Injured soldiers work on balance at Tacoma clinic

Bret DiFrancesco bears unseen scars of war.

"I don't sleep much anymore," the specialist stationed at Fort Lewis said. "Just a couple of hours if I'm lucky."

DiFrancesco, 29, also is recovering from an injury that disrupted his sense of balance. At the worst point of his injury, jogging led to motion sickness and staircases became nightmares.

As part of his recovery, he attended physical therapy sessions once or twice weekly at MultiCare Health System's Vestibular Balance Clinic - one of a handful of soldiers sent to the Tacoma clinic this year.

"These appointments don't solve everything," he said last month during his final visit to the clinic, "but they're helping a lot."

The infantryman from Minnesota was on a dismounted patrol in Ramadi, Iraq, two years ago when a nearby roadside bomb exploded. Shrapnel tore into both arms and his right leg; the blast threw him to the ground. Both eardrums were blown out.

He was eventually diagnosed with post-traumatic stress disorder and a mild traumatic brain injury, which have caused his balance problems.

Madigan Army Medical Center referred him to the MultiCare clinic six months ago. He attended weekly sessions with physical therapist Karen Perz to regain his balance.

"They say my vertical line - what I consider my vertical line - is canted," he said "It's never going to get fixed. You need to retrain your mind."

Traumatic brain injuries are called the signature injury of the Iraq war, and the symptoms are wide-ranging: Patients can suffer headaches, feel restless and tired, be easily frustrated and have trouble remembering things or doing more than one task at a time.

Last year, the Army launched programs to help mild traumatic brain injury sufferers and their families. At Fort Lewis, soldiers returning from combat zones are required to complete an online questionnaire to help identify the condition.

For soldiers she works with, Perz says treatment requires training the brain to recalibrate its sense of balance.

"The brain is hardwired to work as though everything is normal," she explained. "When something becomes not normal, part of what we do is train the brain to work around so the outcome is normal even though the brain circuitry isn't normal anymore."

Some people can completely recover their balance, but many won't. For the latter, that means a lifetime of practicing the drills Perz teaches.

"The longer someone works at it," she said, "the more efficient the brain will become using the information correctly."

DiFrancesco's final appointment began with a three-walled machine with which he became familiar over the months. He stepped through the open end onto a platform and slipped into a harness. Perz strapped hooks attached to the harness to the top of the machine.

Perz positioned his feet on the platform and stood by a computer. Each mouse click sent the floor or the walls in different directions. Depending on the test, the therapist told the soldier whether his eyes should be opened or closed. Sensors on the floor measured how much weight he shifted.

During his first test in March, DiFrancesco performed well on level surfaces but failed when the ground was tilted. His final appointment was the first time he scored above average on each test.

"Great job, Bret!" Perz told him. But, she added, "you still have a little distance to travel."

DiFrancesco was deployed in Ramadi with a unit of the 1st Brigade, 1st Armored Division. On June 17, 2006, a roadside bomb exploded under an American tank, destroying it.

Soldiers from his unit rotated shifts standing guard over the twisted wreckage so insurgents couldn't use it for propaganda.

DiFrancesco's squad was walking toward the wreckage two days later when a bomb detonated.

He scrambled to his feet and helped two of his friends - one of whom had "golf-ball-sized hole in his leg" from the shrapnel - to the casualty collection point.

DiFrancesco stayed with his unit in Ramadi for another month and finished out his tour in Iraq. The symptoms of his brain injury, including balance issues, weren't immediately apparent, he said.

In July 2007, he transferred to Fort Lewis to join the 5th Brigade, 2nd Infantry Division. The Stryker unit had been formed earlier that year and hadn't received its vehicles yet, so many of its members trained on light infantry tactics.

DiFrancesco first realized something was wrong during these drills.

"We're running around, and I'm tripping over myself," he said. "I can't stay balanced and look at things while I ran."

Other symptoms became obvious. He had trouble sleeping. Trouble walking in a straight line. He would lose his train of thought.

It affected his personal life. He would get frustrated easily at his son, now 6. And family fishing trips on his boat became a chore; even on still waters, DiFrancesco would get severe seasickness.

He needed time to get well, yet he remained in 5th Brigade for another four months until he transferred into the Warrior Transition Battalion, a unit created last year for soldiers with complex medical needs.

"When you're in the infantry, you don't show weakness," he said. "Just as a man, you try not to show weakness. So it took a while to get the help I needed.

"I knew that I could go into combat with those guys and they would be there for me, but I would be failing them because I couldn't run without vomiting a lot of the time."

DiFrancesco practiced various balance drills during his appointments. One had him wearing safety goggles with white paper taped to the front, with small eyeholes punched out.

Perz held a sign, then told the soldier to focus on a letter, close his eyes, turn his head to the side and back, open his eyes and see if he focused on the same letter.

Perz called it "relearning where his head is relative to his body."

Other drills mixed variables of foot placement and movement, vision focus and head movement.

"When I first started, I was often close to vomiting and always falling off balance," he said.

DiFrancesco felt nauseous a few times during his final appointment. Once, when he rocked back and forth on his feet and tilted his head in different positions while Perz flapped a drawn curtain in front of him, he lost his balance and grabbed a nearby bar.

One exercise, in which he walks forward while moving his head while focusing on a point, is the drill Perz said he "gets to do the rest of his life."

DiFrancesco performed the exercise in the main room of the clinic about 15 times. When he was finished, Perz asked him how he felt. He smiled. No problems, he said.

"I'm pleased," Perz said, "and let me admit I'm a little surprised."

But while DiFrancesco seemed happy with his progress, he realized it's just one of many steps. He wants to stay in the Army, maybe eventually transfer to an aviation unit.

His balance issues, however, have scrapped the idea of becoming a warrant officer and flying helicopters.

"I know I've got work ahead of me," he said. "I've got to keep working at this stuff. I still have PTSD and MTBI. But I still feel like I've got more I can give."

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Information from: The News Tribune, http://www.thenewstribune.com