Mental exercise

Sunday, July 11, 2004

WASHINGTON -- Brain injury specialists at the Army's premier medical center have taught Spec. Jamie Brown how to exercise his mind and get it working again.

He is learning to recall the last thing he read and remember the next place he is going, just as he learned to be a cook and college student in civilian life -- and a forward artillery observer for the Indiana National Guard.

Brown, 22, knows progress can be slow after a grenade explodes in your tent and the blast sends you hurtling into a metal pole.

The Associated Press interviewed Brown and two of his doctors at Walter Reed Army Medical Center in Washington to see how the military and Veterans Affairs Department treats brain-injured soldiers and airmen.

Some are injured in plane crashes and vehicle accidents. Many more are victims of roadside explosions and rocket-propelled grenade attacks in Iraq.

Brown came to Walter Reed in a medicated stupor in early December. At the combat hospital in Iraq where he was first treated, he learned that he had lost a kidney, his adrenal gland and spleen. His pancreas were damaged. Shrapnel in his stomach caused a stabbing pain.

And his brain was damaged.

But Brown was lucky, his doctors said. The damage was mild enough to permit recovery, even though he was injured when he was not wearing body armor or his helmet.

"He's made remarkable progress," said Dr. Lou French, a neuropsychologist who has been guiding Brown through rehabilitation.

French and other specialists have tried to improve Brown's memory, problem-solving ability, speech, use of language and speed in making decisions.

Among the techniques are:

A short story about a storm, with a dozen details to be recalled.

Plastic balls, arranged in patterns, to be duplicated by the patient with the fewest number of moves.

Fourteen minutes of nonstop concentration on a computer screen, with a mouse click needed every time a designated letter appears.

Pictures of objects to identify, as common as an acorn and as infrequently seen as a mathematical protractor used for measuring angles on paper.

"It was very draining," Brown said.

Brown was injured on Nov. 20, 2003, in Iraq while sitting in his tent. He said he was watching a movie with fellow guardsmen when a grenade exploded about 8 feet away.

"The next thing I know, boom. I can remember feeling the heat, I can remember seeing the dirt and the sand fly everywhere," he said.

Brown arrived at Walter Reed two weeks later. For a while, every day was a blur. His weight had dropped from 170 pounds to 110. He awoke one day to find his wife next to him.

"My first day of full consciousness," he said.

It was the start of a long-distance race to recovery as Brown learned the first day he had a dental appointment at the hospital.

"I asked my wife six times where we were going," he said. "I may have to read something a couple of times instead of just once."

Brown's first test of retention and memory "suggested he wasn't retaining things the way he should," French said.

"He had a tendency to get an idea in his head and he couldn't let it go. There would be one part of a story he would keep repeating. He couldn't remember other parts," the doctor said.

Someone with major brain trauma often loses confidence, said Dr. Deborah Warden, who is based at Walter Reed but is national director of the government's brain injury network.

She has seen brain-injured soldiers wait until the mess hall was about to close before arriving for meals, just to avoid crowds, the cacophony of many conversations and the sudden sound of a dropped tray.

Brown said his most dramatic improvement came in April when he went back to familiar territory, his home town of Evansville, Ind., for a short leave. The surroundings improved his mental state, Brown said.

French agreed.

"I sensed he was much less distressed," the neuropsychologist said. "His speech was smoother, he spoke at a normal rate, he smiled more, he was generally happier."

Brown now is thinking about the future. He'd like to return to college, at least part time.

"We want to see any pattern that he's forward-looking," French said. "Looking forward helps recovery."

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