In military instruction, there is a specific sequence of events that is consistently followed, so that all training develops a familiar tempo and feel.  A program of instruction (POI) usually starts with a demonstration of the task to be learned.  This demonstration is conducted under the same conditions and time allowance in which the recruits/students are ultimately tested on.  Once observed, the task can then be broken down into smaller steps. These smaller steps can be practiced at slower speeds to gain familiarity.  After many rehearsals, the student is tested at full or “combat speed" on their ability to perform and understand the training.

Sometimes, it helps to have a good training aid to explain a concept or piece of equipment.  The use of training aids is actually something military personnel are very familiar with.  Training aids are devices like charts, diagrams, or giant replicas of an actual piece of equipment, that enhance learning, visualization, and retention.  

(Above is a picture of a training aid used in assembly of a 9 mm pistol.)  On rare occasions, a real, live human being is used and we refer to this person as a “demonstrator.”  When dealing with issues of the brain, especially with my wounded brothers and sisters, I am finding the use of a particular training aid very helpful.  His name is Phineas Gage.  He is no longer alive, but his use as a training aid, or demonstrator, have been well documented, especially in the field of neuroscience

In The Beginning

In 1848, Gage was a 25-year-old railroad foreman of a work gang that was blasting rock while preparing the roadbed for the railroad.  Sometimes the terrain, where rail lines were being constructed, contained large rocks and boulders.  Not having the equipment to move the rocks, the solution of the 1800’s was to use dynamite.  In order to blow up a boulder, a hole was bored into a body of rock, dynamite would then be inserted into the hole, and then sand would be compacted into the hole to “force the explosion down into the boulder.”

One of Gage's duties was to add blasting powder, a fuse, and sand, then compact the charge into the hole using a large iron tamping rod.  While performing this duty one day, the powder accidentally exploded, propelling the large tamping rod through his head. The iron, which measured an inch and a fourth in diameter, and three feet and seven inches in length entered on the side of his face.  It passing behind his left eye, out of the top of his head, and landed some 80 feet away from the blast site, "smeared with blood and brain."  What happened next was both amazing and ground breaking.

Amazingly, Gage spoke within a few minutes, walked with little or no assistance, and sat upright in a cart for the 3/4-mile ride to his lodgings in town. The first physician to arrive was Dr. Edward H. Williams.  Dr Williams’ notes were recorded, as follows, “I first noticed the wound upon the head before I alighted from my carriage, the pulsations of the brain being very distinct. Mr. Gage, during the time I was examining this wound, was relating the manner in which he was injured to the bystanders. I did not believe Mr. Gage's statement at that time, but thought he was deceived. Mr. Gage persisted in saying that the bar went through his head.  Mr. G. got up and vomited; the effort of vomiting pressed out about half a teacupful of the brain, which fell upon the floor.”  Phineus would later come under the care of Dr. John Martyn Harlow whose initial notes read like this:

“You will excuse me for remarking here, that the picture presented was, to one unaccustomed to military surgery, truly terrific; but the patient bore his sufferings with the most heroic firmness. He recognized me at once, and said he hoped he was not much hurt. He seemed to be perfectly conscious, but was getting exhausted from the hemorrhage.  Pulse 60, and regular.  His person, and the bed on which he was laid, were literally one gore of blood.”  Though he would live another 12 years Phineus Gage was forever changed, or as many cited he was “no longer Gage.”  If you talk to any parent or loved one of a wounded warrior, you will hear similar statements, when they refer to their warrior home from battle.

Many cite the example of Phineas Gage to explain the importance of the frontal lobe of the brain in controlling our rage.  Originally, Gage, a nice, dependable railroad worker ultimately became angry, irritable and unstable and not just because he'd had a rod driven through his skull. Rather, the rod had destroyed the part of his brain that could inhibit an angry response.  Dr. Harlow began to speculate that the part of Gage’s brain that had been destroyed, was in fact the cause of the change in Gage’s behavior and personality.  If Dr Harlow were alive today he would witness an explosion of research into the frontal cortex. He would know that the cardinal function of the prefrontal cortex is the “temporal organization of behavior supported by the subordinate functions of short-term memory, motor attention, and inhibitory control.”  

The change in Gage’s personality would be consistent with damage to the “orbitofrontal cortex of the ventral aspect of his frontal lobe”, affecting logic and emotion. Harlow might be surprised to read in a recent publication, “To date, that knowledge has remained by and large either ignored or shrouded in speculation.”4 He could take comfort, however, in the knowledge that 150 years after his original observations, we are a step forward in our understanding of the relation between mind and brain and the reason why, following his injury, Mr. Phineas Gage was “no longer Gage.”

So What’s The Point?

Some of my readers may be wondering now, so what’s the point?  I’m glad you asked, actually there are three points to this story.

First:  Injuries to our brains can change our emotional states and our behaviors.  If you’ve been exposed to multiple explosions in combat, there is a good chance that you have been wounded in an area of your body that is very difficult to diagnose and very difficult to treat.

Second:  In healing, the steps we need to take are identical to the ones we as warriors used in our training POI’s; namely breaking down tasks into smaller, sequenced steps.

Third (and most important):  These smaller steps are practiced initially at slower speeds until we gain familiarity.  It is important, however; that we do the work to gain proficiency—even if this were a task that we once mastered.

Take Away

Recovering from Traumatic Brain Injury takes time, patience, and a deliberate methodology.  At times, I know that many warriors become impatient with their perceived rate of recovery.  If you recall what made you successful as a recruit or newbie, you’ll quickly realize it was the discipline to follow the steps and to not rush your development until you had rehearsed and practiced the task at hand.  Albert Einstein once said, “The value of achievement lies in the achieving.”  

These are great words to reflect on when recovering, so slow down and take your time.  Embrace the progress you make rather than the steps you lack…but keep moving toward your objectives.  This is your new tempo and as a warrior, you continue to fight the good fight.  You have a new purpose, you've got a new task.  But most importantly, you've got a new "combat speed."

Warrior, out!

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