Device gets Soldiers back to work on their feet, preventing amputations
August 15, 2013
By David Vergun
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WASHINGTON (Army News Service, Aug. 15, 2013) -- "Over the last two years, this limb-salvage device has saved me from doing at least 100 amputations," said an orthopedic surgeon who has amputated hundreds of Soldiers' limbs since 9/11.
At last count, some 460 service members are using it, including SEALS, Delta Forces, Rangers and other special operators who've returned to duty or even combat, said Lt. Col. Donald A. Gajewski, a doctor, and director of the Center for the Intrepid, or CFI, at Brooke Army Medical Center, Fort Sam Houston, Texas.
"Without this device, they would have been boarded out of the military," Gajewski said.
The Intrepid Dynamic Exoskeletal Orthosis, or IDEO, was invented in 2009 by Ryan Blanck, a prosthetist-orthotist working at CFI.
At that time, a lot of Soldiers were returning from Iraq and Afghanistan with severe injuries that often required amputations, Gajewski said, "so this was a Godsend."
IDEO is a sort of hybrid between a brace and a prosthetic, Gajewski said. "To call it a brace or prosthetic would be inaccurate. It does both."
It's really pretty simple, he continued. As Soldiers move about, it stores and then releases energy much like the action of a leaf spring. No electronics, moving parts or fancy gadgetry is involved.
The released energy takes the pressure off the affected parts of the lower leg or legs, thereby relieving the pain and allowing the Soldier to move around and even run, he said.
The device is commonly used by those suffering from injuries to the Achilles tendon, chronic lower-leg pain and even post-traumatic arthritis. Although it targets neurologic injuries below knee, it could also be used for above-the-knee injuries, he said, with the addition of an auxiliary cuff attachment.
If a patient has pain in the ankle when moving, for instance, the use of IDEO would bear the weight at the top portion of the device to decrease loading on the foot-plate portion near the ankle, thus relieving the pressure and alleviating the pain, he said. Bars behind the device take the compression load.
The device is "extremely customized" to match the profile of the Soldier's leg as well as to focus on the region where the pain is occurring, he said.
Gajewski explained how IDEO focuses on specific regions.
"You dial in a range of motion," he said. "So if you have 20 degrees of painless range of motion, we can give you that 20 degrees and then block the rest" of the limb's movement and maybe extend the range a little later on.
Eventually, a whole new IDEO may be needed as muscle mass builds, he said. Soldiers may not have been using the limb for some time so strengthening is inevitable.
It's the complete opposite for an amputated limb where the residual limb atrophies without movement and loading, he said. In that case, a smaller socket would be needed where the prosthetic device connects with the residual limb.
Other reasons for needing a new IDEO include weight gains or losses and breakage. They're tough but not indestructible, he said. For instance, a Soldier jumping off a truck carrying a 100-pound rucksack might cause it to crack.
In that case, a new one with the same specs would be mailed, he said. For a Soldier serving in Afghanistan, it is likely he or she would have spares nearby.
LEARNING TO USE IT
CFI holds a four-week, sports medicine-based training program for those fitted with IDEOs.
"It's like an NFL training camp," he said. "All the IDEO users are together, from those who are first fitted to the those who are in their fourth week. They encourage each other and take each other through it. It's very therapeutic."
From day one, Soldiers are expected to run with the IDEO on, he said, admitting that most don't want to because it's so sudden and some haven't run for two or three years.
"We have to get them to trust the device," he said.
Learning is fast, he said, because there's no brain-to-muscle coordination training needed.
"You just go with it once the range of motion is dialed in," he said.
While most see almost immediate and dramatic results, others are not as fortunate.
There are a number of reasons IDEO is not for everyone, he said. Some drop out of the program and go on to amputation because infection sets in again, but not as the result of wearing an IDEO.
A small minority try it and say it just doesn't work for them, he said.
But saddest of all, he said, are those who've been dealing with the pain for many years and over time have gone through the grieving stages and have come to accept an amputation as the only alternative.
"They say to themselves: 'This is my path. Take it off.' It's psychological and you can't convince them otherwise," he said.
But for the 85 percent being helped, this is a big deal, he said.
"It's humbling when a Navy SEAL puts it on for first time and 95 percent of his pain is gone, and you see tears in his eyes because he realizes he can stay and do his job," Gajewski said.
Now that operations in Afghanistan are winding down and amputations are on the decline, Gajewski, sees a much larger role for IDEOs, as training or recreational injuries require interventions, including IDEO.
Right now, CFI is the only location where the devices and the training program are available. But Gajewski said IDEO will eventually become available at other Army rehab centers as well.
And Gajewski sees an eventual expansion to the rest of the DOD and the Department of Veterans Affairs and then to civilian treatment centers.
In fact, interest in the device has the potential to go international, with the U.K. interested in training personnel to treat their own soldiers with the device.
"We have an obligation to take this technology to rest of the world," he concluded.
Soldiers who think IDEO might be for them should contact their primary care manager or physician.