Home' Technology Review : May June 2008 Contents FEATURE STORY 59
WWW. TECHNOLOGYREVIEW. COM
uncontrollable twitching, or an inability to speak. At first, doc-
tors attributed the symptoms to brain damage caused by the fre-
quent explosions that characterized the new trench warfare. But
as soldiers who had never been exposed to blasts began report-
ing similar complaints, military psychiatrists started to suspect a
sort of combat-triggered hysteria. A labeling system used by the
British army at the time suggests the di culty of distinguishing
between the two problems (and the moral opprobrium attached to
those whose condition was deemed psychological). Victims were
designated either "shell-shock wounded," meaning the symptoms
arose after the soldier was shelled, or "shell-shock sick," meaning
the symptoms were not linked directly to an explosion. Only those
with "wounded" status were awarded pensions and granted the
honor of wearing "wound stripes" on their uniforms.
Walter Reed's David Moore hopes that new imaging technolo-
gies will finally resolve the debate by identifying the subtle neuro-
logical damage inflicted by concussion. One promising technology
is di usion tensor imaging (DTI), a variation on traditional mag-
netic resonance imaging (MRI) that highlights white matter, the
long nerve fibers connecting brain cells. Recent studies of people
with mild traumatic brain injury (from car accidents, for example)
suggest that changes in the organization of the brain's white matter
correlate with patients' cognitive deficits. Preliminary evidence
suggests that patients who show the greatest disruption of white
matter early on also have the poorest outcomes.
In a large, ongoing study at Walter Reed, which Moore is over-
seeing, researchers will use DTI to compare returning soldiers
who have experienced blasts and report the hallmarks of con-
cussion---loss of consciousness or situational awareness---with a
military control group reporting no previous brain injuries. The
scientists hope the images will help them identify specific brain
changes linked to concussion, which will make it easier to diag-
nose the injury and predict its outcome.
Three years after Geo rey Ling's time in Iraq, his war on brain
injury has really just begun. Scientists have preliminary evidence
that forces unique to blasts can damage the brain directly, inde-
pendent of any blunt injuries that the blast might also cause. The
key questions, however, remain unanswered. Which aspects of
the blast do the most damage? How can the military better pro-
tect its personnel? And perhaps most important for legions of
soldiers on patrol, can repeated exposure to weak blasts lead to
long-lasting brain damage?
The prognosis for soldiers returning home with symptoms
of brain damage is not encouraging. Decades of research into
civilian head trauma have come to very little; treatments that
seemed promising in animal models have turned out to be inef-
fective in human tests. "It's a completely untapped area of medi-
cal development," says trauma surgeon Jon Bowersox. While the
military is testing a handful of existing drugs, there's a "time mis-
match" when it comes to developing new treatments specifically
for traumatic brain injury, Bowersox observes. "The military is
interested in developing products they can have out during the
current war," he says. "They are not used to the fact that medical
development has a longer time line."
Even the few therapies that do exist will be di cult to deliver
to everyone who needs them. "What will we do with all these
people?" asks Barth. "We're talking about thousands. This is going
to overwhelm the VA hospitals." The military is preparing some
of those hospitals to better deal with brain injury, hiring neuro-
psychologists to make diagnoses and other experts to run reha-
bilitation programs. But resources are limited. At some of the
medical centers, "physicians haven't had any training in reha-
bilitation other than clinical medicine," says Bowersox.
Perhaps the greatest challenge will be to help injured soldiers
resume their previous lives. "Young people are not equipped
emotionally and financially to handle this," says Marilyn Price
Spivack, founder of the Brain Injury Association of Massachu-
setts, which has recently begun an outreach e ort aimed at vet-
erans. "Often they can't go back to their civilian jobs and are very
hard to employ."
The goal of facilities like NeuroCare is to return people to ser-
vice or to their civilian jobs. But even a quick visit with some of
the patients shows what a long road that will be for many of them.
In the clinic, one patient apologizes as he twitches uncontrolla-
bly. Another abruptly leaves the room, suddenly overcome with
anxiety. And Pendergrass, who has had serious balance problems
since he was injured, is unlikely to be able to return to his previ-
ous job hanging power lines. He doesn't yet know what he'll do
when he leaves the rehab center.
EMILY SINGER IS TR'S BIOTECHNOLOGY AND LIFE SCIENCES EDITOR.
Ling's team will soon set
to work studying specific
potential culprits. For
example, IED explosions
trigger an electromagnetic
pulse, which can interfere
with nearby electronic
devices. "The brain is an
electrical organ," says Ling.
"If an EMP pulse can take
out a radio, why not short-
circuit the brain?"
Links Archive March April 2008 July August 2008 Navigation Previous Page Next Page