I’ve worked with victims of brain injury for years. When I read this article I felt the struggles and milestones one can and often does reach when they face severe wounds. No other injury is quite as devasting as a brain injury. It’s effects can be felt for a lifetime. There is a science to treating these wounds, and it’s been around for a long time. To the military it is new though…I got a chuckle out of some of the terms they use. This is a good article (even if it’s from the very biased NYT).

PALO ALTO, Calif. – It has taken hundreds of hours of therapy, but Jason Poole, a 23-year old Marine corporal, has learned all over again to speak and to walk. At times, though, words still elude him. He can read barely 16 words a minute. His memory can be fickle, his thinking delayed. Injured by a roadside bomb in Iraq, he is blind in his left eye, deaf in his left ear, weak on his right side and still getting used to his new face, which was rebuilt with skin and bone grafts and 75 to 100 titanium screws and plates.

Survivors of auto accidents have dealt with the very same medical issues for decades. Losing limbs, eyes, burns from gas tanks blowing up…along with a brain injury. Most who have experienced such a trauma do not remember the actual event- it is forever blocked out of their memories. Yet many who go through it will remember things right before the event and the months they may spend in a coma.

Even so, those who know Corporal Poole say his personality – gregarious, kind and funny – has remained intact. Wounded on patrol near the Syrian border on June 30, 2004, he considers himself lucky to be alive. So do his doctors. “Basically I want to get my life back,” he said. “I’m really trying.”

But he knows the life ahead of him is unlikely to match the one he had planned, in which he was going to attend college and become a teacher, get married and have children. Now, he hopes to volunteer in a school. His girlfriend from before he went to war is now just a friend. Before he left, they had agreed they might talk about getting married when he got back.

“But I didn’t come back,” he said.

Nope…life will never be the same for anyone who is a victim of this stuff. But I have seen many many survivors walk again, talk again, eat regular food again…and drive, attend college, get married and yes, have kids. It’s not impossible.
Sometimes it takes YEARS. The human brain has a way of healing in ways no one with medical knowedge can explain. It goes into a state of dormacy for a long time, with no changes (it’s why we see people wake up from a 10 year long coma…)then one day everything comes back. It’s complex and completely unknown, the brain. Scientist are learning more and more everyday, but there is SO much we don’t know.

More than 1,700 of those wounded in Iraq are known to have brain injuries, half of which are severe enough that they may permanently impair thinking, memory, mood, behavior and the ability to work.

The most severe brain injuries will present with symptoms such as permanent state of coma, the famous vegative state, total dependence upon others for all ADL’s (activities of daily living which include feeding, bathing, toileting, dressing and mobility- things needed in order to live). I work with mostly this population, and many of them start out in a coma and wake up only to endure the challenges involved with re-learning how to do things for themselves. KEY WORD- re-learning. It can and does happen- all the time. The next level of ADL is called IADL- Incidental ADL…this includes the abilty to cook, clean, shop, manage money, read, get a job, ect. (The things not directly required in order to survive). This is another process we deal with. Re-learning these skills requires a different approach, but it can be done and is done. Often. I’ve seen victims with half their head missing get PhD’s and move to become educators and scientists and nurses and doctors. It’s truly amazing what the human body is capable of.

The consequences of brain injury are enormous. Penetrating injuries can knock out specific functions like vision and speech, and may eventually cause epilepsy and increase the risk of dementia. What doctors call “closed-head injuries,” from blows to the head or blasts, are more likely to have diffuse effects throughout the brain, particularly on the frontal lobes, which control the ability to pay attention, make plans, manage time and solve problems.

When we first contact a patient with a brain injury (head injury is no longer a term we use with this stuff), we can tell what part of the brain has been harmed the most, by the way the patient postures. Immediatly after the event, the human body goes into one of two positions. Medical people are trained to respond to this positioning and we treat accordingly. The success rate- of coming out of these horrible trauma’s depends SO much on how the victim is handling shortly after their accidents or war wounds. Everything from this point on has a care pathway that is followed with typical timeframes for critical medical interventions, to surgeries, to therapies…it’s really neat to see this all blend together and work.

His unit was among the first to invade Iraq. He was on his third tour of duty there, just 10 days from coming home and leaving the Marines, when he was wounded in the explosion.

A week later, he was transferred to Bethesda, still in a coma, and his parents were told he might never wake up.

“I was unconscious for two months,” Corporal Poole said in a recent interview at the V.A. center in Palo Alto. “One month and 23 days, really. Then I woke up and came here.”

He has been a patient at the center since September 2004, mostly in the brain injury rehabilitation unit. He arrived unable to speak or walk, drooling, with the left side of his face caved in, his left eye blind and sunken, a feeding tube in his stomach and an opening in his neck to help him breathe.

Where I work, we get victims within days of the initial trauma. They start “therapy” very soon after admission. People in coma’s are not just left to lay there…they require the most care of any patient population. Nursing care is intense and never ending. We’re responsible for keeping these patients alive, in medically stable conditions. The care needs of this group are considered high acuity…meaning we have to constantly monitor them, provide hands on skilled nursing, and be alert for so many other problems and try to prevent them. I work with feeding tubes, central lines, PICC lines, shunts,- you name it, I’ve played with it. Patients in coma as a result of a brain injury often cannot breathe on their own, we have to place a trach tube into their throats and attach tubing to a ventalator. This unit must be attached to a humidifier- and set the machines to a rate of breaths per minute. Because of the high risk for respiratory distress among this population, we usually hook them up to heart and 02 monitors as well. Therapy at this early stage includes sensory stimulation and physical therapy. We use our hands as well as machines to move non effected limbs through a complete range of motion, several times a day. Respositioning of the patient usually requires a hydrolic lift of some sort. Their heads are usually in some sort of brace to keep it aligned properly.

Evi Klein, a speech therapist in Palo Alto, said that when they met in September 2004 Corporal Poole could name only about half the objects in his room.

“He had words, but he couldn’t pull together language to express his thoughts,” Ms. Klein said. “To answer a question with more than one or two words was beyond his capabilities.”

Not all victims regain their abilty to use their voices. Many are silent for the rest of their lives. For them, communication is a real struggle. They must use other means. If they have the ability to read, use of a communication board is often used…then they “graduate” to a computer with pre-selected phrases…with thousands of words, sentences, questions, simple commands. It takes a lot to be able to work with this system. There are many speech language disorders that are a part of the territory of brain injuries (and strokes). Vison and voice, abilty to read and read correctly are often effected. Many victims see words backwards, upside down, sideways. Others can read the words and sentences very well but cannot understand or remember them. Many can only see out of the uneffected eye and therefore positioning of the communication system is critical in it’s success. It’s an amazing thing to observe- people re-learning to communicate. About half never regain their voices. We often depend upon eye movement, finger movement, foot movement-whatever works- for communication. And some of those with these severe deficits in this area are able among that group I wrote about above, who have gone to colleges and gotten degrees and are making good money doing what they love to do. It’s an inspiration.

Reading this article I did pick up on some negative vibes…typical of the NYT to be so. All in all though it is a good accounting of life after a brain injury. It’s not at all the end of the world. It’s a major side step down a road of ugliness that I would never wish upon anyone. It’s really important to remember to be respectful towards anyone with any kind of disabilty. They are no less human than anyone else. And it’s important to remember that the life of someone who has sustained a severe brain injury isn’t over. It may take a very long time, and a lot of hard work, but they can accomplish a lot and be worthwhile members of society.