Bouncing back from war

The wobble starts when Ketti McClanahan closes her eyes. For 30 seconds, with her arms folded and her feet planted on a thick foam pad, the 51-year-old Army mechanic struggles to keep her balance. Her face fails to hide the frustration.

But she knows that each exercise here, under the guidance of her physical therapist at Memorial Hospital's Adult Outpatient Rehabilitation Center, might keep her from falling down the stairs back home.

McClanahan is among hundreds of Fort Carson soldiers who have come home from the Iraq war, only to wage a new battle at home with traumatic brain injuries, where victories are measured in mundane behavior that is automatic for most people: Avoiding falls. Balancing the checkbook. Not getting lost while driving to familiar places. Carrying on a conversation. Coping with irritability.

The growing number of TBI patients in the area has created greater demand for the specialized treatment they need. In response, Memorial and Penrose-St. Francis hospitals and other local health care providers are adapting to treat soldiers, building on previous experience with brain injuries that was mostly limited to victims of car crashes, athletic mishaps and falls. In addition, Fort Carson has emerged as a national leader in research on traumatic brain injuries, in part because of its high number of cases and experience dealing with them. It recently opened a center dedicated exclusively to treating brain-injured soldiers.

McClanahan's story shows that while the injury can happen in an instant, the struggle can take years.

LITANY OF PUZZLING SYMPTOMS

McClanahan encountered three explosions while serving in Iraq. The first hit her vehicle June 6, 2007. She was just thankful to be alive when she regained consciousness - two other soldiers in the vehicle behind her had not been so fortunate. She was rocked by another one in July, and again in October.

The headaches that followed didn't surprise her, given that she hurt all over after the blasts.

It wasn't until several months later that a litany of puzzling symptoms told her something wasn't right. Crowds made the usually mild-mannered woman inexplicably irritated. Her right eye wouldn't focus and would twitch. She suffered headaches and zoned out during conversations. She'd get lost while driving to familiar places.

And there was that business with the stairs.

"It was like I couldn't keep my balance," she says. "I'd miss the first step. I just thought it was old age catching up to me."

The purpose of the foam-pad exercise for McClanahan was to help her brain re-learn how to balance without relying too much on vision, said physical therapist Colleen Boatright.

"Hands down, they over-rely on vision. We take that away to help them," she said.

Other parts of the regimen included walking a balance beam and throwing a ball while standing on an unstable surface.

Memorial has treated more than 300 Fort Carson soldiers for brain injuries in the last few years, according to Mary Mocilac, a case manager for its outpatient rehab program.

Penrose-St. Francis's rehabilitation department sees about 15 soldiers each week for TBI, said Kristi Ecklund, the lead outpatient physical therapist there.

That's not surprising: A recent study found that nearly 23 percent of Fort Carson soldiers in a brigade combat team returning from Iraq had clinically diagnosed TBIs.

Most are mild, and symptoms tend to decrease over time, said the study's co-author, Col. Heidi Terrio, a doctor and epidemiologist and chief of deployment health at Evans Army Community Hospital. Still, the word "mild" is assigned to the injury, not the symptoms.

There are plenty of soldiers like McClanahan who only briefly lose consciousness at the time but find themselves struggling with everyday life long-term. Their conditions are frequently compounded by co-occurring problems such as Post-Traumatic Stress Disorder and depression.

And some soldiers don't realize they've suffered symptoms of a TBI until they're back home. While deployed, a soldiers' day is predictable and doesn't challenge his or her ability to handle multiple tasks. That's a different story when they return home and juggle household responsibilities and the diversity of daily life, Ecklund said. A spouse will send the person to the grocery store, "and they're coming back with all the wrong items and they're forgetting little things here and there," she said.

While area hospitals and medical providers treat the injury, Pikes Peak Behavioral Health Group and advocacy organizations have been working with soldiers and their families to help them cope.

Brian Duncan, program manager for the group's First Choice Counseling Center, said the social consequences of a TBI can be devastating for a soldier. Counselors hear from people who are torn apart because they can't explain an angry outburst that scared their children, or they have tearful spouses who say the soldier who left for war isn't the same as the one who came back. In short, it is grief counseling for a life lost.

"There's a lot of grief, there's a lot of loss, there's a lot of pain in that," Duncan said.

‘FIERCELY COMMITTED'

For McClanahan, as it is for most soldiers, struggling with simple tasks is especially frustrating in the tough-minded military culture. But Boatright and other therapists say that expectation to perform helps them recover, because they tend to be fiercely committed to the exercises they're asked to do.

After about eight months in therapy, McClanahan's life is hardly normal. She still gets irritable. Sometimes she slurs her words, if she can find the right words in the first place.

"I have my good days and I have my bad days. Yesterday was a terrible day," she said Friday.

Despite this, she says she's come a long way. Her memory recall has improved significantly, and she's equipped with strategies to help her through the day. A support network of family and friends helps.

And daily stumbles are now once or twice a week.

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Call Newsome at 636-0198. Visit the Pikes Peak Health blog at pikespeakhealth.freedomblogging.com and the Gazette's Health page at Gazette.com/health

WHAT IS TBI?

A traumatic brain injury occurs when a blow or jolt to the head or a penetrating head injury interrupts normal brain function. Not all blows to the head cause TBIs.

SOURCE: The U.S. Centers for Disease Control and Prevention

MILD CAN BE MISLEADING

Most traumatic brain injuries are considered mild, but that can be misleading. Although "mild" usually means a condition is not highly symptomatic, TBIs are classified based on the nature of the injury, not the symptoms. Someone who briefly loses consciousness from a blow to the head is considered to have a mild TBI, even though symptoms could be significant and long-lasting - especially if there have been repeated injuries.

Concussions are considered mild TBIs. A moderate to severe TBI occurs when someone loses consciousness for an extended period of time. Although 98 percent of Fort Carson's TBI patients are considered mild, many have serious symptoms that require medical attention.

Source: Col. Heidi Terrio, chief of deployment health

TBI AND THE MILITARY

At Fort Carson, 20 percent of soldiers have suffered a traumatic brain injury, a figure reflected in the Army as a whole. All but 2 percent are mild, but mild TBIs can still cause multiple symptoms.

For soldiers suffering TBIs in combat, 20 percent have persistent symptoms more than three months post deployment, and 10 percent have them six months later. At one year after deployment, 5 percent of those suffering a TBI still have symptoms that threaten their ability to continue military service.

SOURCE: Col. Heidi Terrio, chief of deployment health