Bracing the Intrepid

The U.S. Army had a problem:
The majority of its
soldiers’ combat wounds
sustained while serving in
Operation Enduring Freedom
in Afghanistan and
Operation Iraqi Freedom
were extremity wounds.
Explosive injuries with open
fractures, collectively referred
to as high-energy lower-extremity
trauma (HELET),
were commonplace. Advances
in surgical techniques
allowed attempted
salvage procedures for many
of these limbs. However,
the commonly accepted
standard of a successful
limb salvage procedure-
pain-free standing and walking-
was inadequate for this
highly active group, many of
whom wanted to return to
active duty. Further, patients
who underwent limb salvage
were doing their rehabilitation
side by side with
those who had experienced
lower-limb amputations
and watching them return
to higher levels of function
much more quickly. Established
orthotic technologies
were attempted, including
off-the-shelf (OTS) plastic
and carbon fiber AFOs and
custom carbon fiber AFOs,
but proved inadequate to
restore these soldiers to their
desired levels of function.
So the rehabilitation team at
Brooke Army Medical Center’s
Center for the Intrepid
(CFI), San Antonio, Texas,
developed its own energy-storing
carbon fiber orthosis,
the Intrepid Dynamic Exoskeletal
Orthosis (IDEO).
This article reviews a series
of publications outlining the
development of the IDEO;
the levels of functional
return experienced by some
of its users; comparative
outcomes between it and
other orthoses; and the role
that the associated training
appeared to play in overall
rehabilitation.