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Mon March 31, 2014
Orthotic Brace Takes Soldiers From Limping To Leaping
Originally published on Tue April 1, 2014 1:31 pm
A deceptively simple leg brace is changing the lives of hundreds of wounded service members. Soldiers with badly injured legs who thought they'd have to live with terrible pain can walk and run again, pain-free.
Earlier this month, Army Spc. Joey McElroy took his first steps in the Intrepid Dynamic Exoskeletal Orthosis, or IDEO (pronounced: eye-DAY-oh). The device squeaked a bit as he stepped briskly on an indoor track.
McElroy was hit by a car and thrown from his motorcycle on Dec. 5, 2012.
"I knew that when I looked down there was bones comin' out of the leg that didn't look correct. And my leg didn't work," he says.
Doctors were able to save McElroy's mangled leg, but he had to learn how to walk again. Running was out of the question.
"You don't realize how much you miss something 'til you don't have it anymore," he says. "The ability to be able to run again for my own health is a very big deal."
McElroy is known as a "limb salvage patient" since he avoided amputation. Physical therapists say some patients like McElroy later decide they would be better off without the leg when see their amputee buddies running around easily on prostheses.
"For a while there I was like, 'Just get rid of it.' If I can be on a prosthetic in a week or two and be running, just lop it off," McElroy says. But with the IDEO brace, "Now I'm glad it's here."
The brace, which was developed at the Center for the Intrepid at Brooke Army Medical Center in San Antonio, is molded out of lightweight black carbon fiber and custom-fit to each person. A foot plate inside a shoe attaches to a strut that runs up the back of the calf to a cuff.
The inventor, prosthetist Ryan Blanck, says it works kind of like a spring. Force applied to the foot plate bends the strut. As a person steps down, it bends the foot plate, transferring energy forward.
And if you use it correctly, it takes pain out of the equation.
The biggest challenge with the IDEO comes in relearning how to run. A patient can't land on toes or heel — instead, they have to adjust their stride to hit mid-foot.
After trying to run for the first time, McElroy breathes heavily but is all smiles.
"It's exhausting but it's awesome," he says. "I just wanna go faster."
So far the Center for the Intrepid has fitted more than 550 service members with the IDEO.
Dr. Donald Gajewski, an orthopedic surgeon and director of the center, says the IDEO has made for less business in the operating room – and that's a good thing.
"It's great to have a bunch of people around here who I don't know their names," Gajewski says. "Because if I'm getting involved with their care, I'm taking a limb off."
Gajewski admits the IDEO is not right for everyone. Some patients still have pain with it, so they opt for an amputation. But for most, the orthotic device has allowed them keep their leg. Some have gone on to run marathons, surf and jump out of airplanes. About 50 percent of IDEO users will return to active duty.
Blanck, the inventor, is now working in the private sector to bring the device to civilians. It costs around $10,000. At the Center for the Intrepid, there's a waiting list of two to three months.
ROBERT SIEGEL, HOST:
This is ALL THINGS CONSIDERED from NPR News. I'm Robert Siegel.
MELISSA BLOCK, HOST:
And I'm Melissa Block, hosting all this week from member station KERA in Dallas.
(SOUNDBITE OF THEME MUSIC)
BLOCK: And for All Tech Considered today, we're going to hear about a leg brace that's changed the lives of hundreds of injured service members.
JOHN FERGUSON: OK, down and back real quick.
BLOCK: Soldiers with leg injuries who thought they'd have to live with terrible pain and were told they'd never run again. Now, they're hearing this...
BLOCK: We've come to the Center for the Intrepid at Brooke Army Medical Center in San Antonio, to hear about a revolutionary orthotic brace that was invented here. It's custom-fit; molded out of lightweight, black, carbon fiber. There's a foot plate that goes inside a shoe, a cuff around the knee, and a strut connecting them that runs up the back of the calf. It's called the IDEO, for the Intrepid dynamic exoskeletal orthosis
FERGUSON: OK, lap. Give me a lap. I'm going to catch you coming back this way.
BLOCK: That's chief prosthetist John Ferguson. He's just fitted Army Spc. Joey McElroy with his IDEO. And he urges the soldier into a fast walk around an indoor track.
(SOUNDBITE OF FOOTSTEPS)
FERGUSON: OK, how are you feeling?
SPC. JOEY MCELROY: Pretty good. Some of my leg muscles are actually getting tired 'cause they're not used to going so fast when you walk, you know. So...
FERGUSON: That's expected. And that's what you're here for.
MCELROY: It feels great, you know. Honestly, being able to move that quick again - holy cow.
MCELROY: It's been a long time.
BLOCK: Since Dec. 5th of 2012, to be exact. That's the day McElroy was hit by a car and thrown from his motorcycle.
MCELROY: I know that when I looked down, there was bones coming out of the leg that didn't look correct. And my leg didn't work.
BLOCK: Doctors were able to save McElroy's mangled leg, but he had to learn how to walk again; and running was out of the question. Later, on the day we visit, he's going to run again for the first time since the accident.
MCELROY: You don't realize how much you miss something until you don't have it anymore. That ability to run - like, I have a daughter who is, you know, starting to run around, too. And I can't even keep up with her. And that's kind of sad, you know. So the ability to be able to run again for my own health is a very big deal. You'll probably see me cry. Don't tell nobody.
(SOUNDBITE OF FOOTSTEPS)
JOHNNY OWENS: Your first two weeks, you're going to have some knee pain.
BLOCK: McElroy heads outside to a large turf field with physical therapist Johnny Owens.
OWENS: The IDEO is going to own you, at the start. It's going to push your leg back and cause a little bit of pain.
MCELROY: Yeah, definitely...
BLOCK: Joey McElroy is what's called a limb salvage patient. In other words, he avoided amputation. But therapist Jonny Owens says he's seen lots of limb salvage patients later say, cut it off. Here's the irony: They'll see their buddies who are amputees doing great, running around easily on prosthetic legs.
OWENS: Guys were coming back a year or two later and saying, I'd like you to just go ahead and amputate my leg. And almost always, when we ask them why, it was 'cause they can't run on it. Right?
MCELROY: Yeah. For awhile there, I was - just get rid of it. If I can be on a prosthetic in a week or two and be running, just lop it off. Now, I'm glad it's there.
BLOCK: And that's where the IDEO has been a real game-changer. The inventor, prosthetist Ryan Blanck, came up with the idea here, at the Center for the Intrepid. He explains it works kind of like a spring.
RYAN BLANCK: The more force that they apply through the foot plate reacting from that upper cuff, that deflects and bends that strut. It stores energy as they come across over from heel to toe. And as they come off their toe, in a run or a walk, it deflects and provides and generates power to the next step.
BLOCK: And Blanck says it takes pain out of the equation. On the field, McElroy meets up with his rehab group - all of them wearing the IDEO orthotic brace.
UNIDENTIFIED MAN #1: You're going to get to know them all well.
BLOCK: There are a couple of newbies, like him. Others are almost done with their four-week Return to Run training session. Some of the servicemen suffered blast injuries when they stepped on IEDs. Some were shot. Others were in accidents. All of them are about to be put through a grueling morning of exercise.
UNIDENTIFIED MAN #1: Pull through. Pull through. Pull through. Pull that leg through; don't just stop it.
UNIDENTIFIED MAN #1: This is the key part to running, right here. For guys who do this good, are the good runners.
BLOCK: Balancing exercises.
UNIDENTIFIED MAN #2: Touch down and level. Ten, nine, eight...
(SOUNDBITE OF GROANING)
BLOCK: Rapid leg flicks.
UNIDENTIFIED MAN #2: And quick-fire that glute. Down. Up. Down. Up...
BLOCK: And the key thing: a lesson on how to run with the IDEO.
UNIDENTIFIED MAN #1: Now, you don't want to run on your toes. If you run on your toes, you're going to snap the foot plate underneath your toes. All right? So you need to...
BLOCK: The IDEO looks pretty simple; crude, even. The black cuff around the knee and calf supports and stabilizes the limb. The specialized strut running down the back of the calf connects to that individually molded foot plate.
UNIDENTIFIED MAN #3: Midfoot, midfoot, midfoot. Touch toes forward. Go. Go. Go. Go. Go. Go.
BLOCK: And finally, the moment Joey McElroy has been dreaming of for more than a year. It's time to run. The men line up on the turf, each with a partner behind him holding two ropes - one Velcroed around each ankle of the runner. As the pairs take off, the ropes provide resistance.
UNIDENTIFIED MAN #2: You're supposed to be nice and relaxed when you're pumping your arms. Guide through with your hips. Push back with the feet.
BLOCK: And pretty soon, the men are running on their own. It takes your breath away: a line of wounded warriors striding across the field, arms pumping in the sun.
UNIDENTIFIED MAN #4: You got it. Push it up.
UNIDENTIFIED MAN #3: Let's go. Let's go. Keep going. Keep going. Yeah!
UNIDENTIFIED MAN #3: Woo!
UNIDENTIFIED MAN #3: Good job, buddy.
BLOCK: The new patients wince and hobble a bit. But even so, Joey McElroy is all smiles.
UNIDENTIFIED MAN #3: How does that feel? Use your hand, brother.
MCELROY: (Breathing heavily) Woo! It's exhausting, but it's awesome,. I just want to go faster.
BLOCK: And for therapist Johnny Owens, this never gets old.
OWENS: Two guys that haven't run, that didn't think they were ever going to run since their injuries, first day, and they're running. You know, that's pretty cool.
BLOCK: So far, the Center for the Intrepid has fitted more than 550 service members with the IDEO. I go back inside to visit with the director, Donald Gajewski. He is an orthopedic surgeon. And the IDEO means he has less business in the operating room, with fewer people choosing to have a late amputation.
DR. DONALD GAJEWSKI: It's great to have a bunch of people around here who I don't know their names. 'Cause if I don't know their names, that means I didn't have to get involved with their care. 'Cause if I'm getting involved in their care, I'm taking a limb off.
BLOCK: Gajewski makes it a point to get out of surgery and watch the IDEO rehab.
GAJEWSKI: I go up there every once in a while to see those aha-moments - you know, have somebody that hasn't run for six years put it on for the first time, thinking I can run out of this place right now. And sometimes, there is a lot of tears involved. We have some big, tough, bulky, tough guys. But even sometimes this brings them to tears 'cause they realize their life has changed.
BLOCK: Now, Gajewski does say the IDEO is not right for everyone. Some patients try it, and it just doesn't work for them. They opt for an amputation. But for most, this orthotic device has let them keep their leg. And many of them can return to duty.
(SOUNDBITE OF BOUNCING BALL)
BLOCK: That's the goal for Spc. Jordan Thrash. I find him shooting hoops after the day's workout.
SPC. JORDAN THRASH: I got my legs run over by a UH60 Black Hawk.
THRASH: Bagram, Afghanistan
BLOCK: And when was that?
THRASH: April 23rd of last year.
BLOCK: What did they tell you when that injury happened, about what...
I'm going to take your leg. (Laughter) And I told them, me and my leg got a pretty good relationship.
Without the IDEO, Thrash says he limps in pain. Now, he has it on all the time.
I got it, wore it around for an evening and then we went for, like, a three-and-a-half-mile hike. I felt like champion of the world. It was great. 'Cause if I would've tried that before the brace, I would've ended up crawling across the finish line. (Laughter)
BLOCK: Folks here will brag a bit. They'll talk about patients who've gone on to run marathons with the IDEO, surf, jump out of airplanes. The inventor, Ryan Blanck, is now working in the private sector to bring the device to civilians. It costs around $10,000.
At the Center for the Intrepid, there's a waiting list of two to three months for the IDEO.
UNIDENTIFIED MAN #3: Drive. Drive. Drive. Drive. Drive. Drive. Breathe.
UNIDENTIFIED MAN #4: Nice job, man. Nice job. Transcript provided by NPR, Copyright NPR.