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Lack of resources backlogs high-tech leg brace for injured GIs

Before and after IDEO ankle fusion case

An injured soldier with a fused ankle, who struggled to walk, is able to run again after getting an Intrepid Dynamic Exoskeletal Orthosis, which is a prosthetic-like device that stabilizes the lower leg and gives the wearer a springy power to his movement. (Courtesy of the U.S. Army)

BROOKE ARMY MEDICAL CENTER, Texas — Severely injured servicemembers, once barely able to walk, can run again — even go back to war — with the aid of an advanced orthotic device created here a few years ago. But the team that builds it is so under-resourced that only a fraction of the troops and veterans in need have one.

“We’re busting at the seams (with too much work),” said Lt. Col. Joseph Hsu, an orthopedic trauma surgeon who specializes in limb salvage. “We’ve been functioning above capacity for a long, long time.”

For a patient with a damaged limb the prosthesis-like brace can often be the difference between choosing to amputate or keeping the leg. The wounded servicemembers, whose legs can have massive tissue, nerve and bone damage, go from slowly limping along to sprinting, cutting and jumping after a month of training with the device, which stabilizes the lower leg and gives a springy power to their movement.

“It’s a huge advancement and represents one of those breakthrough moments,” said Andrew Pollak, president of the Orthopeadic Trauma Association.

Demand is high. There are about 5,300 limb-salvage patients from the Iraq and Afghanistan wars — five times the number of lower-extremity amputees. The brace, called the Intrepid Dynamic Exoskeletal Orthosis, doubles the chances that the servicemember can return to duty.

Still, the IDEO effort is only a two-man operation — one prosthetist and one physical therapist — that exists by pilfering from the amputee department at the Center for the Intrepid.

Sheer force of will has kept the effort going, the IDEO’s inventor, Ryan Blanck, said.

Since the device was created in 2009, multiple published studies have demonstrated its success in areas such as returning troops to duty and reducing the number of late amputations, and the IDEO has garnered glowing media attention. But it has yet to be pushed up the chain in the Army. Almost three years in, the hospital commander, a first stop for championing the IDEO, hasn’t had an official briefing. Most troops in need hear of the IDEO through word of mouth.

For a relatively cheap investment -- the IDEO costs about $3,000 to make -- valuable experienced servicemembers with years of expensive training can stay in the fight. This is a huge savings of talent and dollars, particularly among the special forces community, where it costs upward of $250,000 to train each man.

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Rebecca Hooper, a retired colonel and program manager at the Center for the Intrepid, said the IDEO is not lacking in funding and the center hasn’t requested additional resources to expand the IDEO effort, but leadership will have a meeting with the hospital commander soon and is looking to repurpose workspace.

“We’re working towards a solution,” she said.

Discussions about the IDEO only came up recently, because first they had to see whether it was the right thing to do, she said.

“If we jumped at every new idea right away, we’d constantly be reinventing the wheel.”

For now, there’s a four-month waiting list for active-duty servicemembers all over the country, and veterans who have medically retired because of the injury are out of luck. They can’t get an IDEO.

“We have to turn them away, because we don’t have the resources to do it,” said Hsu, the consulting surgeon and clinical researcher for the IDEO. “Those are the people that haunt me, because I know their lives could be better.”

The IDEO team is like a boutique shop with a mass market demand. Even with only active-duty being accepted as patients, they can’t keep up.

“We’ve overgrown this space. It’s chaos,” Blanck said about the workshop and training area they’ve elbowed and squeezed their way into at the center, which Hsu describes as “amazingly high-tech and absolutely gorgeous” but “not enough.”

Before the IDEO got its fancy name it was known as the Ryan Blanck Super Brace, because not only is he the inventor but he’s also the only one who can manufacture it. He doesn’t have the time or resources to train anyone else to do what he does.

Blanck arrives before 5 a.m. each day, fields about 80 texts daily from servicemembers across the country, and even takes late night phone calls from Afghanistan. Each carbon-fiber IDEO is custom fit to the patient, and plaster molds of patients’ legs are stacked up along the wall, waiting -- Blanck’s version of an inbox.

He has commandeered a few amputee-program technicians to help with the manufacturing, but the finalized product comes down to him. Because of that, patients must wait six to eight weeks after the initial fitting to get their IDEO.

So far more than 240 servicemembers, including about 50 from special operations, have received one.

Many patients who come to the IDEO team are on the verge of having their leg cut off. They’re frustrated at their gimpy gait and slow recovery, and they see that amputees are able to run again. Longing for the same mobility and the chance to return to duty, some limb-salvage patients opt for amputation, on average a year after the injury happened, Hsu said.

Before the IDEO, doctors and trainers had little means of persuasion to get a guy to keep his mangled leg.

“They weren’t buying it, and it was because of one reason: They weren’t running,” said Johnny Owens, a limb-salvage rehabilitation expert who does the training for the IDEO.

They could learn to walk again, but “they couldn’t get to running and jumping and back to duty,” Hsu said.

Their intense desire to regain the same level of athletic ability they had before they were injured, even if it means chopping off their leg, makes them a “unique slice of society,” Pollak said, noting elective amputation is rare outside the military. “We don’t see that motivation in the civilian population.”

Now with the IDEO, which Blanck designed based on the energy-storing principles of prosthetic technology, servicemembers like Marine Sgt. Saul Monroy are changing their minds about amputation.

Monroy was hurt by a roadside bomb in Afghanistan in October 2010 and left with bones broken so badly they had to be fused. Multiple surgeries and long days of rehab had given him the ability to walk again but not much else.

“If I kept the leg I could only walk on even pavement,” Monroy said. “Or I could remove it and do a lot more with the amputated leg.”

The IDEO opened up another option.

“Being able to run last week for the first time was the best feeling ever,” Monroy said.

Owens, taking on as many patients as he can, puts 15-25 at a time through four weeks of high-intensity training to adapt to the IDEO and learn a totally new way of running.

“We treat it like it’s a new limb. They have to retrain the motor patterns in the brain,” Owens said.

A vast majority are able to get close to their abilities before the injury, and that has “totally changed things” for Hsu, a self-described limb-salvage zealot.

“When a guy comes off the bird and says, ‘What are the chances I can run?,’ I can tell him now ‘80 percent,’” he said. “It’s a powerful statement to make to a young kid lying there with his leg all shot up.”

The IDEO’s reputation is spreading fast, but there are no firm longterm plans for expansion.

“We need money and a commitment,” Hsu said. “This is the biggest leap forward for limb salvage, I think, in the history of the country.”

The military needs to make the IDEO an official program and extend its reach, Owens said, “so we don’t have more guys lose legs who don’t have to.”

mccloskeym@stripes.osd.mil
Twitter: @MegMcCloskey

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