When University of Southern California wide receiver Garrett Green bobbled the football on a key play against Washington State in a recent game, red flags went up among the Trojans' athletic trainers on the sidelines. Only minutes before, Green had tackled an opponent, hard, on a kickoff return. His sudden lack of coordination struck team trainer Russ Romano as a likely sign of concussion.
Romano called Green to the sidelines, asked him a few questions and got back answers confused enough to take the senior out of the game. The next day, Green took a battery of cognitive tests to check for concussion symptoms. When they showed some lingering effects of injury, the 21-year-old was ordered to sit out practice for at least a week.
It's a dilemma faced by coaches, by emergency medical technicians, by supervisors called to the site of a workplace accident: This person looks fine on the outside, but has his brain been hurt?
Every seven seconds across the United States, the answer is yes.
Through January 2009, nearly 9,000 U.S. troops in Iraq or Afghanistan had been evaluated or treated for traumatic brain injury, or TBI. But a recent assessment by the Rand Corp. estimates that at least 180,000 -- and as many as 360,000 -- U.S. troops serving in those wars may have sustained head trauma capable of causing brain injury.
That has put the Pentagon and Veterans Affairs, which provides care to those returning from combat, on high alert for such injuries.
For the first time, medical professionals serving on the sidelines of sports and front lines of war are huddling with gadget geeks, neuroscientists and rehabilitation experts at confabs regularly called by the Pentagon.
The results are promising new approaches to treating traumatic brain injury.
Prevention: Better helmets: Until recently, the helmets worn by soldiers and Marines were designed to protect the head against only penetrating wounds such as bullets or shrapnel, not impact. Newer helmets are making use of impact-absorbing designs widely devised for head protection in collision sports such as football.
Neuroprotectants: Neuroscientists have tried mightily, but without success, to discover some drug that can "harden" the brain against knocks or, following an injury, disrupt the cascade of events that leads to brain cell death. "Neuroprotection" is an idea the Pentagon loves as well and has funded studies to explore.
Diagnosis: CT scans are the most reliable means of detecting bleeding in the brain, but they're not available near the battlefield. And CT scans have another shortcoming: Although useful in alerting doctors to the potential need for surgery to remove a clot in the brain, they rarely reveal signs of mild brain trauma.
Cognitive tests: To detect concussion, the sports world has ImPACT, a battery of neuropsychological tests that a player can take on a hand-held computer on the sidelines. It's a lot more precise than "how many fingers am I holding up?" The military has issued all its medics in the field a MACE card -- that's Military Acute Concussion Evaluation -- an inventory of questions to ask and symptoms to look for to detect the daze of brain trauma.
Imaging: With defense Department funds, doctors are exploring ways of detecting brain injury with new and existing medical imaging technologies.
Treatment: At a scientific conference in early September called by the Pentagon, Clemson University bioengineering professor Ning Zhang offered an innovative way to reduce TBI-related disability: plugging the holes in the brain that trauma can leave behind.