BADER Consortium and the Thought Leadership and Innovation Foundation recently collaborated on a special supplement to Military Medicine, the International Journal of AMSUS.

Amputee climbing wall with fellow soldiers

The focus is the “New Normal” of military care – namely, how the military and civilian sectors are flexing to care for servicemembers with orthopedic combat injuries. During the five operations in Iraq and Afghanistan since 2001, more than 1,640 members of the U.S. Armed Forces have suffered a traumatic injury requiring a limb amputation. These men and women require high-level, multidisciplinary care that addresses their needs in the short and long term while also helping them reach their highest level of function possible.

Addressing these varied needs of injured service members requires the development of strategic infrastructures that integrate patient care and clinical research. This is the work of the BADER Consortium.

The Military Medicine supplement talks about the challenges and successes in fostering this “New Normal” approach. It includes insights gleaned from a recent gathering during the AMSUS Annual Continuing Education Meeting in San Antonio, Texas. “WARfighters Receiving Innovative Orthopedic Rehabilitation  (WARRIOR) Symposium: Research and Treatment of Patients with Extremity Trauma and Amputation” discussed how state-of-the-art programs are using research to impact the care of people with limb loss.

This event was a first in bringing together military, civilian and industry representatives to talk about ways to partner in the future. John Shero, director of the Department of Defense/Veterans Affairs Extremity Trauma and Amputee Center of Excellence, or EACE, called the gathering “a brain trust” of people he had never before seen together. For the BADER Consortium and others invested in orthopedic rehabilitation research, it’s exciting to think of what may come from that meeting.

Other articles in the supplement include the results of an analysis of Medicare claims for patients receiving lower-extremity prosthetic services. The findings suggest that prosthetic services provide value to the Medicare program in terms of fewer acute-care hospitalizations and less facility-based care as well as improved quality of life for patients.

Another article by a multidisciplinary panel of health professionals focuses on the recommended guidelines for the prescription of orthotic services.

This supplement presents a timely look at the tremendous effort that has gone into advancing the care for these wounded warriors. It’s critical for this important work to be sustained through continued partnerships and research. After all, the approaches taken by military health professionals have implications in the civilian world as well.

Members of the BADER Consortium are in San Antonio, Texas for the 2015 AMSUS Continuing Education meeting, where federal and military health professionals are discussing how healthcare is flexing to meet the changing needs of its patients.

The conference features top leadership from the Department of Defense, Department of Veterans Affairs, Defense Health Agency and others talking about health and scientific issues under the theme, “The New Normal.”

AMSUS is a non-profit organization for federal and international health professionals that helps advance healthcare knowledge and effectiveness among its members. It includes the uniformed services along with the Department of Veterans Affairs.

Dr. David Shulkin, Under Secretary of Health for the VA, will provide an update on the current and future state of the VA and also describe his vision for veterans’ healthcare. Medical and clinical operations, global health, and military health system updates are among the educational tracks.

In addition, BADER Consortium is co-sponsoring the WARRIOR Symposium. The symposium will discuss rehabilitation needs for servicemembers and civilians following amputations or extremity trauma.

WARRIOR stands for WARfighters Receiving Innovative Orthopedic Rehabilitation. The symposium is intended to offer a comprehensive look at the issue of orthopedic rehabilitation, from a military and civilian perspective. It will include a discussion of the findings of the Defense Health Board report issued earlier this year, which made recommendations for the sustainment and advancement of amputee care.

Participants in the WARRIOR Symposium include Vice Admiral Raquel Bono, MD, director of the Defense Health Agency, discussing the “Roadmap for Change;” Maj. Gen. George Anderson, MD, talking about the Defense Health Board report; and Maj. Daniel J. Stinner, MD,  and Col. (Ret.) Paul Pasquina sharing insight about federal programs.

Civilian programs also will be highlighted, with perspectives from James Campbell, PhD, president of the American Orthotic and Prosthetic Association; Jason Highsmith, PhD, president of the American Academy of Orthotists and Prosthetists; and Dennis Clark, president of the Orthotic and Prosthetic Group of America. Al Dobson, PhD, will discuss the economic value of orthotic and prosthetic services among Medicare beneficiaries.

There also will be a panel discussion featuring Lt. Col. Kathleen Yancosek, director of the Center for the Intrepid; Lt. Col. Owen Hill, PhD, chief of the Research & Surveillance Division with the Extremity Trauma and Amputation Center of Excellence; and Brandon, Sampson of the Limb Lab.

Dr. Steven J. Stanhope, director and principal investigator of the BADER Consortium, will talk during the symposium about the way BADER serves as a bridge connecting clinical care and research for patients with limb trauma.

Helping wounded warriors with limb loss and limb difference re-engage in their life and work activities is the vision of the BADER Consortium, which is centered at the University of Delaware and works with orthopedic researchers around the country.

“BADER Consortium is playing a central role in supporting the critical efforts in orthopedic rehab research to help these men and women reach their new normal,” Stanhope said.

Stanhope also will be part of an expert panel, “The New Normal: Sustainment and Advancement of Care for Warfighters with Extremity Trauma.” The panel, moderated by Dr. Fred Cecere, will discuss how best to operationalize the Defense Health Board recommendations and maintain readiness for future conflicts.

It’s great to see so many people on social media giving thanks on Veterans Day for the service and sacrifice of strangers and loved ones who served in the military for our protection.  And while those accolades are important, it’s also critical that we make sure these brave men and women have access to state-of-the-art technology and treatment to ensure they are reaching the highest level of function possible.

Veterans with traumatic limb loss are learning what it means to return to their work and home lives following an amputation. But they aren’t altering their life goals or downgrading their plans – rather, they are relying on state-of-the-art technology and advancements in patient care to help them reach optimal clinical outcomes, whether it’s running again or attending to activities of daily living.

They are veterans like Travis Mills, a retired U.S. Army staff sergeant and one of five Afghanistan war veterans to survive a quadruple amputation. There’s many words to describe him, but one of the most powerful ones is runner.

Fitted with specially made running blades, Mills can now run more 1 1/2 miles. He plans to do a 5K. In a story for Runner’s World, he describes his first experience on the blades this way:

Travis Mills, running in his annual Miles for Mills 5K in Augusta, ME.

“I was so excited to get running, I broke one in half one of the first times I put them on. I drove two hours that same day to get it replaced. I wanted to keep at it.”

Mills is an example of a veteran seeking the highest level of function possible – a goal that should be the norm for all people with limb loss.

It’s this “new normal” that offers so many opportunities – for the person with limb loss, but also society. Just getting by isn’t good enough for someone with traumatic limb loss. At the same time, society needs to see a person with limb loss in the same way we see a person with glasses – that is, we notice the person, not the equipment they use.

The new normal is the topic of a recent opinion piece in The News Journal by Dr. Steven J. Stanhope, director of the BADER Consortium. It’s also the subject of the annual meeting of AMSUS, to be held later this month in San Antonio, Tex. AMSUS is a non-government funded organization for federal and international health professionals with more than 8,000 members.

These health professionals will be covering some heavy topics about the new normal, including the psychological health consequences of combat blast exposure, innovative orthopaedic rehabilitation and collaborative approaches to care among the Department of Defense and Department of Veterans Affairs.

The BADER Consortium also is trying to be a part of the new normal. BADER stands for Bridging Advanced Developments for Exceptional Rehabilitation. Our program started in 2011 when BADER was awarded a five-year, $19.7 million grant from the Department of Defense to establish impactful, evidence-based, orthopedic rehabilitation care for soldiers with musculoskeletal injuries to help them return to optimal function in their daily lives.

The Consortium’s partners include government agencies – like the VA and DOD – military treatment facilities, academic institutions and industry leaders. The goal is to support innovative, high-impact and clinically relevant orthopedic rehab research. The work being done by our researchers offers the potential to change care for patients with limb loss – not only through technology advancements but also in quality of life measures.

Cyclists ride 67 miles from Killeen to Waco, Texas during the 2014 Ride 2 Recovery Texas Challenge. As a 501(c)(3) organization, R2R helps injured active duty service members and veterans improve their health and wellness through individual and group cycling.

Veterans Day is a time for reflection and honoring the sacrifice these men and women have made on behalf of their country. But as much as veterans – like Cpl. Todd Nicely, another quadruple amputee – inspire us, they should also serve  as a reminder that these men and women deserve nothing less than the opportunity to soar in their new normal.

Optimal outcomes are possible. Just ask Nicely, who is relearning how to drive his car with his prosthetic arms and feet.

“I’m just trying to find something new to do every day,” he said.

For the second time this year, the BADER Consortium has collaborated with other military health organizations to produce a special supplement to Military Medicine, the International Journal of AMSUS.

Left to Right – Ken Kaufman (BADER), Bill Oldnam (TLIF), Fred Cecere (TLIF), and Steven Stanhope (BADER) in attendance at the 2016 AMSUS meeting.

“Raising the Bar: Extremity Trauma Care,” was produced in partnership with the Thought Leadership & Innovation Foundation (TLIF), the Extremity Trauma and Amputation Center of Excellence (EACE) and the Center for Rehabilitation Sciences Research (CRSR). It focuses on the collaboration and innovation that is taking place in today’s military health system.

Today’s wounded soldiers have access to cutting-edge medical care, technology and research efforts in the seconds following their injury, making it possible to reach optimal outcomes for this high-performing group. This kind of success is the result in part of a synergistic approach taken by BADER, the EACE and CRSR to identify and develop research capabilities that translate advances into clinical care.

The 80-page supplement highlights the many examples of how military health professionals are “raising the bar” when it comes to finding ways to work together to address the complex needs of combat wounded soldiers.

The issue includes an article about the BADER Consortium and how it relies on strong partnerships with military treatment facilities (MTFs) to strengthen and support orthopaedic rehabilitation research. You also can read about some of the latest research taking place at these MTFs.

The BADER Consortium is proud to be part of the effort to help wounded service members return to their highest level of function following a traumatic limb injury. This supplement provides a snapshot of the ways our University of Delaware staff, funded through BADER, are making a difference.