Brooke Army Medical Center
Rehab Center For War Wounded is opened
Fort Sam Houston will be the site of a new state-of-the-art physical rehabilitation center that Department of Defense officials hope will enhance patient care. The Center for the Intrepid will be a 60,000-square foot, four-floor building housing rehabilitation technology that will assist amputees and other injured soldiers in recovery. It will be located near Brooke Army Medical Center (BAMC).
The center will be built through a partnership between the federal government and a nonprofit organization called the Intrepid Fallen Hero Fund (IFHF), 
based in New York, that is funding the new center. A groundbreaking ceremony for the center is scheduled this month and it is hoped that the center will be open in January of 2007, according to Col. Mark Bagg, MC, USA, BAMC chairman of the Department of Orthopedics and Rehabilitation and orthopedic consultant to the Army surgeon general.
"This structure will have everything combined for amputation patients, burn patients and soldiers that have undergone limb salvage procedures. It's going to cover more than amputee care for amputees. This will give us more flexibility in providing care to not just amputees, but to a whole host of other trauma-related patients that have the potential to return to active duty. It is truly going to be state-of-the-art, in regards to rehabilitation of those with war wounds," he said.
Walter Reed Army Medical Center (WRAMC) in Washington, D.C., and BAMC have been the two main military facilities handling amputee care and rehabilitation. WRAMC had been planning a new $10 million, 39,000-square foot amputee center, but those plans have been on hold because WRAMC was included this year in the list of medical facilities to be closed under the latest Base Realignment and Closure (BRAC) proposals.
Dr. Bagg said that the new facility at BAMC will focus primarily on the acute rehabilitation of patients sustaining war wounds, in hopes of bringing those patients to a physical level where they can return to active duty if they choose.
"Our feeling is that we have invested so much time in their training that if they want to stay on active duty, we should try to get them that ability to do so," he said.
New Center Enhances Care
According to Lt. Col. Jennifer Menetrez, MC, USA, Chief of Physical Medicine and Rehabilitation Service at BAMC, BAMC is currently actively seeing about 48 amputees. With the new center, about 100 visits per day in physical therapy alone from amputee, limb salvage and burn patients are expected. About 65 to 70 staff are expected to work at the new facility.
The facility will house a host of new technology and equipment to help patients rehabilitate. For example, Dr. Bagg said that the center will have what is known as the Computer Assisted Rehabilitation Environments (CAREN) system, which is a system that uses virtual reality to simulate different environments for patients with prosthetics. This allows for clinicians to analyze how patients with prosthetics move in different environments.
"Essentially, what this is, is a simulation center designed to replicate certain kinds of activities, to restore balance. We think this will offer a significant level of expertise that is above and beyond what we have now in rehabilitation," he said.
Dr. Bagg said that the new rehab center will include a gait lab where patients can walk on three different tracks and their movements on different terrain, different prostheses, and at different speeds can be analyzed by clinicians.
"Though we have one now, this one is multifunctional, having an ability to test for running and also to do other types of activities," he said.
In addition, there will be a swimming pool with turbulence that will allow patients to train with kayaks, a climbing wall, rappelling wall, indoor running track, vehicle simulator and prosthetics, among many other features. The location of the new center will also be advantageous to patients, according to Dr. Bagg. The center will be located adjacent to two new Fisher homes with 21 handicap-accessible rooms, allowing convenient access to the center by patients.
Caring For Soldiers
Dr. Bagg said that advances in prosthetic care and rehabilitation are making it possible for injured military personnel to return to active duty.
"Where in the past it was an automatic disqualifier towards staying on active duty, our feeling has changed a lot because a lot of results of the advances in prosthetic care. In 2005, these kids [with prosthetic legs] are able to walk without any kind of gait disturbance, and in fact when they put a uniform on, it's sometimes hard to tell that they are an amputee," he said.
An example of an advance in prosthetic care that Dr. Bagg cited is the use of myolectric prosthetics, which are microprocessor-controlled. These prosthetics pick up electric signals from muscles through sensors, amplifying these signals, and turning on an electric motor to provide function. Myoelectric, or "bionic" prosthetics, have been used in the United States since the 1980s, but technological innovations have allowed the user to perform more hand functions than in the past.
"I think we are seeing a lot more successes in the application of myoelectric prosthesis. They have always been there, but they are being utilized a lot more frequently. I think we have a better idea as to how to use them and rehabilitate soldiers with these kinds of devices," he said.
Even with more advanced prosthetic limbs, Dr. Bagg said that not every soldier wants to return to active duty.
"Many of them, at least initially, want to stay on active duty, then they come to a slow realization over time that this is probably not the right thing for me, so there's a lot of going back and forth in the healing process to make that final determination. It generally takes about six months before one has a fairly good idea about which direction they want to proceed," he said.
Whether patients desire to return to active duty or not, Dr. Bagg said that they will work with all patients to help each reach their maximum potential.
"Everyone stays until they have reached the maximum potential that we can achieve. They've got to get their final prosthesis and that usually takes several months, [when] their wounds are closed and they are stable and we can get them to their highest degree of functioning. Some go earlier, some go later," he said.
In the long run, Dr. Bagg said that they envision working with injured veterans at the center.
"If this war goes away, the plan would be to involve the VA and provide some of the services we provide now to the veterans. That's the long range vision for the center," he said.