United States Department of Veterans Affairs
 Health Care
VA Polytrauma: Working Miracles, One Veteran at a Time
On exercise mat, woman assists man doing situps
Kyle Anderson works his muscles with a little help from VA Physical Therapist Wendi Slattengren.
VA photo by April Eilers

In October 2004, 19-year-old Marine Lance Corporal Kyle Anderson was on patrol in Iraq when a roadside bomb exploded near him, sending pieces of shrapnel through his helmet and into his skull. The searing hot metal penetrated deep, ripping through the entire left side of Anderson’s brain.

The young marine was quickly airlifted to Baghdad Hospital, where surgeons operated.

“That first surgery saved his life,” said Anderson’s dad, Tim. “But they had to remove part of his skull, and parts of his brain, in order to clean things out.”

Not too long after that, the badly wounded marine was flown to the United States.

“I have to be honest, when I first saw my son at Bethesda Naval, I didn’t know if he was going to make it,” Tim Anderson said. “The worst thing we’d ever had in our family, prior to this, was a scuffed knee. This was not a scuffed knee.”

Weeks later, Kyle Anderson’s doctors at Bethesda Naval Medical Center deemed him to be medically stable. In late 2004 he was flown to the Minneapolis Veterans Affairs Medical Center where he began comprehensive rehabilitation for his acute traumatic brain injury (TBI). Minneapolis is home to one of four top-level VA polytrauma centers located around the country. These centers specialize in treating Veterans and active duty military personnel who’ve suffered multiple traumatic injuries.

“When Kyle first arrived, our team members observed a young male lying in his bed, with a large concavity where the left part of his skull had been,” said Michelle Peterson, Kyle’s physical therapist. “He was nonverbal. Kyle could only communicate with automatic facial expressions such as smiling, or crying. He couldn’t move his right arm or his right leg. He had a right visual field loss, and significant hearing loss in both ears.”

Woman stands next to man on treadmill
Anderson uses a treadmill to improve his coordination and endurance.
VA photo by April Eilers

The Long Road Back

VA surgeons promptly went to work, essentially rebuilding the side of Kyle’s head with the help of a custom cranioplasty plate. They used a CT scan to design the plate so it would fit the exact dimensions of Kyle’s missing skull.

Kyle’s successful surgery, however, was just the first step in a long journey toward recovery. The surgery only provided the bone to protect his brain but regaining function required extensive rehabilitation. Modern medicine had repaired his shattered body, but learning how to use it again was another matter. Kyle would need to start at the beginning, slowly relearning the basics of how to walk. How to speak. Even how to swallow.

But Lance Corporal Anderson was ready for the difficult work ahead, and so was his polytrauma team at VA.

“Kyle received our full spectrum of interdisciplinary care, everything from basic medical to speech, physical, and occupational therapy,” said Dr. Mike Armstrong, chief of the Physical Medicine and Rehabilitation Department at VA Minneapolis. “The surgeons in Baghdad saved Kyle’s life. It was now our job to give him his life back.”

Armstrong emphasized that in addition to Kyle’s extensive rehabilitation for TBI, the young marine also needed a high degree of nursing care. “Our nurses are the foundation of our polytrauma program,” he said. “A solid nursing team is critical to the rehabilitation of any TBI patient. Without strong nursing, nothing else can happen.”

In addition to therapy, recovering successfully from a traumatic brain injury requires yet another key ingredient: emotional support. This is why the Minneapolis Polytrauma facility has a seasoned team of mental health professionals and social workers on hand to help TBI patients — as well as their families — deal with the tremendous stress they suddenly find themselves under.

“A family must cope with a lot of emotions and changes when one of its members suffers a traumatic injury,” explained Stacy Tepper, Kyle’s lead social worker and primary care manager. “Our team provided Kyle and his family with the counseling and support they needed during this unfamiliar journey.

“This support continues to be an important aspect of treating Kyle as a whole person,” she added.

Thumbs Up!

As the weeks went by, Kyle gradually began showing signs of improvement.

Speech Language Pathologist Martha Manthie reported that Kyle was eventually able to follow gestures and make some guttural sounds. But as his strength and alertness grew, so did his impatience.

“He started to be impulsive,” Manthie said. “He was easily distracted during his therapies. As he gained more and more awareness of his deficits, he became frustrated. Who wouldn’t?”

As time went on, Kyle’s frustration became plainly evident: he began having emotional and behavioral outbursts.

“He was particularly frustrated with his communication ability,” Manthie said. “So we worked on establishing communication by head nods, or ‘thumbs up’ or ‘thumbs down.’ It helped relieve some of his frustration. Eventually, he progressed to the point where he began learning some words.”

Manthie said that because Kyle had been getting his nourishment from a feeding tube for so long, her speech therapy team needed to work with him on another fundamental: learning how to eat again. “We worked with him on coordinating his swallowing,” she explained.

In addition to eating and communicating, Kyle also needed to learn how to walk again.

“Our physical therapy team initially worked with Kyle on basic functional mobility like moving in and out of bed, and standing,” said Physical Therapist Michelle Peterson. “There were also a lot of strengthening exercises. Later, when he was stronger and up on his feet, we worked with him on improving his balance, his endurance, and his gait pattern.”

Kyle was improving, slowly but steadily. Eventually he reached a point where Occupational Therapists Mandy Smoot and Chantel Ostrem could begin teaching him some simple life skills.

“We worked with him on daily living activities such as brushing his teeth, getting dressed, combing his hair, even preparing simple meals,” Smoot explained.

“We also worked with Kyle on improving his upper extremity function,” Ostrem said. “Eventually, Kyle was able to perform his self care routine by himself, using a sequence of photographs of his personal items, like his comb or toothbrush.”

The End of the Beginning

Today, nearly six years after his catastrophic injury, Kyle lives in his own house in the St. Paul suburb of Inver Grove Heights. His dad, Tim, and older brother Mat live there with him to provide the continuous care Kyle will need for the rest of his life.

“Kyle has made great progress,” Tim explained, “but he still needs around-the-clock care. We got him this house for one reason and one reason only — for him to have the knowledge and security that he always has a home. He’s living in his home town, the town where everybody knows him, the town where he won his state wrestling championship when he was in high school.”

Tim Anderson emphasized that family involvement plays an enormous role in the recovery of any Veteran who has sustained a traumatic brain injury.

“These kids need to know they are still loved,” he said. “They need to know that someone’s going to be there to look out for them.”

Kyle holds down a part-time job as a housekeeping assistant at the Minneapolis VA, where he continues therapy to improve his strength and language skills. He exercises, goes to the movies, attends wrestling matches at his old high school — all the things you’d expect a normal 25-year-old to do.

“That neurosurgeon who saved my son’s live in Baghdad performed a miracle,” Anderson said. “Then the people at VA performed a miracle of their own. Kyle is up and walking around now. He’s got over 500 words in his vocabulary. He’s becoming more and more independent. He even went on safari in Africa.”

Tim Anderson said VA continues to provide him with the support and encouragement he needs, answering any questions he might have about how to best take care of his son. “If I need to know something, they’re always right there for me,” he said. “The VA is good about that. You’ve got to hand it to them.”

Dr. Larisa Kusar, medical director of VA’s Polytrauma Rehab Center in Minneapolis, served as Kyle’s primary doctor during his year-long stay at the center. “We’re proud of Kyle,” she said. “He still has a disability, but that doesn’t mean he doesn’t have a rewarding life. He’s enjoying his life, which is all that matters to us. It means we did our job.”

By Tom Cramer, VA Staff Writer