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thedrifter
11-08-06, 02:14 PM
Getting amputees back on their feet
Navy's one-stop, state-of-the-art rehabilitation center in California helps war injured realize goals
- Eilene Zimmerman, Special to The Chronicle
Wednesday, November 8, 2006

11-08 04:00 PST San Diego -- Nathaniel Leoncio, a petty officer third class with the U.S. Navy, was on patrol with the Marines in the Iraqi city of Ramadi a year ago when a roadside bomb exploded and changed his life. Leoncio had a host of severe wounds, including abdominal injuries that necessitated his wearing a colostomy bag for months.

But most traumatic was the loss of his right leg, at mid-thigh.

Two weeks before Christmas last year, Leoncio received his first prosthetic leg and started walking. His goals now are to run again and to pass the Navy's physical requirement test. To get there, he is tapping the expertise of a Paralympic gold medalist and a celebrity prosthetist, both part of the military's newest amputee rehabilitation center located at the Naval Medical Center San Diego.

The state-of-the-art Comprehensive Combat Causality Care Center, or C5, as it is known, is the military's first and only center for amputee care in the Western United States. A virtual one-stop shop for amputees, the center combines the services of orthopedics, prosthetics, physical and occupational therapy, wound care, psychiatry, brain injury care and mental health counseling.

Designed to serve amputees and other severely injured combatants that want to have their rehabilitation in California near their family or military unit, the center is expected to handle about 50 amputees a year. That may not sound like much, but such cases can be long and complicated, with amputees often requiring multiple surgeries and years of care.

Construction of the $7 million facility within the Naval Medical Center -- is set to begin within weeks, but all the necessary services, equipment and staff are in place, scattered throughout the medical center. Five amputees are currently receiving treatment.

As of Sept. 30, war amputees from Iraq and Afghanistan numbered 725, according to Walter Reed Army Medical Center, which also has a military amputee center. Because so many of them are young -- often under 25 -- the military's aim is to treat them as the highly conditioned, athletic men and women they were prior to being injured. It is the reason Paralympic gold medalist Casey Tibbs is working as a peer-to-peer counselor with amputees at C5.

Tibbs, 26, is a below-knee amputee, the result of a motorcycle accident in March 2001. In 2002, while sitting in his prosthetist's waiting room, he read an article about the Paralympics. "It was the first time I'd ever heard about it," he said. "It showed all these types of running legs, made for sprinting. So I said to my prosthetist, 'Make me one of those legs, I want to do this.' "

Tibbs, who is also a naval petty officer, won both a gold and silver medal in 2005 in Athens, where he also set an American Paralympic record in the pentathlon. With the help of the U.S. Paralympics and the U.S. Olympic Committee, C5 has incorporated Paralympic sports into its rehabilitation program.

On a Tuesday morning late last month, Tibbs worked with Leoncio on the treadmill, watching him walk and discussing prosthetic knees and feet. "This is the carbon VSP, I just got it," Leoncio told Tibbs. He was referring to his prosthetic foot, a Flex-Foot VSP made by prosthetic manufacturer Ossur, that works well with his Rheo Knee, which contains a microprocessor and artificial intelligence capability and is also made by Ossur.

"It feels pretty good," Leoncio said. "But I've only run down the hallway."

He was determined to participate in the Army's 10-mile run, that weekend, with Tibbs by his side. "I don't want to be a Paralympic athlete but I want to be able to run and stay in shape," Leoncio said, holding the side rails of the treadmill as he looked down at his leg. "And I'd like to play golf."

Tibbs nodded in understanding and pointed to Leoncio's foot. "This is actually a great foot for golfing."

Leoncio finished the "Army 2006 Ten-Miler" in a little over three hours, having walked most of it. It would take a little more time to get used to running with a prosthetic leg and foot.

Although coaching, counseling and training are important for military amputees trying to regain their prior athletic ability, the prosthetic is vital to their success. "You can only deal with life as well as your prosthetic allows you to," said Tibbs.

To that end, C5 hired Peter Harsch as its chief prosthetist, now somewhat of a celebrity after his recent stint on the CBS reality show "The Amazing Race." Harsch has spent the last four years as senior clinical manager for Ossur and worked with U.S. Paralympic teams and amputees at Walter Reed and Brooke Army Medical Center.

"My specialty is being able to fit high-end prosthetic limbs for running, cycling and other sports," Harsch said. "It's the prosthetist that gets the patient up and walking again and enables them to achieve their goals, whether it's walking down the aisle with their fiance, playing with their kids or going back to active duty."

And, in fact, between 17 and 20 percent of amputees do return to active duty. In previous wars, that number was about 2 percent, said Capt. Brian Belnap, a U.S. Army physiatrist who transferred to San Diego from Walter Reed in Washington.

That success rate is due in part to better prosthetic technology, especially high-end artificial feet, ankles and knees with inbuilt microprocessors, which give amputees -- the majority of whom have lost lower-extremity limbs -- much more stability and speed than in the past, Harsch said.

Advances in materials also have improved prosthetics. The lightweight carbon fiber prosthetic that Tibbs uses to run is so flexible it allows its users to sprint or do distance running, Harsch said.

U.S. military amputees receive the best prosthetic technology available with virtually no financial restrictions. Yet even though some patients benefit from a good fit and can use their prosthetic immediately, for many others that process can take years.

Belnap, Harsch, Tibbs and the others at C5 know that. They are in San Diego for the long haul, working to give each amputee that comes to the center a life of quality and, ultimately, options.

"The guy I'm going to run with today, he wants to compete in the next Paralympics in China. Another guy, he has been missing his leg for a year now, and he really wants to stay on active duty. It's all about possibilities," Tibbs said.

"We just want to make sure they don't keep their leg in a corner and not use it. We want them to get out there and live their lives."

Ellie