ORLANDO, Fla. — Soldiers who have undergone significant limb salvage procedures are able to return to active duty and athletic activities following orthotic management, according to studies presented at the 2011 Annual Meeting and Scientific Symposium of the American Academy of Orthotists and Prosthetists.
Ryan Blanck, CPO, and Johnny G. Owens, MPT, both from the Center for the Intrepid (CFI) at Brooke Army Medical Center (BAMC) in San Antonio, explained here.
Among the available options in what Owens called CFI’s limb salvage arsenal, the medical team at BAMC is able to use circular fixation and an energy-storing orthoses in various capacities to avoid amputation. Later this year, team members will begin trials using regenerative medicine techniques and less invasive fasciotomies to help augment the limb salvage program.
As a first step, the limb salvage team fits the patient with the circular external fixator frame, allowing the injury to heal while giving the soldier the freedom to continue physical therapy and begin strength training.
Upon graduating from the external fixator, patients received a customized energy-storing patella tendon-bearing ankle-foot orthosis (AFO), called the Intrepid Dynamic Exoskeletal Orthosis (IDEO). Soldiers return to the rehabilitation process fit with the AFO and aggressively train with the device. The ultimate goal is a return to duty, or to an ability level equal to the one they had prior to their traumatic lower extremity injuries.
“We encourage them to be as aggressive as they want — that includes flipping 400-pound tires,” Owens said, commenting on one of the soldiers in his video presentation.
He noted that soldiers in all levels of rehabilitation train right next to each other, as a way for them to stay motivated for the next step in the process.
To date, eight of 22 of these lower extremity limb salvage cases using the CFI Dynamic Strut AFO have been deemed “fit for duty,” according to the studies, and five of them have returned to their previous military occupational specialty. As an important qualification for many of these patients, the CFI Dynamic AFO also allows them a low-profile solution to their condition; it makes all the difference to a soldier that an orthosis cannot be seen underneath traditional military-issued clothing and footwear.
Both Blanck and Owens noted that this technology and rehabilitation process can and will be adapted for the civilian population.
“We have a lot of patients that we deal with who are achieving incredible levels of functionality,” Blanck said. “At the Center for the Intrepid it’s no different from a lot of your practices — you’re dealing with patients that like to raise the bar, even after their amputation or injuries.”
Our two speakers from the Center for the Intrepid demonstrated a dynamic ankle foot orthosis that obviously is unique to their center and their high-activity users — service members — but also points to the trend we’re seeing within the industry of people who are clinically applying dynamic ankle foot orthoses for higher end users. So it goes beyond our traditional articulated AFOs. These are following prosthetic technology so that they are getting some energy return during their gait cycle.
— Gary G. Bedard, BSc, CO, FAAOP
Clinical application liaison, Becker Orthopedic