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New Technologies in the Works to Detect Brain Injuries

Handheld devices and blood tests that could give medical personnel quick, reliable ways to test for concussions in the field are advancing, but remain a few years away.

1st Lt. Timothy Dwyer is strapped into a machine to test his balance at the Fort Campbell Army base in Kentucky on June 3, 2010. Soldiers in Dwyer's unit have undergone hours of exhaustive cognitive testing in the military's first-of-its-kind study of mild traumatic brain injury. New technologies on the horizon may make testing for brain injuries faster, easier and more portable. (Josh Anderson/AP Photo)

Traumatic brain injuries have been called the signature injury of the wars in Iraq and Afghanistan, affecting more than 155,000 men and women in uniform.

But these traumas don't always have outward signs, making them difficult to diagnose. Right now, tests to detect them can be expensive or require sophisticated medical equipment, such as CT scanners. The Automated Neuropsychological Assessment Metrics, or ANAM, a computerized cognitive test the military administers to troops, has never been scientifically proven to work.

New technologies on the horizon may make testing for brain injuries faster, easier and more portable. These tests -- which rely on objective physical measures of trauma, such as bleeding in the brain or markers in the bloodstream -- could help detect at least some brain injuries in real time.

Not all traumatic brain injuries cause bleeding, but those that do require medical attention -- fast. In the past month, two handheld devices that use light to detect bleeding in the brain have inched toward availability. The FDA just approved the InfraScanner, a battery-powered device developed by the Office of Naval Research (ONR). Also, a team of scientists at the National Institute of Health (NIH) and the Center for Neuroscience and Regenerative Medicine recently published a paper on their own detector. Both devices would allow medics to administer basic tests in the field, identifying soldiers who needed further testing.

"I want this to be a device that some soldier who has no training can take out of the back of a Humvee and use to tell if a person has a hematoma," said lead author Jason Riley, an NIH scientist who specializes in optical and brain imaging.

The devices work because pools of blood in the brain absorb and reflect light differently than normal brain tissue. By shining a particular wavelength of light -- near infrared -- onto different parts of the head, the device can spot life-threatening bleeds, or hematomas.

The InfraScanner has been used in Europe for several years, and detects about 75 percent of all hematomas picked up by a CT scan. It takes measurements at locations on both sides of the head, comparing each side with the other to detect anomalies (here's a video of how it works). The device must be held still to obtain accurate readings, because motion gets picked up as unwanted "noise" that interferes with the signal.

The NIH device, still in the prototype stage, moves over the whole head and uses that "noise" as a baseline to compare changes in blood volume (dramatic spikes indicate a brain bleed). According to Riley, this motion-based sensor produces a more complete image, allowing the device to detect bleeding that spans both sides of the head.

Both devices would work quickly, yielding results in only a few minutes. The next NIH prototype will cost a few thousand dollars, but the inventors hope the final version will cost a few hundred. Each InfraScanner costs $15,000.

In addition to tests that measure amounts of bleeding in the brain, scientists are also developing ways to detect changes in blood chemistry caused by brain injuries. Doctors have designed a new blood test that registers specific proteins released into the bloodstream after a trauma to the head, and a preliminary army study found the test detected even mild traumatic brain injuries with 90 percent accuracy. Like the infrared detectors, the screen would mostly act as a triage tool, helping medics decide who needs further tests.

"We do blood tests all the time for all kinds of diseases," said Linda Papa, lead author of the study and an emergency physician at the Orlando Regional Medical Center. But right now, there is no widely available blood test for the brain.

That might change in the next few years. Last year a biotech company called Banyan Biomarkers was awarded $23 million from the Defense Department to develop a blood test that detects brain trauma. The company, founded by two former faculty members at the University of Florida, has collaborated with Papa and other scientists to study several different protein fragments produced by the injured brain. The army study, which measured a protein called glial fibrillary acidic protein that rises sharply after a trauma, is their latest, most successful attempt.

Though promising, most of the new testing options won't be ready for the battlefield for some time.

InfraScan is working on a "ruggedized" version of its handheld device for use outside of hospitals or ambulances that is expected to be out next summer. The NIH device must go through several rounds of clinical testing, and Riley expects it will not be on the market for at least five years. It also will take five years or more to win FDA approval for trauma-detecting blood tests.

The vast majority of blast related m-TBIs do not result in brain bleeds or hematoma. So the hand-helds are of limited utility for blast injuries.

I believe the total DoD spend on Banyan was closer to 60MM and excluded alternate targets such as S100B promoted by Cleveland Clinic. The Banyan project, yet to be validated, and not being validated in combat for unknown reasons (the testing is stateside in vehicular trauma cases), has limited time frame around the expression of the protein fragments. Even if validated, it is unclear whether a ruggedized version is possible or how difficult it will be to maintain. Furthermore, if validated, it is unclear whether the test will offer any inference regarding the severity of the injury or the prognosis for recovery. So for the hundreds of thousands of soldiers that have been exposed to blast over the past decade Banyan offers no guidance for clinicians regarding these cases.

Finally, due to the lack of a standardized objective measure and database there is little hope of identifying, tracking or treating those wounded years ago.

I’m a tiny bit suspicious that a “miracle device” shows up on the Pentagon’s doorstep just as ANAM is exposed as unhelpful, but OK.  Better for the troops is better for the troops.

However, does the FDA have oversight on military equipment and techniques?  Consider that the equipment, by the military’s nature, isn’t intended for use in this country, nor by civilians.  I can imagine the Pentagon wanting someone else to sign off, but it feels like foot-dragging when lives are actually at stake.

If the Banyan approach works, though (this is the first I’m hearing about it), that’s a serious game-changer.  That’s the sort of thing that could be monitored from inside each soldier’s body and recorded before the victim even realizes he’s been hit.

what is needed at the front lines?  a sophisticated device that can diagnose brain bleeding?  Or a device that can help commanders make the decision that a troop has or has not been affected by an event that could possibly produce a tbi?

the difficulty is not instances where people have been knocked unconscious for some period and have had an altered state of consciousness: these people clearly need further evaluation and should not go back to duty until they have a more detailed medical evaluation.

the problem is with those who are exposed to an incident (explosion, vehicle rollover) but who do not have an apparent injury (I’m OK, Doc, go work on Jones, he’s hurt bad).  How do you know this guy is hurt or not: like many athletes on the field, s/he is going to want to “stay in the game” and not let the unit down.

Is there something that can be used to quickly and reliably detect those who have had an injury, those who do not have an injury, and those who are equivocal?  Can that device be used to detect who will need further follow up to insure no long term injury?

And can that device be used to keep those who have been affected, off duty where bad decision making can affect the safety of his unit and others (seems clear TBI affects executive decision making, and, like it or not, some of our lowest ranking troops are making decisions in the field that can affect world events).

Brain injury is caused by certain chemicals. It could be caused also genetically, but very rare.

In Canada, I witnessed a lot happened against my people. The Government and people who are in better positions know it very well. But, since it is conspiracy, they all covered each other.

If I got chances, I will exposed them.

Every body deserves to be get paid for good works and labor but where is money? How govt. can collect the funds?
Catching with digital proofs is easy now. Tax evading wealthy filthies all over the world are now at risk, not only kings and prime ministers of oil rich and / or third world countries but every animalistic selfish, too greedy Billionaires and millionaires who are reaping the fruits of other’s hard labors.
However, patriotic war is not being considered as great thing, unlike past, by the new generation that has better things to do and worried about.

Hi , I just wanted too comment on mtbi . Nothing mild about ...in highspeed rollovers withlittle or no loss of consciousness, you still can have shearing which shows quickly with symptoms of post concussive syndrome . Personality changes , headaches, sleep problems , attention and or concentration problems , etc . This subtle diffuse axonal injury   most likely wont show up on ct or mri . One way too check is run baseline pituitary hormones testing yearly for a long time . The survivor will look normal but they are hurt and usually have trouble. Also watch for coup or contra coup injuries . Ask how much force was involved . Its a silent killer and common sense will give a good idea . can wreak havoc on a persons life but if they are taught about it then they know how too help themselves and ask for help. I have been a caregiver for severe tbi for family since 91 . You wouldnt believe what I have found out . I just want too help the walking wounded and their families . They will need help , but most dont get it and rather kind of hobble crippled with pain and a host of body system symptoms that affect every bit of their quality of life . God bless the tbi patient and their loved ones.

WHAT ABOUT THE VETERANS OF THE VIET NAM WAR ... NOTHING IS EVER SAID ABOUT THEM !

AFTER AN INCIDENT WHILE IN THE MARINE CORPS I HAD (AND STILL DO) MIGRAINES AND TROUBLE REMEMBERING AND LOSS OF WHERE I WAS .
I HAVE BEEN TREATED BY THE VA FOR THESE PROBLEMS SINCE 1972 , RIGHT AFTER MY DISCHARGE AND TO DATE THE VA IS FIGHTING ME OVER THE PROBLEMS !

Larissa Jones

Jan. 8, 2012, 11:26 p.m.

@Bob Sawyer

Migraine patients never have been taken seriously whether it is within the VA system or in private practice. It is only since about 2000 that we’ve started to get some respect in private practice and that’s only if you see a neurologist that specializes in migraines.

Don’t even get me started on how ER facilities STILL treat us.

T.B.I. STARTED LONG BEFORE 2000 AND THE VIET NAM ERA VETERANS ARE JUST GIVEN ANOTHER PILL THEN SAID TO LEAVE AND TRY THEM FOR 6 mos. AND DISCUSS THE PROBLEM WITH YOUR PRIMARY CARE DOCTOR WHO DOESN’T CARE ANYWAY !

Agree there is NOTHING Simple about mTBI… during a blast TBI the brain cells are either twisted, pulled or severed.  I am the belief if one survives a blast than they are expposed to further complications of PTSD and Second Impact Syndrom.  Being told or belief that mTBI is only a concussion is self serving and minimizes the damage in the long run.  Vietnam Vets and those before who acquired head trauma were ignored, survived to fight another day.  I am more convinced the way to address TBI effects is thru AWARENESS and Promoting Awareness.  Communicate to our Congress and CIC.  My suspicion is that if one of their love ones had this injury mild or severe they would want all info and action taken.  TBI can affect all ages, all walks of life, all professions.  A person with TBI becomes a different person with a forgotten past and acquintenances,

This article is part of an ongoing investigation:
Brain Wars

Brain Wars: How the Military Is Failing Its Wounded

The military has failed to diagnose brain injuries in thousands of soldiers returning from overseas.

The Story So Far

Traumatic brain injury is considered the “signature wound” of soldiers fighting in Iraq and Afghanistan. Official military statistics show that more than 115,000 soldiers have suffered mild traumatic brain injuries since the wars began. Shock waves from roadside bombs can ripple through soldiers’ brains, causing damage that sometimes leaves no visible scars but may cause lasting mental and physical harm.

More »

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