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  The Polytrauma of War: Severity of Injuries Requires New Forms of Rehabilitation

The Polytrauma of War Severity of Injuries Requires New Forms of Rehabilitation

By Jörg Blech

Part 2: A new kind of patient

Every patient who comes through the doors of the polytrauma rehabilitation center in Minneapolis suffers from a specific combination of different injuries, explains Larisa Kusar, one of the doctors working there. "For about three years now, we've been seeing a new kind of patient," she says. "Many of them would have died in Vietnam." It's not unusual for 12 specialists to deal with a single case.

Kusar hesitantly presents a CT scan showing the skull of a soldier injured in Iraq. A piece of shrapnel from an exploding grenade shot through his right eye and buried itself deep inside his brain. The piece of shrapnel has a diameter of five millimeters (0.2 inches). In the image, it gleams like a bright particle inside the dark tissue surrounding it. But there's something else that isn't normal: A full third of the skullcap is missing.

A soldiers' sacrifices

The doctors sawed it off on purpose. Thanks to this so-called "decompressive craniectomy," the injured brain tissue was able to swell, Kusar explains. Later on the hole in the cranium will be sealed with a steel plate.

The doctor proceeds to the next patient, speaking quietly. He's about 20 years old and tried to defuse a bomb built by an insurgent in Iraq. The attempt went badly wrong. The young soldier lost both arms and his sight. The blast wave that moved through his skull reduced his mental capacity to that of a small child.

"We know what sacrifices these soldiers have made," Kusnar says. "Now we're concentrating on improving their lives -- on making sure they can make the greatest possible use of the abilities they have retained."

The doctors in Minneapolis have at least been able to treat the patient's brain to the point where he has been able to return home. He lives in a suburb of Minneapolis with his wife and two small children and is currently undergoing rehabilitation training for the blind.

Compared to the young soldier, Tim Wicks is making great progress. Orthopaedists are currently restoring mobility to his legs by means of titanium and bone cement. Making his mind agile again is a task reserved for occupational and speech therapists. Day after day, they present him with increasingly difficult problems to solve.

At first, the therapists asked him to tell them what day and what year it was and where he was every couple of minutes. For a time, Wicks had to think hard before answering, but at one point he replied: "Hey, didn't I just tell that to your colleague?" His short term memory was slowly returning.

In the polytrauma unit's handicraft room Wicks has already disassembled and reassembled a gasoline-powered lawn mower three times. He puts the components that are left over in a plastic bag -- each time there are less of them. His memories of what happened to him since the 1980s have also been returning -- in chronological order. Wicks now seems perfectly normal in conversation, apart from the odd absent-mindedness that sometimes overcomes him. "Learning new things takes a little longer than it used to," he explains.

The story of Wicks's recovery is reassuring to the 38 employees at the polytrauma unit. Their efforts have clearly produced remarkable results: The severed links between nerve cells have reconstituted themselves. The paralysis of the right side of his body has all but disappeared.

Not even the doctors know exactly what goes on with nerve cells during such a recovery. But speech therapist Jack Avery suspects that "patients use their brains in a different way than before."

Two weeks ago -- just over four months after the explosion in Afghanistan -- Wicks was using his restored brainpower to start making grand life plans. He wants to return to his sons and buy or build a bigger house. He wants to pass a fitness test for injured soldiers so that he can re-join the National Guard.

Wicks has to perform another five years of service -- only then will he be entitled to a full pension.

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