JOINT BASE MCGUIRE-DIX-LAKEHURST, N.J. - When U.S. Army Sgt. Nathan Martucci is asked if he hurt his leg, he has become accustomed to nodding yes and walking away while holding his cane for balance, but he doesn't have a leg injury.

Martucci's injury isn't visible. It's on the inside. He has a brain injury. A brain injury is caused by a blow or jolt to the head or a penetrating injury that disrupts the normal function of the brain.

The blows and jolts he experienced came from exposure to more than 25 improvised explosive devices that detonated near his tank while conducting route clearance, presence patrol, cordon and search and recovery missions in Iraq with the 3rd Armored Cavalry Regiment of Fort Carson, Colo., in 2005, then again with the 3rd Infantry Division of Fort Stewart, Ga., in 2007.

Martucci, a Warrior Transition Unit soldier, and former tanker, is no longer able to drive to WTU's Case Management building, or anywhere else on Joint Base McGuire-Dix-Lakehurst. He uses public transport.

"If I didn't have this," said Martucci raising the cane he holds in his right hand off the ground, then letting it go to dangle from the cord that ties it to his belt loop, "no one would say anything."

The month of March has been dedicated to the more than 260,000 military members who have been documented as having varying degrees of brain injury during the past decade.

Martucci's symptoms are severe, his balance, vision, memory and speech are impacted.

Awareness of brain injury, also referred to as TBI or traumatic brain injury, and its symptoms, can help to identify possible injuries and expedite their treatment.

"The good news is because of the awareness of both the noncommissioned officer and officer corps, there is a lower threshold in people recommending help and in people getting help," said Dr. John Ragone, a psychiatrist at the WTU for the past eight years. "When I first started, there were not as many as there are now that come and get help."

Ragone is optimistic because he has seen soldiers getting better, but as with any injury, timely care and treatment is important.
"The earlier someone gets help," said Ragone. "The higher the likelihood they will make a substantial improvement."

The U.S. military began implementing the Automated Nueropsychological Assessment Metric, or ANAM, in 2008.

The ANAM, a computer-based cognitive assessment, is a tool to aid in early brain injury identification.

Service members complete a battery of performance tasks that relate to attention, memory, mental speed and accuracy. It takes approximately 20 minutes and provides a cognitive baseline for service members in areas of performance that are usually affected after an injury to the brain.

"Everybody gets a pre-deployment ANAM," said Dr. Harini Kumar, a physician at the WTU who specializes in traumatic brain injury, and ANAM data interpretation. "If somebody has had an event or exposure, or some kind of change they get identified to do a post deployment ANAM."

The ANAM baseline could have helped to identify Martucci's brain injury earlier.

"I could have started treatment up to three years earlier," said Martucci. "The ANAM could have at least established some sort of trail showing that I had something wrong."

A change from the pre to the post-test, doesn't always indicate brain injury.

When a brain injury is identified, each person is unique. If a service member is identified for care or treatment, an individualized rehabilitation process can be initiated at WTU.

"It depends on the individual's need," said Kumar. "Somebody may need vestibule rehab for balance, some may need speech, or occupational therapy to help with daily living activities or improve memory."

Martucci has utilized several of these areas of rehabilitation throughout the past seven weeks with the help of U.S. Army Lt. Col. Carla Patton, a nurse and officer in charge of case management at the WTU.

"Injury care and treatment is a multifaceted issue that affects many areas of the whole person," said Patton.

Some of this individual rehab is offered here at Joint Base McGuire-Dix-Lakehurst but service members with multiple issues require a polytrauma center like the facility at the Veterans Hospital in Richmond, Va., Patton added.

Patton and the rest of the medical team at the WTU are eager to get the word out about brain injury awareness in order to help improve the lives of military members like Martucci.

WTU hosted a TBI opening ceremony Friday and is scheduled to have a TBI resource table in the Exchange lobby March 13, 10 a.m - 2 p.m. followed by a lunch and learn titled "Concussions" March 18, 12-1 p.m. at Building 5613, Room 2.

"Brain injury is not a show-stopper," said Rigone. "Identifying a critical situation in and out of theater and getting rapid help is what protects people."

Martucci said he wishes all brain injured individuals were treated the same and helped equally, not just those like him, whose injury is apparent due to the presence of a cane.

People who suffer from brain injury often do not show any physical sign of injury, but cognitive and emotional symptoms include: irritability, depression, slower thinking, substance abuse, aggression and impaired judgment.

Martucci feels leaders, like those in his command that got him help when he needed it, are a critical first line of defense in identifying triggering events such as blasts, accidents, vehicle roll-over and blunt-force trauma that can lead to brain injury.

Go to U.S. Army Public Health Command website for more information or to access the U.S. Army Soldier Leader Risk Reduction Tool, for help identifying potential risks or critical events such as brain injury.