Deployable Brain Monitor Could Help Treat Soldiers’ Head Injuries

John E. Kimura’s new brain monitoring system fits inside a backpack. It can operate in desert heat. And in an instant it processes huge amounts of electro-physiological data.

Most importantly, it can send its readings anywhere in the world.

Kimura, the president and CEO of Sensorium Inc., believes the system will allow neurologists in the United States to peer into the heads of wounded soldiers in remote areas. He’s been working with the Uniformed Services University, in Bethesda, Md., to produce a brain monitor that can operate on the battlefield.

Currently, soldiers who suffer head trauma in Iraq and Afghanistan fly thousands of miles to be tested by similar systems and evaluated by a doctor. “The military medical establishment doesn’t have specialists, such as neurologists, out in the field, so this allows us to provide data that has been processed mathematically to a neurologist’s desk anywhere in the world,” Kimura says.

“We’ve essentially shrunk brain [monitoring] down to a cap you mount on your head, a box the size of a shoebox and a computer with Internet.”

The system can withstand rain, desert heat and possibly even a fall from a moving truck, Kimura says. Its battery lasts up to 12 hours, and it can transfer data via the Internet or through satellite and cell phones. It doesn’t produce actual images of the brain, but instead provides measurements of the electrical activity on the surface of a patient’s head.

Last summer, military researchers tested the product at a facility near Harrisburg, Pa., and further tests are planned. The system will cost $50,000 to $100,000, depending on which features the military includes.

Uniformed Services University has one of the systems, and doctors there are using it to develop algorithms that could represent a breakthrough in head-trauma care. They’re trying to predict which head-trauma victims are likely to experience neurological disorders that often don’t appear until months or years after the initial trauma.

Paul E. Rapp, director of the university’s traumatic injury research program, demonstrated the system for National Defense. It’s housed in a small laboratory at the university with equipment to process brain signals. A padded lawn chair sits in the middle of the room, where researchers have tested more than 30 patients. The patients sit in the chair and put on a nylon cap with wires hanging from it. They’re shown stimuli, such as flashing lights, and the system measures the electrode levels in different parts of their brains as the lights appear and disappear. The nylon cap’s wires plug into a box that digitizes and processes the data, then sends it to a ruggedized laptop. The resulting information helps neurologists detect certain types of brain damage.

“This will also have important applications for civilian use,” Rapp says. “And the support of civilian medicine in third-world countries is becoming an important role for military medicine.”

Medical workers in the world’s poorest countries will be able to send brain-injury data to neurologists in some of the most advanced hospitals, he adds.

But Rapp is most excited about the potential to incorporate into the system the possibly groundbreaking algorithms that he and a team of researchers have been developing. With the algorithms, the system will be able to predict which soldiers are likely to experience late-onset conditions that sometimes follow head trauma, such as post-traumatic stress disorder, depression and schizophrenia. This would allow military medics to pull these soldiers from the battlefield, a step that would reduce the likelihood of subsequent head injuries, which can cause devastating complications. The soldiers also could start preventive treatments.

“We’re concerned about individuals who have received a head injury who, in the immediate recovery period, seem just fine,” Rapp says. However, “several months down the road something bad happens.” What makes this an intriguing and frustrating problem is the diagnosis, he says.

In many cases head-trauma victims recover from their immediate injuries but later return to the doctor after a family member or coworker refers them, he says. “People become non-performing in jobs, their attention wanders,” Rapp adds. “Disciplinary and family referrals are, unfortunately, often where we see these people for the first time after they’re treated for head trauma.”

The solution lies in detecting problems in brain synchronization, or the ability of different parts of the brain to communicate with each other. Head-trauma patients with synchronization problems are at risk for late-onset conditions, data show. Sensorium’s system detects such problems, but algorithms are needed to help doctors interpret the data, Rapp says.

Doctors are alerted that a problem exists, but the findings don’t tell them exactly what the problem is — the same way a person’s body temperature indicates if he’s sick but doesn’t pinpoint the sickness.

“There is never going to be a technological substitute for a experienced clinician spending time with a patient. Clinicians are always going to be central to the diagnosis,” Rapp says. “But if you’re flagged by our technology, we’ll know to do clinical analysis on you and look for early signs of depression and other conditions.”

The algorithms that detect neurological disorders, while promising in their current form, are still at least a year-and-a-half from completion, he says. “To get something a whole lot better than what we’ve got now, would take 18 months,” Rapp adds. “But we want to do a lot better than that.”

Sensorium’s brain monitor should be ready to be fielded soon. The company spent the last three years ruggedizing the product so that it would meet military specifications, Kimura says.

He hopes one day that all soldiers will be tested on his machine upon joining the military. This way, medics could access a head-trauma patient’s baseline data for comparison. The baseline results could be saved in electronic medical records — online documents that detail a soldier’s full medical history since joining the military. Defense Department researchers have been working since at least 1995 to develop a system for compiling and maintaining these records.

It would be much easier to detect brain damage in patients who have baseline measurements, Kimura says. The brain recording system looks for subtle changes in the way one part of the brain sends signals to another.

“The premise behind it is to establish which neural networks that connect to the brain are or are not working,” Kimura says.

Head trauma can cause the two sides of the brain to rattle at slightly different speeds, potentially causing concussions and the late-onset conditions that Rapp is seeking to detect. Testing for these problems on the battlefield could lead to better — and more cost-effective — treatments for some of the world’s most debilitative and least understood disorders, Kimura says.   

Image: A scalp topology from the Sensorium’s 144 channel electro-physiological stimulus and recording system. (Image by Paul Kieffaber, PhD., Professor, William and Mary College)

Topics: Health Affairs, Combat Medicine