Brain expert sees progress

Technology to diagnose brain injuries has improved tremendously over 30 years, says Dr. Erin Bigler, noted clinical neurophysiologist.

"But the problem is we haven't made tremendous gains in how to treat these people," he added in an interview. "The brain is very complicated."

Bigler is a professor of psychology and neuroscience at Brigham Young University, adjunct professor of psychiatry at the University of Utah School of Medicine and faculty member of the Utah Brain Institute.

He is an author and researcher who is sharing his expertise with Hawaii psychologists and physicians as the Morita Distinguished Fellow for 2008 at the Rehabilitation Hospital of the Pacific.

He is also giving a class for psychology and neuropsychology fellows at Tripler Army Medical Center and a new neuroscience class at Brigham Young-Hawaii.

Bigler was at the Barrow Neurological Institute at St. Joseph's Hospital and Medical Center in Phoenix in 1975 when it was one of the first places to get computerized tomography.

"The first time I saw a CT scanner, it was like, 'Wow!'" he said. "It was very primitive, but we were now actually looking at brain tissue, not just a silhouette of the internal cavity."

Now, with improved CTs and magnetic resonance imaging, he said, "What we view today is exactly what you would see if you had an anatomic specimen."

While the new imaging tools allow physicians to better diagnose problems in the brain, he said, "we're still in infancy in how to treat these. That's the focus that is so important right now.

"Brain tissue doesn't regenerate," he explained. "Therefore you have to deal with pathways that survive and how to re-engage those pathways. That is the goal of rehabilitation when the brain is injured."

The brain is well designed to withstand minor problems, Bigler said. "It recovers from a fall and a blow quite well. But it's a new era we're in. The brain isn't designed to withstand high-velocity impact," he said, such as from motor accidents, sports and military combat.

Gladiators were not at risk for traumatic brain injuries as much as National Football League players, he said.

An estimated 40,000 head injuries have occurred in Afghanistan and Iraq, Bigler said, noting former ABC World News co-anchor Bob Woodruff's recovery from traumatic brain injury in Iraq was "unbelievable." He said Woodruff's case shows much more could be done to treat brain injuries "if we had unlimited resources."

"Traumatic brain injury is a huge issue," he said. Many people in the past discounted effects of a mild head injury or concussion, thinking it could not have significant consequences, he said.

Most people do recover from a mild concussion, Bigler said, explaining he was knocked out playing football when he was a high school senior. He spent the night in the hospital but played the game the next weekend and went on to graduate, he said.

But more than 1 million to 1.5 million Americans have concussions, and 5 percent to 10 percent "don't have a good outcome," he said.

He said the key to knowing how to treat a brain disorder is to first understand the pathology, which is what he has been focusing on.

"When we started doing three-dimensional work with the brain ... it took us over six years to analyze the data because all of it had to be done by hand," he said. With automation, he said, his lab and others "can do in minutes to hours what would literally take us months to years to do a few years ago."

"We're looking to centers like REHAB to take the information and hopefully use it to guide therapies, to understand the brain better.

"With newer imaging techniques," Bigler said, "we may be able to target specific areas and tell how functional that area is, and there may be ways to engage that brain region" with medications, cell regeneration, cell growth stimulation, reconnections or repairing neurons.

The Morita Distinguished Fellow Program was established in 2003 in memory of SONY founder Akio Morita and his wife, Yoshiko. Morita received treatment at REHAB Hospital and became one of its major supporters.