200 Section - The Role of a Comprehensive System of Longitudinal, Interdisciplinary Rehabilitation Care in a 23-year-old Male US Army Veteran who Sustained a Traumatic Above Knee Amputation While Volunteering in a Foreign Conflict: A Case Study.

A 21-year-old American male veteran of the US military sustained combat-related bilateral lower-extremity blast injuries while independently volunteering as foreign infantry in an active combat zone overseas. After 4-months of attempted limb-salvage he eventually underwent right transfemoral amputation. He was initially fit with a prosthesis and achieved limited prosthetic ambulation before return home interrupted care.

Prior to injury, patient led a fully-independent, highly-active lifestyle. This report describes how he was able to achieve ambitious higher-level vocational/recreational goals with help of an interdisciplinary amputation rehabilitation and prosthetics team.

Case Description:

Shortly after return to the US, the patient developed skin breakdown and residual limb discomfort due to his challenging residual limb morphology. He had not yet achieved higher level functional goals. He initially sought care in the civilian sector, however prosthetics coverage was denied by private health insurance.

Several years later, the patient established care with an interdisciplinary amputation rehabilitation and prosthetics team as part of a nationally-integrated healthcare system for Veterans and servicemembers. There, he was admitted to inpatient rehabilitation for evaluation and management of medical, rehabilitation and prosthesis needs. He was able to work regularly with physiatrists, prosthetists, physical therapists, and other experts. Numerous prosthesis approaches were trialed to address challenging residual limb characteristics. He continued work with the interdisciplinary team over following months on prosthesis-related goals and other rehabilitation and medical goals.

Discussions:

Ultimately, he was able to achieve higher-level goals including improved standing tolerance, navigating slopes/uneven terrain, ability to ascend/descend stairs step-over-step, and running. This allowed him to advance career goals and return to favorite outdoor activities.

Conclusions:

This young patient with transfemoral amputation from combat-trauma sustained while volunteering overseas initially made limited progress due to interruptions in care and coverage. He was ultimately able to meet his high-level occupational/recreational goals by working with an interdisciplinary amputation rehabilitation team.