Center for the Intrepid helps amputees reach their full potential

Also this week:

By MEGHAN PORTILLO
NCO Journal

Waking up to the sound of an explosion was not something out of the ordinary for Sgt. Edwin Gonzalez during his tour in Afghanistan. But the blast he heard before the break of dawn July 28, 2012, began a day he would like to forget.

Gonzalez uses his running leg to lift weights June 18, 2013, at the CFI. “Before, I wanted to do FBI SWAT, but this experience has changed me,” he said. “I love working out. I love training; I love training others. It’s awesome. Its great seeing someone come it not being able to walk, all scrawny and whatnot, and seeing them walk out healthy and strong.” (Photo by Meghan Portillo)
Sgt. Edwin Gonzalez uses his running prosthtic to lift weights June 18, 2013, at the Center for the Intrepid at Fort Sam Houston, Texas. “Before, I wanted to do FBI SWAT, but this experience has changed me,” he said. “I love working out. I love training; I love training others. It’s awesome. Its great seeing someone come it not being able to walk, all scrawny and whatnot, and seeing them walk out healthy and strong.” (Photo by Meghan Portillo)

Gonzalez’s unit was on a mission to create a decoy to assess the reaction of individuals in the area suspected of making improvised explosive devices. When he heard the blast, he thought it was someone clearing an IED out of the way, someone just doing their job.

But the Soldiers realized one of their own had been hit in the explosion, and the operation was immediately abandoned. Their new mission was to get their wounded comrade to safety.  Yet before Gonzalez knew it, another explosion had gone off, hitting another friend.

Gonzalez and the other Soldiers made their way to the wounded, avoiding the roads where they could.

“I woke up in a ditch,” Gonzalez recalled. “It felt like it happened instantly — at one moment, I was on my feet and the next, I was on my back.”

He had stepped on an IED made of the carbon rods found in batteries.

Gonzalez looked down and immediately realized he was in trouble. He could see a black foot through his shredded boot, his leg dangling below the knee by strands.

A buddy close behind Gonzalez called out to him, “Can you put a tourniquet on?”

After he applied the tourniquet, Gonzalez was carried to a recovery vehicle. He waited several hours for the two other wounded Soldiers before being evacuated to the nearest forward operating base.

“Thanks be to God, we are all doing well now,” he said.

From Afghanistan he was transferred to Germany, then to Fort Sam Houston, Texas. He spent about a month at the Brooke Army Medical Center before heading across the street to the Center for the Intrepid, where he continues his rehabilitation.

An outpatient facility under BAMC’s Department of Orthopaedics and Rehabilitation, the CFI provides a full spectrum of services to amputees, as well as to burn victims and limb salvage patients with residual function loss. Rehab includes physical and behavioral medicine, case management, occupational and physical therapy, wound care and prosthetic fabrication and fitting. The center uses some of the most advanced technology in the world to assist wounded Soldiers as they return to the highest possible levels of physical, psychological and emotional function. Even after suffering injuries that not too long ago would have ended their lives, many Soldiers are able to continue to serve on active duty. They may even deploy several times, proving they are as strong as ever.

A center full of hope

The state-of-the art care Gonzalez has received at the CFI has changed his life, he said.  He has been inspired by other amputees and his therapists, and now wants to help others. When he has finished his rehabilitation, he hopes to go back to school to become a physical therapist or a personal trainer.

“Before, I wanted to do FBI SWAT, but this experience has changed me. I love working out. I love training; I love training others. It’s awesome. It’s great seeing someone come in not being able to walk, all scrawny and whatnot, and seeing them walk out healthy and strong.”

Gonzalez said that even if he had known he would lose his leg, he still would have joined the Army.

“I’d do it all over again,” he said. “I have no regrets.”

The best technology and care at their fingertips

Though Gonzalez still has a lot of nerve pain, the prosthetics created for him at the CFI allow him to pursue almost any physical activity.

“They work with you for everything,” Gonzalez said. “If you want to rock climb, they have legs for that. Swimming, biking — they have legs for everything.

“I have a boxing leg. It’s pretty much a running leg with a heel in the back — like a foot with no toes. I have that bounce, but I still have leverage if I need to lean back quickly or come in for a strike. It’s pretty cool.”

Staff Sgt. Lennis Gray practices with his prosthetic June 17, 2013, by picking up clothespins and attaching them to a plastic board. Gray has been a patient at the CFI since February 2013. (Photo by Meghan Portillo)
Staff Sgt. Lennis Gray practices using his prosthetic June 17, 2013, by picking up clothespins and attaching them to a plastic board. Gray has been a patient at the CFI since February 2013. (Photo by Meghan Portillo)

In addition to in-house prosthetic fitting and fabrication, Soldiers at the CFI have access to a wide range of the best technologies to help them reach their full athletic potential.

A motion analysis lab assists specialists in detecting the slightest irregularity in a Soldier’s gait on different types of terrain. They use infrared cameras, force plates in the floor and electromyography to measure motion, ground reaction forces and electrical activity during muscle contraction. Therapists and doctors use the data to assess a patient’s progress and tailor his or her treatment.

Occupational therapists utilize the center’s fully functional model apartment to help Solders practice the skills needed for independent living. Soldiers can also immerse themselves in a 3-D, computer-assisted rehabilitation environment that uses sensors placed on the body to simulate interactive, lifelike situations on a 300-degree screen.

Physical therapists use cutting-edge sports equipment to help Soldiers regain strength and range of motion.  In addition to an indoor track, rock-climbing walls and several weight rooms, they can use an anti-gravity treadmill to gradually increase the amount of weight they bear while walking. In the natatorium, Soldiers body surf on the FlowRider, a wave simulator that helps them increase their balance and core strength.

They are not alone

Master Sgt. Dan Hendrix was first treated at a civilian hospital in Illinois after bones shot through the bottom of his foot during a parachuting accident. He went through treatments for a year to save his leg, but two staph infections eventually made amputation his only option.

“That’s when I was sent here, and thank God,” Hendrix said. “The prosthetics care I got out there compared to the prosthetics care I receive here at the CFI, it’s like night and day. At the civilian hospitals, they are not used to treating someone who wants to be so active.”

He recalled the “pirate leg” he had received from a civilian company — nothing more than a metal pole with a wooden foot at the end.

Gray uses his training socket to pick up clothespins. He controls the prosthetic’s elbow by moving his shoulder, and turns the wrist right or left by contracting his triceps or biceps. To open and close the hand, he flexes both his triceps and biceps at the same time.  (Photo by Meghan Portillo)
Gray uses his training socket to pick up clothespins. He controls the prosthetic’s elbow by moving his shoulder, and turns the wrist right or left by contracting his triceps or biceps. To open and close the hand, he flexes both his triceps and biceps at the same time. (Photo by Meghan Portillo)

“No flexibility. No bending. No moving. Nothing. Now, with this new leg, I can move, pivot. I’m part of the kayaking program, and I’m even starting to run a little bit. I just want to get back to doing everything I was doing before.”

Staff Sgt. Lennis Gray, an Active Guard Reservist, was also treated at a civilian hospital after a car accident led to the amputation of his left arm. He received a prosthetic from a hospital in Nashville, Tenn., but became discouraged by his lack of progress.

“They only gave me a four-hour block of instruction,” Gray recalled. “It was very frustrating; I could close it, but I couldn’t open it. Frankly, I didn’t even wear it much at all.”

Gray was sent to the CFI and instantly regained his motivation. He described his progress as he practiced picking up brightly colored clothespins with his training prosthetic and clipping them to a circular board hung above the table.

“I want to be able to use my prosthetic on a day-to-day basis — really use it, not just put it on for show-and-tell. I thought I would never get to that point. But now, coming here and seeing the progress of all the others, I realize it can be done.”

Gray flexed his triceps to rotate the prosthetic in the other direction.

“There were probably amputees at the hospital where I was, but I never saw one,” he said. “Then I got here, and there are so many others like me. They really encourage me because, even though they have had this misfortune, they just drive on. They are just being themselves — proud to be alive, just like I am.”

The sky is the limit

John Fergason, chief prosthetist at the CFI, watched Hendrix walk back and forth. With each step, Hendrix put his weight on the prosthetic carefully, compensating for discomfort.

Master Sgt. Dan Hendrix explains to chief prosthetist John Fergason  where he is experiencing pain. Within minutes, Fergason had reshaped the inside of the prosthetic, allowing Hendrix to walk out of the CFI pain-free. (Photo by Meghan Portillo)
Master Sgt. Dan Hendrix explains to Chief Prosthetist John Fergason where he is experiencing pain. Within minutes, Fergason had reshaped the inside of the prosthetic, allowing Hendrix to walk out of the CFI pain-free. (Photo by Meghan Portillo)

“Every time you take a step, just tell me when you feel pain,” Fergason told Hendrix.

Hendrix walked back across the room. “Now… now… now…” he said.

From the timing of the pain, Fergason knew exactly where to adjust the prosthetic. He took the leg to his shop in the next room to reshape a small section.

When Hendrix put his prosthetic back on, he was surprised the pain was completely gone. He stood with his head high and walked with a spring in his step.

“What I just did probably couldn’t be done in the field,” Fergason said, “but I train these guys how to make adjustments on their own prosthetics. If someone is deployed or is declared deployable, we set them up with extras and backups and some tools to service them.

“It’s not a career-ending situation for a lot of the guys. Some choose it to be because they can’t go back to doing exactly what they were before.  Boots-on-the-ground infantry might be difficult for someone with an above-knee amputation and an injury on their other side.  But many, like Hendrix, have no problem. NCOs should never limit them.”

Fergason said he hopes NCOs will acknowledge the capability that someone has with limb loss. He spoke of a former patient who is now leading a Ranger unit. While other Soldiers are changing socks, he changes legs or liners. But he is absolutely capable of performing all that is required of him and more, Fergason said.

“NCOs shouldn’t have a preconceived notion of what someone can or can’t do. Let them show you,” Fergason said. “They wouldn’t be back to you if they hadn’t already demonstrated that they could do it. Now that they are back, you have to trust that their rehab has been appropriate and has prepared them — otherwise, they wouldn’t be there.”

Hendrix, now on active duty and stationed at Fort Sam Houston, recently celebrated 20 years in the Army. He said that once his leg was amputated, he was astonished at his progress and at what he was capable of. It was a blessing in disguise, he said, and he is not going to let anything hold him back.

“I was in a wheelchair and on crutches for over a year,” he said.  “I was in a state of limbo — one step forward, two steps back. Now, I’m taking leaps, jumps, runs forward. I’m doing it all.”

To contact Meghan Portillo, email meghan.r.portillo.ctr@mail.mil.

Also this week:

Fergason molds a prosthetic in his shop June 17, 2013, at the CFI. (Photo by Meghan Portillo)
Fergason molds a prosthetic in his shop June 17, 2013, at the CFI. (Photo by Meghan Portillo)

Staff Sgt. Ty Carter receives Medal of Honor at White House

By J.D. LEIPOLD
Army News Service

Staff Sgt. Ty Michael Carter became the second Soldier to receive the nation’s highest military award for extraordinary gallantry and selfless actions during the Battle of Kamdesh at Combat Outpost Keating, Afghanistan, on Oct. 3, 2009.

After telling the story of the ambush, which raged for 13 hours between 53 Soldiers and some 300 Taliban, and citing Carter’s complete disregard for his own safety, President Barack Obama draped  the Medal of Honor around the 33-year-old Cavalry scout’s neck in the White House East Room on Monday.

Near the Pakistan border, the Keating battle was the first since the Vietnam War in which two living service members received the Medal of Honor for their individual actions in the same battle. Staff Sgt. Clinton Romesha was presented the Medal of Honor on Feb. 11, 2013.

Carter braved merciless enemy fire from rocket-propelled grenades, anti-aircraft machine guns, mortars and small-arms by running the 100-meter length of the outpost twice to retrieve ammunition for his fellow Soldiers. At the same time he provided suppressive fire to keep the enemy from over-running the post. Then, with complete disregard for his own safety, and in spite of wounds, he discarded his M-4 and ran to a critically wounded Soldier, rendered life-extending first aid. He carried the Soldier to medics as Romesha and his team provided cover.

The battle would end the lives of eight Soldiers. An additional 25 others suffered wounds.

Before the citation was read, Obama recalled Carter’s words to him earlier in the day, then asked the Soldiers from his unit — the 61st Cavalry Regiment — to stand and be recognized along with the families of the eight fallen Soldiers.

“Ty says, ‘This award is not mine alone,'” the president said. “The battle that day, he will say, was ‘one team in one fight,’ and everyone ‘did what we could do to keep each other alive.’ And some of these men are with us again. And I have to repeat this because they’re among the most highly decorated units of this entire war: 37 Army Commendation Medals, 27 Purple Hearts, 18 Bronze Stars for their valor, nine Silver Stars for their gallantry.”

Obama took a few minutes to address not only Carter’s courage on the battlefield, but the courage to seek help for what he finally accepted and recognized in himself as post-traumatic stress.

“As Ty knows, part of the healing is facing the sources of the pain,” Obama said. “So now he wants to help other troops in their own recovery. And, it is absolutely critical for us to work with brave young men like Ty to put an end to any stigma that keeps more folks from seeking help.

“So let me say it as clearly as I can to any of our troops or veterans who are watching and struggling: Look at this man. Look at this Soldier. Look at this warrior. He’s as tough as they come. And, if he can find the courage and the strength, to not only seek help, but also to speak out about it, to take care of himself and to stay strong, then so can you. So can you.”

President Barack Obama places the Medal of Honor around the neck of Staff Sgt. Ty Michael Carter during a ceremony Monday at the White House. (Photo by Staff. Sgt. Bernardo Fuller)
President Barack Obama places the Medal of Honor around the neck of Staff Sgt. Ty Michael Carter during a ceremony Monday at the White House. (Photo by Staff. Sgt. Bernardo Fuller)

Center for the Intrepid program trains wounded Soldiers to run again

Also this week:

By MEGHAN PORTILLO
NCO Journal

Master Sgt. Tim Crusing dug his toes into the carpet and took off running down the hallway, a smile across his face.

Prosthetist Ryan Blanck examines the fit of Tim Cursing's Intrepid Dynamic Exoskeketal Orthosis and knee brace June 17, 2013, at the Center for the Intrepid at Fort Sam Houston, Texas. Blanck created the IDEO to help limb-salvage patients regain their ability to run. (Photo by Meghan Portillo)
Prosthetist Ryan Blanck examines the fit of Master Sgt. Tim Crusing’s Intrepid Dynamic Exoskeketal Orthosis and knee brace June 17, 2013, at the Center for the Intrepid at Fort Sam Houston, Texas. Blanck created the IDEO to help limb-salvage patients regain their ability to run. (Photo by Meghan Portillo)

He had just met with prosthetist Ryan Blanck for a fitting of his Intrepid Dynamic Exoskeletal Orthosis, or IDEO, a device used by Soldiers who have trouble walking or standing because of lower leg injuries. Crusing is not an amputee, but the IDEO he wears resembles a prosthetic. It is worn over his injured leg, allowing him to run once more.

Crusing laughed. “This feels great. Can I get one for my good leg?”

After suffering a severe wound to his leg during training and then breaking it while hiking years later, doctors had told Crusing they might need to fuse his ankle, which would have taken away his range of motion. But Crusing refused to give up hope and opted for a less aggressive, cutting-edge approach. His doctor, who had completed his residency at the Center for the Intrepid (CFI), part of the Brooke Army Medical Center at Fort Sam Houston, Texas, sent Crusing there for an evaluation. Crusing was thrilled to learn he was approved as a candidate for the center’s Return to Run Clinical Pathway.

Whether Soldiers want to get back to the fight or simply want to be able to chase their kids around the backyard, the Return to Run program changes their lives.  For now, the IDEO is only available at the CFI.  As more become aware of what the device can do, the program has remained at capacity, and several new participants join each week to learn to use the IDEO and train their muscles to run again.

“Don’t think that this is just for someone who has had a traumatic injury like a limb salvage from a blast injury,” said Johnny Owens, a physical therapist and director of limb salvage rehabilitation at the CFI. “Now we’re really getting a lot more who have bad arthritis or an ankle sprain from a jump and just can’t run any more. If there is any lower leg pain or loss of leg power, that individual may be a candidate for the program.”

The start of something new

Prosthetic orthotic technician Megan Wright, left, constructs a hip brace, while Richard Perez, also a prosthetic orthotic technician at the CFI, works on an IDEO.  (Photo by Meghan Portillo)
Prosthetic orthotic technician Megan Wright, left, constructs a hip brace, while Richard Perez, also a prosthetic orthotic technician at the CFI, works on an IDEO. (Photo by Meghan Portillo)

In 2008, Owens and Lt. Col. Joseph Hsu, an orthopedic surgeon at the U.S. Army Institute of Surgical Research, noticed that though new surgical techniques were allowing many wounded warriors to keep their legs, the Soldiers often returned years later requesting amputations. Soldiers expressed disappointment because of the limitations imposed on them by their injuries, and envied the amputees who were able to run, jump, climb, participate in active sports and remain on active duty.“They wanted to amputate because of their inability to run,” Owens said. “There were a lot of reasons why they were not able to run — they didn’t have power in their legs from their injury, the joint was too destroyed and they had a lot of pain, or they didn’t have the range of motion they needed at the foot and ankle. We needed a solution.”

Hsu and Owens shared their ideas with Ryan Blanck, a prosthetist at the CFI. Using inspiration from an amputee’s running prosthetic, Blank created the IDEO, an energy-storing device that is worn over the injured leg and supports the foot and ankle.

The device can fit into boots or tennis shoes, with a foot and ankle plate connected by carbon-fiber rods to a cuff below the knee. When the foot hits the ground, the IDEO cycles the energy and delivers it back to propel the individual forward.

Patients’ success with the device increased dramatically with intense rehabilitation and instruction on how to use it correctly, so Owens integrated use of the IDEO into the CFI’s existing rehabilitation program to create the Return to Run Clinical Pathway.

A life-changing program

Every IDEO is custom-made. Initially, each Soldier is evaluated by either Blanck or John Fergason, director of prosthetics at the CFI. Using a mold of the Soldier’s leg, they create a temporary, plastic version of the device.  The Soldier wears the plastic IDEO to ascertain its effectiveness, and is given a physical therapy evaluation by Owens. Together the team decides if an individual is a good candidate for the program. Crusing, whose injuries made him an ideal fit for the program, recalled the liberation he felt the first time he tried on the IDEO.

 

Joseph Mallett, right, a physical therapy assistant, shows Staff Sgt. Krish Lalu how to correctly perform an exercise as part of the Return to Run Clinical Pathway program June 17, 2013, at the Center for the Intrepid at Fort Sam Houston, Texas. On each leg, Lalu wears an IDEO, a device developed at the CFI to help wounded warriors run again. (Photo by Meghan Portillo)
Joseph Mallett, right, a physical therapy assistant, shows Staff Sgt. Krish Lalu how to correctly perform an exercise as part of the Return to Run Clinical Pathway program June 17, 2013, at the Center for the Intrepid at Fort Sam Houston, Texas. On each leg, Lalu wears an IDEO, a device developed at the CFI to help wounded warriors run again. (Photo by Meghan Portillo)

“Just putting on that fragile plastic mold of the IDEO, it was the first pain-free step that I had taken in 12 years,” he said. “I almost broke down. … I have pain every day, but when I’m wearing it, it immediately takes it away.”

Command Sgt. Maj. Rory L. Malloy, commandant of the U.S. Army Sergeants Major Academy at Fort Bliss, Texas, had a similar experience. During a training exercise June 16, 1995, Malloy stepped on a tree branch while carrying a fellow Soldier, breaking his own leg in seven places. Luckily, a surgeon was able to save Malloy’s leg, and he remained on active duty. But over the years, he developed debilitating arthritis in his ankle.

“I told my surgeon, Dr. Justin Orr in El Paso, ‘Either cut my leg off or fix it. I can’t handle the pain anymore,’” Malloy said. “That’s how bad it got.

“The only options were to live with the pain, amputate the leg or cut the ankle out and do a fusion — put a few cadaver parts in. So that’s what I went with, and all of the expectations that I had for the surgery were exceeded by far. Dr. Orr is just a phenomenal surgeon.”

Malloy said though the surgery relieved more than 80 percent of his pain, he would not be able to walk normally and would never be able to run again. However, the IDEO changed all of that. Eighteen years after his injury, he is learning how to run again and is 100-percent pain-free.

“Before, I always had to think about what I couldn’t do,” Malloy said. “My daughter would say, ‘Hey dad, let’s go out and shoot some hoops,’ or ‘Let’s go for a hike.’ Well, I couldn’t. When my wife and I would go to the mall, we always had to figure out where we could park, what doors we could go into that had benches nearby for me to rest my foot.

“Now, I go out and I walk all day without any pain. I’m able to ride a bicycle now; we are going rock climbing this Friday. I’m able to throw a rucksack on and do all of the military stuff I used to do. They have given me my life back.”

Rehabilitation: Pushing the limit

Four to six weeks after Soldiers’ initial trip to the CFI, a carbon and fiberglass version of the device is made, and they return to the center for about a month of physical therapy and training. Malloy emphasized that this period of instruction and rehab is as important as the IDEO itself.

Lalu, left, and Master Sgt. Tim Cursing wear IDEOs as they exercise the muscles they need to run during the Return to Run program in June 2013 at the CFI. (Photo by Meghan Portillo)
Lalu, left, and Crusing wear IDEOs as they exercise the muscles they need to run during the Return to Run program in June 2013 at the CFI. (Photo by Meghan Portillo)

“It has taken months for me to get this far, and it may be even another year before I can run 2 miles,” he said. “The instruction Soldiers receive through the Return to Run program sets them up for success. Without that time and training, they will not be able to reap the benefits of the IDEO.”

As muscles change and grow, the IDEO needs to be altered. During participants’ time in the program, it is continuously adjusted to provide a comfortable fit.

“As you go through the training, it’s like a prosthetic — you have to tweak it,” Owens said. “At the end of the training, we hope to have a perfectly fitting device.”

Soldiers work hard during training to push themselves to their limits, because if something goes wrong with the IDEO, therapists hope it will happen while they are at the center so corrections can be made.

“Your body changes, and you don’t really know what you need until you try it out,” Crusing said. “That’s one of the reasons the Return to Run program is so important. You have to come here and use it in a pretty vigorous fashion in order to figure out what’s going to work for you. Plus, if you adjust anything, it will affect other things. With each adjustment, it gets better.”

Training begins with simple but clear instruction on how to step with the device; Soldiers are taught how to use their hips, to keep their weight forward and to not turn out their feet. As they progress, they begin to exercise harder, jumping from side to side and strengthening their legs with weight training. Wearing the IDEO, they work the muscles they need to run.

Crusing and Staff Sgt. Krish Lalu were among the Soldiers training in the program on a hot July afternoon. Sweat ran down the Soldiers’ foreheads as therapists led participants in exercises to challenge their bodies and the IDEO. They hopped over obstacles, participated in boxing drills and sprinted as fast as they were able, planting their feet firmly in the grass as they turned sharply around the trees.

Lalu, who had lost 85 to 90 percent of both shin muscles due to a late diagnosis of compartment syndrome, said he was no longer on medication, and no longer in pain.

The IDEO’s footplate and ankle brace are connected by carbon-fiber rods to a cuff below the knee. When the foot hits the ground, the IDEO cycles the energy and delivers it back to propel the individual forward. (Photo by Meghan Portillo)
The IDEO’s footplate and ankle brace are connected by carbon-fiber rods to a cuff below the knee. When the foot hits the ground, the IDEO cycles the energy and delivers it back to propel the individual forward. (Photo by Meghan Portillo)

“Right now, only my pride hurts,” he said after finishing the outside group exercises. “It’s so hot out there, and some of those exercises are quite challenging.”

Participants’ levels of fitness and ability varied widely. Some had injuries more serious than others, but the looks of determination made it clear that each was there for a purpose ­— they were there to run.

Because Lalu lacks strength in his shin muscles, his toes flop to the ground first when he walks. The IDEO forces him into a normal gait, and he has now been cleared to return to a conventional unit. He reports in September to the 82nd Combat Aviation Brigade at Fort Bragg, N.C.

“I’m looking forward to it,” Lalu said. “It will be a miracle if I can work myself up and go to jump school. That gives me something to strive for.  Jumping won’t be a problem, but I need to work on my running. That’s the only thing that scares me — being able to keep up with the running that is required at Airborne school.  If I can overcome that hurdle, then I should breeze through it.”

Joseph Mallett, a physical therapy assistant and contractor at the CFI who is also a staff sergeant in the Army Reserve, explained that the program concentrates on running as the basis for other activities.

“Running is pretty much the starting point for any activity, whether it is Airborne, air assault, or whether they want to do triathlons,” Mallett said. “It’s inspiring. They are able to use this as a platform.”

Mallett said many in the program haven’t run in years. They are encouraged by the progress of others in the program or of the amputees they see at the CFI, and they make new goals for themselves. Mallet said he often sees participants reach levels of fitness far beyond what they had achieved before their injury.

“They go on a lot of trips such as skiing, hiking, skydiving or kayaking,” he said. “They push themselves to reach new goals, and having someone else there who has a similar injury is more inspiration. They drive a little bit harder together.”

Program participants return to the CFI several weeks after finishing their training to pick up a backup IDEO as well as a thinner, lightweight version that can be worn in dress shoes. If they feel they need more practice and if their unit approves, Soldiers may stay a few extra weeks for more training. Once they leave with their backup device, they usually only return to the CFI for replacements or adjustments.

Back in action

Many factors influence a wounded Soldier’s decision to remain in or leave the military, but the ability to run is often the deciding factor for whether he or she is allowed to stay on active duty or considered for medical discharge, Owens said.

More than 450 Soldiers have received IDEOs and participated in the Return to Run Clinical Pathway since the program’s inception. Of the first 146 who went through the program, Owens said 51 percent returned to active duty.

Many of those who have returned to their units have deployed several times, and they bring back a wealth of information that helps the CFI team improve the IDEO.

“Anytime one of our guys is deployed, we try and get a breakdown of how things went,” Owens said. “One thing a lot of them said was that with fast-rope operations, they felt like their knee might buckle. So we built a knee portion specifically for fast roping and jumping. Some said the device was busting through their shoes, so we are working with New Balance to develop a new shoe design — more robust to hold up to it.  What they tell us after these deployments is huge, because it’s all brand new.”

 ‘Give Soldiers the opportunity to heal’

While Malloy was training at the CFI, he saw a young recruiter come into the program with only a week to get the IDEO and learn how to use it. Malloy said he was enraged when the recruiter’s commander called and said, “It must be nice just to get to do PT every day.” Malloy said he called that commander and had a chat with him.

Lalu, right, practices boxing drills with an instructor during the Return to Run program June 17, 2013, at the CFI. The drills teach program participants how to properly use their hips while wearing the IDEO. (Photo by Meghan Portillo)
Lalu, right, practices boxing drills with an instructor during the Return to Run program June 17, 2013, at the CFI. The drills teach program participants how to properly use their hips while wearing the IDEO. (Photo by Meghan Portillo)

“Participating in the Return to Run program for at least 3 to 4 weeks is critical,” he said, “because you get the strength back, you understand the device, you learn how to use it so it doesn’t become something that just sits on a bookshelf when you leave here.

“A lot of senior leaders in our Army will talk a good game, but it’s much harder to step up to the plate and actually do it. If you have someone who is injured, embrace the situation and give them the opportunity to heal. In my case, my senior leaders have allowed me to get the surgery and have time for recovery and to get the IDEO. Not all Soldiers are afforded that opportunity, because some leaders are being very narrow-minded.”

Malloy emphasized that if leaders give their Soldiers the time and the tools they need to recover, in return they will get back a stronger Soldier who can actually perform. Without that support, Soldiers will be limited in what they can do for the Army.

“I’m very blessed that I have Sgt. Maj. of the Army Raymond Chandler, John Sparks and other folks who have supported me in getting through this,” Malloy said. “SMA Chandler is a great example of the leadership we need all the way across our force. He could have easily said, ‘Hey, you’re broken; you are going to be out for a month getting the surgery and another month getting the IDEO. I need a commandant full-time, so I’m going to have to replace you.’ He could have done that, but he didn’t. Instead, he encouraged me to come down here to the CFI and get myself fixed so that I can get back into the fight and continue to serve.”

Could this be for me?

If you think you might be a good candidate and could benefit from the Return to Run Clinical Pathway, contact your primary doctor for a referral. For more information about the program, contact the CFI at 210-916-6100. To visit the BAMC website for more information about the CFI, click here. →

To contact Meghan Portillo, email meghan.r.portillo.ctr@mail.mil.

Also this week:

For 30 years, AFAP has brought quality-of-life issues to forefront

By J.D. LEIPOLD
Army News Service

Just over 30 years ago, on Aug. 15, the Army reached out to its entire family — active and reserve-component Soldiers, their families, retirees, survivors and civilian employees, asking them to identify quality-of-life issues and concerns for review and resolution by Army senior leadership.

It was in 1983 when a ground-breaking white paper on the importance of increasing support to the Army family by then Chief of Staff of the Army Gen. John A. Wickham Jr., put into motion the Army Family Action Plan, or AFAP.

Since inception, AFAP has reviewed 692 quality-of-life issues and resolved 520 of them while classifying 158 as unattainable. Additionally, the plan has been the driving force behind the enactment of 128 pieces of legislation and 184 Department of Defense and U.S. Army changes, while improving 208 programs and services.

Throughout those 30 years, AFAP sponsored traditional conferences at 8th Army in South Korea; U.S. Army Pacific in Hawaii and U.S. Army Europe in Germany. Installations and garrisons within each of those command structures sent representatives to voice quality-of-life concerns and issues which would then be evaluated and forwarded to Washington.

The review process could be laborious and take nearly 18 months to filter through to the Army staff for final approval or disapproval.

As a result of the Army budget crunch and restrictions on travel and conference funding, AFAP made the decision in the spring to move away from the three regional conferences and instead streamline the reporting procedures down to a two-stage process.

“As we transform to a garrison-based Army faced with unprecedented financial constraints, we need the voice of our customers to help guide and validate the changes the Army is making,” said Christina Vine, who oversees the Headquarters Department of the Army AFAP program, and who is also an Army spouse and mother of twin youngsters.

“Without a successful ground-level AFAP program, the voice of our customers is silenced and senior leaders lose essential situational awareness of what is and is not working in our communities,” she said.

Following local garrison and tenant command AFAP conferences, prioritized issues requiring higher headquarters resolution will be forwarded directly to the assistant chief of staff for installation management, or ACSIM. This does away with running issues through mid-level commands.

Vine said ACSIM leadership would coordinate with the Army staff to consolidate similar issues, then prepare information papers on which of those are viable. A cross-section of constituents from select Army commands will next prioritize the Army staff-vetted issues and return those to ACSIM who tallies and enters the top issues into the AFAP resolution process.

Action officers work the issues and report their progress during reviews chaired by the ACSIM. Those are then reviewed and possibly closed out through the general officer steering committee chaired by the Army vice chief of staff.

Vine said the new process is expected to reduce the resolution time for issues from 18 months to only six. Additionally, she said, it’s expected that 90 percent of AFAP issues will remain at the garrison or unit level for resolution because they’re garrison-specific policies and procedures.

A few issues presently being reviewed include behavioral health care providers for children; an out-of-area TRICARE 24/7 one-call resolution process that would help beneficiaries DOD-wide; funding of service dogs for wounded warriors; an out-of-the-continental U.S. sex offender registry; and a recommendation to extend from one to three years the time a survivor can invest a Military Death Gratuity and Service Members’ Group Life Insurance into a Roth Individual Retirement Account or a Coverdell Education Savings Account. On the latter, grief studies recommend that life-altering decisions not be made during the first year after the loss of a service member.

“We just closed an issue on the application process for citizenship and residency for Soldiers and families and basically that means they can do all their necessary physicals, fingerprints and everything they would normally have to do at an immigration office at their local military installation,” Vine said. “That’s a huge good-news story for a lot of our service members and their spouses because now they don’t have to make that trek to the immigration office.

“The big thing is we’re retaining the voice of the customer; the foundation in that the customer is still creating the issues,” she said. “Thirty years ago, General Wickham asserted a healthy family environment allows Soldiers to more fully concentrate on their mission, so he set about wanting to get feedback on what could be improved to enhance their standard of living and that’s how we started improving quality of life.”

August 1900: Chaplain assistant leads charge up wall

By MICHAEL L. LEWIS
NCO Journal

As the only chaplain assistant to be awarded the Medal of Honor, Calvin Pearl Titus is often cited as a model of bravery and selflessness. Yet, his award for daring gallantry — during combat in China when he was a corporal — actually came at the start of a long Army career of assisting chaplains in ministry, whether as an official chaplain assistant or not.

Cpl. Calvin Pearl Titus
Cpl. Calvin Pearl Titus

Titus was born Sept. 22, 1879, to Calvin and Cora Smith Titus in the eastern Iowa hamlet of Vinton, but moved to Oklahoma at age 11 after his parents died. There, he lived with his aunt and uncle, both evangelists with the Salvation Army and later with the Pilgrim Holiness movement.

Titus learned to play various instruments as a part of his uncle’s traveling church band. During one church meeting in Vermont in 1898, Titus learned of the sinking of the battleship USS Maine, which prompted him to join the 1st Vermont Volunteer Infantry as a musician during the Spanish-American War. His unit, however, never deployed before the war ended.

After the war, hearing troops were needed in the Philippines, Titus enlisted in the regular Army and was assigned as a bugler to E Company, 14th Infantry Regiment, based near Manila. “When they discovered that I played the cornet,” he wrote, “I was in. ‘We’re needing a bugler, and you’re it.’ ”

With his ministerial background, Titus was able to form a long friendship with the unit’s chaplain, Leslie R. Groves Sr., a Presbyterian minister from New York. Titus recalled in a letter to Groves more than 60 years later that they “took to each other at once and became fast friends.” At companies around Manila, Titus became Groves’ unofficial assistant and provided music for services. “I got a violin,” Titus wrote, “and played the tunes for the songs sung at each place.”

In 1899, the Society of Righteous and Harmonious Fists, known as the “Boxers,” began attacking foreign missions in China, killing hundreds of missionaries and thousands of Chinese Christians. Their rebellion eventually made its way to the capital, Peking (modern day Beijing), where the group focused its efforts on destroying the part of the city housing foreign embassies and legations. A coalition force of nearly 50,000 Soldiers from eight countries was sent to rescue the city and to help quash the insurrection.

On Aug. 14, 1900, Titus and the rest of the 14th Infantry Regiment arrived at the Tung-Pien Gate along Peking’s eastern outer wall and immediately encountered heavy fire from atop the wall and adjacent Fox Tower. Needing troops to scale the 30-foot fortification and lay down suppressive fire, the unit’s commander, Col. Aaron S. Daggett, called for volunteers. Titus immediately stepped forward, saying, “I’ll try, sir!”

Carrying a rope, Titus began climbing the jagged wall. “I took off all my equipment: haversack, canteen, pistol, belt and hat, and started up,” he recalled later. “The wall was made of brick of some kind … the mortar had fallen out in places making it possible for me to get finger and toeholds in the cracks. About halfway up, a convenient bush grew out of the bricks and that also helped some. At last, I got to a point where I could look through one of the notches or firing ports at the top of the wall. It was empty. I slid over the top and onto the floor behind. To my surprise, I saw no one.”

Daggett later described watching the treacherous climb from below. “With what interest did the officers and men watch every step as he placed his feet carefully in the cavities and clung with his fingers to the projecting bricks! The first 15 feet were passed over without serious difficulty, but there was a space of 15 feet above him. Slowly he reaches the 20-foot point. Still more carefully does he try his hold on those bricks to see if they are firm. His feet are now 25 feet from the ground. His head is near the bottom of the embrasure. All below is breathless silence. The strain is intense. Will that embrasure blaze with fire as he attempts to enter it? Or will the butts of rifles crush his skull? Cautiously, he looks through and sees and hears nothing. He enters, and as good fortune would have it, no Chinese are there.”

"I'll Try, Sir!", a painting by H. Charles McBarron Jr., depicts Cpl. Calvin P. Titus atop Peking's outer wall during the 14th Infantry Regiment's seige of the city in August 1900. (Photo courtesy of U.S. Army Center of Military History)
“I’ll Try, Sir!”, a painting by H. Charles McBarron Jr., depicts Cpl. Calvin P. Titus atop Peking’s outer wall during the 14th Infantry Regiment’s seige of the city in August 1900. (Photo courtesy of U.S. Army Center of Military History)

After reaching the top unharmed, the rest of his company followed, hauling up their rifles and ammunition belts by a rope made of rifle slings. Soon after, the American colors were hoisted atop the wall, inspiring the allied Soldiers to complete their assault, overtake the gate and enter the city.

Although both Titus and Groves were recommended for the Medal of Honor for heroic actions during the siege, only Titus was awarded the accolade; Groves received an “honorable mention.” Yet, that did not faze the chaplain, who continued to praise his de facto assistant. “He is,” Groves wrote to his wife, “a modest chap, fine looking and afraid of nothing but wrongdoing.”

Titus’ fearlessness soon earned him an appointment to the United States Military Academy, where as a first-year cadet, he was presented the Medal of Honor by President Teddy Roosevelt during West Point’s centennial celebration in 1902. The citation simply read, “[For] gallant and daring conduct in the presence of his colonel and other officers and enlisted men of his regiment; was first to scale the wall of the city.”

“Now, don’t let this give you the big head!” Roosevelt reportedly said. After the ceremony, a second-year cadet named Douglas MacArthur approached Titus, looked at his medal and commented, “Mister, that’s something!”

Upon graduating in 1905, Titus returned to the 14th Infantry in the Philippines as a second lieutenant. He later followed in his mentor’s footsteps, becoming an ordained minister in 1909.

His desire to become an Army chaplain was thwarted, however, as his denomination was not yet recognized by the Army. Instead, he made the decision to, as an officer, change his career field to chaplain assistant in order to continue in ministry to Soldiers; the occupational specialty was officially introduced the year he was ordained. Nearly six decades after Titus’ decision, his church would merge to form the Wesleyan Church in 1968, now among the more than 200 denominations recognized in the U.S. armed forces.

Groves’ son, Leslie R. Groves Jr., would go on to lead the Manhattan Project as a lieutenant general. Titus himself spent 32 years in the Army, including fighting forest fires in Montana, chasing Pancho Villa through northern Mexico, rebuilding France after World War I and teaching Reserve Officer Training Corps cadets at Coe College in Cedar Rapids, Iowa, just miles from his hometown. He retired in 1930 as a lieutenant colonel and died at the Veterans Hospital in San Fernando, Calif., on May 27, 1966, at the age of 86. He is buried at Forest Lawn Memorial Park in the Hollywood Hills section of Los Angeles.

Titus’ famous reply — “I will try, sir!” — became the rallying cry of the 14th Infantry Regiment, and the official motto of the 5th Infantry Regiment. Also in his honor, the Military Sealift Command named a container ship, the MV Ltc. Calvin P. Titus, which is used to carry sustainment cargo to U.S. military units around the globe.

The ship is based in Saipan in the Northern Mariana Islands, the closest major port in the United States to where its namesake earned the Medal of Honor a century earlier.