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Scanner helps find traumatic brain injuries
SAN DIEGO — An advanced, high-tech scanner is providing a team of
Navy, Veterans Affairs Department and university researchers with
detailed pictures of brain activity that will better identify
traumatic brain injury, the signature but often-invisible war wound.
Moreover, said a lead researcher, an initial study involving 55
military members and veterans with mild or moderate TBI shows that
the advanced imaging scanner — using a technique called
magnetoencephalography, or MEG — also can reveal and identify
post-traumatic stress disorder.
“We have some exciting data ... that the MEG potentially
diagnoses PTSD,” said Mingxiong Huang, professor
and associate director of the University of California, San Diego’s
MEG Radiology Imaging Laboratory, in a June 1 interview.
The initial study involved 55 military and civilian patients,
ages 18 to 45, with mild to moderate TBIs. The group includes 23
patients, mostly Marines, who endured blasts from improvised
explosive devices, which are among the common injuries reported by
Iraq and Afghanistan war veterans.
Huang said VA recently approved extending the study, which began
in 2007, for another four years, and the research team, which
includes UCSD professor Roland R. Lee and Dewleen Baker, a VA and
Navy researcher, hopes to broaden the study with additional patients
and expand its research toward better understanding what causes
PTSD. The team plans to publish its initial study next month in a
professional, peer-reviewed journal.
“Can we make the ‘invisible’ injury visible?” Huang said. “Being
able to see the injury is really a key start to help understand how
the brain recovers from TBI. The treatment and diagnosis of TBI and
PTSD may be very different.”
Although the study is preliminary, researchers hope to help
diagnose brain injuries in countless wounded military veterans,
including those with less-obvious injuries from blasts, falls and
“Six to nine months after the injury, the majority of people with
mild TBIs become symptom-free,” Huang said. “The brain, as a system,
“But 20 percent of people with TBI have long-term symptoms,” he
said, noting those patients will require additional therapy or
medications, and some may need treatment and therapy for PTSD. “Part
of the problem is we cannot see the injury,” he added.
Meet the machine
The MEG system, a large machine that resembles a
Transformers-size hair dryer, was originally designed for research
into epilepsy, stroke and other brain disorders.
Unlike an X-ray, the MEG system is a noninvasive machine and
passively records electrical activity in brain tissue.
The scanner can locate abnormal areas of low-frequency waves,
which are telltale signs of injured brain tissue.
“The brain is like a huge network [that] has to communicate with
each other,” Huang said.
Mild and moderate TBIs, like concussions and “closed brain”
wounds from blasts, often go undetected by more conventional imaging
machines — including MRI and computerized tomography, or CT,
scanners. An MRI can show bleeding, but in most cases, it doesn’t
see damaged “axonal injuries” such as torn or shredded brain tissue
that often mark mild TBIs, Huang wrote in an article he co-authored
in the August 2009 issue of the Journal of Neurotrauma.
Although TBIs are considered neurological wounds, PTSD is a
psychological disorder. But patients diagnosed with either share
related symptoms tied to damaged tissue in specific parts of the
brain. Huang said MEG scans of PTSD sufferers show injuries in the
four main parts of the brain, including the amygdala and
hippocampus, which control emotions, sensory responses and memory.
“With the MEG, you can visualize these areas that are injured,”
In one case, a 17-year-old football player who suffered three
concussions complained of headaches, dizziness, fatigue, poor memory
and changes in speech and language — but several MRI and CT scans
came up negative for TBI. The MEG scanner revealed injuries in two
areas of his brain.
Another case of negative clinical MRI and CT scans involved a
27-year-old Marine who was knocked unconscious when his Humvee hit
an IED. He later suffered from anxiety, irritability, poor memory
and sleep, fatigue, dizziness and depression.
The Marine wasn’t diagnosed with PTSD, but a MEG scan showed
brain injuries consistent with TBI, and possibly PTSD.
After now-retired Col. Gary Wilson survived an IED blast in Iraq,
MRI and CT brain scans came up negative and showed normal functions
despite the Marine officer’s symptoms, which
included headaches, poor recollection and inattentiveness. In MEG
scans, three parts of his brain “lit up” to reveal three injured
areas that also reflected his symptoms, “so that explained very well
the problems he was having,” Huang said.
For months after he returned from Iraq, Wilson struggled with
short-term memory, migraines and poor sleep; he said he knew he had
a concussion and was frustrated when MRI and CT scans came up
negative for TBI. The MEG scans, which Huang conducted, revealed TBI
and showed him what was happening in his brain, which explained the
problems he was having.
Wilson said those results helped him begin the healing process.
“For me, it was important to know what was PTSD and what was
TBI,” he said.
He credits therapies with improving his functions and even easing
“It made everything else less severe, because it didn’t add to
the anxiety and to the frustration,” he said. “I’ve become less
hypervigilant, and I started sleeping better.”
Although the MEG scanners provide more detailed information than
conventional MRI machines, there are far fewer of them available
around the country. UCSD’s lab has the only working MEG scanner in
California. Each MEG machine costs about $2.5 million, but there are
higher operating costs, Huang said.
Although Wilson wasn’t part of Huang’s initial study, he said he
hopes VA and the military expand the research and enable broader use
of MEG scanners to help diagnose other wounded warriors, especially
vets who are still struggling through problems and symptoms that
“You have to sort it out, but it’s so hard to do that until you
know what it is,” Wilson said.
Knowing What to Look for Can Aid in Proper
Diagnosis & Treatment of Mild Traumatic Brain Injuries
According to the Centers for Disease Control
and Prevention (2006), approximately 1.5 million Americans sustain
traumatic brain injuries every year, 75 percent of which are
considered mild. There has been a recent surge in interest
concerning mild traumatic brain injuries (MTBI's) in the U.S., due
in large part to the ongoing involvement of American troops in the
Middle East. As many as 18% of the 1.5 million American soldiers who
have served in Iraq and Afghanistan during the past eight years have
suffered from a mild traumatic brain injury, reports the New England
Journal of Medicine.
"The trauma that our military personnel continue to endure has
propelled our need to better appreciate and adequately treat the
dynamics of traumatic brain injury," says Douglas J. Mason, Psy.D, a
neuropsychologist who specializes in the diagnosis and
rehabilitation of people with brain injuries. In his book, The
Mild Traumatic Brain Injury Workbook (New Harbinger
Publications, 2004), Mason explains that often the biggest hurdle to
treating mild traumatic brain injuries is getting the diagnoses.
MTBI's are frequently hard to diagnose because of the individualized
nature of the injury, and the fact that symptoms vary from
impairments in fine motor speed and coordination to changes in
abilities to engage in hobbies and leisure activities.
Symptoms include. . .
anxiety, hopelessness, apathy, irritability and emotional numbness
anger, frustration, impulsivity, and withdrawal
fatigue, numbness, sensory changes (touch, taste, smell, vision,
hearing), vertigo, nausea, and impairments in fine motor speed and
disorientation, alterations in judgment, and increased
Social: changes in abilities to engage in hobbies and leisure
activities, isolation, and increased alienation from others
treatment are vital for those suffering from the effects of a mild
traumatic brain injury. According to Mason, "The effects of head
trauma are treatable and the brain can heal when given the
Source: The Mild Traumatic
Brain Injury Workbook: Your Program for Regaining Cognitive Function
and Overcoming Emotional Pain
(New Harbinger Publications)
TBI ONLINE TRAINING
The Michigan Department of
Community Health (MDCH) and its partners offer a
FREE online training. This course offers
professionals in case management, education, nursing, and social
work the opportunity to earn
continuing education credits toward
their respective Michigan licenses. Caregivers will also benefit
from the course.
The curriculum consists of four modules, each
requiring 30-45 minutes to complete.
Introduction to TBI
Impairments and interaction strategies
Screening for a history of TBI
Many other educational materials are available
from the MDCH TBI project at www.michigan.gov/tbi including:
Resource Guide for Persons with Traumatic Brain Injury and Their
Traumatic Brain Injury Provider Training Manual
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American Congress of Rehabilitation Medicine
Contacts and links to rehabilitation research
American Spinal Injury Association (ASIA)
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Australian Association of Musculoskeletal Medicine
Source of information for doctors and the public about
Brain Injury Recovery Kit
The Brain Injury Recovery Kit is a step-by-step approach to
recovery that can be tailored to each individual’s needs and can be
used at an individual’s own pace.
Brought to you by Day-Timers, the Brain Injury Recovery Kit is a
unique, patented system invented by Lisa Keller – a creative
individual who sustained a brain injury – and her case manager,
Sandra Knutson, CRC, CCM, CDMS, a professional specializing in the
needs of individuals and their families after brain injury.
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GUIDE FOR EMPLOYERS
Concussion and Brain Injury Brochure (.pdf)
Understanding Brain Injury:
Guide for Employers
Returning to work is a goal that drives most survivors of
brain injury through the long and difficult rehabilitation
process. Yet when this goal is finally achieved, there
is often difficulty adjusting to expectations of the
Employers are required by the Americans
With Disabilities Act to provide reasonable accommodations
to help an employee with a disability achieve vocational
The Mayo Clinic has prepared a 28-page
booklet to assist employers in this process:
Understanding Brain Injury:
Guide for Employers and
Understanding Brain Injury:
Guide for Employers in Spanish.
This booklet contains information on the
structure and function of the brain
cause of brain injury
communication, fatigue and other changes after brain injury
of simple workplace accommodations
International Association for the Study of Pain
Website for a professional organization dedicated to furthering
research on pain and improving the care of patients with pain.
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International Brain Injury Association (IBIA)
Information for members and the media concerning brain injury. Also
has links to resources and publications, and details concerning
membership and upcoming conferences.
International Society of Physical and Rehabilitation
Medicine (ISPRM, formerly IFPM&R & IRMA)
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Oregon TBI/ABI Provider Training Manual
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