Alex Grimes ascends the two-story climbing wall at the Center for Integrated Brain Health & Wellness with relative ease, quickly rappelling down so he can rise again.
His climb out of the anger, despair and pain after a brain injury while in the Army has been far more grueling 3 1/2 long years so far.
Diagnosed with post-traumatic stress disorder as well, he's struggling with mood swings, nightmares and seizures as he juggles his treatment with classes at a local community college.
But now that Grimes has a refuge for therapy and counseling, he hopes he's finally found his footing in his recovery. "I'm trying to have a sense of normalcy," he told me. "I'm trying to find some sort of peace."
You can't help but be humbled hearing the stories of veterans like Grimes, and be impressed seeing their rehabilitation. That respect deepens when you think that precisely because of the kinds of wounds they suffered while protecting the rest of us, they could also help society now that they're finally home.
You also can't help but feel some outrage that it has taken so long for the government to get its act together to help vets with traumatic brain injury the so-called signature wound of the Iraq and Afghanistan wars. It has victimized tens of thousands of the 2.4 million men and women who have fought over the last decade, but it took until the last few years to start properly diagnosing and treating a sizable number.
"Overall, it's gotten a lot better. But the fact remains they came too late to the party," says Tom Tarantino, deputy policy director for Iraq and Afghanistan Veterans of America.
Grimes, 24, suffered a non-combat head injury in 2008 and, after four years in the military, received a medical discharge in 2010. He says he didn't really get the treatment he needed until he came to the Martinez campus of the U.S. Department of Veterans Affairs.
Now, he's one of 350 veterans under care at the new $7.2 million brain health center. In military-speak, it is the "tip of the spear" in combating traumatic brain injury a one-stop center for both treatment and research, focusing on milder cases. If there's a big breakthrough in the next few years, it could very well happen in the bland-looking building nestled in the hills of Martinez.
And because 1.7 million Americans a year suffer brain injuries from falls, car wrecks and the like about three-fourths of them also with mild concussions any advances could have much wider benefits.
In addition, some of the research under way could help scientists studying brain diseases such as Alzheimer's and Parkinson's.
Still, military combat is different. Long and repeated tours in Iraq and Afghanistan increased the risk of being exposed to roadside bombs and other blasts, even multiple times. The effects, especially over the long term, of the brain being rattled inside the skull by explosions are not very well understood; symptoms for vets with mild traumatic brain injury seem to last longer, 18 to 24 months on average.
"It's a difficult thing to get a complete handle on mild TBI," says Daniel Barrows, the TBI social worker at the center. "It's constantly a learning process."
TBI can make everyday living a chore, leading to headaches, trouble sleeping, memory loss, slower thinking, personality changes and depression. At the center, vets have access to neurological services, physical and cognitive rehabilitation, speech and language therapy and more. If they need more intensive care, there's a rehabilitation and inpatient clinic next door.
The brain center is designed to make younger vets feel comfortable. There's a clubhouse with pool table, flat-screen TV and video games. Next door is a modern fitness gym with Pilates and weight machines and the climbing wall, which builds strength, flexibility, balance and confidence. Elizabeth McBride, a physical therapist, says her big challenge is getting the vets to not push too hard in their workouts and hurt themselves.
The center also produces a willing pool of test subjects. "They want to help. They know other vets have the same issues," says Anthony Chen, the center's medical director.
Vets who volunteer usually receive $20 or $25 an hour for their time, plus access to cutting-edge therapy.
"The research never interferes with their clinical treatment. Sometimes it adds on to their treatment," Chen says.
More than 25 researchers work at VA Martinez on traumatic brain injury. They're collaborating with colleagues at the University of California campuses in Berkeley, Davis and San Francisco to figure out how to better diagnose and treat the injury.
David Woods, an adjunct neurology professor at UC Davis who has 30 years with the VA, is focusing on the diagnostic side.
He is seeking a more accurate way to spot TBI-caused abnormalities in brain tissue that aren't always visible in an MRI. Using advanced scanners and tracking how fluids flows through brain tissue, Woods says his team is "banging away" at a solution.
His other major project is to develop a computer-based test that better measures cognitive ability another way to diagnose TBI. Test subjects use video game joysticks to click responses to visual and sound triggers on computers, measuring their reaction time to the millisecond.
Chen, who is also an assistant neurology professor at UC San Francisco, is focusing on the treatment side.
One approach that appears promising is to train vets with TBI to relax and refocus to better follow through on both everyday and more complex tasks. Last year, Chen and a colleague reported that those who went through the training showed significant improvement. Now, they're testing how to prolong the benefits.
Chen is also using computer gaming to come up with exercises that vets can do at home to improve their cognitive skills.
Nationwide, the Department of Veterans Affairs is spending some $31 million a year to support a wide range of TBI research.
Some scientists are trying to develop drugs to treat brain injury and limit its severity when it first occurs. Investigators are seeking ways to get nerve cells to regenerate; advances could also benefit those with Alzheimer's, multiple sclerosis and spinal cord injuries. Others are focusing on how to counteract the hearing and vision loss that often accompanies TBI.
The Pentagon estimates that brain injuries constitute one in five combat casualties from our post-9/11 wars. Since 2007, all service members who served in Iraq or Afghanistan have been screened for TBI. Those who show symptoms get a more comprehensive exam.
As of last August, about 104,000 vets were initially positive for mild TBI; of the 77,600 evaluated, about 43,000 received a confirmed diagnosis. In the VA's Northern California Health Care System, which stretches from the East Bay to Sacramento to Redding, nearly 1,800 were referred with initial positive screens. Of the 1,200 evaluated so far, about three-fourths had a TBI diagnosis confirmed.
About 15 percent of all Iraq and Afghanistan vets have post-traumatic stress disorder, and it's not uncommon for them to suffer from TBI, too. There are overlapping symptoms, and these "invisible wounds" can compound each other's effects.
Response took time
VA is now spending nearly $260 million a year on treatment of TBI, five times more than when it started ramping up in 2005.
But when Iraq and Afghanistan vets began coming home in large numbers, the VA was overwhelmed, without the staff or budget to properly respond.
A landmark Rand Corp. study in 2008 estimated that 320,000 of the 1.6 million service members who had been deployed by then may have experienced a TBI. It concluded that a major national effort was needed to provide "minimally adequate" care and avert a major health crisis.
David Cifu, the VA's physical medicine and rehabilitation director, acknowledges there was a lag in addressing TBI, but says it took a while for the military and everyone else to recognize how many veterans were affected.
"It may seem like a long time if you have a brain injury, but it's pretty good" for a bureaucracy as large as the VA, Cifu told me.
Now, he says, services for vets are continually improving and the two dozen VA sites with the highest levels of care are as good as anywhere in the country.
The VA has made some significant strides, veterans groups agree. Tarantino credits it for doing research that the private sector won't, and for trying innovative treatments, such as meditation and acupuncture.
Still, he and other advocates say gaps remain in rehabilitation and long-term care, for instance and warn of a shortage of doctors and mental health professionals. They also say that there needs to be more outreach because many vets are still going untreated.
While some veterans are reluctant to seek help, for those who do, it can be a long road to recovery.
Robert Mattice, 27, has been in some kind of care for more than seven years, since a car wreck while serving in the Navy in Mississippi put him in a coma for a month. He's now coming to the brain center twice a week for therapy and staying in the rehabilitation clinic next door.
Mattice still has problems with his memory and stamina and knows now that if he drinks, it makes the symptoms much worse. He wants to go back to school, so he's hoping his recovery speeds up. But his doctors have told him that progress could come slowly, over 30 years, Mattice says softly.
He's not ready to climb the wall himself, but when Grimes reaches the top for a third time, Mattice claps softly.