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Alumni spotlight: Three alumni help rehabilitate soldiers in VA's polytrauma unit

Medical School alumni Michael Armstrong, M.D., Barbara Sigford, M.D., Ph.D., and Larisa Kusar, M.D., collaborate on rehabilitation plans for soldiers with multiple injuries in the Polytrauma Center at the Minneapolis Veterans Affairs Medical Center.

For three University of Minnesota Medical School alumni, news headlines drive home their daily reality: Fewer soldiers are dying in Iraq and Afghanistan, but more are coming home severely injured.

Barbara Sigford, M.D. ‘87, Ph.D., Michael Armstrong, M.D. ‘01, and Larisa Kusar, M.D., a resident alumna, treat injured soldiers at the Minneapolis Veterans Affairs Medical Center (VAMC). They are part of a specialized rehabilitation team at the VAMC’s Polytrauma Center, one of four in the nation.

Polytrauma means injuries to two or more body systems. At the Minneapolis VAMC’s Polytrauma Center, it usually refers to a traumatic brain injury (TBI) combined with another serious health problem, such as amputation, vision loss, hearing loss, complex fractures, infections, seizures, and posttraumatic stress disorder (PTSD).

Kusar directs inpatient care at the center, Armstrong oversees outpatient care, and Sigford is the VA’s national program director for physical medicine and rehabilitation.

There are many reasons for this shift to fewer deaths and more injuries, says Armstrong. Body armor and Kevlar helmets are protecting vital organs. Evacuation processes are quicker. Military medics are using better techniques to keep soldiers alive.

But the warfare in Iraq and Afghanistan is also different from that of other wars. Improvised explosive devices and land mines—not bullets—do much of the damage.

“In Iraq, no one is ever safe,” says Sigford. “In Vietnam, you could at least get away from the front lines. In Iraq, it’s constant stress.”

“I’ve heard it described as, ‘Every time I got into a Humvee, I knew I was going to die,’” Armstrong says.

Despite the improved protective gear soldiers wear, a blast can still cause severe injuries to the head and other parts of the body. Some soldiers have suffered TBIs without even knowing it, Sigford says.

The Minneapolis Polytrauma Center team continues to see soldiers with head injuries and PTSD from combat stress. “One of the legacies of this war is the combination of the two,” says Sigford.

“Military units are now getting better at recognizing this combination and are sending their soldiers here for consults while they’re on leave,” says Armstrong. “Most soldiers come here with the intention of going back to active duty, but we have had to intervene in some cases.”

Because a TBI can influence all other aspects of rehabilitation, the three alumni work with an extensive group—including psychologists, nurses, social workers, physical therapists, occupational therapists, speech therapists, and recreational therapists?—?to ensure that their patients can achieve the best results possible.

“It’s definitely a team process,” says Kusar, residency Class of 2003.

The Minneapolis Polytrauma Center has seen about 60 inpatients since the beginning of the war, many of them referred to the center from Walter Reed Army Hospital and Bethesda Naval Medical Center. Its team is also following almost 200 outpatients who have experienced brain injuries and polytrauma.

Clinically, Kusar and Armstrong, who describe Sigford as their mentor, often collaborate on patient care: Some of the patients Kusar cares for as inpatients later transition to out-patient care with Armstrong.

The three alumni also are working together to further develop their rehabilitation program—now a pressing issue, as about 2,700 members of the National Guard are scheduled to return to Minnesota in March.

“A lot of the people who are coming back have had multiple exposures [to explosions] that could cause brain injuries that don’t take them off the battlefield,” says Sigford. Many of them have suffered mild TBIs, such as concussions, combined with PTSD and have a hard time integrating back into their communities because of it, she says.

That’s where the Polytrauma Center’s expertise comes into play.

“When injured soldiers return from duty, their mission becomes recovery and rehabilitation,” Armstrong says. “For some, the goal may be communicating with a loved one, walking on a prosthetic limb, or living independently. For others, it may be returning to work, school, or military duty. Whatever their goal, our team helps injured service members complete this mission in the face of disabling combat injuries.”

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