The ongoing conflicts in Afghanistan and Iraq mean that thousands of Americans will spend their lives with war on the brain. Literally.
"Recovery," said neurosurgeon Rocco Armonda, "plateaus to a degree, meaning it levels out, but it actually continues for years. We see recovery in patients from the Vietnam era almost 15 years out in some instances."
Armonda is an Army colonel who has operated on hundreds of traumatic brain injury, TBI, patients at the Bethesda National Naval Medical Center in Maryland, including ABC's Bob Woodruff, who was severely injured in a blast from an improvised explosive device, IED, nearly 18 months ago.
"Our brain is used to being in a closed cookie jar," Armonda said. "When the cookie jar is opened, our brain doesn't function as well because atmospheric pressure presses on the brain."
"[The brain] is used to being in a fluid-supported medium that's enclosed," the neurosurgeon explained further as he lifted away a section of a plastic reproduction of a human skull. "When we take that away, the brain starts becoming compressed. You have impairment in speech and in motor movement."
'I'm Not as Smart as I Used to Be'
In February, in a documentary called "To Iraq and Back," Woodruff chronicled his own recovery along with the struggle of Army Sgt. Michael Boothby and Marines Lance Cpl. Jeff Landay and Sgt. Shurvon Phillip, among others.
Six months ago, Boothby could barely walk and had difficulty even moving the fingers of his left hand.
Today, he said, "it's a lot better. I can do everything with my left hand that I couldn't before." And he can not only walk, he can run.
Six months ago, Landay could barely speak. Now, though he sometimes struggles to find once familiar words and is no longer fluent in Spanish, he speaks with ease.
"I'm not as smart as I used to be," he explained, "but I don't think in an accident like that, it won't be 100 percent again. I'm not going to be the same, but I'll get there."
Landay's and Boothby's recoveries have been achieved through their own hard work and through the selfless determination of their families.
Landay's mother, Michelle, and Boothby's wife, Megan, have sacrificed their jobs and homes to stay by their loved ones' sides — and fought a cumbersome bureaucracy to assure that they got critical therapy after they left the hospital.
"Part of the TBI experience," explained Michelle Landay, "is getting not just the right kind of therapy, but the right therapists as well."
'Battling' for Treatment and Therapy
Michelle insisted on getting her son in treatment at the Balboa Naval Hospital near their El Dorado Hills, Calif. home, but it took six months, and the delay "did slow down his rehabilitation," she said.
"You know, if I hadn't kept battling, we'd probably still be at home waiting. We'd probably still be at home waiting for the service, because there was nobody in our hometown area that was able to give him the services he needed."
When Boothby returned to his Comfort, Texas, home, his condition actually deteriorated as he waited for Dallas Veterans Administration officials to get him into a rehab program. While paperwork delayed the process, his brain collected fluid and he could no longer move his left arm.
Finally, Boothby entered a civilian rehabilitation program, and he's made steady progress. "It's a struggle for us to make him go to therapy," said his wife, Megan, who's pregnant with the Boothbys' fifth child. "He doesn't like it and he doesn't think that he needs it."
Many of those whose brains have been rattled by the explosions of IEDs and other munitions may not even know they've suffered TBIs and many more show no physical signs.
While someone suffering from TBI may look and act normal — like Boothby and Landay, who look physically fit — they can actually be impaired.
A preliminary study by the American Psychological Association in February noted, "It is possible to have a traumatic brain injury in the absence of any observable physical damage to the brain. Difficulties after a traumatic brain injury include headaches, sleep difficulties, decreased memory and attention, irritability, depression and slowed mental processing."
'I Know He's in There Fighting'
For some victims of IED blasts, the consequences are dire. Marine Sgt. Shurvon Phillip's Humvee was shredded by an IED in May 2005. The explosion crushed his skull, deprived his brain of vital oxygen and left him paralyzed and unable to speak.
Phillip is still mute, but now is able to sit up in a chair, lift one of his arms and thumb-wrestle with one hand. Each movement requires a Herculean effort, and his appearance is still a shocking sight to the Marines who stop by his home to visit and cheer him up.
Each week, a physical therapist works with Phillip for two hours. He sees a speech therapist for one hour a week. An aide is there to assist his mother, Gail Ulerie, with Phillip's care for 40 hours each week. All are employees of the Veterans Administration hospital in Cleveland where Phillip lives with Ulerie, who is his primary caregiver, 24 hours a day, seven days a week.
When Woodruff recently visited Phillip, he asked Ulerie, "Did you think, when he first started coming out of it, waking up, that it would be this bad?"
"Well, I didn't think it was going to last this long," Ulerie said in an accent reflecting her Caribbean roots. "The first time when he opened his eyes and he saw me, he would just like stare at the ceiling all the time or have his eyes closed. I would always keep talking to him and telling him, he can do better and I know he's in there fighting."
Ulerie hovered over her son, tending to his intravenous lines, removing the spittle and phlegm that collects in his mouth and squeezing his cheeks to move the paralyzed muscles of his face. She takes hope from seeing the successful recoveries of other TBI patients.
"His brain was deprived of oxygen, so I knew that his recovery would take a little bit longer," she said optimistically. "Whenever I see someone else who has recovered really quickly, I just praise the Lord and say, 'That's gonna be Shurvon one day.'"