Thousands of GIs Cope With Brain Damage

Bryan Malone, an Army specialist, left, and Eric O'Brien, right, an Army staff sergeant, pose at Vanderbilt University Medical Center, Aug. 2, 2007, in Nashville, Tenn. As a result of a rocket attack on a Baghdad gym where the two were working out, they both suffer from traumatic brain injury, the "silent epidemic" of the Iraq war. (AP Photo/Mark Humphrey) (Mark Humphrey - AP)

Memory trouble is a common sign of TBI. It isn't like Alzheimer's disease, where people are so disconnected from reality that they forget things like how a key works or where they live. It isn't like amnesia, where a chunk of the past is missing.

"I don't have any problem remembering the past. I have trouble with now," O'Brien said.

Multiple or complex tasks confound and irritate people with TBI. Therapists challenge them through exercises, like a computer game where they run a hot dog stand and must manage inventory, set prices, do banking and anticipate demand according to the weather.

Other therapy focuses on life skills like following directions while paying attention to something else.

"I counted three trash cans," O'Brien announced after a scouting mission to find landmarks using a map and tally cans along the way.

"I counted five," said therapist Jenny Owens.

Improving these skills is key to living a normal life, especially driving.

"Most of them don't drive. A van brings them down. They were hitting mailboxes, they'd get lost. We draw them maps and they forget when they're supposed to be here," Schneider said.

The Army gives some injured soldiers Palm Pilots _ handheld computers to help manage their lives.

"It costs them more for us to miss two appointments than to give us one of these," O'Brien explained.

But devices and mental exercises do only so much. Troops must be able to use information and reason, but TBI keeps many from being aware of their gaps.

"They don't realize their judgment is impaired," said Vanderbilt neuropsychologist Elizabeth Fenimore.