Raising the Bar: Extremity Trauma Care
“Raising the Bar” in Extremity Trauma Care: A Story of Collaboration and Innovation
1
Fred A. Cecere, Bill W. Oldham
The Extremity Trauma and Amputation Center of Excellence: Overview of the Research and
Surveillance Division
3
Christopher A. Rábago, Mary Clouser, Christopher L. Dearth, Shawn Farrokhi, Michael R. Galarneau,
M. Jason Highsmith, Jason M. Wilken, Marilynn P. Wyatt, Owen T. Hill
The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium:
Reaching in Partnership for Optimal Orthopaedic Rehabilitation Outcomes
13
Steven J. Stanhope, Jason M. Wilken, Alison L. Pruziner, Christopher L. Dearth, Marilynn Wyatt, Gregg W. Ziemke,
Rachel Strickland, Suzanne A. Milbourne, Kenton R. Kaufman
The Center for Rehabilitation Sciences Research: Advancing the Rehabilitative Care for
Service Members With Complex Trauma
20
Brad M. Isaacson, Brad D. Hendershot, Seth D. Messinger, Jason M. Wilken, Christopher A. Rábago,
Elizabeth Russell Esposito, Erik Wolf, Alison L. Pruziner, Christopher L. Dearth, Marilynn Wyatt, Steven P. Cohen,
Jack W. Tsao, Paul F. Pasquina
Improving Outcomes Following Extremity Trauma: The Need for a Multidisciplinary Approach
26
Daniel J. Stinner
The Prevalence of Gait Deviations in Individuals With Transtibial Amputation
30
Christopher A. Rábago, Jason M. Wilken
A Narrative Review of the Prevalence and Risk Factors Associated With Development of Knee
Osteoarthritis After Traumatic Unilateral Lower Limb Amputation
38
Shawn Farrokhi, Brittney Mazzone, Adam Yoder, Kristina Grant, Marilynn Wyatt
Differences in Military Obstacle Course Performance Between Three Energy-Storing and
Shock-Adapting Prosthetic Feet in High-Functioning Transtibial Amputees: A Double-Blind,
Randomized Control Trial
45
M. Jason Highsmith, Jason T. Kahle, Rebecca M. Miro, Derek J. Lura, Stephanie L. Carey, Matthew M. Wernke,
Seok Hun Kim, William S. Quillen
Functional Outcomes of Service Members With Bilateral Transfemoral and Knee
Disarticulation Amputations Resulting From Trauma
55
Barri L. Schnall, Yin-Ting Chen, Elizabeth M. Bell, Erik J. Wolf, Jason M. Wilken
Core Temperature in Service Members With and Without Traumatic Amputations During a
Prolonged Endurance Event
61
Anne M. Andrews, Christina Deehl, Reva L. Rogers, Alison L. Pruziner
A Review of Unique Considerations for Female Veterans With Amputation
66
Billie J. Randolph, Leif M. Nelson, M. Jason Highsmith
Outcomes Associated With the Intrepid Dynamic Exoskeletal Orthosis (IDEO): A Systematic
Review of the Literature
69
M. Jason Highsmith, Leif M. Nelson, Neil T. Carbone, Tyler D. Klenow, Jason T. Kahle, Owen T. Hill, SP USA,
Jason T. Maikos, Mike S. Kartel, Billie J. Randolph
Descriptive Characteristics and Amputation Rates With Use of Intrepid Dynamic Exoskeleton
Orthosis
77
Owen Hill, Lakmini Bulathsinhala, Susan L. Eskridge, Kimberly Quinn, Daniel J. Stinner
VOLUME 181
NOVEMBER/DECEMBER 2016
SUPPLEMENT
M
ILITARY
M
EDICINE
AMSUS - The Society of Federal Health Professionals should not be held responsible for statements made in its publication by contributors or advertisers.
Therefore, the articles reported in this supplement to MILITARY MEDICINE do not necessarily refl ect the endorsement, offi cial attitude, or position of AMSUS or
the Editorial Board.
The Thought Leadership Institute, BADER Consortium, the Center for Rehabilitation Sciences Research
(CRSR), and the Extremity Trauma and Amputation Center of Excellence (EACE) wish to acknowledge
the efforts of the following people in the coordination of this supplement:
Kelly Bothum
Elizabeth Russell Esposito
Jeremy G. Johnson
Michelle Mattera Keon
Maria Pellicone
Christopher A. Rabago
Rachel A. Strickland
MILITARY MEDICINE, 181, 11/12:1, 2016
“Raising the Bar” in Extremity Trauma Care:
A Story of Collaboration and Innovation
Fred A. Cecere, MD; Bill W. Oldham, MBA
Today
’s military health system is working in remarkable
ways to provide complex extremity trauma care that helps
injured service members reach their highest level of function.
The difference in outcomes as a result is staggering. In the
1980s, only 2% of soldiers remained on active duty following
limb loss, despite relatively minor injuries such as a partial
hand amputation.
1
By 2010, 19% of service members
remained on active duty after suffering limb loss caused by
major extremity trauma. About 25% of this group actually
returned to theater, even though their injuries were much
more devastating than those suffered during previous con
flicts.
2
Wounded soldiers now have access to cutting-edge tech-
nologies, multidisciplinary care, and research efforts aimed
at realizing optimal outcomes for a population already used
to performing at high levels. The approach is holistic and
family centered, focusing more on the patient
’s ability than
disability. Best of all, advances in the care of these patients
offer bene
fits to other injured service members as well as the
civilian population.
This work is possible because of the synergies that exist
between programs operating through the Department of
Defense (DoD) and the U.S. Department of Veterans Affairs
(VA) across the patient care spectrum. The result is comple-
mentary rather than competing care that begins at the point
of injury and continues for the rest of a patient
’s life.
Efforts to cultivate this collaborative approach to ortho-
pedic rehabilitation care have been bolstered by three sepa-
rate but interconnected programs that have identi
fied and
developed critical research capabilities and infrastructures
that translate research advances into clinical care for patients
with traumatic extremity injuries.
The Extremity Trauma and Amputation Center of Excel-
lence (EACE) was created by Congressional mandate as a
joint enterprise between the DoD and the VA to develop a
comprehensive strategy to help service members with trau-
matic injuries optimize their quality of life.
The Center for Rehabilitation Sciences Research (CRSR)
was established to advance the rehabilitative care for service
members with combat-related injuries while also educating
the next generation of military medicine professionals.
The Bridging Advanced Developments for Exceptional
Rehabilitation (BADER) Consortium was developed as
a research capacity building program to further establish
research infrastructures and investigators at DoD and VA sites
and to launch a series of multiteam clinical research initiatives.
These programs operate independently, but they are
designed to be interdisciplinary and collaborative in nature.
This complementary approach is re
flective of the efforts by
the DoD to address the complex health needs of the combat
wounded before they reach the VA, which has already had
an established amputee and rehabilitation science program.
Together, they provide a unique opportunity to strengthen
DoD/VA research programs and in
fluence the long-term
direction of care for this unique patient population.
It is an approach that is working, as evidenced by a 2015
report by the Defense Health Board on the sustainment and
advancement of amputee care.
3
It found that the DoD is
“leading the Nation and the world in extremity trauma and
amputee science and care through its infrastructure, systems
and approach.
” That same report also reiterated the need
for collaborations between institutions, practitioners, and
researchers across disciplines and organizations in order to
sustain these advancements.
Whether it is team members from the EACE and the
BADER Consortium embedding at military treatment facilities
(MTFs) to help answer clinically relevant questions and support
research in high-priority areas or CRSR staff working to
de
fine and validate rehabilitation strategies for injured service
members,
the focus
remains
constant
—to help these
wounded warriors get back to the life they were living
before their traumatic injuries.
By working collaboratively, researchers do not have to
give up their autonomy. Indeed, each domain of rehabilita-
tion care can and should be able to work independently.
The resultant creativity and energy is evidenced by the
myriad of research projects already underway at MTFs and
VA centers around the country. These researchers are not
constrained by working toward the same goal
—helping
patients regain their highest functional levels
—but rather,
they are empowered to meet those goals in different ways.
One project funded by the Defense Medical Research and
Development Program and supported by the EACE and
BADER focused on preventing falls in service members
with amputations through the use of advanced rehabilitation
training.
4
At CRSR, they are
finding improvements in pain
management strategies that can improve the quality of life
for patients with severe combat injuries. The BADER Con-
sortium supports the goal of optimal outcomes by providing
needed administrative assistance and infrastructure support
to help address important gaps in clinical orthopedic rehabil-
itation research and patient care.
Thought Leadership and Innovation Foundation, 16775 Whirlaway
Court, Leesburg, VA 20176.
doi: 10.7205/MILMED-D-16-00314
MILITARY MEDICINE, Vol. 181, November/December Supplement 2016
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