Captain Trevor Greene with the help of his wife Debbie and occupational therapist Lila Mandziuk works out inside his garage April 8, 2011 which has been converted into a home gym at their in Nanaimo.
A year ago, Trevor Greene could barely stand. Today, he can do 30 squats while gripping a ladder mounted to the wall.
"I go pretty low," says the retired Canadian Forces captain, whose brain was severely injured in a horrifying incident in Afghanistan five years ago.
Hours and hours of intensive, repetitive exercises are paying off as new connections between his brain and body slowly replace the ones he lost when an attacker drove an axe through his skull.
At night, he no longer needs the help of a mechanical lift to get into bed. At the table, he can raise a glass to his mouth and drain the last drop. He's learning again to eat with his right hand.
His remarkable recovery - and his brain's astonishing transformation - is being documented thanks to a partnership he and his wife, Debbie, formed a year ago with two scientists.
Every three months, the Greenes travel from their home in Nanaimo, B.C., to Victoria, where he is strapped into a functional magnetic resonance imager and moves one arm or leg at a time while keeping the rest of his body still.
As he lifts his arm to his mouth, or pushes his knee away from his chest, the machine measures the activity in his brain. The researchers are particularly interested in his motor cortex, the part of the brain that controls movement. It was damaged in the attack.
"When he moves his arms, we have seen more than a six-fold increase in the extent of motor activation. With his legs, there is more than five times as much activity over the past year," says National Research Council neuroscientist Ryan D'Arcy. He is working with the University of Victoria's Stephen Lindsay, a cognitive psychologist, to document Mr. Greene's against-the-odds recovery,
Mr. Greene and his wife helped design the two-year study and will be co-authors when the results are published in a scientific journal, says Dr. D'Arcy.
While the images help motivate Mr. Greene and his wife, they say they hope the study will encourage other patients who have suffered a brain injury. "It is the whole reason we are doing it," says Ms. Greene.
Dr. D'Arcy says Mr. Greene's case is challenging conventional wisdom that there is only a narrow window for the brain to recover from a severe injury. Experts says patients make the most progress within the first few months after a severe traumatic brain injury. Many don't get therapy in the years that follow, Dr. D'Arcy says.
Ms. Greene says she and her husband were told not to expect any improvement after two years - but he is making more incremental progress now than ever before.
Mr. Greene, 46, has applied his soldier's discipline to his retraining mission. A competitive rower in the 1980s, he has the drive and intense focus of an elite athlete. With the help of his wife, he puts in 2½ or more hours of physical and occupational therapy every day. They've turned their garage into a gym.
Ms. Greene put aside her career as a chartered accountant to focus full-time on his rehabilitation, although the couple has found time to finish a draft of their book, tentatively titled A Warrior's Path, to be published by HarperCollins. He is also doing some motivational speaking.
They have a six-year-old daughter, Grace, and this week they attended her first school concert.
Five years ago, Mr. Greene's prognosis was grim. He spent the first year after his injury in critical care and nearly died from pneumonia and during an operation to rebuild his skull. One physician urged Ms. Greene to put her then-fiancé into a long-term care home, but she told herself that they didn't know Trevor.
He spent 14 months at the Halvar Jonson Centre for Brain Injury in Alberta. Since his return home, physiotherapist Bonnie Lamley and occupational therapist Lila Mandziuk have helped guide his recovery.
Mr. Greene and his wife, who were married this summer, are sustained by their love and encouraged by his slow-but-steady progress and the occasional breakthrough. He recently began using a walking machine called a Lokomat. It supports him in a harness and moves his legs on a treadmill, slowly putting more weight on his feet.
"After the fifth time, in the middle of the workout, my muscle memory came back," Mr. Greene says. "It was like my body remembered how to walk. The sixth time it was automatic."
He still has a long way to go before he can walk independently. But in the machine, he can now go for two kilometres and take half of his weight.
Dr. D'Arcy and Dr. Lindsay say that while Mr. Greene is an extraordinary man, his case study will have implications for other patients, including those who have had strokes or other types of brain injuries, and for their doctors. "They can see it can be done," says Dr. D'Arcy.
A year ago, Mr. Greene said he felt like an iceberg slowly thawing out. Now, he says it's more like he is an athlete learning a new sport. He is getting stronger, his balance has improved and he can tell where his feet are.
"I see improvement every day," he says.