New Amputee Care Center Opens at Walter Reed

By Fred W. Baker III
American Forces Press Service

Sept. 13, 2007 - Army National Guard Spc. Marco Robledo wants to go home to Arkansas in November standing on his own two feet. A roadside bomb claimed the combat engineer's left leg and arm in Iraq in May. Since then, he has been recovering at Walter Reed Army Medical Center here. Every day he walks slowly around an indoor track attached to a harness. A lanyard connects the harness to a trolley locked into an aluminum track mounted to the ceiling. It makes a slow dragging sound as he steps forward with his prosthetic leg.

And so it slowly goes for Robledo -- step, drag, step, drag. He's making progress thanks, in part, to this one-of-a-kind walking system at Walter Reed's new Military Advanced Training Center.

The 31,000-square-foot, $10 million center opens today two months early and offers some of the most state-of-the-art care found anywhere in the world, officials said.

Patients began using parts of the facility, such as the indoor track and the Solo-Step system used by Robledo, last week.

The facility combines office and counseling space with workout facilities, data gathering, high-tech simulators, and even a family lounge with a full kitchen. It is designed to bring together all the hospital's elements of advanced amputee care, but much of it also will benefit other patients, such as those suffering from traumatic brain injuries or post-traumatic stress disorder.

The hospital's gait lab has nearly doubled its size in the new building. The lab electronically records patients' movements while wearing prosthetic devices to give feedback to the patients and specialists on rehabilitation efforts. It can now record movements from 23 camera angles, up from eight, and has six force plates, up from four, that measure pressure put on the ground as steps are taken. It also added a treadmill built into the floor that will allow specialists, for the first time, to collect force plate data from soldiers while running.

"This lab is going to allow us to do so much more on the research and clinical side than we were able to do before," Brian Baum, a biomechanical engineer.

Capturing the data allows for more focused and faster rehabilitation for soldiers, he said.

"We can give feedback to the clinicians to help expedite their rehabilitation. So, if the patient's goal is to return to duty, we now have a more solid baseline," he said. "We can now look at a broader picture and really pinpoint rehabilitation from multiple angles, rather than just looking at walking. Returning to duty is a lot more than walking. Returning to a functional life is also a lot more than walking."

One of only three in the world, a high-tech computer-assisted rehabilitation environment was added to the center to help amputee soldiers adapt to real-life scenarios.

In front of a large projection screen, soldiers stand on an elevated, multi-axis platform that rocks and sways as the computer-driven scenario changes. In one scenario, the patients stand as if in a boat as it moves through a course. In other scenarios, patients are required to raise their hands while moving to hit objects that appear to be flying by. This helps patients become more stable and confident using their prosthetic devices.

An indoor running track encircles "upper-extremities" workout areas. One half of the top floor is open to allow soldiers to look down on others using the lower-extremities workout equipment. A climbing wall rises from the lower level, and climbing ropes and a rappelling wall allow patients to develop overhead skills and confidence. Windows allow sunlight to stream throughout.

Most of the equipment is standard fitness-center equipment to allow soldiers to transition from the center to a gym in their hometown or Army installation with no adjustment to their workouts, officials said.

Also among the treatment rooms is a weapons simulator to get soldiers back to shooting, a vehicle simulator to help them relearn to drive using prostheses, and areas that offer practice walking on uneven terrain features, such as sand, gravel and cobblestone.

Counseling offices offer a private view of the workout areas through two-way mirrored glass. Psychologists, social workers, benefits counselors, and case managers all have office spaces, offering a virtual one-stop shop for amputee care at the clinic.

Officials said that initial amputee care will still be managed in the main hospital clinics. The new center is for those who are in the more advanced stages of rehabilitation. It is designed to transition patients from their basic recovery to either returning home or to duty, they said.

The building was funded in September 2004, but building plans were nearly nixed after the Base Realignment and Closure Commission set Walter Reed to close in 2011. But after officials considered alternatives and found that the center needed to be built and quickly, construction began in November 2006 using a fast-track system. This allowed designers to apportion the plans and deliver just what the builders needed to start. To start, they delivered the designs that allowed excavation to start, then the structural designs to order the steel, and so forth.

This also allowed for changes to be made along the way that would better benefit patients, said Elihu P. Hirsch, project manager for the Army Corps of Engineers. For example, the Solo-Step used by Robledo was not in the original proposal, he said.

Hirsch said the visual reminders of those who would be using the facility helped to motivate the crews. Only steps away from the building is the helipad where wounded soldiers are delivered. Patients also walk around the hospital and the construction site using their prostheses.

"All along, you have the tangible reminder of why you're building the facility, and that gave everybody the added incentive to increase production," Hirsch said. "Everybody who worked on the project has been walking away with great feelings of satisfaction."

As of June, the hospital has treated almost 500 limb-loss patients from operations Iraqi Freedom and Enduring Freedom. It serves an average of about 100 daily. Stays for rehabilitation range from eight months to two years.