Knowledge Gaps of the Physical Therapist With the Limb Salvage Recovery Process
Estimated Reading Time: 4 minutes
September 11, 2001, is a day that every single one of us can recall exactly where we were and what we were doing.
The tragedies that took place on this day were followed by 2 gruesome wars: Operation Iraqi Freedom (OIF) and Operation Enduring Freedom.
Due to our adversaries' use of improvised explosive devices, these wars brought with them mass casualties that we had never seen before.
US servicemen and women were returning home with missing limbs; something that we were not used to seeing.
The influx of mass causality called for immediate action to understand how to best rehabilitate the men and women.
My passion for this patient population began when my uncle reenlisted in the Army and entered OIF. I remember coming home from school every day and turning on the news to see updates from the war, praying that I would never see him on TV.
Michelle's uncle, Vinny Marchionni (left)
They would talk of warfighters returning home without limbs. The second-grade me did not understand how these men and women would ever walk again.
As years went by and the war went on, highlights from the National Naval Medical Center and Walter Reed Army Medical Center (now known as Walter Reed National Military Center) began to showcase the rehabilitation of these service members. They would show soldiers taking their first steps with their new legs and interview the rehab team. These stories were so powerful and so moving that I knew this was a line of work that I wanted to follow for the rest of my life.
We have come a long way since the early 2000s with our treatment of individuals with limb loss.
Prosthetic advancements have opened a whole new world to this population, such as the Paralympic Games and Invictus Games. There now exists a clinical practice guideline for amputation rehabilitation, and we are better suited to provide optimal care to this population.
But while we've made progress in amputation care, there seems to be a giant gap in our knowledge when it comes to limb salvage. In fact, we do not even have a solid consensus on what limb salvage even means.
I was invited to attend the 8th Department of Defense State-of-the-Science Meeting, focusing on limb salvage and recovery after blast-related injury, and had a sort of epiphany.
Throughout my time in physical therapy school, I have been focused on the wound management side of amputation (eg, postoperation incision management, blisters from poor socket fitting), and my only focus was that people with limb loss will have integumentary issues, so I better be an expert in wound management. It never really occurred to me that I may treat a patient one day after a severe trauma, who was able to keep their limb. With that realization, I was energized, curious, and eager to learn more.
This meeting had an array of professions represented, but from the rehab side of things, it was apparent that we had a huge gap in our knowledge for treating a patient whose limb was saved.
What is the proper rehab dosing for this population? What mode of rehab should we provide? When is it considered too early to weight bear? What type of frequency and intensity should we be working this population at?
The answer is we are not sure.
It seems like everyone else's major focus has been on the amputation side of things and that we missed out on the other side of traumatic limb injury: salvage. This is a crucial topic that we as physical therapists and physical therapist assistants need to understand.
As Joseph Caravalho, MD, MG (retired), president and CEO of the Henry M. Jackson Foundation for Military Medicine stated: "Our goal should be to make people want to keep their limb."
We need to identify outcome measures to use with this population to determine successful limb restoration, but also identify reasons leading to the transition of an amputation. We need to define a proper rehabilitation protocol to follow when working with limb salvage and make it applicable across all stages of rehab (acutely and long-term).
Managing this population certainly requires an interdisciplinary approach, and physical therapists should stand at the forefront—I know I will.
Michelle Jamin, SPT, is a student at Elon University. You can connect with Michelle on Twitter at @Michelle_Jamin.