The Atlanta Journal-Constitution
April 10, 2011 Sunday
Area Center Helps Fight Wounds Of Modern War
by Bill Torpy
SHARE Initiative gives those with brain injuries training and therapy.
A year ago, Sgt. Kalin Green was navigating the rugged terrain of Afghanistan. As he and his soldiers went about their job of building bridges, they approached all missions the same: Do it fast, do it right, get out alive.
But on a recent day, Green sized up the assignment that lay ahead and was clearly hesitant. This simple errand of grocery shopping for taco fixings, was no minor outing.
Now forgetful and apprehensive in public, Green doesn't like eye contact with strangers.
"I see people look at my scar," the 28-year-old Columbus native said, tracing the large crescent on the side of his head. "That's why I wear this hat," he said, slipping on a toboggan cap before heading out.
Green and half-dozen other current or former soldiers are relearning life skills after suffering brain trauma. As patients in the SHARE Initiative at Atlanta's Shepherd Center, they immerse themselves in cognitive rehabilitation therapy (CRT).
Roadside bombs and the accompanying concussions left tens of thousands of soldiers with brain trauma, the "signature injury" of America's 21st century wars.
In Shepherd's unique therapy program, the patients live in apartments near the facility and relearn everyday tasks. Treatment ranges from strengthening muscles to performing memory exercises to learning exactly how to cope with the challenges that come with diminished cognitive functions.
"I'm going to take advantage of this opportunity," Green said. "I'm going to do everything I can here."
The SHARE (Shaping Hope and Recovery Excellence) Initiative was started three years ago by Atlanta philanthropist and Home Depot co-founder Bernie Marcus. Marcus decided to put up the money to run the program, which costs about $1 million a year, after growing impatient waiting for the Veterans Administration and the Department of Defense to pay for CRT.
While some neurologists say the therapy can be beneficial, government provider Tricare has concluded there's not enough proof that the therapy is worth its high price tag, especially when it comes to patients with so-called mild traumatic brain injury. So Tricare will pay for some of the treatment it deems necessary, but not all of it. The VA doesn't reimburse Shepherd at all, the hospital said.
It can cost $1,000 a day to house and treat a CRT patient, who often stay two to four months. The military pays perhaps 30-40 cents per dollar, Marcus said. That means the hospital either loses money or has to look for donors to cover the deficit.
"Every kid they take, they lose money," said Marcus, referring to Shepherd, his voice rising. The government "spends billions on stupid bridges to nowhere but not for these kids. . . . This is a national disgrace."
CRT is a complex set of treatments that include physical therapy, anger management, psychiatric help, occupational therapy, speech therapy and post traumatic stress disorder counseling. Each soldier is assessed and given an individualized treatment.
Those with mild traumatic brain injury can suffer headaches, muddled thinking, memory and attention deficits, mood swings and anger. The impairments can last a lifetime.
Soldiers with moderate to severe cases have an inability to think clearly, numbness in their limbs, amnesia, paralysis, seizures and emotional problems. Some end up in comas.
CRT is "not a single thing; it's not a procedure," said Dr. Darryl Kaelin, SHARE's medical director. Each brain is different and treating such injuries is different for each patient.
"There's a science here," he said. "But it's wrapped around an art."
Kaelin said the military is reluctant to turn over patients to Shepherd. "It's like pulling teeth," he said. "There's often a feeling of, 'We can take care of our own.' "
The problem, Marcus said, was that soldiers often waited weeks for services (like counseling or occupational therapy), stewed in long lines, then were sent home to come back another day for the next treatment.
The government's reservations about the course of treatment has kept SHARE from growing or other similar programs from starting, both Kaelin and Marcus said.
"The need is huge, bigger than what we and the military can provide right now," Kaelin said.
In an e-mail to The Atlanta Journal-Constitution, a VA representative said, "The evidence for providing CRT to patients recovering from mild [brain injuries] continues to be debated across the medical community."
The VA does pay "for CRT services on a fee-basis when necessary, although the problem is often finding qualified providers in the private sector that deliver such services," the VA said.
Program catching on
SHARE has caught on with advocates for the wounded. Kim Bradley, a visiting nurse for the nonprofit Navy-Marine Corps Relief Society, said the program has worked when treatment at VA hospitals has fallen short.
"They do the best they can, but sometimes the VA can reach its maximum with a person," she said. "They don't think outside the box."
Bradley has been following the case of a wounded 25-year-old Marine from Illinois named James Sperry, who spent five years trying to self-medicate the torments of his service in Iraq.
Sperry had enlisted after high school graduation in 2003. By November 2004, the lance corporal had been wounded three times, although just one brought a Purple Heart. Then, on Nov. 9, 2004, during an assault on Fallujah, Sperry suffered his fourth wound when he was hit in the helmet by a rocket-propelled grenade. It didn't explode, "but it was like a 300 mph, 20-pound steel football hitting you in the head," he said.
Sperry was medically retired in 2005. "I was a little slower. I couldn't think of things, couldn't think of the word I wanted. I couldn't deal with people in general. I'd go out, people would make me mad, and I'd get into a fistfight with a random stranger."
He enrolled in community college, but the onetime honor student washed out, unable to concentrate. He stuttered. His marriage fell apart. He attended a PTSD therapy group at the VA. "But I wasn't in a controlled environment," he said. "I dredged it all up for an hour and then it was, 'Come back in two weeks.' "
"Every night, I was smoking pot and drinking," he said. "Last fall, I was driving home from a buddy's house. Everything was hurting. I couldn't sleep. I felt like I didn't know how to pick myself up. So I called Kim [Bradley, the nurse]."
Months earlier, Bradley had noticed "he was going downhill" and suggested he check into SHARE. It took a while for Sperry to realize he was ready.
Sperry came to Atlanta's Shepherd in January and immersed himself in the 30-hour weekly curriculum.
"It's not like the VA, where you come in and they give you a pill," said Sperry, who wears sunglasses to protect his eyes, which have become sensitive to light since the trauma.
He uses his iPhone and iPad as sort of a backup brain to help keep track of schedules, names, concepts and even the coping skills he learned in class. "Now I know what to do when I have anxiety. I know how to redirect that energy. There is medication here but more education. There are strategies and coping skills you can use."
Sperry has learned to accept his new reality. "You have to know what your limitations are," he said. "I want to be the same as before. That won't be. I have to focus on the positives, things I can accomplish."
His long-term goals? Finding a relationship, volunteering with the Wounded Warrior Project and working for the Fish and Wildlife Service.
He expects to leave the program late this month or in May. "I'm excited about getting back to real life," Sperry said. "Here, I tapped into my old self, who I used to be."
While Sperry has the most time in the program, the two-tour veteran Kalin Green is the newest. Green differs from most of the 176 others who have gone through SHARE: He was injured after returning home.
In February, Green, who developed PTSD after returning from Afghanistan and Iraq but is still on active duty, was visiting his mother in Columbus when he was attacked by someone. He remembers nothing about the attack, which is still being investigated by authorities.
Green's brain swelling was so severe that surgeons had to saw out a section of skull to relieve the pressure. Before the attack, Green suffered from PTSD, a severe anxiety disorder sometimes triggered by battlefield experience. Since the attack, those symptoms have subsided. Ironically, doctors say they may return as his brain heals.
On the day of his recent shopping trip, Green strode the aisles with a sense of purpose. He studied the shelves for items on his list and processed the onslaught of information, the many decisions each shopper routinely makes.
As he reached the end of each aisle, Green's cart screeched to a halt. He craned his neck looking out around the corner cautiously.
Before the grocery trip, he figured he would have a hard time interacting with other shoppers. But during this outing, he greeted a couple and chatted with the checkout lady.
Later, in the parking lot, he was pleased with the effort.
"Not bad," he said with a grin.