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Wounded Warriors Amputation Alternative

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SAN ANTONIO, Texas ( Ivanhoe Newswire) - Troops coming home with injured legs are requesting those limbs be cut off instead of saved. Advances in prosthetics are a major reason why. But now a breakthrough, that some believe could be the most significant orthopedic advancement to come out of the war on terror, has many wounded warriors reconsidering.

Sophisticated prosthetics allow military amputees to run and return to duty. Those whose limbs are salvaged haven't been so lucky.

"Every time I took a step, it felt like walking on a bed of nails," Staff Sgt. Ammala "al" Louangketh, told Ivanhoe.

That's why he considered having his leg cut off after it was riddled with bullets in combat.

"It's a very difficult decision," Joseph Robert Hsu, M.D., chief of orthopaedic trauma at SAMMC in San Antonio, said.

Before wounded warriors make that decision, Doctor Joseph Hsu is offering them another option.

"The IDEO has been a real game changer for us," Dr. Hsu said.

"It feels like putting on a new leg," Staff Sgt. Louangketh said.

It's the return to run program at the center for the intrepid. After surgery and lots of rehab, injured service-members strap into the IDEO. Since his leg was mangled in an IED attack, specialist Caleb Redell has problems walking on his own, but as soon after putting on the IDEO, he can jump.

"It was exciting," Spc. Redell said. "I haven't done anything like that since I got hurt."

Captain Victor Munoz struggles to walk since his legs were crushed by a drunk driver, but with two IDEO he can sprint.

"I wear them as much as I can just because I feel much more normal and pain free," Cpt. Munoz said.

Developer Ryan Blanck said the brace supports the wearer's weight, which can help relieve pain. Struts connect the top and bottom, giving wounded warriors back the ability to thrust their bodies forward. Blanck said while some who try IDEO do decide to go through with amputations, he's seen a lot of people change their minds.

"I may not be back to 100 percent, but I'm going to give 110 percent," Staff Sgt. Louangketh said.

There are more than 200 wounded warriors using IDEOS in the return to run program. Doctor Hsu said he could probably have thousands in it, but right now it's not an officially funded program. He said efforts are underway to change that and to eventually make it available to civilians.

RESEARCH SUMMARY

WHAT IS THE IDEO? The Intrepid Dynamic Exoskeletal Orthosis, or IDEO, was designed by prosthetist Ryan Blanck at the Center for the Intrepid. It is a custom-fit device made from carbon and fiberglass that supports the foot and ankle and resembles an amputee's running prosthetic.  The energy-storing orthopedic device, along with an extensive rehabilitation program, is allowing wounded warriors who previously had difficulties walking or standing due to lower leg injuries to run again.
(Source: www.army.mil)

HOW IT WORKS: The IDEO is custom-made using a mold from the warrior's leg. The three piece device fits in shoes and boots. The top piece that is shaped like the top portion of a prosthetic leg is placed just below the knee. Both pieces are held together by a sturdy and flexible support bar. The upper and lower sections are joined by a carbon fiber dynamic response strut system originating from prosthetic technology used with the high-activity amputee population within the Department of Defense.

In order to maximize the full benefits of the IDEO, warriors go through extensive rehab sessions. During the initial sessions, warriors are trained on how to step with the device. As they progress through the rehab, they are introduced to more stringent training that involves running and jumping up and down and side to side. Then weights are introduced into the rehab.
(Source: www.army.mil)

THE STUDY: A study performed at The Center for the Intrepid found that the IDEO improved performance 10 percent to 37 percent when compared with three commercial braces. Performance measurements included walking speed over smooth and rocky terrain, the ability to climb stairs, the 40-yard dash and other tests of speed and agility.
(Source: www.stripes.com)

HIGH PRAISE FOR IDEO: Dr. Michael Bosse, clinical chair of the Major Trauma Extremity Research Consortium and an orthopedic surgeon at the Carolinas Medical Center in N.C., said that the IDEO has the potential to be one of the most significant medical advancements from the wars in Iraq and Afghanistan.

"This will change the game for patients that don't get amputations," said Bosse, who has seen the device in action and has no financial stake in it. "And the long term benefits for society are potentially huge." (Source: www.stripes.com

INTERVIEW

Dr. Joseph Robert Hsu, Chief of Orthopedic Trauma for SAMMC in Houston, talks about the simple device that's changing the minds of many wounded warriors considering a life-changing procedure.

What kind of injuries do you usually see?

Dr. Hsu: We here at SAMMC receive injuries from the war; the majority of what we deal with in this department is extremity injuries.

With all the technology and techniques, are you able to save some of those injuries that wouldn't have been able to be saved?

Dr.Hsu: We don't like the word save, we prefer to use the setting. What we know from the medical literature, mainly in the civilians heading, is that once you've had a severe lower extremity injury, whether it's from an amputation or a limb salvage scenario, your life is a different path. There are very high rates of disability among people that have had severe injuries. We may only have information for the lower extremities. Technology has really advanced our ability to salvage limbs which has raised the question, which one should we salvages and which one shouldn't we salvage. That's really the crux of the issue.

The patients themselves then have to decide should I salvage or go with a high tech prosthetics. What kind of emotions do you see in patients?

Dr.Hsu: It's a very difficult decision. THE Amputation program with this conflict has been very successful. Technology has advanced, which is typical from any military conflict. If you look back at this nation's history, a lot of the advances in extremity trauma care have occurred around military conflict. So it's no surprise that with this conflict the same has occurred. As far as prosthetics in the amputee care, they and for the patients that chose to have a limb salvaged

Have you had it where they had the limb salvaged and then came back and say I would rather be like them and run and jump?

Dr Hsu: As a matter of fact it's happening fairly frequently. It's the reason why we created the return to run clinical pathway. We want the limb salvage patients to function at the same high level that the amputees were preforming. We actually did a study at this institution that looked at what rate of patients that have an amputation had a late amputation. We define the late amputation as the amputation that occurred after twelve weeks based on some preliminary data from the civilian world. It turns out that about fifteen percent of amputees, major limb amputees, had a late amputation. We would presume is due to an inability to achieve the desired level of function.

When they made that decision, is that something that the hospital will say okay we'll amputate versus they'll try to rehab it the way it is?

Dr. Hsu: We do, especially before we started the return to run clinical pathway. It was a very common scenario for our patient to desire a late amputation and it still does occur. The way that we manage it is we really have a variety of surgeons see the patient. Some of us primarily do limb salvage; some primarily do amputation and some in the middle do both. We have another variety of other healthcare providers, physical therapy, prosthetics and rehab physicians. We actually send the patients to the variety of those healthcare providers and physicians and have an opinion rendered by each of them, so it really becomes a very interactive process with the team here as well as with the patient. We actually try to get the families involved as well because it's a lifelong decision to make.

Talk a little bit about what the return to run clinical pathway is about.

Dr.Hsu: The return to run clinical pathway is a program we started about three years ago. We started it because of this desire for late amputation. It was a situation where on a weekly basis we were seeing wounded warriors that had undergone limb salvage or even had a variety of other problems like post traumatic arthritis and desired a late amputation. The real reason why is obtaining the high level of function was very difficult for the limb salvage patients. For the amputees due to the advances in prosthetics and advances in rehabilitation of the amputees they were achieving that. It was very difficult to bring a wounded warrior with limb salvage to that level due to limitations with their post traumatic arthritis, muscle damage, nerve damage. We could get the bone to heal, get the alignment good and in a lot of settings that considered to be a success. With our wounded warriors they did not consider a success. The average wounded warrior is a twenty six year old E-4. They're very, very active and what they want to do is return to their life's chief activities. The problem that we had in the limb salvage side is those patients did not feel like they could return to their life's chief activities, which involved athletic activities and in a lot of cases returning to duty. We developed the return to run clinical pathway which is a multidisciplinary rehabilitation protocol to target that self-efficacy and to target that high level of function where we were able to take patients and get them back to running, jumping, playing sports and returning to duty to include deployment.

FOR MORE INFORMATION, PLEASE CONTACT:

Ryan Blanck, CPO
ryan.blanck@us.army.mil 
(210) 916-8429

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