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Relief Ahead For Traumatic Brain Injuries?

With growing frequency, we read of U.S. combat soldiers in the Middle East suffering traumatic brain injuries (TBI) from blast explosions. On the home front, brain trauma made headlines this winter with the shooting of Rep. Gabrielle Giffords. Our awareness of TBI is expanding—and rightly so, says David W. Wright, M.D., director of Emergency Neurosciences at Emory University School of Medicine. “Until we started hearing about soldiers coming home with TBI, it had been a silent epidemic,” he says. “TBI trumps HIV, breast cancer and spinal cord injuries combined.”

Brain trauma can happen when a blunt object hits the skill or, in the case of Congresswoman Giffords’s injury, when an object such as a bullet penetrates brain tissue. Symptoms can range from headaches and drowsiness to blurred vision, slurred speech or loss of consciousness.

Diagnosing and treating TBI effectively has involved a good deal of guesswork in the past. While sophisticated imaging machines might see physical damage to the brain, they cannot show whether those areas of the brain are functioning well. That part of the equation, at least, is changing, says Anne Vivian-Scott, president and CEO of BKIN Technologies, a Canadian company that develops robotic devices to measure brain function. BKIN’s new KINARM machine is the first to measure the injured person’s motor function.

“We’ve had ways of measuring cognitive function for a while,” Vivian-Scott says, “but there was no way to tell whether the individual could pick up a dime off of the table.”

Such measurements, she adds, can be applied to people in all walks of life, including teens injured playing school sports, stroke subjects, people developing Parkinson’s disease or ALS, and even babies born with fetal alcohol syndrome. “We Canadians are into ice hockey and those players are whacked up against the wall all the time,” she says. “So did they sustain an injury because they’re a little dizzy? Should they go back onto the ice? KINARM can give a precise measure of their motor function so they’ll know exactly how badly they were injured. It will inform their treatment plan if they need one.”

At this time, treatments for TBI are mostly limited to physical and occupational therapy, speech therapy, physiatry (physical medicine), and any psychological or social support that’s necessary. Two developments, however, give hope for future treatments: in one Clemson University study, researchers found that injecting a chemical gel at the site of a brain injury in an adult rat can stimulate growth of new cells; loading the gel with different chemicals might stimulate different biological processes. However, it should be noted that such gel injections have only been tested in rats and it may be at least three years before they are used in humans.

Other research conducted at the National Institutes of Health found that applying a mild electrical current to the injured motor control region of a brain could improve a person’s ability to learn and perform complex movements.

And there is a bit of good news for women who suffer TBI: Dr. Wright’s team at Emory has discovered that women recover better than men following traumatic brain injuries, due to the presence of progesterone in women. “That seems to be the most robust nerve protectant,” Dr. Wright says. “Our first study in 2005 found that injecting progesterone into the brain caused a 50 percent reduction in deaths; those results were replicated within a year by two other studies, so we knew we were on to something.”

Studying women’s injuries affirmed those findings. Now, 31 hospitals are conducting a new efficacy trial to get more precise data on blunt-trauma brain injuries in women of various ages and situations. And what, from all of these findings, can we extrapolate for Congresswoman Giffords’s recovery?

“We don’t know her monthly cycles or her progesterone levels, so we can’t say too much,” Wright says, “but we can say this: there is more hope for Ms. Giffords’s recovery than if she were a young male.”

CONNECT THE DOTS

For more information on TBI, visit the Brain Injury Association of America’s website, or the National Institute of Neurological Disorders and Stroke.

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