By Michael Swanger

Retired United States Army 1st Sgt. Cindy “C.J.” Robison dodged improvised explosive devices (IEDs) and enemy mortar fire “so powerful it would shake your teeth” while commanding six truck companies and more than 1,000 soldiers for the 185th Combat Support Battalion in Iraq. Now she matches wits with a computer-based cognitive training program in the privacy of her rural New Virginia home in an effort to recover from a traumatic brain injury (TBI) she incurred on the job.

“Some days it kicks my butt,” Robison said. “But I’ve been a hard-ass too long to quit now.”

TBI is so common among veterans returning from Iraq and Afghanistan that the Department of Defense is calling it the “signature” wound. Army officials say that one in every nine American soldiers deployed to Iraq suffers from TBI, and according to Department of Defense statistics, there are more than 22,000 current bomb blast survivors, with TBI estimated to affect at least 25 percent of them. In 2006, more than 254,000 veterans were reported to live in Iowa.

Robison, 40, sustained hers in 2004 when she fell from the ladder of a heavy equipment transporter to the ground, fracturing her leg and hitting her head while wearing 100 pounds of gear. Prior multiple exposures to blast waves and the direct hit she survived while heading to Baghdad as part of the “Fallujah Fury” also contributed to her TBI.

Robison says it took the Army two years before it granted her a full retirement for an injury to her back and post-traumatic stress disorder, but it did not recognize her TBI because “it wasn’t an injury they could see because they couldn’t fit me for a machine or a leg.” She is undergoing another review with the military. Today, she receives VA benefits, but no assistance from the military for her TBI, from which she clearly suffers. The trained medic, 22-year Army veteran, Purple Heart recipient and single mother of two teenagers — Amber (13) and Ben (19) — wears a hearing aid, walks with a cane thanks to bulging discs in her back, suffers from memory loss and “sometimes intolerable pain,” has difficulty concentrating or making decisions and is slowed in her ability to think and communicate — many of which are telltale signs of TBI among war veterans. Those and other symptoms, experts say, can compound the trauma of returning home from war and undermine a soldier’s reintegration to civilian life.

“Many face gaps and barriers to access health care, job training and employment, housing, recreation and transportation, limiting their ability to fully participate in family and community life,” said Doug Carmon, assistant vice president of Easter Seals Military and Veterans Initiatives, in a statement. “They are struggling, bound to a system that is itself stressed and often ill-equipped to meet their unique needs, especially those with TBI.”

But for Iowa veterans like Robison, who have been turned away from military and private hospitals that are not staffed or equipped to treat TBI patients, there is help. Easter Seals Iowa is launching a statewide program to help returning veterans with TBI participate in Posit Science Corp’s “Brain Fitness Program,” a 40-hour, eight-week computer-based rehabilitation program designed to improve thinking skills and memory. Administered locally by Easter Seals Disability Services in Des Moines, as one of only three pilot programs in the country, it is free to military service members and veterans who qualify. A disability rating is not needed to participate and participants receive a modest stipend.

“Nearly every veteran we meet has a story like Cindy’s,” said Tracy Keninger, director of Iowa Easter Seals’ Rural Solutions, a program that helps Iowa farm families with disabilities. Keninger monitors Robison’s progress through test scores gathered by Posit Science that are sent to her and Robison.

“Their courage is inspiring,” she said.

Increasing brain plasticity

Each morning, when she is at her peak both mentally and physically, Robison turns on her laptop computer and begins her cognitive rehabilitation. Some days she can complete the one-hour session in one sitting, other days she breaks it up into a second session following an afternoon nap.

Posit Science’s Brain Fitness Program was founded in 2003 by Dr. Michael Merzenich of the University of California at San Francisco. The program enhances brain function by improving the accuracy and speed of the remembering and thinking brain. The exercises focus on auditory reception — how quickly and clearly you can understand, respond to and remember what you hear. In other words, it rewires a TBI patient’s brain through intensive, repetitive and challenging activities.

The program has six themes to choose from: animals, family, pets, color, music and Robison’s favorite — travel. It consists of six computer exercises that have been clinically proven to help people think faster, focus better and remember more. For every correct answer, points are tallied and test results are gathered by Posit Science and returned to the participant and plan administrator so progress can be monitored.

Exercises like “Tell Us Apart,” “Match It” and “Sound Replay,” Robison said, would prove to be difficult for healthy participants. An intense competitor and former athlete who does not like being told she cannot do something, Robison welcomes the challenge.

“The first week, I couldn’t do it,” she said. “Most of me wanted the feedback, but the blemished part of me — my ego — didn’t. It’s hard; it would frustrate college graduates — you have to pay attention.”

Many veterans, however, are in need of such cognitive stimulation. Nationwide, Posit Science officials say, health care professionals have suggested that at least 30 percent of soldiers who have engaged in active combat for four months or longer in Iraq and Afghanistan are at risk of neurological disorders from exposure to blasts from IEDs and mortars. The problem is many veterans don’t know that they have TBI or they are too proud to ask for help and are therefore missing out on brain training that may help their condition.

“One of the challenges we face with vets is their desire not to accept the problem,” said Henry Mahncke, vice president for research and outcome at Posit Science. “These are tough people who don’t want help, which is why we’re building a program with the military and Easter Seals to help people realize they deserve help, so they can be all that they can be in civilian life. Most veterans are not lucky to live near a hospital that specializes in TBI services. The technology we have developed makes it possible for everyone to get the help they need. The sense of hopelessness these soldiers have is the disturbing part about it.”

Robison was one of those veterans who initially refused help, but changed her mind after her mother, Mary Long, helped convince her otherwise. Long approached Keninger at a function held at Camp Dodge for returning veterans and asked Easter Seals to help her daughter.

“She told me her daughter was dying, and she couldn’t get anybody’s attention,” Keninger said. “Cindy tells me that if it wasn’t for her family, she would have given up a long time ago.”

“I thought it was hopeless, that I would be like this forever when my speech, hearing and memory got worse this spring,” said Robison, who didn’t tell her family she was seriously wounded while hospitalized overseas so they would not worry about her. “On top of that, I have a pride problem. My ego was not injured in Iraq and I didn’t want to take something from someone who needed it more than I did.”

Once her family and Keninger convinced her that her participation in the program might inspire other veterans to participate, she decided to give it a try.

“That was a shot of hope for me — that it was available to everyone, because the soldiers that are serving, they’re my heroes,” said Robison, one of seven Iowans actively participating in the Brain Fitness Program. “My colonel told me ‘If it was your soldier and you had the opportunity to talk them into doing this program and it would benefit them, you would do it.’ If it helps just one veteran, it’s worth it.”

Though the Brain Fitness Program is not a cure-all, Mahncke said the results often surprise soldiers. Published studies show that in older populations, it improves memory by an average of 10 years. The brain, like the body, requires constant attention to keep it in shape. Experts say the experience of cognitive decline begins with occasional forgetfulness in one’s 30s, with the rate of decline accelerating for most people after age 50. But the brain is also malleable and learns by physically changing itself. Such changes are known as brain plasticity, which allows it to learn thousands of things many of us take for granted, like using a spoon or driving a car.

“If you talked about TBI 30 to 40 years ago, once the brain was broken it stayed broken,” Mahncke said. “What this means now is we can build programs to ask the brain to do specific things to improve plasticity.”

Mahncke said Posit Science’s programs have also proved to be beneficial to aging patients experiencing memory loss, as well as those suffering from chemo-brain and schizophrenia. He said their work disproves misconceptions from the medical world that TBI patients lack treatment options. “We’ve shown people some hope so that they understand they can get better and be taken care of,” he said.

Equally rewarding, Mahncke said, are stories relayed to Posit Science from the Easter Seals of wounded veterans who benefit from their research.

“We’re excited about the potential to be helpful in that area,” he said. “Easter Seals has been tremendous about reaching people in the field, and we’re learning together how to do this. We’re pleased with the partnership, and to understand the scope of people they help has been an eye opening experience for me. Our goal is to build a program that really works for veterans because a lot of people are coming home with these needs.

“We hope people can eventually regain what they lost and can do what they want in life.”

A soldier’s hope

All Robison ever wanted to do, since she was 6 years old, was to serve her country. She hails from a long line of servicemen and at the age of 18, she fulfilled that dream and enlisted in the Army.

“My dad was a sergeant in Vietnam, so I think I wanted to do it partially for him,” she said. “Somebody told me I couldn’t do it,” and she was determined to prove them wrong, adding, “I always knew I would have to prove my skills.”

What Robison didn’t anticipate was that she would have to prove to herself she could do the things she once took for granted, like drive a car, or participate in activities with her children.

“I don’t get to play ball in the yard, and there are days I can’t get up because of the pain. Then I look at my family and I think, ‘How can you give up on that?’” Robison said. “I don’t know how soldiers do it without their families.”

One thing that hasn’t been affected, however, is Robison’s biting sense of humor. “My kids have it made pretty good. I sometimes forget whether I’ve grounded them or not,” she joked.

Nor has her will to succeed softened. In 2006, she graduated from Grand View College and spoke at her commencement ceremony.

“She told everyone who had the opportunity to turn around and look at their families and those who supported them,” Long said. “She always gets back to the basics.”

Unlike many of her fellow college graduates, however, Robison has had a hard time finding work. In the meantime, she has decided to share her memoirs she wrote in Iraq and “what it’s like to be thrown in the middle of hell and waiting for snowballs” with a friend who is a writer with the hopes of one day publishing them.

“I can’t be a nurse. I can’t be in the Army. I tried planting flowers, but that lasted about a week,” Robison said. “But I’m the kind of person that makes things happen. I’m going to find my purpose.”

Each day, though, Robison focuses on making strides through the Brain Fitness Program.

“The main thing is I’m not stagnate,” she said. “That’s huge. If it gives me that much of an edge, it makes my life that much easier. What a blessing.” CV

Comment on this story | Return to top