Posts from ‘Govt/Military’
Spinal Cord Injury and Afghanistan
Military medical officials have expressed concern over an increase in spinal injuries among U.S. troops coming home from Afghanistan. Afghan insurgents have responded to the increased presence of heavily armored U.S. vehicles with larger and more powerful roadside explosives.
Roadside bombs have become the top killer of U.S. troops in Iraq and Afghanistan. Not only do the roadside bombs lead to crushed spines and other spinal injuries, they also result in traumatic brain injuries when soldiers are exposed to blasts, even with no impact to the head.
A USA Today story reported that the recent increase in spinal injuries occurred among soldiers in Afghanistan and not Iraq. The increase in spinal cord injuries among troops has arisen due to increased potency in roadside bombs used by insurgents. The U.S. Military issued 3500 Mine Resistant Ambush Protected (MRAP) vehicles as an attempt to deal with the roadside bombings. Unfortunately, Afghanistan insurgents responded with stronger and larger bombs.
Some of the 3500 MRAP vehicles deployed in Afghanistan have been lifted a few feet off the ground by roadside bomb explosions. Even though the MRAP vehicle may remain intact, some soldiers have suffered serious spinal cord injuries in the explosions. The MRAP vehicles cost about $1.4 million.
Medical professionals and Army engineers are comparing data to explore possible alterations and improvements to the MRAP vehicle design to make it safer for soldiers who are exposed to increasing roadside bomb possibilities. The MRAP vehicles, which cost about $1.4 million to make, have a hull designed in a V-shape, which helps to deflect the force of explosions away from the center of the vehicle, the USA Today article reported.
Since there are very few paved roads in Afghanistan, rebels can easily bury roadside explosives in the dirt roads, undetectable to soldiers driving along the roads at high speeds. Although the military has recently send over newer and lighter MRAP vehicles with better seating and harnesses, more improvements are still in the works to ensure the vehicles are safe for combat.
Doctors are matching up data on injuries with the victims’ positions in the vehicles at the time of the explosion and the vehicle type in which the accident occurred. Their hope is that engineers will be able to use the data to design more explosion-proof MRAP vehicles and to prevent any further incidence of spinal cord injuries if possible. USA Today reported that a doctor in Kandahar is currently at work designing a shock-absorbing seat that would provide a better guard against spinal cord injuries.
References:
- Zoroya, Gregg. (November 5, 2009). “Spinal Injuries Up Among Troops.” Retrieved December 6, 2009 from the USA Today website: http://www.usatoday.com/NEWS/usaedition/2009-11-04-1Aied04_ST_U.htm?csp=34
In early September of 2009, The Department of Defense (DOD) Congressionally Directed Medical Research Programs (CDMRP) hosted the Military Health Research Forum (MHRF) in Kansas City, MO. The forum was dedicated to exploring new research on traumatic brain injury (TBI).
Military interest in brain injury research has increased dramatically over the past few years due to an alarming rate of servicemen and women who have suffered from TBI due to close range, non-impact exposure to explosive blasts and other combat-related injuries. The CDMRP estimates that about 20% of combat soldiers suffer from TBI.
Two programs of the CDMRP, the Psychological Health and Traumatic Brain Injury Research Program (PH/TBIRP) and the Peer Reviewed Medical Research Program (PRMRP), funded studies on various issues surrounding TBI in combat soldiers, such as prevention, diagnosis, and treatment of the condition. The researchers and funding agencies also hope the research will lead to improved care for civilians with TBI.
What follows is a summary of the research presented at the MHRF.
The US Army Aeromedical Research Laboratory presented research that demonstrated the value of new Advanced Combat Helmets. Their research revealed that paratroopers wearing the older Personnel Armor System for Ground Troops Helmet were 2.3 times more likely to suffer brain injuries than those wearing the Advanced Combat Helmets. The researchers said further research to improve helmets and armor systems is underway.
Clemson University researchers presented data on their development of an injectable hydrogel to promote brain tissue regeneration at lesion cavity sites in rats given TBIs. Researchers funded by CDMRP also performed neural stem cell transplantation into the injury sites and used the hydrogel, which mimics native brain tissue, as a carrier. They reported that functional recovery was significant after eight weeks of treatment.
Finally, researchers at Duke University presented research on their testing of three different biomarkers used to better evaluate the severity of and diagnose mild traumatic brain injury (mTBI). Many patients with mTBI show no external signs of brain injury, thus a new method is needed to better diagnose the presence of brain injury in these cases. The researchers found that two of the three biomarkers, brain natriuretic peptide (BNP) and D-Dimer, showed a 92% sensitivity rate in determining the presence of intracranial abnormalities in diagnostic CT scans.
The vast and expansive collaboration of research and funding that went into all of the data presented at the MHRF will likely provide demonstrable advances toward the prevention, diagnosis, and treatment of TBI not only in military personnel, but in civilian populations as well.
Admiral Michael Mullen, the chairman of the Joint Chiefs of Staff, is promoting a new Army policy that would limit the number of mild traumatic brain injuries an Army combat soldier can suffer before being relieved of combat duty. The new policy would limit soldiers’ exposure to three mild brain injuries, after which they would be reassigned to non-combat positions on Army bases.
Mullen is motivated partially by a disturbing story of a soldier who was exposed to 30 explosions at close range before being removed from combat duty. USA Today reported that if the policy were enacted, it is estimated that only about 400 soldiers, out of the 20,000 troops deployed in Afghanistan, would be removed from combat and put to work on bases for the duration of their tour of duty.
Admiral Mullen is motivated also by data published in recent studies on multiple concussions and traumatic brain injuries experienced by football players. The studies, reported on here, demonstrated that people whose brains had suffered multiple concussions would heal more slowly from future injuries and would be more likely to have more serious future concussions. The same studies also showed that multiple brain injury sufferers have also been shown to be at a higher risk for long-term brain dysfunction and complications.
We have explored some of the recent research on the physiological effects on the brain of repeated exposure of military personnel to explosive blasts. While the injuries are similar to those experienced by football players, the exposure to bomb blasts has a distinctly different and less understood effect on the brain.
The USA Today article reported that, “up to 300,000 service members may have suffered a mild TBI in the Iraq and Afghanistan wars.” It is data like this that has spurred Admiral Mullen to take action to prevent soldiers from suffering serious long-term brain damage that could be prevented by a simple change in policy.
The U.S. Marines already operate under a policy that limits marines to three mild traumatic brain injuries before removal from combat, and the Army is currently designing a policy that will likely follow suit. Although further research is ongoing, the workings of the brain and how it reacts to injuries remain mysterious and not fully understood. Yet, as more and more studies are published, it’s inspiring to see military leaders using current scientific data in the design of their policies and protocols.
(pic from ameddcsdl.org)
Soldiers returning home from Afghanistan and Iraq suffering from a high rate of traumatic brain injury due to exposure to explosive blasts have prompted research projects to determine exactly how brain injury occurs during an explosion in which direct impact to the head does not occur.
Researchers from the Defense and Veterans Brain Injury Center in Washington D.C. recently conducted research in which they ran DTI scans on soldiers ranging from completely healthy to those who suffered direct head impacts, acceleration brain injuries, and finally, nonlethal explosive blasts.
Previously, MRI and CT scans were proven ineffective at revealing and diagnosing concussions. However, researchers have recently made use of DTI scans to detect neurological damage on the level of the neural networks connecting brain cells, which scientists call the brain’s “white matter.”
The recent research using DTI scans showed “a more diffuse pattern of damage to the white matter,” in those soldiers who had experienced non-impact brain injury from close proximity to explosions. This research demonstrates conclusively that soldiers near an explosion can indeed suffer brain damage even without any physical impact.
Common concussions arise from direct impact to the skull and from acceleration injuries as in automobile accidents. Brain injuries from explosions can cause impact and acceleration injuries, as well as a wave of rapid pressure that puts even more sudden, but invisible, impact on the brain itself.
Scientists also discovered signs of inflammation in brains exposed to explosive blast shockwaves, many months after the initial injury occurred. Another team of researchers at the Defense Advanced Research Projects Agency found signs of brain injury in the blood, even when no other signs of injury showed up.
DTI scans, while promising in brain research, still has limits. Soldiers with shrapnel in their body are unable to undergo MRI and DTI scans due to the powerful magnetic fields inherent to the scans. Researchers hope to vastly expand the available tools for more effective and efficient diagnosis, treatment, and rehabilitation of patients suffering from traumatic brain injuries, especially those due to close proximity to explosive blasts.
The U.S. military is increasingly interested in understanding and more efficiently treating blast-induced brain injuries, as between 10-20% of the soldiers returning home from Iraq and Afghanistan return with concussions from explosive blasts. Military and health officials hope to see further expansion of research and treatment built upon the foundation of current research and knowledge of traumatic brain injury.
(pic from military.com)
Brain researchers at Boston University and the Sports Legacy Institute in Massachusetts are conducting studies to explore potential links between brain dysfunction in combat veterans and similar cognitive decline experienced by football players.
Researchers posit that combat veterans who experience symptoms of traumatic brain injuries (TBI) may have sustained severe damage to their brains, not from physical damage, but from shockwaves caused by explosions.
The research teams are looking for specific kinds of long-term brain damage signified by the build up of toxic proteins and neurofibrillary tangles, which do not show up in CT scans and MRIs. In order to gather the necessary data, the scientists must collect and analyze the donated brains of more than 20 combat veterans.
They will compare their findings with data on brain damage in football players’ brains to investigate how forces from bomb blasts can lead to physical brain damage, even in the absence of physical impacts to the head.
This research on the brains of military personnel promises to shed some light on the mystery of Post Traumatic Stress Disorder (PTSD), as well as other mental and emotional struggles of veterans long after their tours of duty.
The study was inspired by the observation that many of the symptoms of PTSD and cognitive dysfunction in veterans were similar to those experienced by football players who had sustained repeated head impact over their careers.
By comparing the actual brains of veterans and football players, the two research institutes hope to discover the nature of the physical damage sustained by soldiers in non-impact explosions.
If the institutes do prove that shockwaves from explosions cause physical brain damage, combat veterans could be rewarded not only purple hearts, which are currently given only to soldiers injured physically in battle, but also proper recognition, expanded disability benefits and more advantageous treatment of their conditions.
While the focus remains on the brains of combat veterans, the benefits of such studies may ripple out into the general population in the form of greater knowledge of how the brain responds to trauma and injury and possible treatments for resulting conditions.
Even though the scientists are eager to continue their research, it advances slowly due in part to the difficulty and sensitivity involved in collecting brains from donors upon their deaths.
Boston University and the Sports Legacy Institute are paying for the studies, and while the U.S. military supports them, they have not yet contributed to the research financially.
Image from here.
