According to the World Health Organization, brain injury is the largest cause of disability worldwide. In the United States, the CDC reports the 3 to 5 million Americans are living with a chronic disability due to traumatic brain injury. TBI is a complex condition. It can impact a wide range of bodily functions such as walking, hand function, cognition, sleep, and even bladder and bowel function. Still, the most frequent complaint among those living with TBI is impaired memory.
Traumatic brain injury, a form of acquired brain injury, occurs when a sudden trauma event causes damage to the brain. TBI can result when the head suddenly and violently hits an object, or when an object pierces the skull and enters brain tissue. Symptoms of a TBI can be mild, moderate, or severe, depending on the extent of the damage to the brain. A person with a mild TBI may remain conscious or may experience a loss of consciousness for a few seconds or minutes. Other symptoms of mild TBI include headache, confusion, lightheadedness, dizziness, blurred vision or tired eyes, ringing in the ears, bad taste in the mouth, fatigue or lethargy, a change in sleep patterns, behavioral or mood changes, and trouble with memory, concentration, attention, or thinking.
A person with a moderate or severe TBI may show these same symptoms, but may also have a headache that gets worse or does not go away, repeated vomiting or nausea, convulsions or seizures, an inability to awaken from sleep, dilation of one or both pupils of the eyes, slurred speech, weakness or numbness in the extremities, loss of coordination, and increased confusion, restlessness, or agitation.
Because little can be done to reverse the initial brain damage caused by trauma, medical personnel try to stabilize an individual with TBI and focus on preventing further injury. Primary concerns include insuring proper oxygen supply to the brain and the rest of the body, maintaining adequate blood flow, and controlling blood pressure. Imaging tests help in determining the diagnosis and prognosis of a TBI patient. Patients with mild to moderate injuries may receive skull and neck X-rays to check for bone fractures or spinal instability. For moderate to severe cases, the imaging test is a computed tomography (CT) scan. There is a considerable opportunity for portable and field-deployable diagnostic system that can detect mTBI. Moderately to severely injured patients receive rehabilitation that involves individually tailored treatment programs in the areas of physical therapy, occupational therapy, speech/language therapy, physiatry (physical medicine), psychology/psychiatry, and social support.
In early 2017, the board of directors of the Brain Injury Association of America patient advocacy group, adopted a position paper related to rehabilitation. The paper offeres insight into the manner by which existing outcomes research should be evaluated and urges that the utmost care be taken in the design, interpretation, and reporting of future studies of brain injury rehabilitation outcomes. “Outcomes research on brain injury rehabilitation is a complex undertaking,” according to Nicholas Cioe from Assumption College and his coauthors. “The injury is characterized by substantial heterogeneity in etiology, severity, chronicity, and disease progression. There are vast differences in the demographics of individuals who are injured and in their access to care. There are also important distinctions in treatment settings, provider expertise, intervention types and intensities, and measurement tools. Alone or in combination, each of these variables can significantly impact the outcome of brain injury rehabilitation.”
There are significant developments in prevention, detection and treatment for TBI. The FDA as approved several assessment tool of brain injury. Some systems use EEG with machine learning and brain sensors, eye-tracking assessment tool or metabolic data to held triage potential TBI in emergency situations. A team of researchers conducted by the Madigan Army Medical Center, San Diego Naval Medical Center, the University of Miami and the University of Pittsburgh may have found a tool that may both objectively detect concussions and be used to monitor the subacute concussion recovery of those patients. Using the I-Portal device developed by Neuro Kinetics Inc. and a battery of OVRT (oculomotor, vestibular, and reaction time) tests, researchers can accurately measure mTBI symptoms both initially and during convalescence.
Researchers at the Feinstein Institute for Medical Research and the department of neurosurgery at the Hofstra Northwell School of Medicine published research findings that could have implications for the treatment of severe traumatic brain injury. The team of researchers found that in an animal model with TBI, trigeminal nerve stimulation resulted in increased cerebral blood flow and oxygen to the brain. In the animal model, the use of electrical TNS for improving CBF and delivering more oxygen to the brain, with the goal of decreasing secondary injury. Researchers found that TBI rat models with TNS treatment demonstrated significantly increased systemic blood pressure, CBF, oxygen, as well as significantly reduced brain edema, blood-brain barrier disruption and lesion volume.
In terms of treatment, neural rehabilitation systems can offer new treatments for conditions resulting from TBI. A study using neuropsychological therapy and digital gaming technology led the Department of Defense to validate effectiveness of the therapy system through clinical testing in VA hospitals. The effort is a collaboration with Kinetic Muscles Inc. (now Motus Nova) with Emory University, Division of Neuropsychology, the DoD, the VA, and the University of Advancing Technology in Tempe, AZ, which is recognized as one of the foremost gaming schools in the nation. TBI is not only the most prevalent injury affecting today’s soldiers, but is also a major health issue for the general population. Results from its registrational trial evaluating the safety and effectiveness of the Portable Neuromodulation Stimulator for the treatment of people with chronic balance deficits due to mild-to- moderate TBI were announced by Helius Medical in 2017. The multi-center registrational trial evaluated a total of 122 randomized participants (61 active and 61 control). Subjects, age 18 to 65, received five weeks of treatment (two weeks in-clinic and three weeks at-home) consisting of physical therapy and either a high-frequency PoNS device (active) or a low-frequency PoNS device (control). The trial successfully met primary and secondary safety endpoints as measured by a decrease in falls and headaches. The device is currently approved by Health Canada.
At the 2015 meeting of the North American Neuromodulation Society, Jamie Henderson from Stanford University discussed research on DBS for TBI, including investigational work done by Andre Machado of the Cleveland Clinic in 2008. Ali Rezai from West Virginia University has also participated in a clinical trial of DBS for TBI. DARPA’s Restoring Active Memory program seeks to develop and test wireless, implantable neuroprosthetic devices that can help service members, veterans, and others overcome memory deficits incurred as a result of traumatic brain injury or disease. The two universities that are heading up a multidisciplinary team to develop and test electronic interfaces that can sense memory deficits caused by injury and attempt to restore normal function. Under the terms of separate cooperative agreements with DARPA, UCLA received up to $15 million and Penn received up to $22.5 million over four years. The commercialization of the technologies developed through this program are currently underway. One such commercialization effort is a newly founded company, Nia Therapeutics, which is in the early stages of development and testing.
In 2017, the NIH awarded a $21 million grant to an international consortium of academic research institutions to develop better ways to prevent epilepsy in patients who have suffered from TBI. The grant is led by seven principal investigators at five institutions: Albert Einstein College of Medicine, David Geffen School of Medicine at UCLA, Keck School of Medicine at the University of Southern California, University of Melbourne, and University of Eastern Finland. The investigators will collaborate in the fields of bioinformatics, molecular biology, cellular pathology, therapy discovery and the health sciences. The research team will identify biomarkers associated with the development of epilepsy and develop novel therapies designed to prevent or modify the condition. They will also engage with people living with the condition and their families to help identify their most pressing needs and concerns, encourage them to participate in research, and provide educational resources. The project, the Epilepsy Bioinformatics Study for Antiepileptogenic Therapy, or EpiBioS4Rx, includes an international network of 13 centers for TBI and seven pre-clinical research centers with expertise in TBI, epileptogenesis, the identification of plasma, tissue, EEG, and imaging biomarkers, and pre-clinical therapy development.
These are just a few examples of the recent efforts to development neurotechnologies to better diagnose, treat and rehabilitate from brain injuries. Just as there are varied degrees of brain injuries, there are varied technologies for treatment. Neurotech Network offers free resources and a directory of devices specifically for brain injuries or concussions. Check out our page here.