A Look Inside the Brain

NICHD Develops New Technology, Explores New Treatments for Traumatic Brain Injury

Monday, November 3, 2014
Brain resonance

Traumatic brain injury (TBI) can happen to anyone, at any age. Approximately 1.7 million people experience a TBI in the United States each year; about 53,000 die from TBI-related causes.1

TBIs can occur during such ordinary activities as riding in a car, playing sports, or tripping over the rug at home. They can also occur in higher-risk settings, such as war zones and construction sites.

The NICHD is one of several NIH Institutes researching brain injuries, seeking ways to detect and treat these injuries and to rehabilitate those with TBI. Select a link below to learn more about some of its research projects.

Handheld Device Detects Brain Bleeding
Magnetic Resonance Imaging (MRI) Detects Even Subtle Brain Damage
Collaboration Funds On-the-Field Assessments
Researchers Study Drug Therapy Treatments
More Information

Handheld Device Detects Brain Bleeding

Within the NICHD, the Program on Pediatric Imaging and Tissue Sciences (PPITS) conducts research on ways to detect and diagnose TBI using imaging technology.

Dr. Amir Gandjbakhche and his team in the Section on Analytical and Functional Biophotonics—with collaborators from the Center for Neuroscience and Regenerative Medicine (CNRM)External Web Site Policy, part of the Uniformed Services University of the Health Sciences—have developed a prototype device that could be used by battlefield medics, athletics coaches, emergency medical technicians, and others to detect subdural hematomas, or bleeding on the brain.2

A subdural hematoma is often associated with mild TBI/concussion. This bleeding can cause permanent brain damage unless treated. Outside of a hospital, there is currently no way to test for this type of bleeding. The new prototype device would allow detection of bleeding on the brain in the field and provide on-the-spot indication that the individual should be sent to the hospital for treatment.

 

Magnetic Resonance Imaging (MRI) Detects Even Subtle Brain Damage

Like his colleague Dr. Gandjbakhche, PPITS Director Dr. Peter J. Basser and his group, the Section on Tissue Biophysics and Biomimetics (STBB), are developing non-invasive ways to detect brain injury in vivo.

One new technique uses MRI to detect “blebbing” of injured nerve cells.3 Blebbing is a swelling of the cell membrane that can occur in various circumstances, including when nerve cells are stretched or damaged.

Blebbing as a result of injury can be minor and heal on its own. Or it can lead to the death of affected nerve cells, which can result in deficits in function depending on the region of the brain where the blebbing occurs. Being able to track blebbing could help researchers better understand TBI and identify treatments that may reduce nerve cell death and deficits.

Dr. Carlo Pierpaoli, a member of STBB, is working on projects using diffusion tensor imaging MRI (DT-MRI) to advance our understanding of brain structure and function. DT-MRI, developed in Dr. Basser’s laboratory 20 years ago and then further developed into a reliable clinical tool, provides a way to view the features of tissue microstructure, composition, and architecture in the living brain.

Dr. Pierpaoli has grants from the CNRM and the Department of Defense’s Congressionally Directed Medical Research ProgramsExternal Web Site Policy to study TBI in animals, to identify and quantify biomarkers for TBI, and to investigate the ability of the brain to recover as a result of cognitive training in soldiers who have mild TBI.

 

Collaboration Funds On-the-Field Assessments

A large portion of NICHD research on TBI is supported through the TBI and Stroke Rehabilitation (TSR) Program within the National Center for Medical Rehabilitation Research (NCMRR). The NCMRR supports research to better understand brain injury and to develop interventions that are safe and effective for treating TBI and related problems.

The NCMRR is currently managing two pilot projects to diagnose sports concussions. These projects are funded by a partnership among the NIH, the National Football League (NFL), and the Foundation for the National Institutes of Health.

  • Researchers are testing the effectiveness of Spot Light, a mobile application (app) designed to help doctors, coaches, athletics trainers, and parents detect and manage sport concussions. The app can help track the progress of young athletes from the time of a concussion through their recovery period. The goal is to improve diagnosis of concussions among young athletes and to ensure appropriate care and full recovery before they return to play. Researchers will test whether the app results in more reporting of concussions, a greater number of referrals to doctors, and better adherence to guidelines on when athletes may return to play. For more information, visit Evaluation of Spot Light: A Concussion Injury Management App for Youth Sports.
  • Researchers are also investigating whether a portable device that delivers vibrations to the fingertips could be used to identify concussion and promote recovery. The study will include youth 13 to 17 years old who suffered a sports-related concussion between 1 and 3 weeks earlier. The researchers expect that those who have suffered a concussion and who have not yet recovered will experience the vibrations differently from those who have not suffered a concussion or who are fully recovered from their concussion. For more information, see Somatosensory Processing-Assessing Youth Sport-Related Concussion and Recovery.

For more information about research supported by this partnership, see NIH and NFL Tackle Concussion Research.

Additional NCMRR-supported research led to the development of a specialized detection and monitoring system that is mounted inside a football helmet. This system is now in use in football programs at all levels.

 

Researchers Study Drug Therapy Treatments

TBI and its effects are often complex, and so treatment can require broad and long-term approaches. Because little is currently known about the effects of medications on outcomes for TBI, the NCMRR funded six studies focused on basic research of drug therapy combinations. Each study has a different aim:

  • Improving the effectiveness of progesterone—a naturally occurring hormone that has shown benefits in clinical experiments with patients with TBI—by supplementing it with vitamin D
  • Protecting neurons using 11 different medications that rely on different mechanisms for effectiveness
  • Improving outcomes of children and adolescents with TBI by using two experimental medications that could protect against brain injury
  • Using medications to help an antioxidant drug get into the brain and spinal fluid
  • Combining an immune suppressor with dietary choline supplementation
  • Improving outcomes in pediatric TBI by combining an immune suppressor and an anti-inflammatory drug

These studies are drawing to a close, and researchers plan to publish the results in a special issue of a research journal.

Through its now sunsetted TBI Clinical Trials Network, the NCMRR also sponsored a 4-year clinical trial of citicoline, a substance found naturally in the brain that was shown to have protective or reparative effects on the injured brain in previous studies. This Network study found that patients with TBI who took citicoline did not have any greater improvement in function than those who took a placebo.4 The National Institute of Neurological Disorders and Stroke is now supporting an effort to add data from this trial to the Federal Interagency Traumatic Brain Injury Research (FITBIR) informatics system to make it freely available to investigators worldwide.

These are only a few of the ongoing NICHD projects that aim to develop better ways of detecting and assessing brain injuries. The Institute will continue this work to uncover what happens in the brain when these injuries occur and find ways to prevent them, treat them, and to promote rehabilitation for those who experience them.

 

More Information

For more information about TBI research, select one of the following links:

 

Originally Posted: November 3, 2014

 

 

All NICHD Spotlights


  1. Coronado, V. G., Xu, L., McGuire, L. C., Wald, M. M., Faul, M. D., Guzman, B. R., & Hemphill, J. D. (2011). Surveillance for traumatic brain injury–related deaths―United States, 1997–2007. Morbidity and Mortality Weekly Report, 60(5), 1–32. PMID: 21544045
  2. Riley, J. D., Amyot, F., Pohida, T., Pursley, R., Ardeshipour, Y., Kainerstorfer, J. M., . . . Gandjbakhche, A. H. (2012). A hematoma detector—a practical application of instrumental motion as signal in near infra-red imaging. Biomedical Optics Express, 3(1), 192–205. PMC: 3255337
  3. Komlosh, M.E., Benjamini, D., Budde, M. D., Holtzclaw, L. A., Lizak, M. J., Horkay, F., Nevo, U., & Basser, P. J. (2013). d-PFG MRI assessment of axonal beading in an injury model. Capital Region TBI Research Symposium, Bethesda, MD.
  4. Zafonte, R. D., Bagiella, E., Ansel, B. M., Novack, T. A., Friedewald, W. T., Hesdorffer, D. C. … Dikmen, S. S. (2012). Effect of citicoline on functional and cognitive status among patients with traumatic brain injury: Citicoline Brain Injury Treatment Trial (COBRIT). Journal of the American Medical Association, 308(19), 1993–2000. PMID: 23168823
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