RAISING THE BAR: EXTREMITY TRAUMA CARE
Fred A. Cecere, MD
Steven J. Stanhope, PhD
Kenton R. Kaufman, PhD
Bill W. Oldham, MBA
COL John C. Shero, MS USA (Ret)
COL James A. Mundy, MS USA (Ret)
SPECIAL ISSUE – Supplement to Military Medicine, Volume 181, Number 11/12
Fred A. Cecere, Bill W. Oldham
Christopher A. Rábago, Mary Clouser, Christopher L. Dearth, Shawn Farrokhi, Michael R. Galarneau,
M. Jason Highsmith, Jason M. Wilken, Marilynn P. Wyatt, Owen T. Hill
The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium:
Reaching in Partnership for Optimal Orthopaedic Rehabilitation Outcomes
Steven J. Stanhope, Jason M. Wilken, Alison L. Pruziner, Christopher L. Dearth, Marilynn Wyatt, Gregg W. Ziemke,
Rachel Strickland, Suzanne A. Milbourne, Kenton R. Kaufman
The Center for Rehabilitation Sciences Research: Advancing the Rehabilitative Care for
Service Members With Complex Trauma
Brad M. Isaacson, Brad D. Hendershot, Seth D. Messinger, Jason M. Wilken, Christopher A. Rábago,
Elizabeth Russell Esposito, Erik Wolf, Alison L. Pruziner, Christopher L. Dearth, Marilynn Wyatt, Steven P. Cohen,
Jack W. Tsao, Paul F. Pasquina
Daniel J. Stinner
Christopher A. Rábago, Jason M. Wilken
Shawn Farrokhi, Brittney Mazzone, Adam Yoder, Kristina Grant, Marilynn Wyatt
M. Jason Highsmith, Jason T. Kahle, Rebecca M. Miro, Derek J. Lura, Stephanie L. Carey, Matthew M. Wernke,
Seok Hun Kim, William S. Quillen
Functional Outcomes of Service Members With Bilateral Transfemoral and Knee
Disarticulation Amputations Resulting From Trauma
Barri L. Schnall, Yin-Ting Chen, Elizabeth M. Bell, Erik J. Wolf, Jason M. Wilken
Anne M. Andrews, Christina Deehl, Reva L. Rogers, Alison L. Pruziner
Billie J. Randolph, Leif M. Nelson, M. Jason Highsmith
M. Jason Highsmith, Leif M. Nelson, Neil T. Carbone, Tyler D. Klenow, Jason T. Kahle, Owen T. Hill, SP USA,
Jason T. Maikos, Mike S. Kartel, Billie J. Randolph
Descriptive Characteristics and Amputation Rates With Use of Intrepid Dynamic Exoskeleton
Owen Hill, Lakmini Bulathsinhala, Susan L. Eskridge, Kimberly Quinn, Daniel J. Stinner
AMSUS - The Society of Federal Health Professionals should not be held responsible for statements made in its publication by contributors or advertisers.
Therefore, the articles reported in this supplement to MILITARY MEDICINE do not necessarily reﬂ ect the endorsement, ofﬁ cial attitude, or position of AMSUS or
the Editorial Board.
Elizabeth Russell Esposito
Michelle Mattera Keon
Christopher A. Rabago
Rachel A. Strickland
“Raising the Bar” in Extremity Trauma Care:
A Story of Collaboration and Innovation
Fred A. Cecere, MD; Bill W. Oldham, MBA
’s military health system is working in remarkable
injured service members reach their highest level of function.
The difference in outcomes as a result is staggering. In the
1980s, only 2% of soldiers remained on active duty following
limb loss, despite relatively minor injuries such as a partial
By 2010, 19% of service members
major extremity trauma. About 25% of this group actually
returned to theater, even though their injuries were much
more devastating than those suffered during previous con
Wounded soldiers now have access to cutting-edge tech-
at realizing optimal outcomes for a population already used
to performing at high levels. The approach is holistic and
family centered, focusing more on the patient
’s ability than
disability. Best of all, advances in the care of these patients
ﬁts to other injured service members as well as the
This work is possible because of the synergies that exist
between programs operating through the Department of
Defense (DoD) and the U.S. Department of Veterans Affairs
(VA) across the patient care spectrum. The result is comple-
mentary rather than competing care that begins at the point
of injury and continues for the rest of a patient
pedic rehabilitation care have been bolstered by three sepa-
rate but interconnected programs that have identi
that translate research advances into clinical care for patients
with traumatic extremity injuries.
The Extremity Trauma and Amputation Center of Excel-
lence (EACE) was created by Congressional mandate as a
joint enterprise between the DoD and the VA to develop a
comprehensive strategy to help service members with trau-
matic injuries optimize their quality of life.
The Center for Rehabilitation Sciences Research (CRSR)
was established to advance the rehabilitative care for service
members with combat-related injuries while also educating
the next generation of military medicine professionals.
The Bridging Advanced Developments for Exceptional
Rehabilitation (BADER) Consortium was developed as
a research capacity building program to further establish
research infrastructures and investigators at DoD and VA sites
and to launch a series of multiteam clinical research initiatives.
These programs operate independently, but they are
designed to be interdisciplinary and collaborative in nature.
This complementary approach is re
ﬂective of the efforts by
the DoD to address the complex health needs of the combat
wounded before they reach the VA, which has already had
an established amputee and rehabilitation science program.
Together, they provide a unique opportunity to strengthen
DoD/VA research programs and in
ﬂuence the long-term
direction of care for this unique patient population.
It is an approach that is working, as evidenced by a 2015
report by the Defense Health Board on the sustainment and
advancement of amputee care.
It found that the DoD is
amputee science and care through its infrastructure, systems
” That same report also reiterated the need
for collaborations between institutions, practitioners, and
researchers across disciplines and organizations in order to
sustain these advancements.
Whether it is team members from the EACE and the
BADER Consortium embedding at military treatment facilities
(MTFs) to help answer clinically relevant questions and support
research in high-priority areas or CRSR staff working to
ﬁne and validate rehabilitation strategies for injured service
wounded warriors get back to the life they were living
before their traumatic injuries.
By working collaboratively, researchers do not have to
give up their autonomy. Indeed, each domain of rehabilita-
tion care can and should be able to work independently.
The resultant creativity and energy is evidenced by the
myriad of research projects already underway at MTFs and
VA centers around the country. These researchers are not
constrained by working toward the same goal
patients regain their highest functional levels
they are empowered to meet those goals in different ways.
One project funded by the Defense Medical Research and
Development Program and supported by the EACE and
BADER focused on preventing falls in service members
with amputations through the use of advanced rehabilitation
At CRSR, they are
management strategies that can improve the quality of life
for patients with severe combat injuries. The BADER Con-
sortium supports the goal of optimal outcomes by providing
needed administrative assistance and infrastructure support
to help address important gaps in clinical orthopedic rehabil-
itation research and patient care.
Thought Leadership and Innovation Foundation, 16775 Whirlaway
Court, Leesburg, VA 20176.
MILITARY MEDICINE, Vol. 181, November/December Supplement 2016