Philanthropist, not Pentagon, bankrolls promising TBI therapy
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ATLANTA — One afternoon this fall, Bobby McKinney hunched over a coffee table with a clear glass surface. A lamp with a bare light bulb illuminated it from below. Pencil in hand, the former Marine traced the pattern for a tattoo across delicate paper, a swirling, intricate design reminiscent of a Celtic cross.
McKinney’s small apartment faded from his thoughts. The closet filled with eight shirts and eight pairs of jeans, hung 3 inches apart, all facing exactly the same direction, the way the Marines had taught him. The box packed with a dozen brown plastic medicine bottles. The worn couch that he slept on instead of the bed. The eraser board on his refrigerator where he had scrawled “A coward dies a 1,000 deaths.A warrior dies one.”
Suddenly, a nurse’s aide knocked on the door. Had he checked the oven? McKinney leapt up and ran to the kitchen, pulling out a tin of brownies on the point of burning.
“I guess I was just very focused on the tattoo design,” he told a counselor later, pushing a camouflage baseball cap back on his head. “I set the alarm. I guess I just didn’t hear it.”
“Try to work on one thing at a time,” she told him. “Multitasking is just asking the brain to do two or three things not too well.”
McKinney, 29, nodded in agreement. It seemed so obvious once she said it. But his mind — the mind that once helped sniper teams in Iraq, that navigated battlefield maps and complex rules of enemy engagement — had just not come up with the idea to do one task instead of many.
“When you think about it, it kinda makes sense. But I wouldn’t think about it on my own,” he said.
McKinney is an Iraq war veteran who suffered multiple concussions, also known as mild traumatic brain injuries. Bomb blasts jarred his brain, leaving him with no outside scars, but nagging mental problems. His short-term memory is bad. He moves slowly through ordinary chores. He gets disoriented easily, and can’t find his way to the home that he has lived in for months without the aid of a GPS.
A farm boy fond of the Georgia Bulldogs and chewing tobacco, McKinney has pinned his hopes for recovery on cognitive rehabilitation therapy, a subtle and complex treatment for a subtle and complex injury. Doctors and studies have shown that the therapy helps servicemembers. But the Pentagon’s primary health plan for soldiers and seriously wounded veterans, Tricare, will not cover the treatment, saying it is still unproven.
To see what cognitive therapy looked like, ProPublica and NPR spent several days with McKinney and fellow soldiers and veterans at Project Share, a charity to help brain-damaged soldiers. The program is based out of the Shepherd Center for Brain and Spinal Cord Injury in Atlanta, a nationally recognized hospital for head injuries. Project Share, founded by former Home Depot magnate and philanthropist Bernie Marcus in January 2008, is dedicated to filling the gaps left by Tricare and military and veterans hospitals, which often lack the expertise and staffing to provide a full-scale program of cognitive rehabilitation therapy.
The visit revealed no flashy techniques, no cutting-edge medical devices. Instead, the men spent their entire days with therapists who focused on improving their memory, speech, balance and psychological health.
The men lived in apartments provided by the center. They went on daily field trips, doing errands that are commonplace for most but difficult for those with cognitive problems. They shopped at a grocery store. They cooked dinner. They helped assemble wheelchairs for the needy. They went to a horse park, where they combed, fed and rode horses.
At each step, a therapist helped them prepare for the job at hand. They suggested making to-do lists; using an iPod to keep track of medications; storing medical and military records into clearly labeled file folders.
Soldiers get a blue rubber bracelet with the initials SWAPS. The letters are supposed to remind them of a course of action should they become frustrated or mentally overloaded. The letters are an acronym: Stop; What’s the problem?; Alternatives and options; Pick a plan; Satisfied?
The men stay for two and three months at a time. Afterward, a Project Share worker follows them for up to a year to make sure they are using the techniques they have learned to cope with life in the real world.
Cognitive therapy is not a silver bullet, nor a one-time treatment, nor a rigid, well-defined program. Instead, therapists here say, it employs a variety of techniques designed to do the hard work of retraining each soldier’s brain to compensate for the things it can no longer do.
“We all see that they start out unable to do basic tasks,” said Bonnie Schaude, a speech pathologist who coordinates many of the treatments. “People are leaving here, and they can function independently.”
The visit made just as clear, however, the difficulty of implementing such an intensive, long-term plan for the military or Department of Veterans Affairs. Official Pentagon figures show that 188,000 soldiers have suffered some kind of brain injury since 2000. The number includes blast wounds, but also head trauma sustained in vehicle crashes, training accidents and household falls. Previous NPR and ProPublica stories have shown that the number likely falls short of the full tally by tens of thousands of soldiers.
The vast majority of head injuries are concussions, from which most soldiers recover quickly. The only treatment needed is bed rest and perhaps pain medication for headaches.
But providing the kind of care available at Project Share to even the small percentage of brain-damaged soldiers who need it would require a tremendous commitment of time and money from military and veteran medical systems.
The Pentagon’s medical budget is $50 billion a year, expected to skyrocket to $65 billion by 2015. The system already has trouble recruiting and retaining brain specialists, who can make far more in the private sector. The VA has to care for an enormous population of aging veterans, whose geriatric care needs are far different than the group of injured Iraq and Afghanistan war veterans.
Marcus, the philanthropist who supports the soldiers’ efforts, said the high expense would be worth it. He envisions a nationwide network of civilian rehabilitation clinics working with the military to supplement their care system. So far, the Army has not taken him up on his offer, he said.
Cognitive rehabilitation is “very time-consuming. It’s not an easy deal,” said Marcus, who estimates that he’s spent about $1 million over the past two years to treat about 70 soldiers and veterans. “Isn’t this worthwhile? Isn’t this something we should all be concerned about? Whatever it takes is what we should give them.”
