-free psychological assistance to give Veterans suffering from PTSD a place to turn, day or night, for help.

Read it here.



Integra LifeSciences Supports Newest Edition
of Brain Trauma Foundation's Guidelines for
the Management of Severe Traumatic Brain Injury


CNN MONEY.com, PLAINSBORO, N.J., June 28, 2007
-- Integra LifeSciences Holdings Corporation (Nasdaq:IART) announced today its support for the third edition of the Brain Trauma Foundation's Guidelines for the Management of Severe Traumatic Brain Injury (Guidelines). The Guidelines are nationally recognized and referenced by many of the leading trauma centers in treatment of patients with traumatic brain injury. They are available for viewing at www.braintrauma.org.

The Guidelines were developed by the Brain Trauma Foundation (BTF) in association with the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the AANS/CNS Joint Section on Neurotrauma and Critical Care, and incorporate the latest published research findings relevant to the diagnosis and treatment of severe traumatic brain injury.

Read it here.

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The number of TBI's caused by injuries in the Iraq War continues to stretch the government's ability to treat them. As the following excellent article points out, no one was prepared for the high number of wounded, kept alive by improved body armor. And no one really knows exactly how many of those wounded are TBI survivors:
Only an estimated 2,000 cases of brain injury have been treated, but doctors think many less obvious cases have gone undetected. One small study found that more than half of one group of wounded troops arriving at Walter Reed Army Medical Center had brain injuries. Around the nation, a new effort is under way to check every returning man and woman for this possibility.
Even with the continuing media coverage of the war's injured, and the recent flurry of interest by Congress, I still don't think the average American's knowledge (or even awareness) of TBI has increased by much. I hope I'm wrong. I know that Bob Woodruff got a lot of press, and that he made the rounds of television talk shows. I suppose we just need to be patient. Change takes time, and it will be a while before people's understanding of TBI increases appreciably. Here's an excerpt from the article:
Orangeburg Times Democrat, June 23,2007 -- These are America's war wounded, a toll that has received less attention than the 3,500 troops killed in Iraq. Depending on how you count them, they number between 35,000 and 53,000.

More of them are coming home, with injuries of a scope and magnitude the government did not predict and is now struggling to treat.

"If we left Iraq tomorrow, we would have the legacy of all these people for many years to come," said Dr. Jeffrey Drazen, editor-in-chief of the New England Journal of Medicine and an adviser to the U.S. Department of Veterans Affairs. "The military simply wasn't prepared for its own success" at keeping severely wounded soldiers alive, he said.
Continue here to read the entire article.

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FORT CARSON, Colo. — The Army, faced with thousands of cases of brain injury from the Iraq war, will soon begin testing brain-scanning equipment in hopes of finding a more accurate way to identify hard-to-diagnose wounds...

To date, the Army has not extensively used neuroimaging equipment to detect brain injuries in returning soldiers because not enough testing has been done to judge the

Read the rest of the article.

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