Captain Trevor Greene, shown with is finacee, Debbie Lepore, this week.Fred Lum/The Globe and Mail
His voice is raspy, the words come slowly. Trevor Greene says it is because he no longer has the reflex to breathe before he speaks, so he has to remind himself constantly to take in air while he talks.
Yet that he speaks at all, let alone in front of large crowds, as he did in Toronto this week, defies the grim prognosis that doctors described to his fiancée, Debbie Lepore, when he was in a coma after suffering a horrific brain injury almost four years ago. One physician told her to put him in a long-term-care home. She told herself, "They didn't know Trevor." She was right.
The 44-year-old harnessed his willpower to the latest neuroscience, to build new pathways to get signals from his brain to his muscles so he could move and talk again.
He can talk, type, sit up and stand. He vows he is going to walk down the aisle at his July 24 wedding. Ms. Lepore said she doesn't expect that dramatic an entrance. "I'll be happy if he takes one step."
Their love for each other, and the role it has played in his against-the-odds recovery, has come to define Captain Greene far more than the attack that damaged his brain when was serving in the Canadian Armed Forces in Afghanistan. Canadians were horrified at the news that a fighter had driven an axe into his brain, but are heartened by how far he has come - and impressed by the woman who cheered every baby step along the away.
She has put aside her career as a chartered accountant to focus full-time on Capt. Greene's rehabilitation and takes a supportive role - quite literally - in his physiotherapy by helping to hold him up while he learns to control his muscles.
It takes a lot of willpower to retrain the brain, to put in the hours of physical and occupational therapy he does every day. He said he is motivated by his love for Ms. Lepore and their four-year-old daughter, Grace.
"Willpower is willing your body to do things you can't do," he said. "When I was an athlete, I would use willpower to go beyond the pain. Now I'm willing my legs to flex when I push up. It is a conscious thing: I think, now gluteus maximus, now thighs, now calves, like that."
Sometimes, he said, he can almost feel new pathways forming from the pins and needles in his arms or legs that mean his brain is being activated. His motor cortex, the region of the brain that usually controls movement, was badly damaged in the attack, so he has had to retrain his brain to make his body move.
"It is neuroplasticity," he explained in an interview this week, before returning to Nanaimo, B.C., where he and Ms. Lepore and Grace live. He had been in Toronto to speak at the inaugural gala for the True Patriot Love Foundation, which supports the families of Canadian soldiers.
"They used to think the brain was like a computer chip. If it was damaged, the chip wasn't any good any more. Now they say there is a possibility that the brain can compensate. In the back of the skull, where my brains leaked out, it has to compensate for that."
The neuroplastic revolution, as some call it, stems from discoveries in the 1960s and 1970s that showed how the brain physically changes as we learn, think and move.
This adaptive potential means the brain has the capacity to heal after an injury, to find new ways of doing things. With the right input, it can repair damaged circuits or create new ones.
Capt. Greene said progress is slow.
"I feels like being frozen in an iceberg and slowly thawing out."
But a breakthrough came earlier this year during an exercise he did repeatedly over several months with his physiotherapist, Bonnie Lamley, and Ms. Lepore. As Capt. Greene sat on the treatment table, each hand grasping an upright pole, the two women would move him into an upright standing position. They did it over and over again. One day, he was able to engage his muscles on his own and feel himself standing.
"That showed the brain was involved and we had stimulated the right pathways," Ms. Lamley said.
It is a huge step forward to feel the weight of his body pressing down on his feet, feel the ground beneath them.
"That means he is getting sensory input back into his brain," Ms. Lepore said. Sometimes, when Capt. Green acquires a new skill, it is as if he is remembering something he used to know, he said. But other times it feels like he is learning something new.
"I have forgotten how to walk," he said.
His progress has been far beyond what his doctors predicted. But the things most of us take for granted, like getting our hand to do what we want it to do automatically, require concentrated effort for him.
It is still early days in the quest to understand how best to help the brain repair itself, and researchers are working on devices and therapies that will help patients recover sight, hearing, balance, speech and movement.
Traumatic brain injury has been described as the signature wound of the U.S. war in Iraq, and some American families have had to lobby so soldiers could get the kind of intensive therapy needed to recover limited movement or the ability to communicate.
Capt. Greene said the Canadian Armed Forces got him the help he needed, and he spent 14 months at the Halvar Jonson Centre for Brain Injury in Alberta.
But that didn't come until after he spent a year in critical care, during which he nearly died of pneumonia and during an operation to rebuild his skull.
Patients with severe brain injuries usually make the most progress three to four months after they are hurt, said Montreal neurosurgeon Judith Marcoux. Ms. Lepore said she was told not to expect much improvement after the three-year mark.
Yet that's when Capt. Greene was first able to stand after having surgery to straighten his feet, which had contracted into a pointed position after so long in hospital. Having his feet flat on the ground has made it possible for him to try walking.
Ms. Lepore said she never wanted to look at his X-rays or brain scans, although she knows that surgeon who initially operated on Capt. Greene called it the worst brain injury he had ever seen.
"I think, subconsciously, I never wanted to get discouraged and I might have if I saw how bad it was."