Cutting-edge device, procedure aid commander's recovery
March 2, 2012
FORT KNOX, Ky. -- Before becoming commander of U.S. Army Cadet Command's 1st Brigade, Col. Michael Blahovec wondered if he would ever lead Soldiers again. He wondered if he would ever run, walk without pain and, most important to him, spend time doing traditional activities with his children.
Blahovec, who entered the Army through the ROTC program at Edinboro University, was stationed in Germany in 2006 when he hurt himself during PT playing a football-like game.
It can happen to anyone -- even a senior leader.
"I went up in the air and came down wrong," he said. "I fell on my ankle just right, broke it in four places and ruptured a ligament."
Blahovec's goals at the time seemed simple -- fix the ankle, rehab and get back to soldiering. After surgery and extensive physical therapy, he said he felt he was good to go. Then he did a 15-month tour in Iraq. By the time it was over, the simple act of walking put him in terrible pain.
"By the summer of 2009, walking was so painful and by spring of 2010, weight-bearing was almost impossible," he said.
By 2010, Blahovec was working in Virginia. He had an initial appointment at Walter Reed Army Medical Center and went back for a second opinion. After much discussion about fusing his ankle, he and his doctor, Lt. Col. Scott Shawen, decided to use a relatively new joint restoration procedure called distraction arthroplasty.
The surgery is designed to preserve ankle motion, unlike fusion surgery, by pulling the joint surfaces apart and allowing the cartilage to soften, re-vascularize and produce a healing response. After the procedure, which is minimally invasive, Blahovec's ankle and foot had to sit in an external cage-like structure attached to pins inside the ankle that held the bones apart for several months.
"They took the cage off a year ago and now -- just walking -- it's a 95 percent improvement from before surgery," he said.
Blahovec's goal wasn't just to walk without pain, but to be as normal as possible -- and keep his job in the Army. And he wanted to run.
Together, Blahovec and Shawen researched his options.
Shawen called San Antonio and talked to the therapist and prosthetist at the Center for the Intrepid. The center decided Blahovec was a good candidate for a new device prosthetist Ryan Blanck designed and physical therapist Johnny Owens teaches patients to use. The device, called the Intrepid Dynamic Exoskeletal Orthosis, is currently in a provisional patent process.
The IDEO fits under the foot, and comes up the heel where the heel-cuff acts as a patella bearing cup. Another piece extends up the back of the leg where it straps around the upper leg near the knee. Owens said that by immobilizing a patient's ankle, he/she doesn't move the ankle and it doesn't hurt anymore. The IDEO, custom fit by Blanck, is made of fiberglass and carbon rods that come up the back of the leg, looking almost like a running prosthetic attached to someone's leg.
Owens and Blanck have fit about 200 braces since Blanck first sketched his design in 2009.
The ankle is a hinge joint, and it can't flex if the ankle is fused or severely damaged. That means the patient can't run. But the unique design of the device allows patients like Blahovec to run, stay in the Army and even play sports with his son and daughter. He said it felt awkward at first, but now it feels like a part of his leg.
"It immobilizes my ankle, but allows me to run at near normal gait," Blahovec said. "There is a sweet spot on the brace bottom (under the foot) that transfers energy up the back of the carbon fiber rods (strapped to the leg) and propels you forward. (The IDEO) feels so comfortable, in terms of my ankle feeling good, that I barely notice it is there."
Blanck and Owens fit Blahovec with one of the devices about five months ago, and Owens taught him how to walk and run in it.
Owens said that for patients who have not been able to bear weight, or walk, it takes time and training to learn how to use the device, overcome the fear of pain and learn what they can do with their new found strength.
"About four weeks is (standard operating procedure) for training," Owens said. "One reason is that you are basically putting a prosthetic on your leg. Also, people who have a messed up leg don't want to put force on the leg, and the hurdle is to overcome the desire to not put force on it.
"Patients do run training, cut training, jump training and deployment training. It takes several weeks to see if the brace fits right -- no rub spots, we check for blisters and skin breakdown. And we need to see if the brace will hold up to what you do with it. Sometimes Ryan has to reinforce it -- he can tweak it so it fits well."
Since he is the only prosthetist who works the brace he invented, Blanck said he has to individually work each one and that takes time.
However, as Blahovec found, the device is not just for Soldiers injured in Iraq or Afghanistan. In fact, he said Owen and Blanck were looking for people like him who were not injured in combat.
"The average NCO or officer who is in for 10 to 15 years and injured in sports, or jumping out of a plane -- this is good for them," Blahovec said. "There are a lot of people who were injured in training or PT whose career would otherwise end early."
Blanck said plenty of patients rehabbing from injuries not sustained in combat have deployed with the device, mostly to Afghanistan. Nine of those are combat deployments -- back to the same job they held before being injured, mostly Special Forces.
"The brace gives me confidence coming into this job," Blahovec said. "I was unsure at one point if I could stay in the Army. And if I did, could I do physical stuff? I can now do nearly everything everyone else can do. I want to set a good example as a leader."
The brace allows him to stay in shape, to lead Soldiers, walk regularly, work out and do extensive PT.
"It feels like nothing is wrong with me when I put that thing on. Mentally it gives me confidence, too," he said. "Now I can run for 20 minutes on a treadmill or a track. I am working on building that time."
But Blahovec credits the leadership he had at the time of his injury and since for the fact he is still in the Army and now running. He said his leadership helped him find a second opinion when the first one was so negative, they gave him the time to heal without rushing him and they trusted him.
"Good leaders don't give up on you, and mine showed that there are leaders that do what we talk about--taking care of Soldiers," he said. "No matter how complex your job or what your focus is, your Soldiers need to know you are there to take care of them. Help your folks get second opinions, (like his did) and allow them time to get healthy."
He added that his leadership supported him beyond what was required when they didn't have to and allowed him time to heal.
"Without that support, I'm not sure what I would have done," he said.
"No matter how much you talk, the day you know you have an injury that will affect your life, it is different. You cross a mental line when it's you. You don't understand, 'How can someone be so bad they can't run?' But when it's you, you understand."
Blahovec advises others who might try to use mental and physical toughness to overcome an injury.
"Don't let bravado make you do stupid things," he said. "But also, don't let a physical disability limit you in overcoming obstacles. For example, my German doctor advised me not to run and I should have paid attention. When the doctor says slow down, it's good to listen."
Blahovec is among the lucky ones. Despite his hurdles, the medical community has given him back much of what he thought he had lost.
"I can now run around the basketball court with my son and daughter," Blahovec said. "I can't play a full one-on-one game yet, but I can play some ball and spend time with my kids. It improves the quality of my life."