Seven years later, breakthroughs and hope at the Intrepid Center
By Sig Christenson | San Antonio Express-News | Published: February 2, 2014
SAN ANTONIO — Former Army Staff Sgt. Clevie Molden has lived in pain, taken prescription drugs and despaired since injuring an ankle nearly eight years ago during a rocket attack on his base in Iraq.
He endured nine operations, shortened workdays to help cope with the injury and, ultimately, an unhappy exit from the Army after spending six years in the war zone.
But after getting fitted last week with a prosthetic device invented in San Antonio, Molden brimmed with excitement when he stood and walked for the first time without pain.
He thought he now could resume an old tradition in Perry, Fla., something he loved to do before leaving the country for seven deployments.
“I'd just run down Main Street, and my mom is working downtown, so I would just run downtown to my mom's job, turn around, say hi to her and run back home,” said Molden, 36. “It's probably like 6 miles, but that's what I did. I woke up every morning and I ran. But I haven't run in seven years.”
Molden's bracelike device — the Intrepid Dynamic Exoskeltal Orthosis, or IDEO — is a success story for the Center for the Intrepid, a revolutionary rehab facility built seven years ago with $55 million in private funds and designed to help troops recover from amputations, burns and other serious injuries.
More than 1,300 troops who were injured in combat, training accidents, automobile collisions or had medical conditions that led to amputations have been treated at the center, built at Joint Base San Antonio-Fort Sam Houston.
Half have lost limbs. Four in 10 are trying to salvage arms and legs.
The patients come from every military branch. Some are veterans, but most still are on active duty. Therapy can take seven months to four years.
The IDEO brace is heralded as one of the center's most important inventions. Many of the troops fitted with the device have returned to active duty, and even back to combat. It's meant a huge reversal of fortune for patients with lower leg injuries. Before the brace appeared in 2009, many service members with such severe injuries were discharged for medical reasons.
“We did an initial analysis of our first several hundred folks to see how many were retained on active duty, and it was about a 50 percent retention rate,” physical therapist Johnny Owens of San Antonio said.
Even more Special Forces troops have resumed their careers, but the device's biggest bonus could be the number of legs it has saved. Ryan Blanck, the IDEO's inventor, said he thinks that up to half of the 600 or so people he has fitted for the brace might have undergone amputations.
It's common for single-limb, below-the-knee amputees to walk and even run normally after being fitted with prostheses.
“It was a one-patient project and then turned into a whole program within the military system,” Blanck said. “It's been a pretty amazing experience to kind of look back and see how a unique situation kind of unfolded and transpired over a four-year period.”
Close call in Iraq
When the Katyusha rocket attack rained down on Clevie Molden's warehouse at Baghdad International Airport just after dawn on April 17, 2006, it was nothing unusual. Rocket and mortar attacks were so common there and at other big air bases that the installations were given nicknames, one of them “Mortaritaville.”
Molden and others in the warehouse ran for cover, racing toward large concrete cubes surrounded by sandbags. He made it a second before a blast that caused a 2-by-4 board to fall on his head.
Suddenly, his right ankle began to sting, but Molden didn't think much of it. Several days passed before he sought help. An exam showed that he had a broken talus bone, which is crucial to rotating the foot.
A string of surgeries followed at Fort Bragg, N.C. Molden said he returned twice more to Iraq, once only days after having stitches taken out of his foot.
Back in the war zone, he was made sergeant of the guard, overseeing 100 American and Ugandan security personnel and working the night shift.
“I did that for like eight months, nine months. I had no calf muscle whatsoever and I was still climbing up 80-foot towers,” he said.
He took pills to numb the pain but had few options after the failed surgeries. Molden pondered an ankle fusion that would have meant never running again and, possibly, walking with a limp the rest of his life.
He was stunned when an orthopedic trauma surgeon, then-Lt. Col. Joseph Hsu, explained the IDEO in his first meeting here in 2012 and how it would change his life.
“I was so happy when Dr. Hsu told me, it was like, 'I can make you run again,'” Molden recalled. “I hadn't run in almost seven years. Just to have the experience of just running again. I felt no pain. It just made me feel good again. I was like a kid at Christmas.”
The Intrepid Center has fitted more than 520 troops with an IDEO, many who were mentally prepared for an amputation.
Fashioned in the mold of a person's leg, the 2-pound device slips into boots and shoes that are typically a size larger than the foot. Part of the IDEO, a carbon-graphite laminate cuff, wraps around the leg below the knee. One or two vertical struts running from the cuff to the footplate act as springs.
The foot and ankle are immobilized, but the leg moves forward, with little or no pain.
Blanck, of Gig Harbor, Wash., incorporated the concept while building prosthetic running limbs for amputees. Tailored to the person's injury, the IDEO deflects pressure on the limb, he said, and stores and releases energy.
Last year, Blanck was given the Meritorious Civilian Service Award for his work by Army Chief of Staff Gen. Raymond Odierno.
“In the beginning, the goal was to get service members running, jumping, skydiving, and redeployed, sometimes carrying up to a 120-pound rucksack,” recalled Blanck, who works for Hanger Clinic, a private firm that will make the IDEO available for civilian use.
“People want to return to work, a life of comfort, stability and the activities that are most important to them,” he continued. “This may mean coaching a soccer team, running a 5K marathon, or hiking Mount Rainier.”
Blanck said the device's design not only has helped patients with limb-salvage injuries, but also partial-foot amputations, sciatic nerve injuries, various forms of spinal cord injury and other kinds of lower extremity dysfunction.
The before and after difference is astonishing. A jogger without an IDEO quickly starts to limp while on a treadmill. Once fitted with the brace, he runs with apparent ease, as if uninjured.
At an estimated cost of $8,000 to $12,000 per device, the IDEO is cheap compared with the cost of today's most advanced below-the-knee prosthetic limbs, which can top $50,000.
Despite its utility and low cost, not everything has gone smoothly in the IDEO's rollout. Thousands of troops in Afghanistan and Iraq came home trying to save their limbs, but so far only a fraction of them have been able to receive the brace.
Efforts are underway to reach more of those wounded who might use an IDEO. The Army this fall more than doubled clinical, technical and administrative staff at the CFI from three full-time workers to eight.
Over the past three months, CFI staffers have trained specialists at Walter Reed National Military Medical Center and a division of Naval Medical Center San Diego to build and fit the device.
“Often, I feel like I'm sitting on an island,” CFI chief prosthetist John Fergason said. “So we're dealing with what's right in front of us right now. We just don't know what else really is out there and how applicable this may be for the larger population.”
A revolution in care
The Center for the Intrepid was born in 2005 amid a crush of badly wounded troops returning from Iraq.
The Intrepid Fallen Heroes Fund set out to raise millions for a rehabilitation facility specializing in amputee rehabilitation, and 600,000 people rallied to the cause.
The fund since has branched out, helping launch a second center for traumatic brain injury care in Bethesda, Md., and 10 satellite clinics for troops and families coping with TBIs. The Pentagon has said more than 200,000 troops have been diagnosed with traumatic brain injuries.
The New York-based Intrepid Fallen Heroes Fund has launched a $100 million fundraising campaign to build satellite centers at installations around the country. Each center will diagnose and treat 1,000 patients a year.
The fund pays for construction and furnishing the facilities. The Pentagon pays for their operation.
“We as a nonprofit organization are a conduit for Americans who want to help, and maybe if the government had infinite resources it might still be able to take care of all the needs out there. As a nonprofit organization, we can design and build these centers faster, less expensively, more efficiently than if it was a government project,” said Dave Winters, president of the Intrepid fund.
“The Center for the Intrepid was built on this mission to expand and improve the therapies and technologies used to treat injured service members. The new IDEO brace, developed at the center, is helping us to realize that mission,” said New York real estate developer Arnold Fisher, a former Army corporal who helped spearhead the San Antonio project.
“Knowing that hundreds of the most seriously injured service members are able to reclaim their lives through this new technology is something we are truly proud of,” he said.
'Return to Run'
Therapy at the Center for the Intrepid involves lots of labored breathing, sweating and more than a little pain.
One day last week, one of the wounded did sit-ups while clutching a large green stress ball as Nirvana's classic, “Paranoia,” played over the radio. Another GI missing his right leg at the knee walked briskly along an oval track.
Others lifted weights.
Among them was Marine Lt. Col. Brian Forney, who was badly injured in a CH-46 Sea Knight helicopter crash in Thailand.
He was on a routine training mission in February 2013 when one of his helicopter blades struck a tree. Part of the Sea Knight was wheels-down on the ground, while the other part was over a cliff.
Forney suffered burns and lost his left arm. The Center for the Intrepid is helping him regain his balance.
He said the center provides a “unique environment. It's not quite as tightknit as being in a combat unit together, but you're at least around guys with similar experiences, similar backgrounds, people understand what you do, where we're coming from."
There are daily morning and afternoon workouts, and exercises in the curriculum that help people move laterally, and jog and sprint. Weight training occurs later in the day.
Physical therapy assistant Joe Mallett leads Return to Run, a daily training session that has become a fixture of the process in becoming an IDEO user. The course runs four weeks and helps the wounded to stretch long-idled muscles, build upper-body strength and learn how to use the device.
During her IDEO therapy, 1st Lt. Kelly Elmlinger jumped out of a four-point stance and began to step into her run around a short oval track. It's essentially a mobility drill, what Mallett calls “muscle re-education.”
Army Staff Sgt. Robert Gould, 48, of San Antonio pressed forward, a yellow strap around his thighs, running in place.
“Ten seconds!” a trainer cried. “Five seconds!”
“It's very hard, extremely hard,” said Gould, who suffered multiple fractures in a leg and lost his Achilles tendon after a motorist talking on her cellphone hit him while he rode his Harley last year. “I would never be able to run again without the IDEO brace, because it allows me to push off.”
A longtime marathon runner, Elmlinger, 34, of San Antonio hadn't run since a cancerous tumor was removed from her lower left leg a year ago. Muscle, bones and tendons were removed, making it difficult to walk, let alone run.
When it's over, the Army nurse was sore but pleased.
“I kind of tell people I compare it to when you're at the airport and you're walking on the people mover,” said Elmlinger, a 15-year veteran. “That's what it feels like in the IDEO. You're moving along, it's nice and smooth and when you make the transition off of it, and it's just like you need to take a second to get your bearings.”