Rehabilitation of the Combat Amputee- Consensus Conference and Creating a Roadmap for the Future

Organizers: Rory Cooper, Ph.D. and LTC Paul F. Pasquina, MD

2007-2008

Numerous military service members have sustained severe limb trauma as a result of the Global War on Terrorism.  To date the Army Medical Department has provided medical, surgical, and rehabilitative care to over 700 military service members with amputations. Most of these amputees have been treated at Walter Reed Army Medical Center (WRAMC) or Brooke Army Medical Center (BAMC).  By caring for these patients, the medical staff at these institutions have learned valuable lessons and helped to establish new paradigms in medical rehabilitation.

Unfortunately, there is little medical literature focused on the optimal treatment and rehabilitation of young combat related amputees.  The majority of clinical studies have focused on the care of older individuals with amputation as the result of complications from vascular disease or diabetes.  Moreover, combat specific amputations, especially from blast injuries, are very different than the trauma related amputations seen in the civilian community.  Combat wounds often are associated with multiple co-morbid injuries, such as burns, traumatic brain injury, spinal cord injury, sensory loss, or extensive soft tissue trauma.  Additionally, the psycho-social aspects of injury during military service are very unique.  To help establish effective and cutting edge treatment in this patient population, more research is needed.

In order to ensure the success of these unique clinical and research programs, the VA and military care community needs a “road map” to provide focus for their efforts and priorities. With this mission in mind, Dr. Rory Cooper, director of the VA/University of Pittsburgh Human Engineering Research Laboratories (HERL) and LTC Paul Pasquina, MD, Medical Director of the Amputee Program at WRAMC, organized “Rehabilitation of the Combat Amputee-Consensus Conference and Creating a Roadmap for the Future,” a three day symposium conducted at the Center for the Intrepid from September 17-19, 2007. 

The event united VA, civilian, and military experts in amputee care and rehabilitation to help establish consensus on standard of care issues, as well as to help identify areas most needed for further clinical, technical, translational and developmental research. The symposium work will be written into a textbook, Rehabilitation of the Combat Amputee, to be published by the Borden Institute as part of their Textbooks on Military Medicine series (TMM). Borden Institute, of the Office of The Surgeon General, Department of the Army has published the TMM since 1989. The textbook series provides a comprehensive, multi-volume treatise on the art and science of military medicine, as practiced by the United States armed forces. The books integrate lessons learned in past wars with current principles and practices of military medical doctrine. Rehabilitation of the Combat Amputee, a joint VA/Department of Defense effort, will be Borden’s first textbook written in this manner.