It's one step at a time for brain injury patients

CHARLOTTESVILLE

They live together in a Victorian house on a quiet street in this college town. Mostly men in their early 20s, they play video games, watch movies, tell stories and practice playing guitar.

But members of the unofficial fraternity at 506 Grove Ave. aren't students at the University of Virginia. They're military members learning how to live with traumatic brain injuries, or TBI.

Lakeview Virginia NeuroCare is one of two civilian-run programs in the United States that offers advanced rehabilitation to military patients with mild to moderate brain injuries. Most, like 22-year-old Edward Bennett of Virginia Beach, suffered blast injuries in combat, or during the course of their work in Iraq and Afghanistan. Others were injured in car accidents, falls or training exercises.

Military officials estimate more than 300,000 troops who have served in Iraq or Afghanistan may suffer from brain injuries, often from explosive blasts. About half of those injured recover spontaneously over a matter of months.

But repeated concussions or exposure to blasts can wreak havoc on the brain. Between 45,000 and 90,000 military members or veterans are thought to suffer from more severe and lasting symptoms. Mild to moderate TBI - the diagnosis for most soldiers at Grove House - usually causes slowed mental processing, short-term memory loss, difficulty sleeping, headaches, irritability and anger control issues.

Other problems include difficulty concentrating, fatigue, and sensitivity to light and sound.

"If someone goes untreated, they're going to have problems for the rest of their lives," said F. Don Nidiffer, a psychologist and Lakeview Virginia NeuroCare's executive director.

"We've had people with severe injuries who recover very, very well, and some people with mild injuries who don't recover well at all," he said. "You can lose an arm or a leg and that can be very tragic, very sad. If you have a brain injury and it's severe, and you don't recover well, it can have a tremendous impact on families."

Bennett was an engineering student at Old Dominion University when his Virginia National Guard unit, the 237th Engineer Company, was mobilized for Iraq. One of the unit's main jobs was clearing Iraqi roads of explosives. After being in the vicinity of dozens of controlled detonations, Spc. Bennett found himself sometimes grasping for words, feeling dizzy and having balance problems. He noticed himself drifting off course when he walked along the steel grate pathways that criss-crossed the base.

Doctors diagnosed him with traumatic brain injury and post-concussive syndrome, and sent him back to the United States.

He spent two months last summer at Walter Reed Army Medical Center in Washington, then was assigned to a Virginia Beach-based unit for wounded Guard and reserve members.

His doctor there suggested Lakeview Virginia NeuroCare, and Bennett began the program after Thanksgiving.

He spent hours working one-on-one with Gary Levine, a speech/language pathologist. Levine is known among the tight-knit staff and patients for two things: playing the banjo, and wearing Hawaiian shirts.

Levine taught Bennett how to turn verbal or written words into images, which the brain finds easier to process. He helped him make visual associations, using mnemonic memory devices. (Instead of memorizing a list of groceries to buy, Bennett learned to link each item to, say, objects hanging on the walls of his apartment. Later, by walking through the apartment in his mind, he can recall what was on the list.)

Hawaiian shirts aside, Levine serves as a mental drill instructor. He'll ask patients to push a button every time they hear the number "two" among a long string of digits. He'll cue up a different computer program that requires listeners to signal every time they hear a number that's one smaller than the figure preceding it. The drills strengthen neurological pathways that promote higher level brain function.

One of the goals, Levine said, is to get patients functioning in complex environments without losing their concentration or having their attention fragmented - an essential skill if they want to stay in the military.

Although brain injuries don't always heal, people with mild to moderate impairment can often learn to compensate.

"It may seem harder or take more energy," Levine said. "But the end result is the same. You pass a point where you can do everything you did before."

Grove House residents often learn something new, too: how to play the guitar.

Levine and Jim Hardiman, a social worker with the program, share a love of music. Levine plays guitar and banjo; Hardiman, the guitar. They came to realize that strumming an instrument requires cognitive and motor skills, but it also serves as a stress reducer. They figured it could be a perfect outlet for military TBI patients, many of whom also struggle with post-traumatic stress disorder.

With the assistance of a retired Marine officer who donates guitars to anyone at Grove House who wants them, Hardiman and Levine now run a weekly music therapy session.

"It's something we all have in common," Hardiman explained. "I don't have PTSD, but I have trouble making a G-chord sometimes."

In January, the group was working on two songs: "The House of the Rising Sun" and "Man of Constant Sorrow."

Bennett has kept up with the guitar since leaving Charlottesville.

"It takes a lot of coordination," Bennett said recently. "I'm getting better. I think my transitions are really good. I can go from note to note without looking anymore."

The focus at Grove House is not just clinical rehabilitation. The program also works to reintegrate patients into the community by arranging unpaid jobs for a few hours a week, having them shop for and cook dinner once a week, and arranging outings for those who may struggle with being in crowds.

Perhaps the most powerful part of the program, though, is the unstructured time at the house. Actually living with "the other guys" was the best part of Bennett's time in Charlottesville.

The house sleeps eight. Rank doesn't matter much. Patients tend to be young, male and enlisted, but women, officers and older military members have passed through Grove House since the program began about seven years ago. Nidiffer estimates 80 to 90 percent of patients are soldiers, Guard members or Army reservists.

"Everybody there can relate to you," Bennett said. "At home, you're kind of hesitant to tell your wife some of the things you went through, and sometimes when you do tell your wife, she wishes you hadn't."

Caretakers like Darlene Brevard, a small woman with big hair and perfectly painted nails, are at the house round the clock and keep it running smoothly. "Mama D," as the men call her, is Grove House's mother hen. She sets out barbecue sandwiches, potato salad and Tater Tots for lunch, empties the dishwasher, and makes sure the refrigerator is stocked. She is generous with hugs.

Therapy, assessments and appointments fill most weekdays between 9 a.m. and 3 p.m. But after-hours activities help stimulate healing, too.

Assembling model ships and planes helps with fine motor skills. Playing Wii requires hand and eye coordination. Growing vegetables in a greenhouse that will soon be built in the backyard will strengthen what's called "higher order thinking": planning, judgment, organization, concentration.

Army Lt. Col. Michael Jaffee is a neurologist, psychiatrist and national director of the Defense and Veterans Brain Injury Center.

He said Lakeview's program fills a need that military and Veterans Affairs facilities couldn't meet at the beginning of the war in Iraq.

Military hospitals could handle emergency injuries, and the VA offers long-term care for those grievously wounded in battle. Nothing existed in the middle, for patients who could possibly return to active duty but needed more help regaining function than they could get at Walter Reed or Bethesda.

Lakeview's program bridges that gap - and does it in a way that allows patients to bond with other military members without the pressure of being a soldier.

"They're not just there to be patients and receive therapy," Jaffee said. "They are there to become vital and productive members of that community."

Many of the 119 military patients who have been treated at Grove House have had to overcome significant physical wounds as well as brain injury, Jaffee said. That makes it even more impressive that approximately 30 percent of their patients have returned to active duty.

Bennett hopes to re-enroll in the ROTC program at Old Dominion University. He will resume classes, part-time, this summer, and plans to take a full load in the fall.

He knows engineering courses will put his memory and critical-thinking skills to the test.

"I'm processing stuff almost like I was," Bennett said. "I'm not as worried about going back to school."

Kate Wiltrout, (757) 446-2629, kate.wiltrout@pilotonline.com