Darryl Summers merges onto Interstate 80, but in his mind, he's back in Iraq, leading a convoy of Army trucks, tanks and heavy equipment in an armored Humvee.
When you're responsible for escorting 50, 60, 70 vehicles behind you, Summers says, you keep constant watch for roadside bombs. It's dangerous. You're on edge. You don't let other drivers impede your progress.
In the heavy Omaha traffic, with other motorists cutting him off, the U.S. Army veteran becomes anxious and starts speeding and driving aggressively, just as he had on those Iraqi roads. As soon as he can, he pulls over and pulls up an app on his phone called PTSD Coach.
Summers, 49, runs through the app's stress-assessment tools and its breathing and relaxation techniques. The exercises, he recalled in an interview, helped him to compose himself.
“It spirals you from where you're at to a more calm, relaxed state,” he said, “so you're ready to hit the road again or ready to re-engage.”
The app, developed by the U.S. Departments of Defense and Veterans Affairs, is one of many that people with PTSD — post-traumatic stress disorder — and traumatic brain injuries can use to help them deal with their conditions. They're not substitutes for therapy, but they can provide help when people need it.
Computer programmers and others have created hundreds of thousands of apps, or applications, over the past few years for use on smartphones, tablets and computers. Many of them, even the ones that weren't designed as rehabilitation tools, can help people dealing with brain injuries or trauma.
A basic calendar that alerts you to an appointment or a game that tests your memory can help brain-injury patients and unimpaired people alike.
“I wish I would have had these last year in school,” said Nathaniel Allen, who left Quality Living Inc.'s northwest Omaha campus late last week after a six-month stay. QLI serves people with brain and spinal-cord injuries.
Allen, 20, of Ainsworth, Neb., was back home last July after completing his freshman year at the University of Nebraska-Lincoln when he rolled his car on a curvy rural road. He suffered a brain injury and damaged his knee, shoulder and ribs in the crash.
When he first arrived at QLI, he said, his memory was horrible. “Five months ago,” he said, “I might not remember to eat breakfast. Or I'd forget to take a shower.” He used the calendar on an iPod Touch to remind him of appointments with his doctors or therapists. “I have it so it vibrates at me five minutes before the event is supposed to happen. It helps me a lot with time management.”
Lindsey Bugee, a speech language pathologist at QLI, said the tools help patients gain control: “We've had residents even grab their iPod and just be, like, 'This is my life. It lets me know exactly what I'm doing, where I need to go. If I lost this, I don't know what I'd do.'”
Bugee is scheduled to speak about the role of technology in the recovery process at Nebraska's annual brain injury conference, which will be held April 4 and 5 in Kearney. The event, expected to draw about 250 people, is aimed at those with brain injuries and their families.
Michelle Wild, a professor at California's Coastline Community College, offers monthly webinars on her website, id4theweb.com, that outline the various features of apps used by people with brain injuries. Wild said she had been using technology to help such people for about eight years.
Wild said she usually recommends Apple-based apps because of their consistency from one device to another. “For a person with a brain injury, the slightest difference in the look or the way in which a device works can really throw them off.”
Among the top apps for people with brain injuries or trauma — according to area health professionals, Wild and the brainline.org website — are PTSD Coach; Lumosity Brain Trainer, which provides exercises targeting memory, attention, speed, flexibility and problem solving; Breathe2Relax, which helps people manage stress, anger and anxiety with breathing exercises; and Proloquo2Go, which serves as an alternative for people who have difficulty speaking.
The Proloquo2Go app costs $190, but that's much less expensive than a stand-alone machine that performs much the same function. Many of the apps are free.
Wild said insurance policies generally don't cover the ones that cost money or the cost of the devices themselves.
Many people with brain injuries, she said, didn't have memory problems before they were injured, so it's easy for them to become frustrated when they can't remember how to perform simple tasks or they forget appointments.
Therapists working with such patients, Bugee said, make sure the patients' schedules are the same every day so they can begin to anticipate what's coming next. Restoring a person's memory, she said, is “a combination of having the device itself, lots of repetition and routine and (the person's) spontaneous recovery.”
John Chesters is slowly recovering his short-term memory after he stopped breathing following a heart attack at work Feb. 8. The several minutes that the 51-year-old went without oxygen left him with a brain injury. He went home to Bellevue from Immanuel Medical Center's inpatient rehabilitation program on March 15.
The memory games that he played on the iPad he used in Immanuel's rehab unit were a big help, Chesters and his daughter Christina said. His family helped him enter his schedule each day so he could refer to it when he couldn't remember what he had to do next.
Chesters' memory problems weren't limited to his schedule.
“At first while we were in the hospital,” Christina said, “he would always ask why none of his friends would come to visit him. But the same people would come up every single day.” Christina said they used the camera on the iPad to document the friends' visits.
“It really has been a remarkable thing for my memory,” Chesters said. “I really do believe it has helped.”
Jocelyn Ritchie, a neuropsychologist with the VA Nebraska-Western Iowa Health Care System Polytrauma Support Clinic, said many of the apps list resources where a person can get additional assistance. “If a person is not involved,” she said, “it can lead them to at least the first steps to getting involved with therapy.”
Wild and others noted that it's important that professionals provide some training on the use of the apps. Unless someone shows people how the skills they acquire in a game can help them with everyday tasks, Wild said, the game apps can remain simply games.
Summers, the Army veteran from Omaha, said the terminology used in some apps might be unfamiliar to someone who hasn't gone through counseling, so it's important to see the app as a supplement to therapy. Summers himself is pursuing master's degrees in clinical psychology and counseling with the goal of assisting other veterans.
But the apps are good tools to have, he said, if he needs immediate help dealing with issues that once might have driven him to alcohol as a coping mechanism. “It talks you through the process. You relax and go for the ride. It's pretty neat.”
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