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
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.

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.”

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.”

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. In retrospect, it seems obvious; Trevor does what many elite athletes do: he visualizes an activity, not just before the competition, or in training, but even in quiet moments. The results in his case are dramatic. The scans show that his imagined rowing is firing the same parts of the brain he’d use on the water. The hope is that, as his brain rewires, his motor control will follow. “That’s Trevor’s scientific discovery,” says D’Arcy. “His discovery for rehab specialists is that mental imagery is a huge way they can help patients toward their goals.”

Is it beyond the realm of possibility he will walk again? “With Trevor, there’s nothing beyond the realm of possibility,” he says. “It’s like I said: you don’t make predictions on this; you’d be proven wrong.”

Accompanying me to the Greenes’ home in Nanaimo is Kevin Light, a Vancouver Island freelance photographer and a newly retired member of Canada’s national rowing team. In more than 10 years on the national team, he has several world championships under his belt and was part of the men’s eight crew that won an Olympic gold medal at the 2008 Beijing Summer Games. He and Trevor hit it off, lapsing into rowing jargon, each understanding at least some of the other’s drive and sacrifice.

Over lunch, the Greenes talk of hopes and goals. “A year from now, I’d like to see you walking up and down our road with your walker, and only one person assisting,” says Debbie. “And I want to see Grace [riding her bike] saying, ‘Watch me Daddy, watch me!’ And Noah,” she says with a laugh, “I’d like to see him walking, too.” And long term? “To row with Kevin,” says Trevor. “I’ll have the boat ready,” says Light.

Debbie, a believer in baby steps, gives Trevor a look. “How about we have a goal to go to Hawaii?” she says. They were two weeks from meeting on the islands for Trevor’s leave from Afghanistan when she was awakened with the devastating news of the attack. He gives her a fond smile: “Maui, here we come.”

There is a point near the end of March Forth where Debbie asks Trevor if he would do it again—go to Afghanistan, “knowing what would come?” Yes, he told her, “I would do it all again.” Today, I ask the obvious follow-up question: why would you do it again? “Afghanistan was my generation’s chance to fight terrorism. And fight evil,” he says. “I often wondered if I would have gone [to fight] in the Second World War had I been in that generation. And I would hope the answer would be yes.”

As he rebuilds mind and body, he’s also rebooted what was already a strong sense of social engagement. He still follows events in Afghanistan, where his role as a civil-military co-operation officer was to foster ties with the Afghans. He believes Canadian forces have had a positive impact during their 10 years on the ground. Health care has improved, there are a million girls in school, “there’s hope for the people again,” he says. “There’s no clear winners in wars like this. You can’t finish with a bang—like kill Hitler and the war’s over. It’s a war on a concept: terror.” Trevor, it seems, has much in common with the fractured physical, emotional and political landscape of Afghanistan. Can it ever heal? Certainly not by giving up on it, in Trevor’s view.

With his days as a soldier behind him, he’s become an outspoken environmentalist. He’s in the midst of writing another book on what he sees as Canada’s many environmental transgressions, from the proposed Enbridge pipeline across B.C. to the government’s withdrawal from the Kyoto Protocol.

The conversation turns to Debbie, gone to pick up Grace from school. She made hope when there was none, never accepting the limits that doctors and rehabilitation specialists put on her broken husband in those first horrible years. “Oh, I’d be drooling in some long-term care facility if not for her, watching soap operas and looking at my feet,” he says. “My love for her grew, and my respect, because at every corner, they were telling her ‘no.’ But she fought like a lioness and made it a ‘yes.’ Not a maybe. A yes.”

In this, they are a brilliant match: happy with the life they have, but fighting to regain what they had. “I’m a rehab athlete. My gold medal is walking,” he says. “People say I’m brave, they admire me for my courage. But I don’t see how anybody could be content like this—if they have the possibility of walking again, of regaining full function.”

Little Noah and I are flopped on a raised exercise mat at one end of the Greenes’ double garage. It’s crowded with exercise equipment and boxes left from a recent move. A combat jacket in desert camouflage hangs from a hook on the wall. A golf bag leans in a corner, gathering dust. Trevor has already sweated through an hour of workout with physiotherapist Edna Ricafrente. Martin Gruys, a friend and physio assistant, arrives to offer added muscle to support Trevor’s weight and to work him through demanding lower-body exercises.

Today, Gruys is here for the main event. Trevor heaves out of the chair, grabbing the bars of an aluminum walker, his arm muscles straining with the effort. The chair is pushed back. Debbie has strapped on knee pads and is crouched behind him. Ricafrente is on one side of him and Gruys the other. Debbie prods one foot and then the other, and Trevor slides them forward about 10 cm a time. Baby steps. He has visualized this often. He has practised it in the pool, aided by the water’s buoyancy. But it’s only been two weeks since he’s been making these steps on land. Damned if Capt. Greene isn’t marching forth.

The thing about walking is this: it’s not solely a brain-to-leg function. There is what D’Arcy calls a central pattern generator—“a little microprocessor in the spine”—that helps produce rhythmic movements. You can think about walking in the abstract but you don’t really think about the process of moving your legs when you’re walking, any more than you think about taking the next breath. It’s a complicated ballet of balance, coordination and momentum you take for granted until it is stolen from you. But Trevor and Debbie have seen the scans. They’ve seen that the brain has found a path around the gaps and scars left by that axe. His brain knows how to walk again in theory; now it’s a question of getting the body back on board.

“It’s a little like rowing,” Light says from behind his camera. “You don’t win it all at once. It’s inch by inch by inch.” Trevor locks eyes with a fellow athlete and grunts in agreement. “That right shoulder is too far forward,” says Debbie. “You’re walking better every time,” says Gruys, as they reach the end of the garage. “You want to rest or go straight on?” Gruys asks. “Straight on,” says Trevor. Lap four: Debbie is beaming.

Noah is clutching one of my fingers, his blue eyes—Daddy’s eyes—more intent on scoping out this stranger in the house than on the miracle of determination playing out in a suburban garage. I gather him on my lap so he can get a better view of Daddy, now on his fifth crossing of the garage. Perhaps at some level, he processes the sound of his father’s laboured breathing, sees the sweat on his brow, hears the excited voices of Dad’s support unit. The determination has always shone through, but there is something else today. There is triumph. Noah seems unimpressed, but maybe he senses that something in Daddy’s eyes. Who knows what is firing inside a five-month-old’s brain? Not something to underestimate. Not anymore.