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Cutting-edge care for wounded warriors

James J. Lee/Military Times Staff
CENTER FOR THE INTREPID

Location: Adjacent to Brooke Army Medical Center, Fort Sam Houston, Texas

Role: One of three Defense Department amputee care facilities in the country

Facility: Four stories, 65,000 square feet

Some features: Military Performance Lab, Gait Lab, Computer Assisted Rehabilitation Environment in a 21-foot dome,

Other amputee care sites: Washington, D.C., and San Diego.

By Michelle Tan for armytimes.com
  
FORT SAM HOUSTON, Texas — The Center for the Intrepid is harnessing technology and innovative thinking to improve its care of wounded warriors.

“When this facility was established, we were given three missions: patient care, research, and education and training of the next generation of rehabilitation specialists,” said Becky Hooper, program manager for CFI.

War almost always drives medical advancements that will have a long-term impact on caring for the wounded, said Lt. Col. Don Gajewski, director of CFI and an orthopedic surgeon.

“The war could end tomorrow, and our patients get better, but the work [the employees and researchers] do here lasts,” Gajewski said. “Not many good things come out of war, and we see the worst of the worst, but this building was a gift from the American people, and we need to use it in the right way.”

The a state-of-the-art rehabilitation center for amputees and severely wounded troops, which opened in January 2007, was built with donations from 600,000 Americans.

More than 700 troops have been treated at CFI. Patients with a below-the-knee amputation could receive care from CFI for as little as seven months; one patient was treated at CFI for as long as four years, Hooper said.

These days, about 200 troops get physical therapy or some other form of care at CFI on any given day.

The four-story, 65,000-square-foot building sits next to Brooke Army Medical Center and is one of three Defense Department amputee care facilities in the country; the others are in Washington, D.C., and San Diego.

The lessons learned from treating these wounded warriors and the research being conducted under CFI’s roof will help the Army better care for the future generation of war fighters, Hooper said.

For example, CFI has the ability to test the latest and greatest prosthetics available in the market today while making sure they fit the needs of the wounded service member, Gajewski said.

“Here we have the option to fit our guys, who are very, very athletic, with all kinds of prosthetics to see what works best,” he said.

Another example of the innovative thinking that takes place at CFI is the Intrepid Dynamic Exoskeletal Orthosis, a custom-made, custom-fitted device powered by the inert energy of the device’s carbon fiber material and the user’s movements.

The IDEO, which was created at CFI, helps propel a wounded service member’s damaged leg, enabling him to walk and even run. It has proved so effective that at least eight wounded troops using the IDEO have returned to serve in the war zone.

Spc. Michael Krapels, who was shot in both legs in January 2010 in Afghanistan, said the IDEO has enabled him to run, jump off platforms and do leg presses without any pain.

He suffered a through-and-through injury in his right calf, but the bullets that tore into his left leg, entered his Achilles’ tendon, broke his fibula and took out about an inch of his tibia.

“For a while, I was told I was going to lose my leg,” said Krapels, who belongs to 2nd Battalion, 503rd Infantry Regiment, 173rd Airborne Brigade Combat Team. “I was told I was never going to be able to return to deployable status, infantry or airborne.”

Now, even though he doesn’t know if he’ll regain full use of his leg, Krapels plans to work his way back to his unit.

“There are a lot of people who are a lot worse off than me who have returned to duty,” he said. “I’m excited. I’m ready to get back to my unit, get back to my guys.”

For troops who are learning how to walk again, either with a damaged leg or a prosthetic, and those who suffer from traumatic brain injury and dizziness, the Computer Assisted Rehabilitation Environment, or CAREN, can help.

The CFI’s CAREN is the only one in the world that is a 21-foot dome with a 300-degree screen. The patient steps onto a platform inside the dome and is then immersed in various virtual reality scenarios, from the streets of New York City to a patrol in Iraq.

To add realism, the platform can move or shake or rumble to replicate passing trucks or an exploding roadside bomb, and a built-in treadmill lets the patient walk or jog as he goes through the scenarios.

According to Jason Wilken, director of the CFI’s Military Performance Lab, the CAREN has proved its effectiveness in treating certain symptoms of TBI.

For example, a soldier who was hit in the head during a freak softball accident was about to be medically boarded out of the Army because he couldn’t shake his dizziness and other related symptoms, Wilken said. But after eight sessions, the soldier’s only remaining symptom was a mild headache. He is now deployed to Afghanistan, Wilken said.

Recently, Maj. Rob, a Special Forces soldier who asked that his last name be withheld, hooked into the CAREN harness and went on a simulated convoy down an Iraqi street.

With a specially rigged rifle in hand, Rob was first a gunner in a Humvee and then walking a foot patrol while spotting for enemy fighters.

Rob, who lost his left leg and badly wounded his right leg while supporting Operation Enduring Freedom, said he enjoyed his time in the CAREN.

“It’s pretty cool,” he said. “Shooting while moving is a skill everyone needs to have. It’s a cool training tool.”

Being able to hold weapons in their hands and simulate a combat patrol sometimes helps the wounded warriors reconnect to their lives before they were wounded and stay motivated, Wilken said.

That’s why Wilken and his team are developing a physical and cognitive assessment for patients who are using the CAREN, he said. Findings from this assessment will be used to help determine whether a wounded warrior is ready to return to duty, he said.

Rob, whose goal is to return to duty with his fellow soldiers at Fort Bragg, N.C., also spent some time in the CFI’s Gait Lab. Using infrared cameras, 3-D technology and a set of 57 retro-reflective markers attached to the patient’s body, therapists can determine how a patient moves and what kind of force he is using.

Pinpointing a patient’s movements and then teaching him how to correct any deficiencies can help an amputee, in particular, move more efficiently and heal more quickly.

Research has shown that after a below-the-knee amputation, it takes 15 percent to 20 percent more energy to walk and move, Wilken said. Amputees who have lost their leg above the knee use 50 percent to 60 percent more energy, he said.

However, by taking the data from the Gait lab and pairing it with treatment in the CAREN, CFI staff members have seen a 23 percent reduction in energy use among amputee patients, Wilken said.

Rob said he never considered not returning to duty.

“It wasn’t a thought that crossed my mind,” he said, adding that he hopes to return to his team in December, less than two years after he was wounded.

On top of all the day-to-day activity at CFI, researchers continue to conduct studies on wounded warrior care, Hooper said. And they don’t have any trouble getting participation and real-time feedback from actual wounded service members.

All patient participation is strictly voluntary, Hooper said.

“But our patients know that what we learn about them can help the next guy who gets hurt, and they understand that, and I think that’s why they do it,” she said.

From providing virtual reality therapy and custom-made prosthetics, to using a Flowrider wave pool and creating a one-of-a-kind orthosis that has helped wounded troops return to combat, the experts here continue to push their patients and set the tone for wounded warrior care in the future.