Friday, August 1, 2014

A new IDEO

Picture: inside Ernie's lower leg:
Just returned from a trip to San Antonio to check out a new type of leg brace for Ernie.

As most readers know, Ernie was hit by a car in 2006, and has mostly been on crutches since then.  The damage was considerable (a compound crush injury at about 40 mph), and most of the expected healing has already happened. Latest X-rays show more bone healing, but Ernie still has shards of fused bone from the original accident and new growth, and very painful sensations of movement in the break area.  Problems with pain, mobility, and circulation continue, and in some cases have worsened despite ongoing care.

The leg brace he currently uses allows him to walk and weight-bear with only one crutch, meaning he can carry a cup of coffee or do some mobile work.  But the brace is designed to support by compression, meaning it cuts off circulation return from his leg.  Circulation return is already not great; further restrictions cause a lot of pain, and a buildup of blood and fluid below the brace cuff.  This limits the useful hours in the current brace to one or two a day, with several hours of foot elevation for recovery.  And there are certain things he just can't do easily in the brace, like rotate his foot into the passenger seat of a car.  This brace is a pretty standard approach for an injury like Ernie's, with instability in both ankle and knee.
 
current brace-
exterior carbon-fiber
cut back from skin graft.

Current brace-
interior side cut back (bone spurs).
Current brace
(Laces up like a corset.)


Mock-up for new brace:
hinged top allows easier entry and removal,
plus more rigid, firm-tissue support. 
Clear plastic behind contoured wings
will be replaced with carbon-fiber flex rods.
The new type of brace is designed for athletic movement; it's extensively used in the Return to Run program for active service members rehabilitating with a brace or prosthetic.  The IDEO uses carbon-fiber elements to provide some spring function, which can be tailored to specific activities like walking and running, cycling, or rowing. They offload the weight using molded supports fitting around hard tissue near the knee, with better results for circulation and force transfer.  Similar to how a prosthetic attaches to an amputated limb.
The foot-plate is full length, limiting kneeling postures, but that hasn't been an option for Ernie for years anyway.

IDEO w/ clip-on knee support
( from ncojournal.dodlive.mil)
Above, Ernie is trying on a thermal-plastic mock up.  The actual brace will look more like this:
IDEO brace
ncojournal.dodlive.mil

Fitting the template.
The Center for the Intrepid, which produces these braces and a number of excellent prosthetics, is impressive.  Nice facility, super-dedicated staff, participants who like Ernie are basically unstoppable (not immortal, just don't see any excuse to quit).  Many return to active service with their new limbs or braces.  For the past year the center has also been helping service veterans for whom this technology was not available at the time of their injury.

The CFI serves a lot of people any given week, usually over 100, with multiple appointments for each.  Most fittings and adjustments are done during morning and afternoon walk-in hours, where the head prosthetist and several assistants work with anyone whose brace needs adjustment.  We  met a Road to Recovery cyclist trying out a cycling-adapted IDEO brace, some guys who'd cracked theirs over the weekend playing soccer on a basketball court, and other folks getting specific adjustments for fit, stability, hot spots, and other issues.  Every brace is custom-fit and altered as needed to fit the particular injury and range of desired motion.  Most participants leave with their custom brace and a duplicate, so that broken braces can be sent back for repairs without interrupting normal activity.

The VA is picking up most of the medical costs, and the CFI coordinator helped us connect with the Fisher House and the Bob Woodruff Foundation to alleviate some of the other costs of the trip.  Both are good places to donate frequent-flyer miles if you have some that might expire.

We experienced warm welcome for veterans and military families everywhere we went locally.  Lots of very young, very athletic service members keeping their chins up as they adapt to a new range of activity.  We met some folks at the Fisher House whose family were in the BAMC's world-class burn ward as well.  Not what you'd prefer to have in common with people, a life-altering injury and all the uncertainties that go with recovery, but heartwarming to have the mutual support.
 


Lizard with a pink throat.
Anole?
Flowering tree- crepe myrtle?
The BAMC Fisher House dorm mother decided Ernie is her "Crocodile Dundee."  (Was it the all-weather Dorfman hat, the fishing vest with pockets upon pockets, or the stubbly chin?)

While we did not manage to cook up a lizard on a stick for her during this visit, we enjoyed exploring the Southern flora and fauna between appointments.

 This is just what we saw between the CFI and hospital on a daily basis.  There are a lot of other on-campus gardens, the river walk, and the historic Mission Trail to explore on our next visit.
Mystery bird -
acts & sounds kinda like a crow or jay,
size between the two, black/brown feathers.
 No matter how pretty, however, we're just as happy to be home for a few weeks before returning to start the training and customization process.   Ernie doesn't care for the muggy heat, but it beats being on fire, and also beats slick ice when you're learning a whole new range of motion.

We are looking forward to seeing what these guys can do for / with Ernie.  It does not sound like they are going to be satisfied with "better" if they can achieve "good" or "excellent."  And they have a whole bank of Ernie's favorite type of rowing machines.


both Ernie and the cats are glad he's home.