title: Rehabilitation and multiple limb amputations: A clinical report of patients injured in combat.
abstract: This clinical report describes the outpatient rehabilitation program for patients with multiple limb amputations enrolled in the Comprehensive Combat and Complex Casualty Care facility at the Naval Medical Center San Diego. Injury-specific data for 29 of these patients wounded by blast weaponry in Afghanistan in 2010 or 2011 were captured by the Expeditionary Medical Encounter Database at the Naval Health Research Center and were reviewed for this report. Their median Injury Severity Score was 27 (N = 29; range, 11-54). Patients averaged seven moderate to serious injuries (Abbreviated Injury Scale scores ≥2), including multiple injuries to lower limbs and injuries to the torso and/or upper limbs. All patients received care from numerous clinics, particularly physical therapy during the first 6 mo postinjury. Clinic use generally declined after the first 6 mo with the exception of prosthetic devices and repairs. The clinical team implemented the Mayo-Portland Adaptability Inventory, 4th Revision (MPAI-4) to assess functioning at outpatient program initiation and discharge (n = 23). At program discharge, most patients had improved scores for the MPAI-4 items assessing mobility, pain, and transportation, but not employment. Case reports described rehabilitation for two patients with triple amputations and illustrated multispecialty care and contrasting solutions for limb prostheses.
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.
authors.forename: Ted
authors.initials: T
authors.lastname: Melcer
authors.affiliation: Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Jay
authors.initials: J
authors.lastname: Pyo
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.
authors.forename: Jay
authors.initials: J
authors.lastname: Walker
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quinn
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.|Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Martin
authors.initials: M
authors.lastname: Lebedda
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.|Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Kamaran
authors.initials: K
authors.lastname: Neises
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.|Comprehensive Combat and Complex Casualty Care, Naval Medical Center San Diego, San Diego, CA.
authors.forename: Christina
authors.initials: C
authors.lastname: Nguyen
authors.affiliation: Department of Medical Modeling, Simulation, and Mission Support, Naval Health Research Center, San Diego, CA.
authors.forename: Michael
authors.initials: M
authors.lastname: Galarneau
mesh_terms: D000328:Adult; D000346:Afghanistan; D000671:Amputation, Surgical / Q000534:rehabilitation*; D001186:Artificial Limbs; D001753:Blast Injuries / Q000534:rehabilitation*; D004185:Disability Evaluation; D006772:Hospitals, Military / Q000706:statistics & numerical data; D006801:Humans; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D008889:Military Personnel; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D012189:Retrospective Studies; D060726:Torso / Q000293:injuries; D034941:Upper Extremity / Q000293:injuries; D055815:Young Adult
keywords: Afghanistan conflict; case history; case management; combat injury; functional assessment; injury severity score; multiple limb amputations; outpatient rehabilitation; physical and occupational therapy; prosthetics