The first room they go to is small and dark, with a single bed in the corner and a blanket hung over the window. The building is covered in a hardened foam that muffles the constant drone of the Apache helicopters, Warthog attack jets and massive cargo planes coming and going from the airfield at the Bagram Air Base north of Kabul, Afghanistan.
One of the major lessons of the Iraq and Afghanistan wars is that quick treatment and rest after a blast can reduce such long-term symptoms as depression, mood swings and thinking difficulties. For service members who have suffered a traumatic brain injury, this clinic can dramatically improve quality of life in the years to come.
Thousands of troops who suffered a brain injury earlier in the wars went right back into the fight without missing a beat. All too often, commanders and soldiers themselves, unable to see the brain injury, did not give the wound the attention it needed.
More than 200,000 American service members, about 10 percent of the troops who served in Iraq and Afghanistan, have been diagnosed with traumatic brain injury, or TBI, and many more have probably gone undiagnosed, according to veteran advocates. Some will suffer psychological and physical problems such as personality shifts, increased impulsivity and epilepsy in the years to come because they received additional brain trauma before their initial injury was given a chance to heal.
But as the war ended in Iraq and begins to wind down in Afghanistan, military officials have begun paying better attention to TBI, especially the more prevalent mild brain injuries, which include concussions. In 2010, the Department of Defense ordered mandatory TBI screening for soldiers who have suffered a blow to the head, were in a vehicle accident or were near a blast. Troops who show signs of brain injury after a screening that tests memory and concentration are taken to one of seven brain injury clinics in Afghanistan, where they receive forced rest and cognitive therapy.
In eastern Afghanistan, troops are airlifted to the hospital at Bagram Air Base, where they spend from three to seven days at the nine-bed brain injury clinic. Nearly all return to duty after going through the program.
"If they get to us early enough, we send 100 percent back to their units," said Air Force Maj. Katherine Brown, an occupational therapist and the officer in charge of the clinic.
Brown said that when service members arrive, they are often disoriented and confused and have problems with their balance. They are encouraged not to do anything but sleep for that first day.
"Usually, if they take advantage of the rest period, they feel much better the next day," she said.
Rest is perhaps the most important aspect of the recovery process, but in combat areas, where soldiers and Marines share tents and live on bare-bones bases, quiet areas are hard to find.
After their initial rest at Bagram, patients go to a day room, where they can watch TV, but not traditional soldier fare. "The brain is not ready for a lot of stimulation," Brown said. "They don't watch war movies, action movies. We start them out on 30-minute comedies." On a recent afternoon, a recovering soldier relaxed in front of an Ashton Kutcher romantic comedy.
At this point, some soldiers ask to return to their units. "We tell them it's not safe for them or their teammates if they go back before they're ready," Brown said. "If they are not ready to deal with something coming at them, they can't be in a war situation."
In a third building, improving patients perform cognitive reasoning exercises such as Sudoku, Foosball and Origami (at this point, soldiers are also allowed to watch war movies again). Patients also begin doing exercises in which they have to move their eyes up and down, such as passing drills with volleyballs. Quick eye movement can be affected by brain injuries but is key to surviving in a war zone.
Brown said that she is working with the Department of Defense on developing TBI rehabilitation protocols, which she said have not been well-researched.
After completing the course, patients might be referred to counselors in the hospital's combat stress department. Others might need more physical rehabilitation. But most return to their units on the battlefield.
"Everybody who comes through these doors are miracles," Brown said. "Six inches the other way and they wouldn't be with us."