AFRL seeks improved rehab therapy for traumatic brain injuries

  • Published
  • By John Schutte
  • Human Effectiveness Directorate
When Dr. Catherine Harrison pitched her novel traumatic brain injury (TBI) treatment methods to Defense and Veterans Brain Injury Center officials in Washington D. C. last fall, she was prepared for a bureaucratic shuffle. 

Instead, the reaction from DVBIC medical director Dr. Warren Lux not only surprised her but launched the Air Force Research Laboratory's Human Effectiveness Directorate and DVBIC on a collaborative research project that could dramatically alter TBI rehabilitation therapy. 

In blessing the proposal for enhanced neurorehabilitation methods, Dr. Lux said a successful project could "revolutionize health-care reimbursement for brain injury" by scientifically establishing the benefits of nontraditional therapies, according to Dr. Harrison, research psychologist for AFRL/HE with a doctorate degree in cognitive psychology. 

Traditional speech and physical therapies and vocational rehabilitation can retrain a patient to perform specific tasks. Dr. Harrison's approach instead stimulates the brain to reclaim broader capabilities that flexibly support the ability to learn many functions. 

Her alternative methods include Tai Chi--the ancient Chinese mind-body exercise of relaxed, flowing movements--and immersing patients in a virtual reality world for a multi-sensory experience. Adjusting a patient's schedule and environment to stimulate the senses and minimize stress are also critical. Insurance companies do not cover these techniques because they are considered experimental. 

Dr. Harrison plans to develop scientific evidence showing these "enriched environment" methods are effective for rehabilitating victims of TBI, which is prevalent today due to an ironic combination of war and advanced protective technology. 

"Traumatic brain injury is the signature injury of the Iraq war," said Dr. Harrison. "We have much better Kevlar armor and helmets so soldiers are surviving head injuries that once would have been fatal." 

Traumatic brain injuries in the military most often occur from the concussive effects of improvised explosive devices, the roadside bombs widely used against American troops in Iraq. About 60 percent of all injured solders entering Walter Reed Army Medical Center from Iraq and Afghanistan suffer from TBI as a primary or secondary injury, according to DVBIC statistics. When there is no open head wound, many cases go undiagnosed. 

For civilians, TBI can result from a sports injury, automobile accident or blow to the head. Symptoms of TBI include loss of attentiveness, headaches, dizziness, confusion, balance problems, loss of memory and irritable behavior. 

Brain injuries sever the neural connectors or pathways a person needs to function normally, so Dr. Harrison proposes therapy to induce the brain to reconnect vital brain regions using different, previously unused paths, ultimately leading to recovery of physical and mental capabilities. 

"Parts of the brain never recover from injury, so to recover the functions that you had you have to rewire the brain," Dr. Harrison says. "We call that forming alternative pathways. You're recruiting parts of the brain to do functions they did not have to do before." 

Traditional TBI therapy teaches patients how to do tasks, but Dr. Harrison wants patients to learn how to learn again through an enriched environment, a term that includes enhanced social opportunities, more physically and psychologically stimulating surroundings, and most importantly, stimulation of the hippocampus--the section of the brain that controls learning and memory formation. 

Two key components for stimulating the hippocampus--and the aspects of this project that make it unique among traumatic brain rehabilitation methods--are three-dimensional exploration and acrobatic learning, Dr. Harrison said. 

Dr. Harrison wants to build a 3-D virtual reality world with embedded memory tasks so patients can actively explore new environments and perform tasks that physical injuries might prevent them from doing in the real world. She believes such activity stimulates experience-based learning and new memory formation that occurs in the hippocampus. 

"Maybe they can fly, climb up into buildings, go into the woods and climb trees in this virtual world," Dr. Harrison said. "We reduce the stress and adjust the difficulty so it's challenging but not discouraging." 

Under the collaboration agreement with DVBIC, clinical trials will be conducted at DVBIC's new facility in Johnstown, Pa. and overseen by Dr. George Zitnay, a prominent TBI rehabilitation advocate and researcher. 

"What makes this different is we are deliberately trying to form alternative pathways in the brain to make learning easier," Dr. Harrison said. "We want to recover the fundamental ability to learn instead of giving rote training for a specific task."