Helping Troops Recover from Brain Injuries

Steve Cobb volunteers at the Martha Jefferson Hospital in Charlottesville, Va.

As part of Steve Cobb's rehabilitation program for his brain injury, he spent a week volunteering at Martha Jefferson Hospital in Charlottesville, Va. John DaVanzo hide caption

itoggle caption John DaVanzo

Men and women are returning from Iraq with more traumatic brain injuries than in previous wars. New armor protects the body, but the head is still vulnerable, particularly from car bomb blasts. For many, recovering from a brain injury is a long process. One innovative program is working to get troops back into the work force.

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RENEE MONTAGNE, host:

This is MORNING EDITION from NPR News. I'm Renee Montagne.

STEVE INSKEEP, host:

And I'm Steve Inskeep.

Wounded troops are coming back from Iraq with a kind of injury that was not as common in past wars: traumatic brain injuries. Often a soldier has to learn a whole new way to cope. And that struggle is the subject of the latest installment in our Span of War series, which examines the health care challenges of returning troops. NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO reporting:

In Charlottesville, Virginia, the oak trees are turning from green to bright yellow. A tall man in a blue blazer walks briskly down the red-brick streets, past strolling college students, past the coffee shops and cafes. George Zitnay stops at a store front with books lined up in the window. This is not your typical used bookstore.

Mr. GEORGE ZITNAY: This is the therapy center where the people with brain injury come for treatment. So come on in.

(Soundbite of door opening)

SHAPIRO: To understand, it helps to know that Zitnay treats people with traumatic brain injury...

Unidentified Woman #1: Hi.

Mr. ZITNAY: Hi.

SHAPIRO: ...and that the people who run the bookstore are his patients.

Mr. ZITNAY: Welcome to the bookstore.

SHAPIRO: Like the man with the distant stare working the front desk.

Mr. STEVE COBB(ph): Paperbacks is a dollar, right? And hardbacks is five.

SHAPIRO: They've got head injuries. Zitnay's a clinical psychologist. He says working here becomes a form of therapy.

Mr. ZITNAY: As you can see, it's a regular bookstore where people work and putting the books on the shelves and develop the cognitive ability to identify the books by title, by subject, and to also sell them to the public.

SHAPIRO: Just putting the right book on the right shelf, taking customers' money and making the right change, that fires up the brain and starts its healing.

Mr. COBB: Well, you have novels, fictions, religion...

SHAPIRO: Steve Cobb is the man with the stony face at the front desk. He was injured in Iraq.

Mr. COBB: You've got some on anatomy, romance. Let me see, did I say fiction?

SHAPIRO: Now he can't remember, can't concentrate. He has trouble keeping his anger in check. He loses his balance when he walks. Cobb's hair is starting to thin and gray. He was 45 and in the National Guard when he was sent to Iraq. He left a good job making auto parts and he left his wife's son and daughter back home in Cross Lanes, West Virginia. Last year, Cobb's truck crashed while he was patrolling the border with Iran. He smashed his head and he stayed in Iraq for another eight months.

Mr. COBB: At first, I really--well, I wanted to deny anything was wrong. But my platoon sergeant made me go to sick call. He said, `Sergeant Cobb,' he said, `You walk like a drunk man half the time.'

SHAPIRO: Cobb says medics gave him aspirin for his headaches and sent him back to his patrol duty. But his buddies often had to wake him up and remind him when it was his shift. He came home with the West Virginia Army National Guard three days after Christmas. Cobb's been diagnosed with depression and post-traumatic stress disorder along with his brain injury.

Mr. COBB: I had a lot of frustration built up inside, because I can't function like I used to. I can't do simple things that I--like my kids. I've tried to do things with my kids, but nothing ever hold my interest. I--and they're--I can't even sit and watch movies. I used to love to watch movies, but 15, 20 minutes tops and I'm up. I've got to do something.

SHAPIRO: When George Zitnay got into the field 45 years ago, brain injuries often went undetected. People got labeled as mentally retarded or mentally ill. Zitnay hated that they usually wound up in state institutions or nursing homes and got little or no treatment. So he pushed for treatment to get people out of medical settings and back into everyday life. Six years ago, Zitnay started Virginia NeuroCare, the rehab program in the bookstore.

Mr. ZITNAY: This isn't--the most atypical therapy center that you ever could imagine. I mean, first of all, therapy centers are not located on a downtown mall behind a used bookstore. But, you know, if you've had a head injury, you don't want to go to an institution or to a hospital. You've already been through that at the acute phase. Now you want to get back to life.

(Soundbite of walking sounds)

SHAPIRO: Zitnay walks past the front rooms of the bookstore and turns the corner to a point where the rows of books end.

Ms. ERIN MATTINGLY (Speech and Language Therapist): OK, before we get started, we have two--I have two projects to assign to you guys. Josh, the paper...

SHAPIRO: Group therapy is starting. Seven men sit around a small table. Erin Mattingly is a speech and language therapist. She's giving these soldiers and Marines a research project. It's designed to teach skills they'll need once they leave here and go home.

Ms. MATTINGLY: David and Josh, you can present tomorrow on alcohol and the brain and the effects of post-brain injury.

(Soundbite of papers being handled)

JOSHUA: How long do you want the presentations to be?

Ms. MATTINGLY: I want it to be like a 10-minute talk.

JOSHUA: All right. I'll do a lot of research on this.

Ms. MATTINGLY: Mike and Scott, I want you guys to do yours on anger and frustration management following brain injury.

SHAPIRO: Just getting on the computer and doing research, that rewires the brain and becomes therapy, too.

This center is one of eight where the departments of Defense and Veterans Affairs send troops with head injuries. Zitnay helped get the network established at the time of the first Gulf War. He says Congress wanted to avoid what happened before.

Mr. ZITNAY: In the Vietnam War, many of the soldiers who had sustained brain injury were never identified. Those individuals were lost. They were a lost generation. They wound up living on the street. They wound up in homeless shelters. They wound up in jail. They wound up with drug and alcohol problems.

SHAPIRO: Today, traumatic brain injuries are showing up more than in any other war. With better protective armor, more soldiers survive with serious injuries, including ones to the head. Zitnay says there's another reason: the weapons being used against American troops.

Mr. ZITNAY: Because of the car bombings, because of these explosive devices that are out there, what we're seeing is a lot more blast injuries.

SHAPIRO: Improvised explosive devices send shrapnel flying, which can penetrate a soldier's head, even through a Kevlar helmet, and the explosive force of a bomb sets off shock waves that rock the brain. That causes closed head injuries that can be hard to detect. The military has no exact numbers, but at Walter Reed Army Medical Center, doctors say nearly 50 percent of wounded soldiers have head injuries. Three of the 11 men being treated at Virginia NeuroCare were injured in Iraq. The others got brain injuries the way most men their age do: in fights and traffic accidents. There was one other place Zitnay wanted to show: a house.

Mr. ZITNAY: This is 506 Grove and, as you can see, it's a typical Victorian...

(Soundbite of knocking)

Mr. ZITNAY: ...and very attractive and very homey. And eight young soldiers live here.

SHAPIRO: It's the end of the day. Staffer Monique Page(ph) cooks dinner.

(Soundbite of frying sounds)

Ms. MONIQUE PAGE (Staffer): ...asked if they wanted ribs tonight, so ribs it is.

SHAPIRO: Steve Cobb shares a sparse room in the back. On top of the small bed, there's a black leather case. Cobb says what's in it is something very important.

Mr. COBB: My memory, my planner.

SHAPIRO: What Cobb's brain can no longer remember, he records on the pages of this day planner. He's marked the day he goes home to see his son play trumpet in the school band, the day he's meeting about a job.

Mr. COBB: I've got to write down everything that I'm going to do or--so I don't forget it, I write down.

(Soundbite of zipper)

Mr. COBB: And this is a schedule that...

(Soundbite of paper crinkling)

Mr. COBB: ...they gave to everybody.

SHAPIRO: Steve Cobb's brain is damaged and full recovery is unlikely, so he knows he's got to master tricks and shortcuts, like using the planner, if he's going to work again and be the good husband and father he longs to be. Joseph Shapiro, NPR News.

INSKEEP: This story continues tomorrow. We will follow Sergeant Cobb as he learns a new job and talk to his wife about loving the different man who came home from war.

You're listening to MORNING EDITION from NPR News.

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