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Pentagon Seeks Battlefield Device to Diagnose Brain Injury

Thursday, April 17, 2008 - 13:10
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Roadside bombs have made brain damage a grim hallmark of modern war. A RAND study out today says 320,000 U.S. troops may have suffered brain injuries in Iraq and Afghanistan — and less than half say they were ever evaluated by a doctor.

Even where there’s no unconsciousness or visible head wound, mild brain damage, without prompt treatment, can cause lasting problems.

U.S. soldiers investigate the scene of a bomb explosion which targeted a U.S. military vehicle April 2006 in Baghdad, Iraq. (Photo: Associated Press)

So how to tell if a soldier is just shaken up, or if he has a concussion needing quick attention? Brain scans aren’t realistic in a battle zone; and thorough field tests can take 15 minutes or more (see a Navy version of the clinical practice guideline for managing concussions). Besides, symptoms of concussion or other mild traumatic brain injury are often easy to confuse with psychological problems and post-traumatic stress disorder.

The Pentagon’s answer: A gizmo that could evaluate a soldier in seconds. And the Defense Department is giving the Brain Trauma Foundation $4.6 million over four years to come up with a device that can do just that–and is rugged enough to function in Iraq. It’s part of $300 million Congress set aside for research into traumatic brain injury and psychological health.

The battlefield-ready version isn’t finished. When it is, it’ll probably include goggles or a visor attached to a PDA. But at its heart will be a tiny, high-resolution camera and software to measure how well the soldier can track a red dot traveling in a small circle. How consistently the eye tracks the dot– both initially, and then while the patient concentrates on a simple task, like remembering five words – indicates how much damage was done, said Jamshid Ghajar, the foundation’s president and a clinical neurosurgeon at Weill Cornell Medical College.

Here’s the science behind the gizmo: When a person’s head whips suddenly – whether from a bomb blast or a car accident – the brain whips around as well. Even if the brain doesn’t slam into the skull and bruise, the sudden motion can create tiny tears in the connections between parts of the brain governing attention. Those tears can cause memory and attention problems, too. And in some cases, the injuries predispose the untreated victim to much more serious brain damage from subsequent concussions.

Some concussions are obvious. Others aren’t, especially in a chaotic environment, says Col. Tony Carter, a U.S. Army colonel, former surgeon and interim director for strategy and planning at the Pentagon’s new Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. Concussion victims may appear to be doing fine — until stressed, when their attention can collapse. (See the Mayo Clinic’s concussion rundown.) As Col. Carter put it: “They may not respond appropriately in circumstances in which, if they had not had their bell rung, they would have responded just fine.”

One way to gauge the extent of the damage is to measure variations in the brain’s timing; the more variation, especially while the subject is concentrating on something else, the greater the damage, Ghajar told Health Blog. His research has measured these correlations, using a version of the eye-tracking test, with damage visible in specialized brain scans of civilian head-trauma patients.

“When you’re paying attention to something, you’re actually predicting what happens,” Ghajar said. “Without timing, you can’t pay attention, you can’t learn, you can’t function in the outside world.”

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