Overwhelmed
Three years after Geoffrey Ling's time in Iraq, his war on brain injury has really just begun. Scientists have preliminary evidence that forces unique to blasts can damage the brain directly, independent of any blunt injuries that the blast might also cause. The key questions, however, remain unanswered. Which aspects of the blast do the most damage? How can the military better protect its personnel? And perhaps most important for legions of soldiers on patrol, can repeated exposure to weak blasts lead to long-­lasting brain damage?

The prognosis for soldiers returning home with symptoms of brain damage is not encouraging. Decades of research into ­civilian head trauma have come to very little; treatments that seemed promising in animal models have turned out to be ineffective in human tests. "It's a completely untapped area of medical development," says trauma surgeon Jon Bowersox. While the military is testing a handful of existing drugs, there's a "time mismatch" when it comes to developing new treatments specifically for traumatic brain injury, Bowersox observes. "The military is interested in developing products they can have out during the current war," he says. "They are not used to the fact that medical development has a longer time line."

Even the few therapies that do exist will be difficult to deliver to everyone who needs them. "What will we do with all these people?" asks Barth. "We're talking about thousands. This is going to overwhelm the VA hospitals." The military is preparing some of those hospitals to better deal with brain injury, hiring neuro­psychologists to make diagnoses and other experts to run rehabilitation programs. But resources are limited. At some of the medical centers, "physicians haven't had any training in rehabilitation other than clinical medicine," says Bowersox.

Perhaps the greatest challenge will be to help injured soldiers resume their previous lives. "Young people are not equipped emotionally and financially to handle this," says Marilyn Price ­Spivack, founder of the Brain Injury Association of Massachusetts, which has recently begun an outreach effort aimed at veterans. "Often they can't go back to their civilian jobs and are very hard to employ."

The goal of facilities like NeuroCare is to return people to service or to their civilian jobs. But even a quick visit with some of the patients shows what a long road that will be for many of them. In the clinic, one patient apologizes as he twitches uncontrollably. Another abruptly leaves the room, suddenly overcome with anxiety. And ­Pendergrass, who has had serious balance problems since he was injured, is unlikely to be able to return to his previous job hanging power lines. He doesn't yet know what he'll do when he leaves the rehab center.

Emily Singer is TR's biotechnology and life Sciences editor.