Searching for Solutions to Traumatic Brain Injury

By J.D. Leipold, Army News Service
From www.army.mil

David A. Hovda, PhD., talks with guests at a twilight tattoo where he received the 4th annual Strength of the Nation Award by Secretary of the Army John McHugh. The professor and director of the UCLA Brain Research Center was recognized for his breakthrough research in traumatic brain injury. (Photo Credit: J.D. Leipold)

WASHINGTON, D.C. –  The man who did more than anyone outside the military and government to ensure mandatory protocols were established that would help Soldiers recover as quickly as possible after suffering a traumatic brain injury, was presented the Strength of the Nation Award, June 15, 2011.

David A. Hovda, Ph.D., professor and director of the UCLA Brain Research Center was recognized for his extraordinary contributions in caring for wounded warriors by introducing the Army to breakthrough research for systematic recovery from brain trauma.

Hovda’s association with the Army and also the Marine Corps began in March 2009 when he received phone calls from Army Vice Chief of Staff Gen. Peter W. Chiarelli and then-Assistant Commandant of the Marine Corps Gen. James F. Amos.

The generals sought Hovda’s expertise, advice and help with mild traumatic brain injury, TBI, — a growing problem for Soldiers and Marines injured largely by improvised explosive devices in Iraq and Afghanistan.

“It really pulled at my patriotic heart to do whatever I could,” Hovda recalled. “I had experienced this type of request before from the World Boxing Council right after 1990 and the NFL in the early 1990s when people were trying to figure out why athletes were having so many problems with these relatively mild traumatic brain injuries.”

What Hovda and his colleagues discovered working with the NFL was that all too often a player who took a concussive jolt to the head was back in the game before he had truly recovered. A follow-on head blow without ample recovery from the first — even a light knock that wouldn’t have caused an initial concussion — makes a player more prone to severe TBI, where brain cells and tissue die.

The realization that concussion was cumulative led the World Boxing Council to change the way it sanctioned fights while the NFL created rules to provide better protection to players.
At the request of Chiarelli, Hovda established a blue-ribbon symposium of the vice chiefs, civilian brain trauma experts and researchers along with medical doctors, psychiatrists and neurosurgeons. The panel recommended several protocols which the Army adopted to treat Soldiers who might have suffered concussion or MTBI.

Once such protocol said if a Soldier was mounted and involved in a vehicle associated with a blast event, collision or rollover; was dismounted within 50 meters of a blast either inside or outside; or suffered a direct blow to the head or loss of consciousness, that Soldier would receive evaluation by medic, a neurological exam, a minimum of 24 hours down-time and another medical reevaluation to determine fitness for a return to duty.

Further, any Soldier suffering TBI or a concussion, or those unconscious less than five minutes, would now require neurological evaluation by a battalion aid station physician or physician’s assistant. Those who were unconscious more than five minutes would require more detailed neurological evaluation by a hospital physician.

“The trick is to understand what has occurred from a blast and to just allow the brain to go through its natural course of recovery before you expose it to another blow,” Hovda said. “MTBI is permanent in about 15 percent of people who suffer concussion, that’s why it’s so important to protect the individual as soon as possible after concussion with rest, sleep and non-stimulation.”

To recover from concussion, the brain needs an enormous amount of energy, but the way in which the brain uses fuel in the form of glucose or sugar changes after a Soldier suffers MTBI or TBI.

“We’ve learned that blood flow gets reduced to the brain — you don’t have a stroke, but the glucose is not being used the same way and the factory inside the cell that makes the energy is compromised and you have an energy crisis,” Hodva said. “That’s why individuals feel lethargic, dazed or very tired after a concussion and explains why they have a hard time remembering things.”

Hovda said finding a solution and a way in which to bring back the brain’s energy after concussion is something the brain research center is working on through funding by the National Institutes for Health.

“It’s a little too simplistic to say we’re going to give a Soldier a Snickers bar, because the rules that mother nature has for the use of the sugar has changed in the brain,” Hovda said.

“The brain is the most complicated organ that we have, and trauma is the most complicated type of an injury,” he said. “If you put those two together, your first notion is just to say, it’s too complicated, give up but I think that’s one of the things that inspires me about the military — all the services — this is a tough problem, and I love tough problems.”

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