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Broken brains

"Broken brains" Continued...

Issue: "Another dark day in America," Jan. 12, 2013

Other patients face immense pressure due to swelling brains. They have to have portions of their skull cap removed and wear helmets until the brain’s proper size is restored.

But the vast majority of TBI cases are temporary due to the brain’s ability to repair, regenerate, and reconnect, a concept called neuroplasticity. “If you have a weak muscle you are going to lift weights to get it strong,” said Steven Lewis, a neurologist with the Womack Army Medical Center at Fort Bragg, N.C. “Just like an unworked muscle will atrophy, many untreated cases of TBI won’t improve the longer they are ignored.”

Using an earthquake analogy, the brain’s TBI-damaged roads can be repaired. And in those cases where the brain’s toppled buildings and destroyed roads are wrecked beyond repair, the healthy parts of the brain can compensate by learning to handle new functions.

“It is like the department of defense takes over for the department of finance because the department finance is not there anymore,” says Dr. Chae, who also is the site director of the Defense and Veterans Brain Injury Center at Fort Belvoir. “But it takes time and training for that to happen.”

The science on TBI is still developing. In 2007, Congress provided the military with $300 million for TBI research. That initial TBI appropriation now has grown to more than $600 million.

The Pentagon opened a $70 million TBI center for treatment and research in 2010 at the Walter Reed National Military Medical Center in Maryland. In an effort to provide soldiers with care closer to their home bases, the military plans to open at least nine TBI satellite rehabilitation centers at major military installations across the country, such as Virginia’s Fort Belvoir and North Carolina’s Fort Bragg.

With the brain being one of medical science’s last fully uncharted territories, there are no surgeries that can repair or pills that can restore a TBI patient’s altered cognitive functioning. Instead the treatment program is grounded on two pillars: rest and a battery of mental exercises that can help a brain learn new pathways for internal communication.

In Fort Belvoir, where 95 percent of the TBI cases are mild, one of Chae’s tasks is convincing soldiers used to an active lifestyle that rest is needed to nurture a healing process that can take days, weeks, or months.

“Playing video games is not resting,” said Chae, repeating a refrain he often has to tell the current generation of soldiers. “People don’t know how to protect their brain for neuroplasticity to be completed. We become coaches until that process happens.”

Retraining the patient and the patient’s brain requires an interdisciplinary treatment team of doctors, therapists, counselors, and social workers. They unleash a battery of drills designed for the mind instead of the body. The activities vary from patient to patient since each individual brain copes with the trauma in different ways.

Jarvis’ symptoms include an inability to sleep more than three hours a night and a tendency to get confused around large groups of people. So his rehabilitation involves an occupational therapist who teaches techniques for handling crowds and a sleep coach who demonstrates relaxation exercises.

Kurt Garrett, 44, suffered multiple TBI incidences as a deployed Marine. The chief warrant officer returned from Iraq so disoriented (he’d check the kitchen trash for scraps to know whether he had eaten) and with a personality change so pronounced that his wife told him he was not the man she married. At Fort Bragg, he sees a neuro-optometrist who helps correct his eye movement and eye focusing abnormalities. The therapy involves machines similar to the ones found in a typical eye doctor’s office. But it also employs objects found at any craft store such as a string with multicolored beads that is tied to a door handle.

Patients like Garrett sit on a chair with the untied end of the string stretched to their nose. They train their eyes to remain focused on a bead of specific color as a therapist moves the beads up and down the string. Garrett, who was knocked out for 15 minutes when a steel beam fell on him while seated in a gun turret, also wears 3D glasses to follow two identical clown drawings as they are moved closer together and farther apart. Repetitive speed drills such as timed word searches help retrain his eyes to focus and then communicate with his brain.

“By the time I am done with an hour of that, I feel like I have done six hours of physical therapy,” said Garrett, who performed 237 patrols while assigned as a mentor to an Iraqi infantry company. “I am worn out.”

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