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Military Health System

Limb Loss: DHA's Three Advanced Rehab Centers Provide Holistic Care

Image of U.S. Marine LCpl. Annika Hutsler works with James Malinak, a prosthetician at Naval Medical Center San Diego’s Comprehensive Combat and Complex Casualty Care clinic to adjust her prosthetic leg. C5 serves to deliver multidisciplinary, quality health services in an outpatient rehabilitation facility for wounded, ill, and injured service members. (Photo: U.S. Navy Mass Communication Specialist 3rd Class Jake Greenberg). U.S. Marine LCpl. Annika Hutsler works with James Malinak, a prosthetician at Naval Medical Center San Diego’s Comprehensive Combat and Complex Casualty Care clinic to adjust her prosthetic leg. C5 serves to deliver multidisciplinary, quality health services in an outpatient rehabilitation facility for wounded, ill, and injured service members. (Photo: U.S. Navy Mass Communication Specialist 3rd Class Jake Greenberg)

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Extremity Trauma and Amputation Center of Excellence

There are more than 30,000 Department of Defense beneficiaries with some level of limb loss or dysfunction.

They include many wounded combat veterans, as well as people who've suffered car accidents, motorcycle accidents, and other severe injuries.

To ensure the Military Health System provides the most cutting-edge medical care for treating limb loss, the Defense Department operates three Advanced Rehabilitation Centers, or ARCs, throughout the country to address the complex needs of individuals with severe limb dysfunction, including amputation.

Located in San Diego, California; San Antonio, Texas; and Bethesda, Maryland, each ARC provides specialized and holistic care through multidisciplinary teams.

They go far beyond the typical range of care, to include occupational and physical therapists, and doctors that specialize in physical medicine rehabilitation, prosthetics, and orthotics.

"The whole structure of the ARC programs for patients with limb loss is holistic, designed to address all the needs of the patient to live a full life, and either return to duty or to life after injury and after the military, depending on what the individual patient's goals are," said Army Maj. (Dr.) Megan Loftsgaarden, a physical medicine specialist at the Center for the Intrepid, at Brooke Army Medical Center, in San Antonio, Texas.

The ARCs' multidisciplinary teams also include nutritionists, multiple types of behavioral health specialists, pain management specialists, plastic surgeons, dermatologists and neurologists.

The doctors "really look at the individual and what their needs are, versus looking at the limb loss," said Stuart Campbell, a physical therapist and chief of global health engagement for the Extremity Trauma and Amputation Center of Excellence, at Joint Base San Antonio, in Fort Sam Houston, Texas.

The three ARCs work in partnership with the Extremity Trauma and Amputation Center of Excellence, which conducts research and provides clinical practice guidance to the ARCs.

In addition to focusing on the individuals with limb loss, the ARCs also support families and caregivers.

"All of the ARCs have Fisher House facilities," said Campbell, referring to the not-for-profit organization that operates comfort homes near military hospitals where military and veteran families can stay free of charge while a loved one receives care.

"So, when the individual is being cared for as an inpatient or as a more acute outpatient, their families have a place where they can stay right on the installation," he said.

Those family members can attend sessions and be involved in their loved one's care program and learn about what to expect.

ARCs

"Each one of the three Advanced Rehabilitation Centers have, for lack of a better term, their own personality," Campbell said.

The ARC in Maryland, known as the Military Advanced Training Center, is embedded within Walter Reed National Military Medical Center.

MATC uses a sports medicine model where service members, retirees, and family members use sophisticated prosthetics and athletic equipment to move from injury to independence, Campbell said.

The ARC in Texas, the Center for the Intrepid, has its own facility on the Brooke Army Medical Center hospital campus.

Retired Senior Airman Heather Carter, an above-knee amputee, runs laps around a track inside the Military Advanced Training Center at Walter Reed National Military Medical Center in Bethesda, Maryland. Carter and other amputees receive physical and occupational therapy at the center as they work toward their goals. One of Carter’s goals is to return to competitive softball. (Photo: Sean Kimmons, U.S. Air Force)
Retired Senior Airman Heather Carter, an above-knee amputee, runs laps around a track inside the Military Advanced Training Center at Walter Reed National Military Medical Center in Bethesda, Maryland. Carter and other amputees receive physical and occupational therapy at the center as they work toward their goals. One of Carter’s goals is to return to competitive softball. (Photo: Sean Kimmons, U.S. Air Force)

Designed to provide full-spectrum amputee rehabilitation and advanced outpatient rehabilitation, CFI's mission includes:

  • Providing rehabilitation for service members who sustained amputation, burns, or functional limb loss
  • Providing education to DOD and VA professionals on cutting edge rehabilitation modalities
  • Promoting research in the fields of orthopedics, prosthetics, and physical/occupational rehabilitation.

"We provide a multidisciplinary, comprehensive care program for polytrauma cases, including everything related to major limb trauma, limb salvage, the IDEO brace program," among others, said Loftsgaarden.

While CFI's priority is active-duty service members, they may also treat beneficiaries whose injuries fit their profile on an as-needed basis provided there is available space, she said.

The ARC on the West Coast, the Comprehensive Combat and Complex Casualty Care Center, known as C5, is at the Naval Medical Center in San Diego.

"It was formed in 2007, as combat injuries were rising, to meet the needs of combat-injured service members from the western and Pacific United States," said Dawn Golding, a physical therapist at C5.

The C5 is equipped to provide the full spectrum of care, from medical evacuation through inpatient care, outpatient rehabilitation, and eventually a return to active duty or transition from the military.

"We mostly see patients ranging in age from 18 to their 70s," said Golding.

Most of their patients are active-duty service members from the Navy and Marine Corps, but they have seen patients from all services and have a few retirees and dependents, she explained.

Historically, most of the C5's patients were injured in combat.

"Recently, a lot of our patients have been involved in motorcycle accidents, some in car accidents," Golding said.

Treatment

The holistic care process begins with treatment to heal the injury and continues with education on how patients can care for themselves. That can extend for weeks or months, if needed, to prepare patients to live an independent, active life.

"Once they're past the protective healing stage, we start pre-prosthetic training," said Golding.

This may include strengthening exercises using crutches or other assistive devices, she added.

Then, they can begin working with a prosthetist to cast and fit their prosthetic limb. That's typically around the six-to-eight-week mark.

Patients work with physical and occupational therapists on gait training to help them walk as symmetrically as possible. They learn to trust the prosthesis and how to maintain their balance on it, said Golding.

Care also includes other health care providers, including neurologists and mental health care experts.

"We take them all the way through, until they're walking and balancing well," said Golding. "And then start increasing activities from there based on their goals."

These can include running, biking, or any activity they enjoy.

For more information, or to be referred to the ARCs, talk to your health care provider or contact your nearest ARC directly.

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Extremity Trauma and Amputation Center of Excellence
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Last Updated: May 04, 2022
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