United States Department of Veterans Affairs
 Health Care
The Long Road Back From Traumatic Brain Injury
Man and woman program electronic device
VA neuropsychologist Harriet Zeiner works with Jason Poole to program a device that turns itself on in his pocket and tells him, in his own voice, what he needs to do next.

Veteran vows: “It’s taking time, but I’m going to get there.”

Jason Poole has been struggling with Traumatic Brain Injury (TBI) for six years. VA doctors and therapists are helping him learn to hear and speak and comprehend life again. On June 30, 2004, Marine Corporal Poole was in Iraq. He doesn’t remember the explosion but he still dreams of being in Iraq and the sky turning bright red. He was on a foot patrol when the bomb exploded and three members of his patrol were killed.

Shrapnel flew into Poole’s face and then out from under his right eye. The impact of the blast fractured his skull in several places. It also injured his brain and damaged one of its major arteries.

When he arrived at the VA’s Polytrauma Treatment Center in Palo Alto, Calif., he was unable to speak. He had been unconscious for two months. He was not getting any blood on the left side of his brain when the blood suddenly started to flow again, which saved his life.

Today, Poole is blind and deaf on his left side.

Dr. Harriet Zeiner is a VA neuropsychologist who first worked with Poole when she was with the traumatic brain unit. “At first, he couldn’t speak and found it difficult to express himself.”

Because the left side of the brain controls language, it was hard for him to talk or comprehend speech. He had also lost his sense of smell.

Dr. Zeiner now directs the VA Outpatient Neuropsychological Intervention Clinic. She still meets with Poole to monitor his progress on the road to recovery from TBI.

Traumatic brain injury can severely damage basic functions like vision and speech. Some cases even result in epilepsy and an early onset of dementia. When a Veteran suffers what doctors describe as a “closed-head injury,” such as the blast in Iraq that injured Poole, the effects are evident throughout the entire brain. Damage to the frontal lobes can take away daily key skills such as understanding time and solving problems.

Because many soldiers are returning with head injuries combined with other wounds, the VA has designated four Veterans Affairs hospitals as “Polytrauma Rehabilitation Centers” to treat them. The Palo Alto hospital where Poole is being treated is one.

“They have to reinvent themselves.”

“They have to reinvent themselves” says Dr. Zeiner. “Their choice is to live well in a somewhat limited environment, or suffer by trying to live in the same complex world as before, but without the capacity to deal with complexity. That freedom to choose, limitation or suffering, is the choice of those with traumatic brain injury.”

Poole has been a patient at the Palo Alto center since 2004, initially in the brain injury inpatient rehabilitation unit. When he arrived he was unable to speak or walk, had a feeding tube in his stomach and an opening in his neck to help him breathe. To the great surprise and delight of all, on his second day in Palo Alto, he managed to walk a few steps.

“He was extremely motivated, and he pushed himself to the limit, being a Marine,” said Debbie Pitsch, his physical therapist. Because of the damage to the left side (the language side) of the brain, it was hard for him to comprehend speech. “He was very hard of hearing, and sometimes he didn’t even know I was in the room,” said Debbie. “But we knew his healing was on the right track the day his British accent came back.”

A team of VA therapists at the Polytrauma Center — speech, physical, occupational and others — worked with him for hours every day.

Damage to the left side of his brain caused Poole to not notice things to his right, even though his vision in his right eye was good. “He would shake his head no when he meant yes,” said Dr. Zeinert. “His mind was working, but his thoughts were trapped inside his head.

Improving Every Day

Evi Klein, a speech therapist at Palo Alto, said that in September 2004, Corporal Poole could only recognize and describe about half the objects in his room.

“He was not able to pull together language to express himself,” Klein said. “He could only answer a question with one or two words.”

Evi had to start at the beginning of learning. She would point to items in the room and say “What is this?” She would show him a picture and ask him to write down what it was. Gradually, he began to speak. Today, Evi thinks Poole is speaking so well that most people would never know how impaired he was. “I knew he would do well,” Evi says, “But I had no idea he would come this far this fast.”

He still receives speech and physical therapy several times a week at Palo Alto.

After months of intensive VA therapy, Poole’s reading ability has gone from zero to that of a third grader.

Poole is philosophical. “Even when I do get low, it’s just for five or ten minutes,” he said. “I’m just a happy guy. It happened to me but I’m still alive.”

Commenting on his progress so far, Dr. Zeiner says:

“It’s incredible how resilient he is,” Dr. Zeiner said. “He keeps trying. He knows moments of great sadness and loss, but he doesn’t collapse in despair.”

“Jason still works at the daily job of rehabilitation. It’s just that now the focus has switched away from basic survival skills in the hospital to the problems we all face: how to maintain our love relationships, form a family, feel that what we do is meaningful, own a home, and have a circle of friends who trust and delight in us.”

“It’s taking time,” Poole said, “but I’m going to get there.”

By Hans Petersen, VA Staff Writer