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Getting injured service members back to activity with the 'Return to Run' program

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You probably haven't heard of the Intrepid Dynamic Exoskeletal Orthosis (IDEO) yet, but you'll want to pay attention because the technology is poised to break barriers in patients with salvaged limbs. In combination with an intensive rehabilitation program, the energy-storing orthopedic device allows wounded warriors to return to high-level activities such as running.

The IDEO is specifically designed for wounded service members who have suffered high-energy, lower extremity traumatic injuries. These individuals are unable to participate in high-level activities such as running with their salvaged limbs. Candidates for the IDEO have chosen limb salvage over amputation for the following conditions: ankle fusion; tibial, talus or calcaneal fractures; posterior tibial or peroneal nerve injuries; soft tissue loss and injury; or partial foot amputations.

"The device offloads the lower leg, stores energy in the device, and then returns some of that power back, while controlling motion and cradling the leg," explained Johnny Owens, MPT, creator of the Return to Run Clinical Pathway at the Center for the Intrepid of Brooke Army Medical Center at Joint Base San Antonio, Fort Sam Houston, Texas.

The Mechanics

The IDEO is the first device for lower leg injuries that allows offloading, adequate range restriction and power generation, Owens said. It allows the patient to operate the lower limb in a way that avoids pain. What's more amazing is that the results are nearly instantaneous.

The device and accompanying rehab program were the brainchild of Owens, Ryan Blanck, CPO, a prosthetist at the Center for the Intrepid, and Joseph R. Hsu, MD, former chief of orthopaedic trauma at Brooke Army Medical Center. What began as a novel approach with local patients has exploded into a robust program that has changed the lives of more than 460 military members.

"We had to approach these patients differently than we would approach civilian trauma cases," Owens explained. "We took extreme measures because we had to do something different to find a solution that would meet their goals."

The resounding theme, according to Owens, is a desire to return to running. The injured seek greater function, but most of all, the chance to run again - hence the moniker "Return to Run."

Owens brought a background in sports medicine to the Center for the Intrepid in 2005. "It was just as the war was taking off and we didn't expect it to last this long," he recalled. Service members began coming back from the war in Afghanistan with mangled limbs from blast traumas, open, contaminated wounds, significant bone and soft tissue injuries, and polytrauma cases.

"These were complex problems in a young, highly motivated population," Owens explained. "They were limb salvage cases that were so severe that they could be amputations, if the soldiers wanted."

According to Owens, many of these patients were watching amputees who were moving faster and with less pain. "We had to devise a solution," he said.

Each device is custom-made from a mold of the patient's leg and foot, explained Owens. The device weighs just over a pound and fits right inside a shoe or boot. The IDEO features carbon fiber layering and its top and bottom are connected by struts on the backside of the device.

To date, this device has been exclusively available for wounded warriors and a few veterans, but specialists at Walter Reed Army Medical Center are planning to learn how to make the device, Owens told ADVANCE. "We are hoping to move the device and the accompanying rehab program into the VA system, and in time, it will become available for civilians," he explained.

A Story of Triumph

"My first day at the Center for the Intrepid, I ran. Not very far, but I was able to run. It was the happiest moment of life. A huge weight lifted off my shoulders because I had the equipment I needed to get back," recalled Retired Navy Hospital Corpsman 2nd Class Tyler Burdick.

Born in Utah and raised in Texas, Burdick enjoyed an active childhood playing soccer, water sports and basketball. He enlisted in the Navy to fulfill his dream of practicing medicine by administering medical treatment during combat operations.

Assigned to the 3rd Battalion, 6th Marine Regiment based out of Camp Lejeune, N.C. from 2007 to 2010, Burdick deployed once to Iraq and twice to Afghanistan.

Burdick was wounded in Afghanistan in July 2010 when his armored vehicle struck a roadside bomb, which resulted in serious injuries to both of his feet. He had one week left of his deployment.

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Before the IDEO, Spc. Michael Krapels could only walk on straight surfaces. Now he can run and jump and is ready to deploy with his unit, the Chosen Company, 2nd Battalion, 503rd Infantry Regiment.

"My platoon and I were conducting combat patrol to show our commanding unit the area," Burdick shared. "We received intel that there was an improvised explosive device (IED) on the road so we stopped and looked for it. When we didn't find it, we headed on our way and thought it was a false report."

Twenty yards later, the IED blew up right under his truck. "No one was killed but I was the most severely injured," Burdick explained. "The blast shattered my feet and lower legs. I was immediately med-evacuated to Germany."

He chose limb salvage over amputation, but more than a year later, was still walking with a cane and could not run or participate in other high-level activities.

After undergoing multiple limb-salvage procedures, Burdick resigned himself to a future as an amputee. "I asked my physicians to amputate both feet, which they felt was a reasonable request," he said. "But they encouraged me to wait because a new device was being developed."

In October 2011, he was fitted with two IDEO devices that redefined his abilities and allowed him to keep his limbs. "My first thought was, I think I can snowboard with these," Burdick said. "I would only consider myself fully recovered when I could return to my favorite sport."

Burdick went back to school in Utah last year and began working with other disabled athletes. He was recruited to compete with the U. S. Paralympic Snowboard team and finished ninth in his first race. He finished the season in second place and was then nominated to be a member of the 2013-14 U.S. Paralympics Snowboard National Team.

"I couldn't have recovered without the Wounded Warriors program, Team Semper Fi and all the support from private charities," Burdick stated. "Our burden is significantly lessened by the support from these various organizations."

Return to Run

Built on a sports medicine approach, the Return to Run Clinical Pathway addresses the patient's strength, agility and power. The patients are ready to enter the program once the therapists have made all necessary adjustments to the IDEO to prevent skin breakdown or device failure.

"Our standard operating procedure requires the soldiers to participate in a 4-week rehab program to make sure the device is used correctly and fits correctly," Owens shared.

During the second phase of the program, Owens has the patients work on footwork, run retraining, and multidirectional retraining with the device in preparation for deployment or other high-level activities.

"Johnny and his assistants were the best team I could ever have asked for," Burdick said. "It was the most difficult PT program I've ever been through. They knew what I was capable of and pushed me until I realized it too. Their dedication and perseverance got me to where I am today."

"We analyzed the results of the initial group of patients and found that 50% returned to duty, and not just desk jobs," Owens said. "The rate of return to duty for below-knee amputees is closer to 16%."

For a patient looking to return to walking, the program would take about a week. "But our patients have bigger goals, such as running, playing sports, cutting and jumping," Owens explained. "And a large portion of them are trying to stay on active duty so they'll need to hike on uneven terrain, carry a load and jump out of a helicopter."

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Advanced Bracing Technology

With an innovative orthotic device, Navy Corpsman Tyler Burdick is recovering from serious injuries sustained in Afghanistan.

The Center for the Intrepid has a virtual reality system that can simulate terrains in Afghanistan and Iraq, and is equipped to handle the IDEO. "Patients can use the system to practice engaging targets while in a similar terrain," Owens explained.

This summer, the American Academy of Orthopaedic Surgeons published data from functional tests such as stair running and agility tests, both with and without the IDEO, after four weeks in the program.

"The brace and the rehab program go hand in hand," Burdick said. "I needed the aggressive rehab to make the device successful to the level that I am functioning now."

According to Burdick, the device will change the face of limb salvage injuries because so many people potentially could benefit from its use. "I have a personal, vetted interest, because my father is debilitated from arthritis, and with this brace, he might be able to return to his normal routine," he explained.

According to Owens, the device has the potential to help a wide range of patients, from pediatric to geriatric, once it becomes available to civilians. "This began as a small idea from three people and we're still in a grassroots phase," he said. "But the results have been outstanding and we have a waitlist now." 

Rebecca Mayer Knutsen is on staff at ADVANCE. Contact: rknutsen@advanceweb.com




     

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