Johnstown neuro center helps brain-injured soldiers to reboot

Most Veterans With TBI Do Not Obtain Care From VA 

By Jennifer Reeger

Dan Maguire pauses at the smoked sausage. His grocery list calls for fresh sausage, and he knows what he’s picked up isn’t right. But he’s not quite sure where to go. He’s 22 years old. An Army specialist. He’s been to war, and now, the simplest tasks sometimes elude him.

Eight months ago, Maguire was patrolling the streets of Baghdad in an armored vehicle.  The push of a button by an IED triggerman changed everything. Since April, Maguire has been waging his war at Laurel Highlands Neuro-Rehabilitation Center in Johnstown.

The center, which opened in April 2007, is one of two civilian sites for the Defense and Veterans Brain Injury Center, a network that includes military and veterans hospitals.

Founded after the Persian Gulf War, the centers treat military personnel and veterans who have suffered traumatic brain injury.

The 15 centers, scattered around the country, treated 7,385 patients with traumatic brain injury between January 2003 and the end of May.

But a recent study by the RAND Corporation estimates that about 320,000 service members may have experienced a traumatic brain injury during deployment — from mild concussions to penetrating head wounds.

About 32 percent of patients who are evacuated to Walter Reed Army Medical Center for battle-related injuries had a traumatic brain injury.

One of them was Maguire.

‘Wrong place, wrong time’

He grew up in Butler, graduated from high school there and, after living in and around Pittsburgh for a time, decided to join the Army.

That was nearly four years ago.

Maguire was based in Germany when he got called up to Iraq last summer.

He was riding in a Stryker armored vehicle on Oct. 21, 2007, on patrol in Baghdad. He was switching positions with another crew member when the IED exploded.

"Wrong place, wrong time. That’s all it was," he said. "’Cause we traveled down that road all the time."

If he had stayed where he was, his body would have been blown apart. Instead, he broke his left femur and left ankle. Scars from shrapnel burns mark an arm and foot.

But what wasn’t apparent immediately was a brain injury that couldn’t be surgically repaired.

"The pressure of an IED, just the pressure itself, can kill you," Maguire said. "It’s a shockwave. It hits you, and your brain goes back and forth."

He had been in seven IED attacks before the big one. All left him with a slight headache.

But the trauma to his brain was exacerbated by a fat embolism from his broken leg that passed through his lungs and lodged in his brain.

Maguire suffered a series of mini-strokes and slipped into a coma.

When he awoke, he was a different person.

"Apparently I punched a doctor. I wasn’t myself. I was moody, and I was disoriented," he said.

He was flown to Germany, then to Walter Reed.

Nurses would constantly ask him questions. What year is it? Where are you?

He thought it was 2010. He said he was at Allegheny General Hospital.

"It was bad when I couldn’t name 10 things that start with ‘A,’ " Maguire said. "Like a computer, my brain just needed to restart."

He spent some time at a Virginia rehabilitation hospital before being released in December.

"At the time, I didn’t realize how injured I was," he said.

Maguire slowly started to realize something wasn’t right. His language skills, attention span and memory were all suffering.

At Walter Reed for more rehab, he asked if there was somewhere he could go closer to home.

In April, they sent him to Laurel Highlands.

A painstaking process

He lives on one side of a duplex on a tree-shaded street in the city. From the outside, it looks like anybody’s house. But inside, Maguire lives with rehab technicians who work around the clock to help him.

Eventually, he’ll move from the transitional side of the duplex to the independent living side, where there is no staff.

During the day, he goes to the treatment facility, where physical and occupational therapists, a speech pathologist and doctors work to reintegrate him into the community.

He’s joined by civilian clients who live in the Johnstown area and are treated at the day program.

Melodee Hursey, regional education coordinator at Laurel Highlands, said the goal of the program is to get people like Maguire back into society and, if they can, back into the military.

Laurel Highlands has treated 16 clients in the intensive, one-on-one program since opening. Up to 12 can be in the program at any one time.

They learn how to read a bus schedule and take the bus, to do housework, to shop for groceries, and to plan, budget and prepare meals.

Each task is a painstaking, step-by-step process.

It’s much more intense that in a hospital setting, where a patient is asked to walk 50 feet before being released.

"How many people walk 50 feet down the hallway and that’s the limits of their mobility?" asked John DaVanzo, the former clinical director at Laurel Highlands. "That’s not functional."

So the clients at the center walk on pavement and on hiking trails. They walk up and down hills.

They also work. The program operates a used book store in downtown Johnstown where clients make sales, stock shelves and do inventory.

At first, Maguire said, he wasn’t sure if he needed all of the therapy.

Now, he’s convinced it’s helping.

"I’m grabbing it by the horns to run with it," he said. "If you do things a little differently, you can still get things done."

But side effects linger. Maguire has a constant ringing in his ears. He has hearing aids, but he doesn’t like to wear them.

He wakes up most mornings with a headache that sometimes makes it impossible for him to function. But most days he works through them.

When occupational therapist Sarah Gall arrived one morning for a therapy session, Maguire had just awakened with a throbbing head.

He popped some Tylenol and smoked a Camel, then got going with the hour-long therapy session, which focused on home management.

Gall wanted Maguire to clean his room as she watched.

He picked up loose items from his dresser — Reese’s Pieces and hearing aid batteries — then dusted underneath. He washed a load of laundry and vacuumed. But Gall had to remind him to make the bed.

"There’s a lot to starting and finishing a task that you don’t realize," Gall said. "Sometimes, after having an injury, the order of things gets mixed up or it’s incomplete."

Part of regaining that order is putting things into logical steps. Everything is planned out before it is done.

The clients must plan and prepare three lunches at the center every week. Thursdays are shopping days, and after a planning session they fan out over the Johnstown area to shop for their parts of the list.

In the beginning, they are driven to the store. Eventually, like Maguire, they will take the bus along with a therapist.

Once he moves to the independent living side, Maguire will do it all on his own with a therapist a phone call away.

Maguire uses his PDA, or personal digital assistant, for his grocery list, adding the actual price next to his budgeted price to keep track of his money.

His PDA isn’t a luxury but a necessity.

"They use those as memory prosthetics," said physical therapist Kristina Shesko. "Most of these guys are savvy, so they put everything on their PDA."

The devices alert them to appointments, remind them to take medications and at what dosages, "because they won’t remember if they don’t have that," she said.

The therapists stay back as much as possible but sometimes need to intervene.

Outside the store, Maguire waited for the bus. Shesko asked if he had exact change. He didn’t.

"We let them problem solve, but we don’t let them stand at the bus and say, ‘I don’t have exact change,’" Shesko said.

Everything is a learning experience. Even weekly outings to the mall, the movies or a museum are really about interacting with other people and problem solving.

On a trip to Seven Springs, Gall watched as Maguire asked an attendant the cost of bowling. Then he asked about the cost of shoes.

Maguire bowled all the time in Germany. Before Iraq, he averaged 180.

He started bowling again since he’s been in Johnstown.

When he arrived at the center, he walked with a cane that now hangs from his bedpost.

His gait has improved to a slight limp. It’s most pronounced when he takes the stairs and drags his left leg a bit.

Shesko said his memory and problem-solving have improved. He doesn’t need as much help with shopping and meal preparation, or managing his medication or finances.

His life is moving forward and yet, he’s stuck in a holding pattern.

He’ll likely be in Johnstown another six to eight weeks. Most military clients stay between 12 to 16 weeks. Civilians in the day program attend for six months or more.

The Johnstown staff will make a recommendation to the Army about Maguire’s status.

Some soldiers can return to active duty. Others cannot.

Maguire has a preference.

He knows that with leg and brain injuries he’ll never be deployed again.

"I did my part, and if I can’t go back and do my part again (in Iraq), I don’t want to stay in," he said.

Instead, he’d like to go to college and study business.

But his head is never far from the desert.

"It kills me that guys are out there getting hurt and killed, and I’m here at Seven Springs," he said.

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