By Ms. Gloria Montgomery (Army Medicine)July 17, 2012
FORT HOOD, Texas (July 16)--To say that Sgt. 1st Class Lemoore Rangel's brain injury and invisible war wounds left her a mess would be an understatement. She'd forget where she parked her car. She'd forget where she put her keys. There was no normal in her 24-hour day, and it frustrated the heck out of her. What's worse, a routine trip to the grocery story could turn into a 3-hour venture into a maze of confusion.
That was more than 18 months ago. Today, thanks to Fort Hood Warrior Transition Brigade's occupational therapists--called miracle workers by many--Rangel's life isn't as much of a struggle. Sure, she has her moments, but routine and repetition have helped bring "normal" back into her life.
"Basically, it boils down to habits," said the Purple Heart recipient, who first arrived at the WTB September 2010 when she was medically evacuated from the battlefield for an illness and a head injury. "Something like not having my keys in the same place was never a big deal before my head injury. Now, if I get distracted, who knows where I might put my keys? I've had to retrain my brain to relearn old habits and to develop new ones."
Much of her recovery success she credits with "JJ" and her boots-on-the-ground (BOG) philosophy, which arms Soldiers with organizational skills built on "consistency, familiarity and routine."
JJ is WTB occupational therapist Janice Johnson-Simcox who three years ago developed her BOG philosophy to teach Soldiers ways to combat the memory problems associated with traumatic brain injuries (TBI).
"I had a Soldier who would lose part of his uniform every day," Johnson-Simcox said, adding that she tagged her structured method "BOG" because it was a term Soldiers understood and could relate to.
"BOG," said Rangel, a 32-year-old paralegal with the California Reserves, "has given me confidence because I'm not stressed in trying to figure out things," adding that she has trained her husband, who recently retired from the Army, on how important routine and consistency at home are in her healing process. "He knows not to touch or move anything of mine."
Married with a young daughter who is living temporary with her Mother in California, Rangel said BOG also had made life easier because it benefits family members.
"When you have a 3 ½ year around the house, it [BOG] makes dealing with her easier because we now do things consistently in a certain way," she said of forming new habits and routines. "In teaching myself new habits, I'm teaching her good habits as well so it kind of has a long-term effect."
Soldiers learn to lay uniforms out the night before, put keys in the same location every night, make a grocery list before going to the store -- memory issues, according to WTB's occupational therapy supervisor Michelle Fielder, that "most of us have problems with anyway."
"Really we're not working on major stuff," she said, "but these things are difficult for Soldiers with TBI and cognitive issues, so we're teaching them how to handle them."
Much like Rangel, Fielder said simple things like grocery store shopping is often overwhelming to those with head injuries and cognitive problems.
"We tell them to treat a trip to the grocery store like a mission, make up a grocery list and then map out a route aisle by aisle," she said, adding that when mission is added to the scenario, Soldiers seem to better understand the task.
It took Rangel five trips to declare her grocery trip a victory.
"JJ gave me a map of a grocery store, which showed what food was on what aisle," Rangel said, adding that JJ encouraged her and even went to the grocery store with Rangel to help her with her grocery shopping mission. "She also taught me to prepare a grocery list just to make my trips shorter."
According to Fielder, the essential goal of occupational therapy is for a Soldier to learn to be independent and comfortable.
"We find out what can this Soldier do or not do," she said. "We then give them the skills to be as independent as possible in their military or civilian environment whether it is home, work or school."
Fielder, who has been in occupational therapy for more than 22 years, added that war really hasn't changed the focus of occupational therapy.
"You're going to be doing the same treatment with a person who has been injured from a car accident as someone who has been a victim of an improvised explosive device," she said. "Yes, our services have changed a bit, but you just adapt by looking at the needs of Soldiers."
For Johnson-Simcox, accompanying Soldiers to grocery stores, while unconventional, reduces the frustration a Soldier may feel when he or she can't do something they did before they were injured.
"Sometimes it's necessary to take them to a real-world environment and assist them so they can feel a sense of accomplishment," she said. "They need to be able to remember what it feels like to be successful. With my being there with them, it gives them a feeling of having a safety net. If they make a mistake with us, it's ok. We correct the error, and not focus on it. Instead, we practice how to perform the task differently so they can remember it for the next time. By using this structured method of shopping, the Soldier can go to the store using the technique we practiced and be back in their car in 30 minutes."
For Rangel, occupational therapy has made her life 'bearable and functional,' as well as reduced the stress on her family since they now understand her medical condition, thanks to rehearsing responses via role-playing exercises with her therapist that helped ease her worries and fear of facing her family for the first time since her injury.
"I was able to talk to my husband who was in Iraq at the time about things I needed him to talk to his family about," she said before her December 2010 visit. "They needed to understand my medical issues, the mental health side of it, the short-term memory problems and the short temper. Role playing was a unique, but necessary aspect for me to make sure the reintegration didn't get too stressful for me and wasn't going to become miserable for my family. It was very trying for me, but JJ rehearsed with me, which helped boost my confidence."
Rangel admits her life was full of "would not's" much of 2010 but a year and a half of boots on the ground reinforcement has given her the strength and security to tackle each new adventure with hope and success.
"There was no way 18 months ago that I could have moved off post," Rangel said, of her life now outside of the barracks. I was afraid because I couldn't remember a lot of things. The combination made it very intimidating to even be living in the barracks without my husband and so far away from home. OT has helped me feel stronger and more confident and has empowered me to take the reins and start controlling my life."