Protecting the Head with Modernized Technology

With a better understanding [of] how traumatic brain injuries occur, a Brown-led research team hopes to develop new standards for head protection and next-generation helmets,” reads a news story from Brown University.  In July, the Office of Naval Research granted the university $4.75 million to study brain injury, specifically as it relates to helmet use in the military and in athletics.

Currently, helmets must essentially follow standards that were set in the late 1970’s (there have been changes in sizing since that time), with the technology that was available 40 years ago when computers were still an anomaly.  “[Brown University associate professor Christian Frank’s lab] has developed a novel technique for measuring for effects of traumatic forces on individual neurons…  a custom-built device that can apply compressive forces to neurons inside three-dimensional cell cultures [not a 2D petri dish, as is presently used].”  With these updated and more stringent standards, Brown University and their associates hope to first develop a helmet that can gather all the data about the brain during the action that resulted in its injury.  Ultimately, because they are now learning about the effects of injury on a cellular level, researchers hope to develop a helmet prototype to completely prevent such injuries.

Camps for a Cure

Located in San Diego, CA, Camp Pendleton proclaims to be, “The West Coast’s Premier Expeditionary [Marines] Training Base.”  Last Tuesday, May 9, they broke ground on a $12 million, 25,000 square foot facility that aims to make the Camp a premier brain injury research and treatment center, too.  The funding needed to build the facility was raised through private donations and the funding of Arnold Fisher, a New York-based real estate tycoon.   Fisher says that he sees helping the troops as his duty as an American.

Part of the Department of Defense organization National Intrepid Center of Excellence (NICoE), which is headquartered in Maryland, the Camp Pendleton facility will be the seventh of nine planned NICoE facilities focused on brain injury and the first on the West Coast.  Presently, NICoE has erected facilities in Fort Belvoir, Virginia, Camp Lejeune, North Carolina, Fort Campbell, Kentucky, Fort Hood, Texas, and Fort Bragg, North Carolina.  A center at Joint Base Lewis-McChord, Washington, is still under construction and facilities are still to be built in Fort Carson, Colorado and Fort Blass, Texas.

Beyond Marine training, the Camp defines part of its vision to be, “providing superior service and support.”  Therefore, they also deal with the injuries that may come as a result of a brain injury or come in conjunction with it – specifically, physical and behavioral problems.  In fact, Camp Pendleton has been training and supporting the troops for 75 years.

So far, NICoE facilities have about a 90% rate for patients to return to duty.  Still, as Capt. Lisa Mulligan, commanding officer at the Camp Pendleton hospital, says, “Science as a whole remains in the infancy of its understanding of the potential for recovery after head injury.  This center will combine the resources of clinical, research and educational specialists to broaden our horizons.

Have a TBI?  Find out anytime, anyplace.

Neurological injury is a significant health concern for military service members, recognizes the Department of Defense.  Last year, for example, 17,672 service members were diagnosed with a brain injury.  While the military may not be able to eliminate neurological injuries entirely, the DoD has granted $11.3 million to Abbott Laboratories for the development of a mobile device that allows one to determine if they have a traumatic brain injury, anytime and anyplace.  Interestingly, this product only relies on such things as the proteins in the blood to find brain injuries.  It will be developed in Princeton, New Jersey, with the assistance of the U.S. Army Medical Research Acquisition Activity in Frederick, Maryland, and has an estimated completion date of October 23, 2019.  (In 2014, the DoD awarded Abbott $19.5 million to develop a portable blood test to determine brain injury.  However, even then, Abbott said that the product being developed was, “the first phase of what… would be a multi-phased contract.”)

Update: Drones Promise Quick, Not Safe Delivery

Drones are on their way to becoming the preferred method of retail delivery and much more.  Currently, however, the air technology can only be used in a few limited locations.  Before they become ubiquitous, though, the Federal Aviation Administration (FAA) must assure that this way of delivery, that may weigh 50+ pounds, is safe for humans.  (Not just for airplane safety, the FAA is responsible for the safety of U.S. airspace from the ground up.)  Given their weight and their height of flight, head safety related to drones is of particular concern.

This has already been an issue this year.  On February 24, 2017, for example, a Seattle man was sentenced to a $500 fine and 30-days in jail because his drone hit a woman, causing her to lose consciousness.  However, current news also shows that drones can prove a benefit to those with a head injury.  In St. Louis, Minnesota the sheriff’s office is testing drones so, ultimately, they, “can look for missing persons, or a child, or maybe someone [who] was injured in an accident and sustained a head injury and wandered off.”

Federal-sponsored drone tests are also revealing.  At a government-approved test center at Virginia Tech, a drone is being tested again a crash-test dummy.  In testing, “the 21-pound drone tilted forward, accelerated sharply and slammed into [the drone’s] head, smacking the crash-test dummy’s neck backward and embedding shards of shattered propeller in his plastic face.”  Mark Black, director of the Virginia Tech drone test, asks, “When does the [head injury] threshold cross an unacceptable level?”

Although it is horrible to think of a head injury threshold, the Federal Aviation Administration knows that it can never make drones perfectly safe, just as airplanes will never be one hundred percent safe.  However, does the proposed FAA rule saying that, “Drones would have to fly 20 feet above people’s heads, and have a 10-foot buffer space on all sides,” satisfy the safety rules enough?

Update: Yesterday, an article appeared on the Fortune website regarding the safety of drones.  Specifically, it references and links to a research study conducted by the FAA that was released on Friday, April 28.  Generally, the research shows that, “both steel debris and the wood block caused significantly more damage to the dummy than the drone, which absorb much of the impact because it’s made of more flexible materials.”

Long-awaited, Expanded Research Facility Opens in Waco

For seven years, there have been high hopes and expectations that Waco, Texas would be host to a world-class VA research facility.  Consolidating the Austin-based Brain Injury Recovery Laboratory and Waco’s Center of Excellence into one facility, it was thought that, 1 “this program consolidation will enable [the] VA to meet its mission of better understanding brain injuries…”  Waco is right next to Fort Hood, so the high hopes seemed in tune with location reality.  Right before it opened, then-Rep. Chet Edwards (D-Waco) lauded it as, “one of the few programs in the country focused on the links between genes and brain anatomy in the development of PTSD and mental illness in our combat soldiers.”  The Center even had many designated areas of the building devoted to the study of TBI and PTSD.  However, after all the excitement of the opening of the facility ended, it seems that much of the research activity in it essentially did too.

Perhaps it was all of these high hopes, coupled with the new, expensive equipment,  that led to the program’s perceived failure.  In 2014, “a 10-month [local newspaper] investigation… found that the VA squandered millions of dollars and six years of research opportunity just as brain injuries were spiking among U.S. service members.”  (Of particular note was the finding that a MRI scanner that was purchased in 2008 for $3.6 million, had since stayed dormant.)  This investigation was noticed by Congress, who started an investigation of their own, launched by Rep. Bill Flores (R-Waco).

Last week, the VA debuted a new, expanded state-of-the-art research facility in Waco, Texas.  (This is very similar to the nomenclature that was used in 2009 for the facility’s original launch and, in fact, this new facility was originally planned to open in 2011.)  Housed in the Doris Miller Department of Veterans Affairs Medical Center, the VISN 17 Center of Excellence for Research on Returning War Veterans, as it’s known, employs 70 people from around the country.  These people must then find residence in Waco.  Waco Mayor Kyle Deaver says that, “attracting these well-paid professionals to Waco will ripple through the local economy,” which is an unexpected benefit of the Center.  Currently, a number of studies have already been planned, including Project Serve, SHE Study, the Moral Injury Project and treatment of traumatic brain injury using EEG neurofeedback.

Trump Acknowledges Brain Injury Awareness Day

“The White House expressed support for brain injury advocates attending the Congressional Brain Injury Task Force’s (CBITF) Brain Injury Awareness Day on Capitol Hill on Wednesday, March 22.”  To accompany the day, President Trump penned a letter to everyone who participated in the event.  An overview of the letter shows that it largely is a list of facts about brain injury that is available to the public already.  However, there is no letter from an earlier president to compare it with, as the Congressional Brain Injury Task Force was only created in 2012.  (The only letter from President Obama that I can find is a letter applauding the creation of the Task Force.)

An overview of the letter, though, also shows that it is comprised of a ten-line paragraph focused on those who suffer a brain injury while serving in the military.  While I am definitely not dismissing those who suffer a brain injury while on the call of duty, the following paragraph that focuses on civilians with brain injury is only five sentences.  As for statistics, the Center of Disease Control estimates that 1.7 million Americans sustain a brain injury each year .  The Department of Defense estimates that about 17,500 soldiers suffered a brain injury last year.    Unfortunately, that means that the percentage of soldiers who are afflicted by a brain injury is much higher; however, the number of civilian Americans who suffer from brain injuries is still a higher number and much more present.  The focus on the military makes sense for Trump though, as military is one of the chief priorities of the Trump Presidency.

I am not sure what would have made this acknowledgement letter something that the brain injury community and all concerned Americans satisfied and, in fact, there is no singular answer to that.  Even if you disagree with the exact wording of the letter, the fact that the President is recognizing that brain injury is a very important and serious issue in America is a definite positive.

States Stop the Stop on Stipends

Veterans are provided with certain benefits from the country, as recognition for their time in service.  In 2000, the National Family Caregiver Support Program was created to provide, “grants to State and Territories… to fund a range of supports that assist family and informal caregivers to care for their loved ones at home for as long as possible.”  Though this program was initially directed towards, “adult family members of other [adult] informal caregivers… providing care to individual 60 years of age and older; adult family members or other [adult] informal caregivers… providing care to individuals of any age with Alzheimer’s disease and related disorders; grandparents and other relatives (not parents) 55 years of age and older providing care to children under the age of 18; and grandparents and other relatives (not parent) 55 years of age and older providing care to adults… with disabilities,” given how much they have given to this country, in 2010, the Caregivers and Veterans Omnibus Health Services Act , Public Law No. 111-163, was enacted nationally.  Public Law No.111-163 allows those who support veterans to apply for these benefits.  (This bill was sponsored by Sen. Akaka (D-HI) and cosponsored in a non-partisan way.)

Because this program relies on the state to determine who should be granted these benefits and how much this grant should be, based on the cost of living and the cost of medical care in the state, it is the states’ responsibility to keep the program running.  Recently, the Oregon VA decided to stop giving benefits to the caregivers of some veterans; 207 have been removed from the program, while 57 veterans are still participating.  However, on April 10, 2017, The Oregonian reported, “Portland VA to temporarily stop removing vets from caregiver program”.  Six members of Congressmen, all of whom happen to be Democrats, Rep. Kurt Schrader, Sen. Ron Wyden, Sen. Jeff Markley, Rep. Suzanne Bonamici, Rep. Earl Blumenauer and Rep. Peter DeFazio, put a stop to the stop.  (Though he did not participate in the halt of the stop, Republican Rep. Greg Walden of Oregon says he supports it.)

Though not yet enacted, the stop that some Oregon congressmen are trying to make is not unique to the state.  As of February 2016, thousands of veterans in Washington and Idaho had already been removed from the program.  However, as the title of these articles state, “Veterans’ caregivers lose VA stipends, struggle to understand why.”  The government says that the stipends given through this program were never meant to be permanent.  However, I can find no information in the text of the law that either confirms or negates this.  For many veterans with certain disabilities, such as some with TBI or PTSD, employment is simply not a possibility.  In fact, these articles profile specific veterans, with TBI and PTSD, for whom full recovery has not yet, and may never be, a medically-reasonable possibility.

A Weapon that Hurts the Soldier with Every Shot

When thinking of war, civilians may think of the possible consequences to soldiers as they relate to the actions of the opposition.  Rarely does one consider that by defending oneself and the country, American soldiers may be harming themselves, as well.

However, evaluation of methods of warfare defense shows that personal-injury will occur when in battle.  For example, the Carl-Gustaf system, a shoulder-fired weapon weighing approximately 10 pounds, may be called “the best [recoilless] multi-purpose weapon.”  A single shot from this powerful weapon produces a burst of gas from its muzzle and breech towards the shooter.  (“It feels like you get punched in your whole body,” is the way one Army gunner described it.)

When the Carl-Gustaf system was presented to the Congressional Brain Injury Task Force, one member asked what all of us wonder and worry:  “What kind of damage is that doing to soldiers in training and on the battlefields?”  The Army knows of this “brain-injury problem” and started testing the effects of the weapon on American soldiers, as early as 2011.

Echoing the Benefits of Exercise after TBI

In 2013, the University of Buffalo found that of the four participants who underwent daily aerobic exercise, all benefited neurologically, particularly in decreasing exhaustion.  In 2015, the National Institute of Health (NIH) conducted a 12-week study with the same results: “individuals with TBI may benefit from participation in vigorous aerobic exercise training with improved cardiorespiratory fitness and diminished fatigue.”  Currently, the University of Kansas is performing a two-year, $500,000 clinical study, sponsored by the Department of Defense, to see if the same applies to wounded warriors.  (The reason why this is even a question is because traditionally, rest is the recommended remedy for a “knock to the head”.)

As opposed to the Buffalo study, the study in Kansas will include more than 100 hundred wounded warriors, stationed in Fort Riley, all of whom were affected by explosive devices.  Also, as the leaders of the study and exercise trainers will agree, all exercise is not the same and does not provide to same benefits.  Therefore, “instead of lifting weights, we want the soldiers running more to improve their aerobic capacity,” says David Johnson, the leader of the study, explaining the aim of the study in a news release.  Beyond fatigue, the study expects to find that aerobic exercise helps the brain heal in other ways, such as in memory and thinking, anxiety and depression.  While this study is focused on the benefits of exercise for those with mild traumatic brain injury, the results may have benefits for other neurological conditions, such as in aiding those with severe TBI, Alzheimer’s, etc.  More so, it could reaffirm the neurological benefits of exercise for all.

A Penny for Your Brain

Imagine if all you had to do was carry around a penny to know if something has negatively affected your brain.  The Office of Naval Research (ONR) is sponsoring the development of such a product, called BLAST (Blast Load Assessment Sense and Test).  Specifically, the ONR, in association with NASA, the University of North Carolina, and Applied Research Associates Inc., a New Mexico-based research firm, is in development of a coin-sized device that would be no burden to the soldier and can be worn on the helmet or body armor, and can identify brain injury, letting the soldier know if they should get immediate medical help.  As Dr. Timothy Bentley of the ONR says, “A system like BLAST is vitally important because it can help recognize the signs of TBI early and tell warfighters they might need medical attention.”

While it may take 5 years to be fully developed and tested, the prospect of such a product has great possibilities, both in and outside of the armed forces.  For example, brain injury in American football has been big news in the past several years, and a coin-sized brain injury “detector” attached to players’ helmets could aid in the quick diagnosis and treatment of such an injury in football and other sports where helmets are worn, such as hockey.  Beyond that, the possibilities are endless.

For more information:

Navy BLAST Sensor Development Looking to Improve Data on TBIs, Military.com

BLAST: Greater Speed, Accuracy in Recognizing Brain Injury, AMERICA’s NAVY

Naval Research seeks to tackle traumatic brain injury, MilitaryTimes