Rewiring Trevor Greene's Brain

CANADA Rewiring Trevor Greene’s brain The former soldier survived an axe attack in Afghanistan, now he’s defying the limits of science in his recovery by Ken MacQueen Jan 7, 2013 Kevin Light It has been 25 years since Trevor Greene gave up competitive rowing for other pursuits: journalism, travel, soldiering, fatherhood, marriage. But today, at age 48, sitting in a wheelchair in his Nanaimo, B.C., home, the forcibly retired army captain is rowing as hard as he’s trained for any event in his life. Today he rows only in his mind, where he also visualizes walking. The frustrations are enormous for a man once thought of as invincible. He used to be part of the men’s eight crew at King’s College in Halifax, and at the elite club level, pulling until his muscles screamed and the callouses were thick on his hands. Now he makes perfect strokes with his mind, the neurons firing along a familiar course as he stirs up long-remembered sensations: the feel of oar in hand and boat in water. “All that stuff: the sound and the heat and the pain,” he says. When the oar enters the water, “I imagine the tug on my shoulders, because it’s a very good feeling. Very distinctive.” To even have these cogent thoughts, let alone articulate them and work toward turning them to action, is near miraculous. This is a man who doctors once thought was doomed to an institution; a member of the living dead. His life of accomplishment and adventure was torn asunder with one violent stroke on March 4, 2006. A teen under the thrall of the Taliban saw a Canadian soldier, helmet off for a goodwill meeting with the elders of an Afghan village, and buried a homemade axe into Trevor’s skull. ADVERTISEMENT Everything changed for Trevor that day. For all the days since, the stakes have been higher than anything he’s faced in a life full of challenges. But as he confronts them, his brain is recovering in ways that rehabilitation specialists once thought impossible. Every three months for two years, researchers have looked into his brain with a functional magnetic resonance imaging (fMRI) machine and charted an amazing pace of healing, years after the brief window of recovery considered the norm for a damaged brain closed. “The reality is that, yes, the results have been spectacular,” says neuroscientist Ryan D’Arcy of the preliminary findings of the study. And the progress, which once seemed so impossibly elusive for a man with a profoundly damaged brain, is defying what were once the known limits of science, medicine and physiology. It’s been four years since I visited Trevor, his wife, Debbie, and daughter, Grace, to write an article for Maclean’s. To see Trevor today is like walking into the midst of an unfolding miracle. His voice is stronger; his core strength and upper-body mobility have made a quantum leap. There is growing power in his lower limbs, and a sense of confidence, accomplishment and momentum—the swagger of a rower after a good day on the water. Some frustrating days he doesn’t see this, Trevor admits, but his brain knows. And when he looks back, he realizes how far he has pulled himself along. Debbie breezes into the house, back from picking up groceries, a whirlwind of positive energy. Grace, born before Trevor’s 2006 deployment to Afghanistan, is almost 8. Five months ago, Debbie gave birth to their son, Noah. In the interim, the couple wrote March Forth, the book title a play on the date of the attack, and the story an account of the six years since. Much of the detail of the first two years of recovery, of which Trevor has no memory, is drawn from Debbie’s diaries. But Trevor, a former journalist with Bloomberg News, was the principal writer for much of the book. Days before my arrival, they learned it was long-listed for the Charles Taylor Prize for Literary Non-Fiction, which tells you all you need to know about his acuity. “Trevor’s mental abilities are extremely good,” says D’Arcy. “He’s certainly smarter than I am.” It was in 2009 in Halifax when D’Arcy saw a repeat of Peace Warrior, an award-winning documentary on the early stages of Trevor’s recovery. There is a devastating moment in the documentary when Trevor is told by a doctor, assessing his fused ankles and non-responsive legs, that there is little chance he’ll walk again. D’Arcy, then working for the National Research Council’s Institute for Biodiagnostics in Halifax, believed the legs weren’t the fundamental problem. He remembers shouting at the TV: “It’s in the brain! It’s in the brain!” He tracked down the Greenes through Sue Ridout, the documentary’s producer. “I think I can help,” he told them. D’Arcy is a neuroscientist in the exploding fields of brain research and the non-invasive measure of brain activity through devices such as fMRI, which maps parts of the brain used for different activities by measuring increases in blood oxygenation and flow in affected areas. “It’s humbling,” he says. “You learn not to make predictions because the field is growing so fast it would be dangerous to say that can’t be done.” ADVERTISEMENT Progress: Scans show improvement in Green's brain A research project was born, one with the Greenes as partners in its design. Every three months, Debbie and Trevor drive down Vancouver Island to Royal Jubilee Hospital in Victoria, where the six-foot-four Trevor squeezes into an fMRI machine, an experience like being stuffed into a torpedo tube, he says. Trevor’s brain at rest is charted and measured against a control subject, usually Stephen Lindsay, a cognitive psychologist at the University of Victoria and a partner in the research project. The Greenes helped set three priorities they wanted to track. One was the movement of hands to his mouth. (“I want to drink beer again,” Trevor said.) Mission accomplished. They also track leg movement because walking is his ultimate goal. Finally, in one of the most exciting elements of the study, Trevor suggested he visualize an activity while in the machine. They settled on rowing. D’Arcy, a former rower himself, was intrigued by the possibilities. He’s learned never to underestimate the brain’s resilience. As the capacity to measure its activity grows, so does a new appreciation of its untapped potential. “I mean, it’s got 100 billion neurons,” he says. “Each of them has tens of thousands of connections that are modulated in all sorts of ways. You start to do the math on that, and you’re moving past 10 to the 28th power of possible connection states. Anyone who conceives they would understand that is asking the wrong question.” Certainly, the results for Trevor have surpassed D’Arcy’s expectations. With each scan, his brain activation increased, preceding improvements months later in his motor function, the area of the brain most affected by the axe blow. “We’re doing the calculations now,” says D’Arcy, who has since moved to B.C. to take twin appointments, a professorship and chair in medical technologies at Simon Fraser University and the helm of health sciences and innovation at Surrey Memorial Hospital. “At last count, it was over a 6½-fold [increase in lower-body brain activation] from time one to time eight.” Reading the scans proved a powerful motivation for both Trevor and Debbie, who assists in his gruelling daily 2½-hour rehabilitation routines. During the first two sessions, Trevor needed a lift to move from his wheelchair to the bed for the fMRI scans. By the third time, he stunned the researchers by getting out of the chair with only Debbie’s help. By the eighth time, Trevor got out of the chair by himself. By the 10th time, he used his hip-flexor muscles to move his legs. “In the two years since I met him,” says Lindsay, “during a time when neurology texts would have predicted no recovery, there have been absolutely striking improvements in his posture, his speaking voice, his ability to hold himself in a standing position.” ADVERTISEMENT One can see displayed on a graph an “exponential” jump in Trevor’s capabilities in the sixth year of his injury—trashing the accepted wisdom of the limitations of brain injury rehabilitation, says D’Arcy. Patients with strokes or other brain injuries are usually told the greatest hope of recovery is in the first few months, “if you’re lucky, six months, maybe a year. But after that, what you have is what you have—and that’s it,” says D’Arcy. While neurologists have a growing appreciation of the brain’s “plasticity”—its ability to relearn, rewire and adapt—the rehabilitation community’s ability to apply that information to patients is in its early stages, he says. Although the research is still incomplete, he is sharing results with brain injury and rehab experts. He doesn’t want to give patients false hope— Trevor was superbly fit before the attack and has a soldier’s and athlete’s discipline in recovery—but D’Arcy does want to impart what he calls “brain hope, to empower patients toward taking little steps to recovery. What I routinely tell patients with brain injury is the lessons to learn from this are: you are now in the elite sport of recovering from brain injury. If you choose to do that, then you’ll see these sorts of gains.” He gives Trevor credit for one of the most exciting findings: the impact of mental imagery.

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