Looking forward – March 2014

David B. Hoyt, MD, FACS

Recently I had the privilege of touring the Walter Reed National Military Medical Center (WRNMMC) in Bethesda, MD, and of presenting the institution with American College of Surgeons (ACS) Level II trauma center verification (see related article). As you may know, Walter Reed Bethesda historically provided medical and surgical care to individuals serving in the U.S. Army. In recent years, however, the former Walter Reed Army Medical Center and National Naval Medical Center merged to form the current WRNMMC. The results of this union have been impressive, and I was honored to have the opportunity to witness firsthand the high level of care the health care professionals there provide to our nation’s injured and ill military personnel.

Care for amputee soldiers

Particularly notable was the state-of-the-art care offered at WRNMMC’s Military Advanced Training Center (MATC), which is focused on caring for military personnel who experienced injuries that required them to undergo amputation. As many of you know, the number of fatalities among the men and women serving in the conflicts in Iraq and Afghanistan has been relatively low. However, many troops are losing limbs to improvised explosive devices and other forms of weaponry, making the need to deliver high-quality services for amputees a key aspect of caring for returning troops.

Wounded warriors follow a clear path from injury to reentry into civilian or military life. They first receive emergency care at military hospitals near the battlefield. They then are transferred to Landstuhl Regional Medical Center in Germany, an ACS-verified Level I trauma center, for definitive care. Once they are well enough to make the trip back to the states, they are sent to the WRNMMC.

The MATC opened at Walter Reed in 2007 with the mission of delivering the most patient-centered, accessible, high-quality care available within the military health system, according to retired U.S. Army Col. Charles Scoville, DPT, chief of amputee patient care service at WRNMMC (pictured above).

Sports medicine model

The MATC opened at Walter Reed in 2007 with the mission of delivering the most patient-centered, accessible, high-quality care available within the military health system, according to retired U.S. Army Col. Charles Scoville, DPT, chief of amputee patient care service at WRNMMC. “Our goal is to transition our patients from injury or illness to functional, independent recovery and reintegration through a rehabilitation process that offers the most memorable and appreciated excellence of care our patients have ever experienced,” said Dr. Scoville.

Dr. Scoville, who received the 2012 National Security and International Affairs Medal for his development of the MATC, has applied his background in physical therapy and sports medicine to create a rehabilitation center that looks and feels more like a world-class athletic center than a hospital. In fact, the MATC patients are treated as “tactical athletes,” Dr. Scoville said, and use much of the same athletic and exercise equipment that can be found in the most exclusive professional training centers in the nation.

Physical and occupational therapists follow the troops—many of whom have experienced double or triple limb amputation—from their initial evaluations through their discharge from the hospital and outpatient rehabilitation to their return to active duty or civilian life.

State-of-the-art technology

The MATC is fully equipped with sophisticated, leading-edge technology. The MATC prosthetic service, for instance, uses advanced technology to design and produce customized prosthetic and orthotic devices. These devices can be made on-site in labs that use 3D printers to produce titanium prosthetic and orthotic components. Once a patient is fitted with the appropriate device, occupational therapists work with them to ensure they are able to use the apparatuses properly and independently.

The MATC also comprises computer-assisted rehabilitation environment (CAREN) technology. One of only 10 of its kind in the world, CAREN provides a simulated setting where patients can work on regaining balance, coping with stress, using new prosthetics, and developing other skills needed to lead fulfilling and productive lives. Here, recovering service members interact with a virtual world projected onto a life-sized screen that they control by shifting their weight on a motion-sensing platform. The CAREN is capable of reproducing 70 real-life tests of physical acuity that individuals may encounter in military and civilian life.

Also housed in the MATC is the Gait Lab of the Center for Performance and Clinical Research, which uses sophisticated motion analysis equipment to quantify patient movements. The information gathered through this process allows health care providers to evaluate or modify their patients’ physical therapy programs and prosthetics and orthotics to facilitate performance of day-to-day functional tasks, such as walking, running, and jumping.

Recreational therapy and adaptive sports activities are other key components of the care provided at the MATC. The recreational therapy program coordinates a community reintegration program that exposes patients to a variety of meaningful experiences outside of the clinical setting. For example, the MATC staff might take patients to shopping malls, movie theaters, restaurants, and museums to help them feel more comfortable in the environments they will encounter as civilians. Adaptive sports activities that are offered include scuba diving, therapeutic horseback riding, basketball, cycling, golf, and so on. Additionally, the MATC offers a service/therapy dog program for patients who could benefit from having a companion animal’s assistance.

Without question, the MATC is setting world-class standards of care. I was truly impressed with the MATC and its approach to caring for our nation’s wounded service members. This is what America is all about.

The MATC at Walter Reed.

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