Nazareth College has been offering a course on TBI ever since Shirley Szekeres, now dean of the School of Health and Human Services, joined the faculty in 1991. Szekeres, who created the course after working in Pittsburgh at one of the premier programs for brain injury in the U.S., is nationally respected as an expert in the field, having published nearly 30 articles and book chapters and given more than 50 regional and national presentations on the subject of TBI. Nazareth also employs several other faculty members who have extensive experience working with children and adults with TBI in acute care, rehabilitation, outpatient, and school and vocational settings.

In addition to its Aphasia Clinic, Nazareth College also maintains partnerships with the Hickok Center for Brain Injury and St. Mary's Hospital Brain Injury Unit, both in Rochester. At those sites, Nazareth graduate students help provide inpatient and outpatient therapy for people learning to meet their life's goals after traumatic brain injuries.

Today, due in large part to the kind of therapeutic programs provided by Nazareth College, the outlook for people with TBI is very different from what it used to be. In the past, traumatic brain injury was little understood and often hidden away by families who held modest hope for the recovery of their loved ones.

Looking back to the mid-1980s, Szekeres recalls one of the first cases of TBI with which she was involved. A man in his 30s, a husband and father, was about to turn into his driveway when he was hit by another car. Coming out of a coma after several months, he was often confused and forgetful. Today, such consequences from TBI are recognized as typical, but that was not the case then. "We weren't sure how to interpret many of the behaviors we were seeing because they were not well-documented," Szekeres recalls.

Now that there is a case history of TBI spanning over generations, it is evident that TBI has been a fact of war at least since World War I, although the syndrome was not then named. Indeed, there is a feeling among many neurologists today that the thousands of World War I soldiers who suffered from so-called shell shock actually had mild cases of TBI. These days, TBI, which has been dubbed the "signature wound of the Iraq War," is receiving increased attention as head injuries are becoming more severe because of more powerful explosive devices. Even shells detonated a mile away from a soldier can cause lasting damage to his or her brain. Also, because they are protected by better equipment, a higher percentage of soldiers today are surviving head injuries that would have been fatal in previous wars. The 2008 death of Tom McHale, a nine-year NFL veteran and former Tampa Bay Buccaneer who died at 45, has also focused attention on the incidence of chronic traumatic encephalopathy (CTE), a degenerative brain disease caused by head trauma, among professional football players.

Clearly, there is still much to be learned about TBI. For instance, recent studies have suggested that both moderate and severe TBI can cause epilepsy and increase the risk for Alzheimer's disease, Parkinson's disease, and other brain disorders that become more prevalent with age.

"We used to call this 'the silent epidemic' because there was so much happening but people didn't have a real understanding of what it was," says Szekeres. "It has been quite a journey."

Clients like Nick DeVries turn to Nazareth's Aphasia Clinic for interdisciplinary, clinical experiences led by teams that include graduate students in speech-language pathology, art therapy, music therapy, nursing, physical therapy and social work.

"I see my biggest challenges right now as improving my memory and working on my speech impediment and handwriting," says DeVries. At the Aphasia Clinic, he is working primarily on his speech issues. "I think people have misconceptions about me, and about individuals with TBI in general," he says. "My speech impediment gives people the wrong impression and makes them automatically assume that I'm drunk or mentally handicapped. My balance issues don't help much to correct that impression."

DeVries, who has progressed since his accident from a wheelchair to a walker and is now fully mobile (in fact, he recently received a new driver's license), goes to the clinic twice a week for an hour at a time. The clinic usually sees less than a handful of TBI clients in a semester, but in late 2008 it provided services for seven individuals, ranging in age from 21 to 78.

"The clients we see here are those folks and families who feel they don't have any services left," says Merideth Rao, an assistant clinical professor and coordinator of the on-campus Aphasia Clinic. Rao explains that the clinic provides affordable care for the underserved - many of whom have used up their allotted medical funding but would like to continue treatment.

Among the features of the clinic is its recently constructed "home transition laboratory," with a kitchen, bathroom, laundry room, and sleeping area. This resource helps clients practice cooking and other household chores that may be difficult for them. In the Clinic's encouraging, non-threatening environment, clients are able to analyze their behaviors and discover useful strategies, such as making lists or, in Nick DeVries' case, relying on a BlackBerry to pick up where his short-term memory leaves off. "That's where the learning comes into play," says Rao. "Gradually, the independent use of strategies becomes like a new habit."

The Clinic also provides a community for people with TBI, who may feel set apart and isolated as a result of their injuries. "The clinic brings a lot of people together," says Rao. "Some clients say they don't really talk much outside the clinic, but when they come here they feel very open and just like everybody else."

Nazareth also has an ongoing collaborative relationship with the Hickok Center for Brain Injury, a facility that offers a safe, supportive environment in which brain injury survivors are encouraged to design and direct their own lives' journeys. The Nazareth graduate students help members of the center compensate for memory problems, learn organizational skills, develop relationships, and engage in conversations.

"The students from Nazareth have a special way of being able to teach people, to talk to people, because they already know what the issues are," explains Elaine Comarella, the center's CEO. "And when they're not here, we miss them. There are times during the year when they can't come, and the members are continuously asking, 'When are the "speechies" coming back?' That's what they call them. They really enjoy the students."

One of the "speechies" currently working at Hickok is Jennifer Rosney '09G, who is earning her master's degree at Nazareth in speech-language pathology. Rosney, who started at Hickok at the end of January, is there three days a week from 9 a.m. to 2 p.m. She is mostly involved with group activities, helping to facilitate a current events circle in which participants, all with TBI, look at articles from the newspapers, pulling out salient information and improving their reading comprehension and social interaction. "They are all so bright," says Rosney. "Very motivated and eager to improve and interact. It's such a great population to work with."

While she's not sure what the future holds for her, her experience working at Hickok has made Rosney think about working with a similar clientele when she graduates from Nazareth. "I would certainly consider it," she says. "My clients are so eager to improve and it's so rewarding to work with them."

For people with TBI the help that is available through Nazareth College can provide a second chance at life. "I'm very close to moving out of my parents' house now and living on my own," says DeVries. "And I'm exploring going to architecture school again. I may need someone to take my notes for me, but I think I'm ready."

According to the Department of Defense, more than 5,500 military personnel have suffered traumatic brain injuries during the conflicts in Iraq and Afghanistan. In fact, it is now known that those who have served in Afghanistan or Iraq are at a much higher risk of TBI than combat veterans from previous wars. In the Vietnam War, 14 to 18 percent of all veterans had a brain injury. Today, the Walter Reed Army Medical Center says 31 percent of those admitted between January 2003 and May 2005 had some kind of brain injury. Public awareness of TBI also reached new levels during the Iraq War when television journalist Bob Woodruff was struck by shrapnel from a roadside bomb. Millions of viewers followed his plight and recovery.

Working closely with the Veterans Outreach Center, Nazareth College is starting to focus on the emergent problem of TBI among returning military members. Nazareth's School of Health and Human Services offers diagnostic, therapy, and wellness services to veterans, while the College of Arts and Sciences helps them with resumes and other business in its technology center.

"There is much that Nazareth can and will do to help our military men and women recover from the injuries they have sustained," says Daan Braveman, Nazareth College president.