Rebuilding body and spirit
Images from the Center for the Intrepid, San Antonio
A place to heal
The four-story, 65,000-square-foot facility opened Jan. 29, 2007, to serve military personnel severely injured in recent conflicts. The center was built by the Intrepid Fallen Heroes Fund, which raised $40 million from private donors, and is run by the Dept. of Defense as an outpatient clinic of the Brooke Army Medical Center. It serves an average of 145 patients a week.
Hurt but basically healthy
Staff Sgt. Felix Chavez does side crunches as part of a core conditioning class in the physical therapy gym. The patients served by the center are soldiers, with needs and expectations that are often quite different than those of the average amputee. In the civilian world, a typical patient with a lower-extremity amputation is a 65-year-old diabetic, according to the Agency for Healthcare Research and Quality. Basic ambulation is the likely rehab goal. At the center, most patients expect to run, and to resume their previous lives.
Multifaceted approach
Col. Jennifer Menetrez, MD, the center's director, (left corner) attends to Cpl. Joe Mixson at an interdisciplinary clinic. Beyond the physical injuries and necessary adjustments, mental health problems such as posttraumatic stress disorder and depression are common. And resources and services have to be lined up for the patient's return to the civilian world. These clinics bring physicians together with other professionals to develop solutions for individual situations. (Dr. Menetrez was a lieutenant colonel when these photos were taken but has since been promoted.)
Small steps
Staff Sgt. Matt Lammers jokes with physical therapist Eli Ramos. Lammers is learning to walk again with short prosthetics called "stubbies." As his balance and stamina improve, he will move into more gait-natural legs. Gym equipment allows him and other severely injured patients to regain their previous physical conditioning.
Gotta have heart
Staff Sgt. Matt Lammers had already won a Purple Heart following a duty-related injury. Now he has another -- after losing three limbs in Iraq. He shows off the tattoo that survived, saying, "This is what they didn't get."
World view
The computer-assisted rehabilitation environment, or CAREN, is a dome-like contraption that is 21 feet at its peak. A 300-degree image is projected onto the dome and surrounds patients as they walk or run on a treadmill embedded in a platform. The activity improves balance, while computer analysis of movements suggests any needed alternations. The environmental simulations are also used in treating posttraumatic stress disorder.
Tools of the trade
Prosthetics are manufactured on-site in a second-floor laboratory which looks, in many ways, like a mechanic's workshop. The walls are covered with racks of screwdrivers, wood files and pliers. The shelves are packed with plastic bins labeled with patient names and filled with artificial limbs. Since opening, this lab has created more than 500 prosthetics.
A leg in the making
John Fergason, director of prosthetics, scans the leg of Cpl. Dustin Fleming, to start the process of fitting him for a prosthetic. Plaster molds capture the sizing information needed to create the socket, which will change frequently as recovery advances. "The laboratory enables a quick turnaround and allows us to see every stage of the process when something is being built," Fergason said.
Matching the movement
Prosthetists Gregory Washington and YaVonne Money consult with Spc. Nicholas Clark as he tries a carbon fiber leg. Because the rehab emphasis is on resuming previous activities, patients with lower-extremity amputations are often fitted with prosthetics designed for specific tasks, such as running or even rock climbing. Most patients leave the center with at least one special activity prosthetic, as well as an everyday leg and a backup.
The long-distance runner
Spc. Nicholas Clark, who hopes to return to long-distance running, tests a carbon fiber prosthetic with a quick jog through the gym.
Walk this way
Sgt. Ryan Fellenz has his walk analyzed at the center's gait lab. The force exerted by each leg is measured by panels in a floor that simulates various terrains. Skin sensors activate an infrared camera that displays additional data about his ambulation. This information guides adjustments of his prosthetic to allow walking as naturally as possible.
Surfer city
Cpl. Shane Parsons boogies through some simulated waves, coached and encouraged by Eli Ramos, physical therapist and aquatics director. While the technology is most often used for recreation and amusement at water parks, here it is harnessed as a tool to build balance and stability. Riding the board is harder than it looks: The rider must engage his core or the waves will send him spinning. Patients must have already experienced significant recovery before hitting the waves.
The person inside
The center serves the spirit and the mind as well as the body. Spc. Frank Fields discusses his future with the chaplain, Capt. Roger B. Van Pelt, while Sgt. Lilina Benning prepares to work out. "He's going to be a stand-up comic in the very near future," jokes Van Pelt. "No pun intended," adds Fields, who is working on several business ventures, including producing and managing musicians. "I got to figure out how to stand up first."
Climbing high
A two-story climbing wall is the centerpiece of the physical therapy gym. Because no one had attempted it in a few days, Capt. Alexander Palomaria, an Air Force chaplain, headed up -- and made it to the top. "That was my first time," he said. "I just wanted to encourage people."