Broken brains

"Broken brains" Continued...

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

At Fort Bragg, where the return to duty rate for TBI patients is 90 percent, therapists use a 5-foot-tall touchpad grid, called a Touch Wall, for balance training—one of the things often lost with TBI. The wall’s 64 squares each contain an LED light that can flash different colors at different speeds. Told to hit only grids that display certain colors, soldiers track the color patterns with their eyes while balancing themselves on a foam pad. The timed sessions can get competitive. Nearby, a “brain bike” integrates physical activity with cognitive tests by using a video touch screen above the handlebars that provides brainteasers for the peddling soldier.

After suffering through a divorce and having to drop out of classes for an advanced degree, Special Forces Sgt. Holt admitted he needed help. He began going through neuro psychology and visual rehabilitation therapy starting in January 2012—more than two years after the deadly helicopter crash. Early in his treatments the exercises would cause headaches so severe he would have to sit in the doctor’s office for 30 minutes before leaving.

One of his therapists, Evelyn Galvis, a speech and language pathologist at Fort Bragg’s Womack Army Medical Center, uses tools as simple as a deck of playing cards, a magazine, and worksheets of memory games to make patients like Holt miserable.

During a recent session, Galvis dealt eight playing cards face down. Flipping over one card at a time, she suggested a memory device for remembering each card.

“It’s 10 of diamonds,” she said. “Remember the time you gave your wife 10 diamonds.”

“Here’s the two of hearts,” she said while flipping over the second card. “Remember the saying, ‘two hearts are better than one.’”

Returning each card to a face-down position, Galvis asked the patient to look at two seemingly identical pictures that have a dozen slight differences. It’s a game found in the pages of most elementary school brain-teaser magazines.

Once the patient listed the differences, Galvis set those aside and verbally gave the patient a series of four numbers to be repeated in reverse order.

Several sequences of numbers gave way to new sequences of objects that had to be renamed in reverse order:

Pansy. Tulip. Rose.

Arm. Leg. Neck. Head.

After several lists and without a break, Galvis pointed to one of the face-down playing cards and asked, “Which one is that?”

She pointed to another. Then another.

Still moving fast, she grabbed the two pictures and asked the patient to rattle off the 12 differences, this time without looking at the pictures.

As patients get more advanced, Galvis will introduce distractions. She turns on a radio in the corner, playing the music at varying volumes. Sometimes she bounces a rubber ball off the opposite wall as the patient tries to concentrate.

One of the challenges surrounding TBI is that it’s hard to detect on the battlefield. Still, the military has begun attempts to identify and treat TBI in combat zones. Medics are trained to assess the orientation, memory, and concentration of soldiers who are near a blast, suffer a blow to the head, or get in a vehicle accident. These screenings, made mandatory by a 2010 Pentagon directive, occur even if the soldier does not appear to be hurt.

The military also has opened a dozen concussion restoration care centers throughout Afghanistan. Here soldiers who don’t pass initial tests receive orders for rest and additional neurological evaluations. Army medics in Afghanistan are field-testing a blood test, similar to those used to measure a diabetic’s blood sugar, to determine if a soldier has damaged brain cells. Research has revealed that certain proteins in the blood may be present only when brain cells have been harmed.

The military has ordered nearly 50,000 sensor helmets with the ability to measure the severity of blows to the head and to detect the potential for concussions. The National Football League is partnering with the military to place similar sensors in the helmets of professional football players.

The technology is helping soldiers become more aware of injuries few knew existed before the wars in Iraq and Afghanistan.

Back at treatment centers, camaraderie among the TBI patients helps with recovery. At Fort Belvoir some of the patients joke that they ought to become professional boxers since their heads have already taken a few lumps. But the military hopes to create greater TBI awareness among the general public where, soldiers say, a stigma still exists.

“Outside of here they know T,B, I are three letters that stand for something, and when you tell them it’s Traumatic Brain Injury, the word traumatic freaks them out,” Jarvis said.


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