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Roadside bombs and Humvee wrecks are often to blame for a common injury. One out of every five soldiers reports coming back from Iraq or Afghanistan with mild traumatic brain injury. Mild cases of what's called TBI can be hard to identify. But Army doctors are finding more cases because of special testing that's begun in the past two years. That means fewer soldiers are suffering in silence.
As Blake Farmer of member station WPLN reports from Fort Campbell, Kentucky.
BLAKE FARMER: Sergeant Albert Couture's road to recovery begins behind a horse stable on the Tennessee side of this expansive Army post.
Sergeant ALBERT COUTURE (U.S. Army): This is Jazz. I just met her today.
FARMER: Horseback riding should help Couture regain some of the balance he lost after run-ins with improvised explosives in Iraq on his last deployment.
Sgt. COUTURE: We weren't always that far away. Then there was a couple of times we got hit by IEDs.
FARMER: Couture didn't leave Iraq with visible injuries, but small concussions can catch up with a soldier, even years later. Army physical therapy technician Dennis Russell says unit leaders don't always pick up on the symptoms, or confuse them with post-traumatic stress.
Mr. DENNIS RUSSELL (U.S. Army Physical Therapy Technician): You can do most of your daily job, but some things make you very anxious, make you dizzy, make you nauseous.
Sgt. COUTURE: Other than having headaches and being a little dizzy every once in awhile, didn't think anything was wrong with me, I figured I was just - had a bad head.
(Soundbite of laughter)
FARMER: But for Couture, dizziness slowly became emotional instability after returning home in November.
Sgt. COUTURE: For some reason I just became an angry person.
FARMER: That wasn't you before?
Sgt. COUTURE: I wasn't told I was. I don't really remember.
FARMER: Couture ended up putting his fist through a glass door. Fortunately, he was one of the first soldiers to take the baseline testing, which originated at Fort Campbell's TBI clinic two years ago. So, Dr. David Twillie, the clinic's director, could turn back time on Couture's brain. The program has since expanded Army-wide.
Dr. DAVID TWILLIE (Director, TBI Clinic, Fort Campbell): The question you have when you see somebody with mild traumatic brain injury is, so what were they like before?
FARMER: The 10-minute neurological assessments are administered on a computer before and after deployment. The questions flex a soldier's short-term memory, emotional state and computation skills. What's three minus one plus four? The Army's telling soldiers that most mild TBI cases get better on their own. But at Fort Campbell, 550 soldiers recently back from deployments, have been flagged for a 12-week therapy regimen.
Dr. TWILLIE: Grit your teeth really hard. Grit.
FARMER: Dr. Twillie stares at a computer monitor charting the chaotic brain activity of Sergeant Michael Hensley. The young father survived a rollover crash in Iraq and an IED attack that killed others. Hensley wears what looks like a water polo cap with a rainbow of wires connected to it. In this relaxation exercise, he attempts to keep the monitors flat by closing his eyes and clearing his mind.
Sergeant MICHAEL HENSLEY (U.S. Army): I was struggling for a while. I had changed in my personality and stuff - more irritated, a lot more forgetful. I wasn't able to multitask. Things I was normally able to do I couldn't do anymore.
FARMER: And still can't, though he's got a good shot at recovering. Hensley's found another assignment within the Army that keeps him off the front lines. More than three-quarters of patients leave Fort Campbell's TBI clinic symptom-free. Many of those without additional injuries return to their combat jobs.
Unidentified Man #1: Enemy rooftop.
(Soundbite of gunshot simulation)
FARMER: A seasoned soldier coolly calls his shots at insurgent fighters if he unloads at a wall of video screens. They show the streets of Baghdad in stunning detail. This simulation is one of the final exercises before being cleared for duty. Six months ago, after a Humvee rollover in Iraq, Staff Sergeant Clifford Lee didn't even remember he was married or had kids. Now he's been cleared to return.
Staff Sergeant CLIFFORD LEE (U.S. Army): I really do want to deploy again. I feel that as long as I can think for myself and I can walk and I can talk, that there's no reason I shouldn't be able to help my brothers and sisters.
FARMER: While doctors have gotten better at identifying and treating TBI, they're still trying to figuring out exactly when a soldier is ready to go back to war. But they're working on it, because a combat-tested soldier has become all the more valuable to a force stretched thin across two wars.
For NPR NEWS, I'm Blake Farmer in Nashville.
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