New Hope For Veterans With Traumatic Brain Injuries

Center for BrainHealth TBI Traumatic Brain Injury
When Josh Lewis returned from four deployments with the U.S. Marines in Iraq and Afghanistan in Feb. 2011, he was pushing 30 and ready to launch a civilian career. Lewis (pictured above) enrolled part-time at the University of Texas at Dallas to study global business.

But upon enrolling, he realized he simply couldn't stand his classmates.

"I want to say them, 'Gosh, you are dumb,' " Lewis, now 30, says. "A lot of politics come up in conversation, and here I am, someone who's been there. So yeah, I felt the anger boil up, and I wanted to blow up at them at times."

The anger was the least of his problems. Battling chronic headaches so severe he would temporarily lose his vision, he also found his memory impaired at times, unable to recall, for instance, what someone had told him five minutes earlier. "This must be how elderly people feel when they can't remember names," was how he described his state.

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The headaches, memory problems and hair-trigger temper are all symptoms of traumatic brain injury. He was diagnosed with TBI in early 2011, shortly after he returned from deployment and enrolled in school. Caused by blows to the head, either by direct impact from a bullet or close proximity to an explosion, TBI can result in memory and sensation loss, a range of mood disorders and difficulty with simple communication, such as trouble taking turns in a conversation and staying on a topic.

The condition affects roughly 1 in 5 veterans of the Iraq and Afghanistan wars; it is a new phenomenon, a result of the fact that this generation of soldiers has been able to survive wounds that in wars past would have killed them. And the number of troops being diagnosed with TBI has been on the rise as the wars wind down, says Hannah Rudstam, a researcher at Cornell University's Employment and Disability Institute. "Someone who has a blast injury probably isn't going to realize it right away, because there isn't any blood."

No Blood

Just before he began school, he tapped into his network of fellow veterans and found a part-time job working 30 hours a week as an associate at the Trident Response Group, a Dallas-based consulting firm that specializes in personal security in both the private and public sectors. But he found himself struggling to be productive there. Lewis was sidelined from work for full days at a time because of the headaches, he says.

Many veterans with TBI struggle to work. A 2004 study conducted by the Center for Outcome Measurement in Brain Injury examined the employment rate of 2,500 adults with TBI. Fifty-nine percent of them had jobs before their injury, but one year after their injury, only 24 percent did.

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After several months on the job, he says that his colleagues reached out to the Center for BrainHealth on his behalf for help. In September 2011, he began participating in the center's cognitive therapy program for victims of brain trauma, known as the Strategic Memory Advanced Reasoning Training, or SMART, program.

'Step Back And Calm Down'

"Intellectually, veterans with TBI should be able to contribute in the workforce, but they first need the proper training," says Sandra Chapman, the founder of the Center for BrainHealth. "We can't just give these veterans a job. We need to rewire the brain."

Attending weekly one-hour sessions for twice a week for one month while working and studying, Lewis took part in the SMART sessions designed to rewire the brain. No surgical procedure is needed. Instead, the program simply dictates strategies to help participants focus on one task at a time. Such an approach, which Chapman calls the "power of one," relaxes the brain, and as a result increases blood flow throughout the cranium, which has the effect of repairing the brain connections damaged by TBI. In practice, the program is a way to let the brain heal itself.

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The center, opened in 1999, recently won separate grants from the Defense Department to provide training to veterans with PTSD and TBI. With help from the grant, the center will soon be welcoming 1,500 veterans to take part in the training. "We now know the brain can recover a lot from injuries," she says.

Since finishing the program in January of this year, Lewis says the rate of headaches have dropped dramatically, and he's only really had one since. As for the fits of anger? "In the military, the idea is to respond by yelling. Now, it's to step back and calm down."

The training has also helped him at work, he says.

"SMART has helped me how to use silence to think deeply and solve complex problems," he adds. "Part of what I do is also teach self defense and SMART has helped me as an instructor to better relate to my students."

Working Alongside TBI

The U.S. Department of Veterans Affairs considers the SMART program a "pilot program," so it is not part of the official treatment program for veterans. Currently, veterans with TBI, or PTSD enter the workforce as physically disabled, as classified by the VA, and so no special classification is provided for non-visible injuries.

But the federal government has aimed to promote employment for veterans with TBI and PTSD through its America's Heroes at Work project. Established in 2008 by the Department of Labor, the program is primarily aimed at convincing employers that veterans with TBI and PTSD can be productive workers and offers tips for how to ease their transition into the workforce.

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For example, employers are encouraged to get rid of fluorescent lights, because these lights can aggravate the veterans' headaches. The employers are also told it's a good idea to urge the veterans to make use of "daily to-do lists," much in the way Chapman promotes the "power of one" mantra.

For his part, Lewis says that his job is aiding his recovery.

"As a Marine, I don't like being bad at things," says Lewis. "And so being good at my job is extremely important for me."

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