Coming Home: The Human Face of TBI

Coming home: it sounds joyous. But often, soldiers returning from battle report conflicted feelings.

When it comes to readjusting to the rhythm of everyday life, factors like physical injuries that can include traumatic brain injury [TBI] and anxiety and general emotional unsteadiness can make the adjustment hard on a soldier.

Soldiers’ Stories

“I can’t remember things, and at first was feeling hyper emotional and frustrated by difficulty in finding the right word,” says former Navy hospital corpsman, E5 Petty Off. 2nd Class Derek McGinnis. McGinnis was seriously injured in November 2004 when a homicide vehicle-borne IED drove into the ambulance he was driving in Iraq. The explosion resulted in the amputation of McGinnis’ leg, which resulted in more than a year of recuperation and rehabilitation, some of it cognitive to address the effects of his TBI. When people expressed concern over the amputation he’d tell them: “No big deal. What really matters: I can’t read.”

Read Part I of Series: Growing Threat to Soldiers: Traumatic Brain Injury

Read Part II of Series: Help for Soldiers Coping With Traumatic Brain Injury

Forty years earlier in the Vietnam War, Capt. William G. Haneke, U.S. Army Retired, was propelled 80 feet in the air after stepping on a land mine. He landed on a barbed-wire fence, his face impaled on its steel stake. “Opening my eyes was a big event,” he recalls.  Haneke was on large doses of anticonvulsive medication because TBI can cause seizures and increase damage to the brain.

“When they tell you your recovery will take a year, that takes a lot of getting used to,” says Haneke, who also required a leg amputation and suffered a mass of critical injuries that resulted in care by 15 different medical services, almost 90 surgeries and 200 medical procedures. “When they spell out what really happened, you begin to realize that things are not as good as you’d hoped,” Haneke remembers.

“There are moments when you’re depressed. Here I was, the son of an army officer, and a West Point graduate with a goal of making the army my career. Things were going fairly well until that day when my future was altered.”

Combined Conditions, Combined Interventions

Current medical evidence suggests that TBI, particularly mild TBI, and Post-Traumatic Stress Disorder are comorbidities.  Dr. David Hovda, director of the Brain Injury Research Center at UCLA, says some current thinking suggests mild TBI “sets up” the brain to acquire PTSD following brain injury.

The link is not surprising, experts say. The limbic system which influences emotional control and logical, rational thinking, functions abnormally in both TBI and PTSD and can lead to emotional control problems.

The interdependence of neuroscience and psychiatry is gaining traction in the treatment of these combined disorders—nowhere better, experts agree, than at the National Intrepid Center of Excellence [NICoE] in Bethesda, Md. Now under the jurisdiction of the Department of Defense, NICoE was funded in part with private money from the civilian-run Intrepid Fallen Heroes Fund. NICoE’s multidisciplinary approach with the most advanced scanning technology combined with cognitive and other holistic therapies makes for a powerful combination that assists in the recovery and education of soldiers.

NICoE ‘s Computer Assisted Rehabilitation Environment [CAREN] is one of only seven machines in the world, and features a motion platform, embedded treadmill and virtual environments for evaluating and rehabilitating a patient’s vision, reaction time, gait and multitasking ability. Additionally, the center uses a Positron Emission Tomography-Computed Tomography [PET-CT], Magnetic Resonance Imaging [MRI] and Magnetoencephalography [MEG], which produce images in multiple dimensions that allow   neuroscientists to see how the brain is responding to an injury and its resulting deficits.

Symptoms Differ

“Everybody’s combination of symptoms is different,” says NICoE director Dr. James P. Kelly of his patient population, which is made up of soldiers typically at the mild end of the TBI spectrum who are experiencing lingering symptoms and psychological problems.

Mainstays of therapies include Cognitive Behavioral Therapies like Prolonged Exposure Therapy and Cognitive Processing Therapy(CPT).

Prolonged Exposure Therapy involves the emotional processing of an event by exposing a patient to sounds and smells that simulate his or her traumatic experience. Cognitive Processing Therapy supports the idea that thoughts inform feelings--for example a soldier might inappropriately feel guilty about the death of a comrade.

“CPT helps you to literally think differently about your experience, and get passed an ‘out-of-control’ event,” Kelly says.

Peaceful Environment

NICoE provides a supportive and healing environment that includes patient rooms for music therapy, sleep studies and recreation therapy and an atrium called Central Park. Central Park serves as a peaceful, naturalistic center with plants, simulated sounds and different surfaces like artificial turf, carpet and stones for service members to experience while walking.

Its strong family focus includes family education and reintegration support. Family members accompany the service members to the center for their two-week stay and reside in a dedicated Fisher House on campus. Family therapists work with families who come to understand that a service member’s issues are not just a matter of returning to duty, as the majority of NICoE patients do, but also engagement with family.

When patients leave the facility, they feel more in control over their destinies and they’ve moved away from reliance on medications to a more cognitive brand of therapy. “A big part of what we do is administer in a gentle way in a calming environment,” says Kelly. “Soldiers are empowered; they’re no longer victims; they know where they’re headed and they’re not passively taking pills.”

NICoE may have been built too late to assist in the recoveries of soldiers like McGinnis and Haneke, but their postscripts are more than promising. Both went on to earn advanced degrees: McGinnis with a master’s in social work and Haneke earned an MHA in health-care administration. Both men continue to work with injured and returning troops at VA hospitals.

Haneke, who works with TBI victims, also reaches out to veterans and families of the Iraq and Afghanistan wars as cofounder of Families of the Wounded, which earned him the Daughters of the American Revolution Veteran of the Year award in 2008.

Both wrote books of their experiences: McGinnis's, Exit Wounds – A Survival Guide to Pain Management for Returning Veterans and Their Families, and Haneke, Trust Not, and say they would never have traded their military experiences.

“The enemy got my body; I will not give them my sanity.” Haneke says.

McGinnis says that he wants people to know that he is grateful for the opportunities this country has afforded him--new legs to allow him to walk, run and surf, and his education.

Maybe he won’t initially remember where he left his keys, but he’s learned how to compensate for these and other routine tasks.

“Each day I experience small victories.”

It’s fair to say that those small victories demonstrate what Kelly calls “a renewed sense of hope.”