Returning To The Battlefield, With A Brain Injury

Returning To The Battlefield, With A Brain Injury

by Blake Farmer, m.npr.org
May 10th 2011

Nashville Public Radio

The signature wound of the wars in Iraq and Afghanistan — mild traumatic brain injury, or TBI — is hard to diagnose and just as difficult to treat. Now, many of these injured soldiers are returning to duty, and doctors are struggling to determine whether and when they're well enough to fight.

One way to find out is to observe patients under the stress of combat in simulated battlefield situations. That's what physicians at Fort Campbell in Kentucky are doing with recovering TBI patients.

On The (Mock) Battlefield

"Jesus!" says Sgt. Joshua Thurman, as an explosion catches him by surprise. He and a team of recovering TBI patients at Fort Campbell sweep a gravel road for possible roadside bombs. They're armed with paintball guns, taking periodic fire from pretend insurgents.

The last time most of these veterans heard bomb blasts and gunshots was the day they nearly died in Afghanistan.

"Manning the .50 cal, there was an explosion, concussion got me," Thurman says. "Came to find out I did have a TBI, but I also lost the hearing in my left ear."

Many of these soldiers now wear hearing aids. That limitation alone may keep some from going back to the front line. The lingering effects of the concussion also get in the way. Memory loss, mood swings and balance problems make returning to duty after a traumatic brain injury difficult, but not impossible.

Physical therapist Tamara Moreland tests the balance of TBI patients after each battlefield simulation.

She asks one soldier, Sgt. Patrick Cummings, to shake his head. Then she instructs others to take 50 steps in place with their arms straight out and their eyes closed.

Moreland watches to see if they end up in the same place they started. Physical symptoms of TBI tend to get worse under stress, and Moreland wants to see how much worse.

Returning To Duty

Until now, returning to duty took a doctor like David Twillie looking at a few charts and signing off. That's changing.

"Soldiers are making life and death decisions, so doesn't it make sense to use demonstrated competence as the standard for returning someone to duty?" he asks.

Twillie directs Fort Campbell's TBI clinic, which has been singled out as a national model by the Pentagon. Here patients must demonstrate their competence through pencil-and-paper tests as well as new real-life exercises.

Most soldiers who get to these simulations will return to duty, Twillie says. But some soldiers appear ready to go back on paper, when they're really not.

"In fact very recently we had a soldier that had a desire to stay in, had done well in all our simulations," Twillie says. "But when all the different sights, sounds, smells came back, he just wasn't able to change his focus, and that's very important in combat."

A Flashback, And Tears

Jeremy Cole, a trainer who works with the TBI patients, tries to see whether soldiers can complete a series of tasks in the correct order even when rattled. He plays audio from a battlefield scene in Saving Private Ryan and then tells the soldiers to put in chest tubes and tighten down tourniquets.

"Catch your breath," he tells one soldier who is trying to assess a casualty.

As the sound goes down and the lights come up, pools of red surround each body.

"I've had soldiers' blood on my hand before, so it takes you back there," says Staff Sgt. Nicholas Smith, looking at his own hands.

He says the amount of blood in this simulation is pretty true to life.

"The only difference is no one's screaming 'Mom!' or 'Get me out of here!' That's the only difference."

Sgt. Patrick Cummings, a big guy with a serious face, says he's surprised by his reaction to the battlefield simulations.

"It kind of brought tears because I was there. I was one of these patients before," he says. "It just hit home."

Despite the flashback, Cummings wants to deploy again. As a TBI survivor, he won't be alone. The Department of Defense estimates roughly 115,000 soldiers have experienced one of these mind-altering injuries. [Copyright 2011 Nashville Public Radio]

TRANSCRIPT:

MELISSA BLOCK, host:

Mild Traumatic Brain Injury, or TBI, has become a signature injury of the wars in Iraq and Afghanistan. Tens of thousands of troops have suffered concussions that left them with TBI. And doctors have struggled to determine when or if a person with the condition can return to battle.

Blake Farmer of member station WPLN takes us to Fort Campbell, Kentucky, where physicians are simulating stressful combat situations. The goal is to better understand TBI.

(Soundbite of explosion)

Sergeant JOSHUA THURMAN: Jesus. Okay.

(Soundbite of laughter)

BLAKE FARMER: An explosion catches Sergeant Joshua Thurman by surprise, as he and a team of recovering soldiers sweep a gravel road for explosives at a training site on Fort Campbell. Armed with paintball guns, they take periodic fire from pretend insurgents.

(Soundbite of paintball shots)

FARMER: The last time most of these veterans heard bomb blasts and gunshots was the day they almost died in Afghanistan.

Sgt. THURMAN: Manning the 50-cal and there was an explosion, and the concussion got me. And came to find out I did have a TBI, but I also lost the hearing in my left ear.

FARMER: Hearing loss alone may keep Thurman from going back to the front line. But the lingering effects of a concussion also get in the way for soldiers. Memory loss, mood swings and balance problems make returning to duty after a TBI difficult, but not impossible.

Between each battlefield simulation, physical therapist Tamara Moreland tests each soldier's balance.

Ms. TAMARA MORELAND (Physical Therapist): You put your arms straight out in front of you, close your eyes, 50 steps in place, stay where you stop.

(Soundbite of footsteps)

FARMER: Physical symptoms of TBI tend to get worse under stress. Moreland wants to see how much worse.

Until now, returning to duty took a doctor like David Twillie looking at a few charts and signing off. That's changing.

Dr. DAVID TWILLIE (Director, Traumatic Brain Injury Center, Fort Campbell): We said soldiers are making life and death decisions, so doesn't it make sense to use demonstrated competence as the standard for returning someone to duty?

FARMER: Twillie directs Fort Campbell's TBI clinic, singled out as a national model by the Pentagon. Patients here must demonstrate their competence through pencil-and-paper tests, as well as new real-life exercises.

Most soldiers who get to these simulations will return to duty, Twillie says. But some soldiers appear ready to go back on paper when they're really not.

Dr. TWILLIE: In fact, very recently had a soldier that really had a desire to stay in, had done well on all of our pencil and pad, our computerized tests and all of our simulations. But when all of the different sights, sounds, and smells, everything that's related to combat, he just wasn't able to change his focus. He could focus on one thing but he couldn't really switch when the conditions changed to something else. And that's very important in combat.

(Soundbite of simulated battle scene)

FARMER: The audio of a battle scene, lifted from "Saving Private Ryan," is pumped into this black box of a room. A strobe light imitates the flashes of gun muzzles. Three mannequins lie in pools of fake blood with amputated limbs scattered around them.

Sergeant JEREMY COLE (Trainer, Fort Campbell Warrior Resiliency Recovery Center): All right, staff sergeant, we've got more than one casualty. Let's go.

FARMER: Trainer Jeremy Cole watches to see if soldiers can complete a series of tasks in the correct order, even when rattled. They put in chest tubes, tighten tourniquets.

Unidentified Man #2: On your knees. We're going to need...

Sgt. COLE: Catch your breath. We're going to need probably blood. He's lost a lot of blood. We're going to need another stretcher.

FARMER: As the sound goes down and the lights come up, Staff Sergeant Nicholas Smith stands in a pool of red looking at his hands.

Staff Sergeant NICHOLAS SMITH: I mean I've had soldiers' blood on my hand before, so it's just like, you know, it takes you back there.

FARMER: There is blood everywhere in this room. And you're saying this is no exaggeration.

SSgt. SMITH: When you have a massacre like this, it's everywhere. So...

Sergeant PATRICK CUMMINGS: The only difference is no one is crying. No one is screaming, Mom, or get me out of here.

SSgt. SMITH: That's the only difference.

FARMER: That's Sergeant Patrick Cummings, a big guy with a serious face, who says he's surprised by his own reaction.

Sgt. CUMMINGS: It kind of brought tears because of just - I was there. I was one of these patients before and it just hit home.

FARMER: Despite the flashback, Cummings wants to deploy again. As a TBI survivor, he'll be in good company. The Department of Defense estimates roughly 115,000 servicemembers have experienced one of these mind-altering injuries.

For NPR News, I'm Blake Farmer in Nashville. Transcript provided by NPR, Copyright National Public Radio.



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