The Brain Team
New UM Neural Injury Center Changes Lives
Iraq War veteran Sergej Michaud is a 4.0 student at UM, a double major in geography and economics, and a husband with a wife and two children. He’s a senior vice commander of the Montana Chapter of the Military Order of the Purple Heart. Michaud also is recovering from a traumatic brain injury (TBI).
In 2007, in Baghdad’s dangerous west neighborhood, Michaud was the rear gunner on a Humvee convoy when he saw a man on a third floor pull a trigger. He remembers the horrific punch of the blast as the roadside detonated two yards away. His next memory is waking at the Baghdad airport clinic. The explosion and shrapnel that struck his helmet left him with a ruptured ear drum and internal bleeding. He’s come a long way from unconscious to five months of treatment at the Vilseck, Germany, Army health TBI clinic, to pursuing his college dream.
“My intelligence is all there, but studying takes me longer,” Michaud says. “A two-hour assignment takes me five, and I forget things.”
Initially, his symptoms were glaring – cloudy vision, multiple headaches, vertigo and anxiety when around large groups of people. The military TBI clinic helped, but brains are complex, and healing can pose its own set of problems. Subtle changes are difficult to diagnose.
That’s why Michaud is signing up for help from the UM Neural Injury Center, formed in 2014 to offer screening services for people with suspected or known brain injuries. The center’s purpose is to bring advances in the lab to any individuals who can benefit from them, with a special emphasis on free service for the 600 veterans attending UM. About 15 percent of veterans currently participate.
The Neural Injury Center specializes in advanced technology and an interdisciplinary approach to identify the tiniest changes in the brain from traumatic injuries. A high-powered research and clinical team reflects the complexity of the brain itself.
Michaud has toured the facility, participated in a promotional video, met with researchers and convinced several other student veterans to sign up ahead of his planned entry at the end of spring semester 2016.
“My buddy was about to give up,” he says, recalling the multiple trips he and his friend made to Veterans Affairs. “In a week, he got more results than in four years with the VA. Now, he knows what’s wrong and where to go next.”
Charles Leonard is the outgoing director of the Neural Injury Center. A professor in UM’s School of Physical Therapy and Rehabilitation Science since 1990, he delayed retirement to fledge a program built on a high-powered team approach.
He says center scientists integrate multiple disciplines in order to gain a broader perspective on the medical issues affecting an individual with TBI, including speech, language, cognition, balance, eye tracking and molecular level changes in proteins within the brain.
Michaud’s initial visit will be with Cindi Laukes, the chief operations officer. She has vast experience in neurological clinical research and a matching dose of compassion.
“When students have memory, cognition and focus issues, it makes life difficult,” Laukes says. She reassures all entering individuals that their screening tests will not be too tiring, because she understands that a common effect of TBI is cognitive fatigue. The tests lead to a comprehensive view of the brain injury that informs a plan for recovery. Staff members follow up on a patient’s progress and offer access to the center’s research.
Former UM Griz wide receiver Ryan Burke has come through that door and out the other side. Now, with a fine-tuned diagnosis, Burke is using new ways to better resolve his symptoms as he finishes school with a degree in finance.
Burke is recovering from a serious concussion suffered September 2015 in a football game against Northern Arizona University. It was the fifth concussion in his life, and the worst. He credits huge initial progress to physical therapist Jill Olson at Peak Performance in Missoula. However, like Michaud, he struggles with memory retention and lengthy assignments. When Burke’s mother found out about the center, he signed up.
“Cindi’s caring came through right away,” Burke says of his initial meeting. “The program is personal, yet professional. That meant a lot to me, because a concussion is such a different kind of injury. Cindi helped me figure out a course that seemed best and was comfortable for me too.”
Alex Santos took Burke through balance, eye-tracking and hand motion tests. Santos, originally from Brazil, is a researcher in neural control of movement and a UM physical therapy professor.
His techniques decipher minute changes with profound effects. Burke, for instance, stood on a force plate that’s hooked up to a computer. Santos asked him to sway forward slightly, then backward. Next, Burke looked at a dot on the wall and closed his eyes. Like Etch-a-Sketch lines, the computer recorded the extent of sways.
“People with TBI may think their balance is fine, yet analysis shows they oscillate more and their speed is slower,” says Santos, who developed the balance analysis computer software.
“A person who hits their head or is exposed to a blast, like a soldier, loses their optimal performance,” Santos explains. “The central nervous system has to be well organized and efficient to be sure you can control all the muscles and perform well, whether standing up, walking, holding something or following a target with your eyes. TBIs, even mild, can reduce this efficiency and progress with worsening of symptoms.”
Santos tracks eye movements with cameras as patients pursue laser-projected objects on a wall. Again, his data show TBI patients follow more slowly and with less accuracy than normal.
Sambit Mohapatra, a licensed physical therapist, neuroscientist and UM assistant professor in physical therapy, focuses on understanding brain areas that control certain rapid eye movements impaired by brain injury. His research involves developing therapies for modulating parts of the brain affected by injuries.
“We know that after a TBI there are at least two major deficits: the front part of the brain that controls rapid eye movements and the second, which is a connection problem between the left and the right hemispheres,” he says.
To find which parts of the brain respond correctly or incorrectly to stimulus, Mohapatra uses a noninvasive brain stimulation device called Transcranial Magnetic Stimulation (TMS). A patient such as Burke sits in a chair with a magnetic coil placed close to his head. The machine has the ability first to understand the functions of the various brain areas, which may have been damaged by injury, and to modulate these areas to improve functions temporarily. TMS is synced with a neuronavigation device, which helps to locate targets on the brain by using patient’s MRI scans. His research contributes to advances in developing novel assessment tools and potential intervention for individuals with TBI.
Not all screening requires high-tech machinery. Computer and paper tests measure memory and cognitive abilities. For Burke, with every test in the center, a similar pattern began to emerge.
“Physically, I felt fine, but when I did a memory test, I was burning out after one or two tests and worse with three or four,” Burke says. “The same thing happened with eye tracking. I’d start well, but then my eyes would move slower.”
That fatigue often fails to show up in standard tests following brain injury, says neuroscientist Tom Rau, who works with Sarjubhai Patel, a molecular pharmacologist, in blood testing to identify unique biomarkers related to injuries to the central nervous system. They focus on the transport of proteins that help cells repair and heal. They’re tracking biomarkers (molecules that influence proteins) that affect the brain’s recovery process.
“On the outside, people look like they are recovered, but molecular changes are continuing way past the time when outwardly they seem okay, and with long-lasting repercussions,” Patel says.
For Burke, his diagnosis holds the key to success in therapy, in academic performance and in his life ahead.
“The information is a relief, and now I have a path forward,” he says. Burke will always have a passion for football, but he has no regrets about his decision not to return to play.
“I love the game of football and always will, but it came down to not risking a lot more in my life that I want to accomplish,” he says.
Michaud also has a big vision for what he wants to achieve in life. He believes the Neural Injury Center holds promise for students, and all veterans with TBI. His dream would be to see those services applied to everyone in the Veterans Affairs system.
“If their work could apply to the whole VA it would save incredible amounts of time, money and stress,” he says. “When they get it all perfect, that should be a Nobel Prize.”
— By Marina Richie