Getting Back to Battle with a Brain Injury

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Sgt. Joshua Thurman relaxes after a battlefield simulation. He suffered a mild traumatic brain injury in Afghanistan and wants to return to duty.

Sgt. Joshua Thurman relaxes after a battlefield simulation. He suffered a mild traumatic brain injury in Afghanistan and wants to return to duty.

The signature wound of the wars in Iraq and Afghanistan – mild traumatic brain injury or TBI – has been hard to diagnose and just as difficult to treat. But determining if and when a soldier can return to battle following a serious concussion has befuddled doctors. So physicians at Fort Campbell have begun observing patients under the stress of combat.

“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 gun shots 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 frontline. But 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.

Between each battlefield simulation physical therapist Tamara Moreland tests the balance of soldiers.

Physical therapist Tamara Moreland tests the balance of TBI patients after each simulation, here asking Sgt. Patrick Cummings to shake his head.

Physical therapist Tamara Moreland tests the balance of TBI patients after each simulation, here asking Sgt. Patrick Cummings to shake his head.

“Arms straight out in front of you,” she tells them. “Eyes closed. 50 steps in place, stay where you stop.”

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

More than Pen and Paper Tests

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 says.

Twillie directs Fort Campbell’s TBI clinic, 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 had a soldier that really had a desire to stay in, had done well in all of our pencil and pad, all our simulations,” Twillie says. “But when all the different sights, sounds, smells, everything that’s related to came back, he just wasn’t able to change his focus, and that’s very important in combat.”

Battle Tested

The sound of bullets whizzing by and the scream of men in pain pumped into a black box of a room. The audio is actually lifted from a battle scene in “Saving Private Ryan.” A strobe light imitates the flashes of gun muzzles. Three mannequins lie in pools of blood with amputated limbs scattered around them.

Soldiers rush to stabilize wounded dummies with the sounds of battle blazing around them and blood coming out of the bodies.

Soldiers rush to stabilize wounded dummies with the sounds of battle blazing around them and blood coming out of the bodies.

“Alright staff sergeant, you’ve got more than one casualty,” Trainer Jeremy Cole yells over the soundtrack. “Let’s go.”

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 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.

Staff Sgt. Nicholas Smith says he's still pulling shrapnel out of his arm. He suffered a mild traumatic brain injury during an explosion in Afghanistan last September.

Staff Sgt. Nicholas Smith says he’s still pulling shrapnel out of his arm. He suffered a mild traumatic brain injury during an explosion in Afghanistan last September.

“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,” says another soldier, Sgt. Patrick Cummings. “That’s the only difference.”

A big guy with a serious face, Cummings says he’s surprised by his own reaction.

“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’ll be in good company. The Department of Defense estimates roughly 115,000 soldiers have experienced one of these mind-altering injuries.

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