xxvii

Index

INDEX 

A

AAC. See Augmentative and alternative communication

AAROM. See Active assisted range-of-motion exercises

ABC. See Acinetobacter baumannii-calcoaceticus; American Board for 

Certification in Orthotics, Prosthetics and Pedorthics

Able-bodied (“normal”) gait

energy conservation and, 539, 540

gait cycle, 540

six determinants of gait, 540

Access to Sailing

contact information, 682

AccessSportAmerica

contact information, 682

Accreditation Council for Graduate Medical Education

pain management recommendations, 13

Accufuser pumps, 244

Acetaminophen

burn casualties and, 297

mechanism of action, 248

phantom limb pain treatment, 248

residual limb or stump pain treatment, 233

Achilles Track Club

contact information, 682

Paralympics sponsor, 15

Acinetobacter baumannii-calcoaceticus

battle wounds and, 194

heterotopic ossification and, 210

prevalence of multidrug-resistant form, 194

soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom and, 197

ACL. See Anterior cruciate ligament

Active assisted range-of-motion exercises

considerations for use of (exhibit), 329

Active duty service

benefits delivery at discharge, 82

financial assistance for purchasing a vehicle, 82

fitness criteria, 61

healthcare benefits, 82

home loan guaranty benefits, 82

individuals with major limb amputations and, 2, 54–55

insurance programs, 81–82

Medal of Honor pension payments, 82

MHS healthcare services mission, 4

need for longitudinal studies to track injured service members 

who return to active duty, 734

phase four of the physical therapy rehabilitation program and, 

479–482, 489–490

recommendations for daily use prosthesis, 578–579

retirement and disability compensation and, 61–62

specially adapted housing grants, 82

Veterans Benefits Administration benefits for, 81–82

vocational rehabilitation and employment, 82

Active range-of-motion exercises

burn edema and, 301, 302, 304

considerations for use of (exhibit), 330

heterotopic ossification and, 329

safety of, 329

skin grafts and, 315

Active reserve service

retirement and disability compensation, 61–62

Activities of daily living

acute phase of burn casualty rehabilitation, 333–335

adaptations for self-care, 333, 496, 497, 500, 522

aids for dressing, 337–338

avoiding trauma or shearing the skin surface, 336

bathing safety aids, 337

benefits of independent performance of, 333

bilateral upper extremity activity of daily living task sample 

technique options and considerations (table), 501–502

bilateral upper limb amputees and, 500–503

burn casualties and, 319, 333–338

circulatory changes and, 336

classifications of, 333

communications, 335, 338

donning pressure garments, 337

electronic aids to, 335, 426, 714–715

factors influencing outcome of functional activity programs, 

333

family involvement and, 333

home accessibility aids, 338

home management responsibilities, 335

housekeeping aids, 338

independence and, 333

intermediate phase of burn casualty rehabilitation, 319, 

335–336

kitchen modifications, 338

long-term phase of burn casualty rehabilitation, 336–338

one-handed, 514

phase one of the upper limb amputee protocol of care and, 

496–497

phase two of the upper limb amputee protocol of care and, 

500–503

phase three of the upper limb amputee protocol of care and, 

511–514

prosthetic training, 511–514

reading and writing, 335, 338

safety and, 333

self-feeding and, 333–334, 336, 496, 500

self-grooming, 334, 336

speed of performance and, 333

spinal cord injuries and, 425–426

toileting skills, 335, 337, 496

work-hardening programs, 336

Activity-based therapy

locomotor training, 423–424

spinal cord injuries and, 423–424

Actuators

characteristics, 727

“cobot,” 727

hydraulic motors, 727

Acupuncture

phantom limb pain treatment, 249

Acute abdomen

spinal cord injury and, 432–433

Acute rehabilitation programs

description, 46

Acute respiratory failure

spinal cord injuries and, 428

AD. See Autonomic dysreflexia

Adapted Adventures

contact information, 682

Adapted housing

home accessibility aids, 338

kitchen modifications, 338

specially adapted housing grants, 81, 82

VA Prosthetic and Sensory Aids Service and, 72

Adapted Sports Association

contact information, 682

Adapted Sports Center

contact information, 682

Adaptive Aquatics
xxviii

Care of the Combat Amputee 

contact information, 683

Adaptive sports program. See also Sports and recreation opportunities

description, 524

ADLs. See Activities of daily living

Adult day healthcare

Veterans Health Administration and, 73

Advanced phase of upper limb prosthetic rehabilitation. See also

Phase four of the upper limb amputee protocol of care

challenges to rehabilitation, 636–637

heterotopic ossification and, 637

interruptions to the rehabilitation process and, 636

neuromas and, 636–637

patient care coordinators and, 635

psychosocial/emotional issues, 637

rehabilitation plan formulation, 635

residual limb and, 635–636

surfacing shrapnel and, 637

Adventure Pursuit

contact information, 683

Advisory Committee of the Secretary of Veterans Affairs on Prosthetics and Special Disability Populations

creation of, 7–8

mission and vision statements, 8

Aerobic training. See Strength training and cardiovascular conditioning

Aerobics/physical fitness

description, 672

opportunities available to amputees, 672

Afghanistan. See Operation Enduring Freedom/Operation Iraqi 

Freedom

Age factors

disease-related amputations, 7

Agent Orange

presumptive conditions considered for disability compensation for veterans exposed to, 76

Ahrenholz, D.H.

creatine kinase as an indicator of muscle damage from electrical burns, 282

Air Force rehabilitation center, Pawling, NY

specialty amputee rehabilitation program, 5–6

Air Force Wounded Warrior Program

description, 107

Air guns/shooting

opportunities available to amputees, 672

Alcohol and substance abuse

posttraumatic stress disorder and, 349

All Out Adventures

contact information, 683

Allografts

burn casualties and, 313

Amateur Softball Association

competitive wheelchair softball regulation, 678

AmbIT pumps, 244

Ambulation. See also Gait analysis and training

arm swing and, 476

assistive devices and, 461–462, 477–478

average energy costs of prosthetic ambulation (table), 546

backward walking, 479

contraindications, 423

evaluation of the amputee’s potential for, 461

goals for spinal cord injuries, 423

in parallel bars, 461

pelvic rotation and, 476

phase one of the physical therapy rehabilitation program and, 

461–462

phase three of the physical therapy rehabilitation program 

and, 476

sidestepping, 479

stride length, width, and cadence, 476–477

swing-through gait, 423

trunk rotation and, 476

American Academy of Physical Medicine and Rehabilitation

VA collaboration with, 49

American Board for Certification in Orthotics, Prosthetics and 

Pedorthics

prosthetist certification, 554

American Burn Association

morphine recommendation, 298

American Canoe Association

contact information, 683

Disabled Paddlers Committee, 676

American College of Sports Medicine

amount of exercise guidelines, 332

American Dancewheels Foundation, Inc.

contact information, 683

American Legion

present-day role, 29

support programs, 111

American Medical Association

Guides to Evaluation of Permanent Impairment, 63

American Medical Rehabilitation Providers Association

VA collaboration with, 49

American Red Cross

relaying information to families, 349

support programs, 111

tours of government buildings for amputees, 523

American Society of Anesthesiologists

“Practice Guidelines for Acute Management in the Perioperative Setting,” 233–234

Task Force on Preoperative Fasting guidelines, 299

American Society of Plastic Surgery

reconstructive surgery definition, 358

American Society of Regional Anesthesia

central neuroaxis blockade guidelines, 238

Web site, 238

American Spinal Injury Association

Impairment Scale, 418

spinal cord injury classification, 418–419

standard neurological classification of spinal cord injury worksheet (figure), 419

American Wheelchair Bowling Association

contact information, 683

regulations for disabled players, 673

American Wheelchair Table Tennis Association

competitive table tennis regulation, 679

contact information, 683

Americans with Disabilities Act

provisions, 710

America’s Athletes With Disabilities

contact information, 683

Amitriptyline

phantom limb pain treatment, 247, 248

Ampicillin

surgical site infection treatment, 196

Amputation Coalition of America

Limb Loss Research and Statistics Program, 598

Amputee care programs. See also Individuals with limb amputations; US Department of Orthopaedics and Rehabilitation; 

specific programs

advances in prosthetics and, 14

continuing education program element, 12

database element, 12

graduate medical education and research element, 11

historical background, 5–7, 20–37

interdisciplinary teams, 10–11, 608

key elements of, 8–15

medical management element, 12–13
Index

xxix

military medical disability system and, 15

nonmedical attendants and, 14, 268

organizational structure element, 9–10

outcomes measures and, 15

pain management element, 13–14

patient flow chart at WRAMC’s amputee service (figure), 9

peer and psychosocial support programs element, 14–15

prevention program element, 12

staffing ratio element, 11

suggested staffing ratios for amputee care (table), 11

surgical considerations element, 12

Amputee Coalition of America

description, 525

peer visitor program, 500

support programs, 14

Amputee counselors. See also Rehabilitation counseling

limb amputation and, 142

Amputees. See Individuals with limb amputations

Amyotrophic lateral sclerosis

presumptive condition for veterans who served in Southwest 

Asia, 77

Anemia

burn casualties and, 294

Anterior cord syndrome

description, 420

Anterior cruciate ligament

knee instability and, 176–177

Anthrax vaccine

development of, 5

Antibiotics. See also specific drugs

antibiotic beads, 180

bursitis treatment, 181

infection treatment, 177, 178, 179

ototoxicity of, 388, 389

postoperative infections in heterotopic ossification and, 160

preoperative prophylactic antibiotics for lower limb amputations, 134

prophylactic, 193–194

protocol for management of infections for amputee/extremity 

trauma patients, 196–197

Surgical Infection Prevention Project guidelines for antibiotic 

prophylaxis, 193–194

surgical site infection treatment, 196

urinary tract infections and, 441

Anticonvulsants. See also specific drugs

benefits of, 246

burn casualties and, 297

phantom limb pain treatment, 246

posttraumatic seizure prophylaxis, 13, 406

Antidepressants. See also specific drugs

burn casualties and, 297

phantom limb pain treatment, 247–248

side effects, 247–248

sleep problem treatment, 271

Antihistamines. See also specific drugs

pruritus treatment, 347–348

Antioxidants

hearing loss prevention and, 393

Anxiety

burn casualties and, 348

traumatic brain injury and, 405

treatment, 271, 348

Aortic aneurysms

lower limb amputations and, 218

Archery

opportunities available to amputees, 672

prosthetic examples, 651–652

upper limb prosthetic considerations, 644

Arem, A.J.

scar tissue research, 318

Armed Forces Amputee Care Program

database estimate of soldiers with major limb loss in uniform, 

63

Armed Forces Retirement Home

eligibility for, 85

Army Ten Miler

description, 524

Army Wounded Warrior program

description and goals, 106

family management specialist locations (table), 113

Arnold, Gen. Henry “Hap”

prosthesis improvements and, 6

support for the “whole patient” concept, 33

AROM. See Active range-of-motion exercises

Aronson, N.E.

major pathogens from war trauma-associated infections, 194

Artificial condyles

joint disarticulations and, 722–723

surgical implantation of, 723

Artificial intelligence

description and examples, 726

Artificial limb research. See also Prosthetics

actuators, 727

artificial condyles, 722–723

artificial intelligence, 726

control systems, 723–726

limb interface systems, 722–723

mechatronics, 726–728

neural-machine interfaces, 724–726

osseointegration, 723

power sources, 726–727

sensors and controls, 728–729

sockets and liners, 722

summary of issues, 729

transmissions, 727–728

ASIA. See American Spinal Injury Association

ASIA Impairment Scale

spinal cord injury grades, 418

ASP. See Adaptive sports program

Aspiration

Heimlich maneuver training and, 428–429

risk factors, 428

spinal cord injuries and, 428–429

swallowing evaluation, 428

Assessment of the vestibular system. See also Vestibular system 

injuries

balance evaluation, 389

causes of imbalance and vertigo, 389

computerized dynamic posturography, 389

computerized dynamic visual acuity test, 389

contradictions to screenings, 389

importance of, 389–390

rotary chair test, 389

subjective visual vertical test, 389

videonystagmography/electronystagmography, 389

Assistive devices. See also Wheelchairs

augmentative and alternative communication, 713–714

benefits of, 696

case presentation (exhibit), 716

proper fit and, 696

rehabilitation robotics, 712–713

seating systems, 704–708

sports and recreation equipment, 708–710

summary of issues, 717

transportation, 710–712

Assistive technology. See also Prosthetics; Wheelchairs

assessment and, 696

future research needs, 737–738
xxx

Care of the Combat Amputee 

goal of, 696

home environment and movable features and, 696

team approach, 696, 697

use changes over the course of rehabilitation, 696–697

VA Prosthetic and Sensory Aids Service, 71–72

AT. See Assistive technology

Athletes. See also specific sports

rehabilitative programs, 36

Athletics. See also Lower limb prosthetics for sports and recreation; Sports and recreation opportunities; Upper limb prosthetics for sports and recreation; specific sports

adaptive sports program, 524

mild traumatic brain injury and, 405

prosthetics and, 522–523

recreational and sports activities, 523

“tactical athletes” description, 452, 732

Atkins, D.J.

informal measures for upper limb amputees using body-powered prostheses, 601

“Unilateral Upper Extremity Amputation: Activities of Daily 

Living Assessment,” 513, 519

An Atlas and Compendium of Burn Splints, 320

Atypical antipsychotics. See also specific drugs

burn casualties and, 348, 349

sleep problem treatment, 271, 348

Audiologic injury from blast exposure

blast injuries to the ear (figure), 384

distance away from the blast and, 383

extent of damage, 383

incidence of, 383

symptoms, 383, 384

traumatic brain injury and, 383–384

tympanic membrane rupture, 383

Auditory temporal processing and patterning tests

description and uses, 390

Augmentative and alternative communication

aided symbols, 713

comprehensive assessment and, 713

goals of, 713

language representation, 713–714

unaided symbols, 713

Auroy, Y.

regional anesthesia and analgesia research, 234, 237

Austin, K.G.

temperature regulation in burn casualties, 360

Automobile crashes

spinal cord injuries and, 416, 417

Autonomic dysreflexia

description, 429–430

fractures and, 437

spinal cord injuries and, 429–430

symptoms, 430

AW2. See Army Wounded Warrior program

Axial flaps

burn casualty reconstructive surgery and, 359

B

Bach, S.

incidence of phantom limb pain (table), 239

“Phantom Limb Pain in Amputees During the First 12 Months 

Following Limb Amputation, After Preoperative Lumbar 

Epidural Blockade,” 239

Bacitracin

topical treatment of skin grafts, 315

Baclofen

spasticity treatment, 406–407, 438

Balance

single leg balance, 460–461

sitting balance, 460

Balboa Naval Medical Center, San Diego, CA

Center for the Intrepid, 4, 10, 20

expansion of the amputee care program to, 8

occupational therapy and, 494

Baltimore Therapeutic Equipment

description and uses, 504

BAMC. See Brooke Army Medical Center, San Antonio, TX

Banovac, K.

heterotopic ossification treatment, 210

Barth, D.I.

gait analysis and training research, 546

Barthel Index

description and uses, 602

Baruch, Dr. Bernard

Baruch Committee on Physical Medicine and, 33

Baruch Committee on Physical Medicine

creation of, 33

Baseball

prosthetic examples, 655–657

upper limb prosthetic considerations, 645

Baseline function

assessment of, 99–100

Basketball

opportunities available to amputees, 673

prosthetic examples, 657

rule modifications, 708–709

upper limb prosthetic considerations, 646

wheelchairs for, 708

Baton Death March

description, 524

Batteries

power source for artificial limbs, 726–727

Belanger, H.G.

traumatic brain injury research, 404

Benign paroxysmal positioning vertigo

canalith repositioning therapy, 392

causes, 386

Dix-Hallpike maneuver, 386, 477

symptoms, 386

videonystagmography/electronystagmography and, 389

Benzodiazepines. See also specific drugs

anxiety treatment, 271

burn casualties and, 297, 349

phantom limb pain treatment, 271

posttraumatic stress disorder and, 271

Berger, N.

upper limb amputation research, 600

Bergman, B.D.

regional anesthesia and analgesia research, 238

Beta blockers

dysautonomia treatment, 407

Bethanechol

slow gastric emptying treatment, 431

Bilateral transfemoral amputees

assistive devices for ambulation, 461

standing and dynamic balance activities and, 473

surgical considerations, 141

transfers and, 453

water sports and, 590

WRAMC rehabilitation protocol, 491–492

Bilateral transtibial amputees

standing and dynamic balance activities and, 473

surgical considerations, 141

transfers and, 453

Bilateral upper limb amputees

activities of daily living and, 500–503

activity of daily living task sample technique options and 

considerations (table), 501–502
Index

xxxi

adaptive equipment and, 526

decision to use a prosthesis, 526

donning and doffing challenges, 630–631

electric prosthesis fitting, 631

fabricating prostheses for specific activities of daily living, 631

independent harnessing of prostheses, 631

interim phase of upper limb prosthetic rehabilitation and, 

629–632

prosthesis considerations, 526–527

prosthesis design, 629–630

residual limb length and, 526

support system for, 526

terminal devices and, 503

training considerations, 526–527

unilateral and bilateral amputee goals for myoelectric and 

body-powered prostheses (exhibit), 507–508

Billiards

opportunities available to amputees, 673

Binaural interaction tests

description and uses, 390

Biological dressings

burn casualties, 312–313

Biomedical research mission of MHS

description, 5

Birbaumer, N.

“Effects of Regional Anesthesia on Phantom Limb Pain Are 

Mirrored in Changes in Cortical Reorganization,” 240–241

regional anesthesia and analgesia research, 239

Bisphosphonates

heterotopic ossification treatment, 159, 208, 209, 210–211, 

437–438

hypercalcemia treatment, 433

Bladder and renal calculi

spinal cord injuries and, 441

Bladder carcinoma

spinal cord injuries and, 441

Bladder management

spinal cord injuries and, 440–441

Blast exposure

audiologic injury from, 383–384

mechanisms of injury, 608

spinal cord injuries and, 417

traumatic brain injury and, 402–403

BlazeSports America

contact information, 683

Blind persons

prosthesis considerations, 577, 632–633

upper limb amputations and, 141

Blind Rehabilitation Service

blind rehabilitation center, 75

handbook, 76

mission, 75

outpatient specialists, 76

Visual Impairment Center to Optimize Remaining Sight 

Program, 75–76

Visual Impairment Services Outpatient Program, 75

Bliss, Dr. D. Willard

surgical work during the Civil War, 22

written description of Cunningham’s surgery, 25

Blomberg, S.

regional anesthesia and analgesia research, 236

Board for Orthotic/Prosthetic Certification

prosthetist certification, 554

BOC. See Board for Orthotic/Prosthetic Certification

Bock, Otto

C-Leg, 726

Ergo Arm, 727

MyoBoy prosthesis, 600

Occupational Therapist Upper Extremity Functional Evaluation, 601

SensorHand Speed hand, 726

Upper Extremity Prosthetic Functional Activity Checklist, 601

Body garments

applying the new garment for the first time, 355

burn casualties and, 322, 324, 354–355

independently donning and doffing, 497

initial fitting for, 355

measuring for, 354

odors and, 355

reassessment of fit, 355

wearing 23 hours a day, 355

Body-powered upper limb prosthetics

advantages/disadvantages of (table), 611

bilateral upper limb amputees and, 631

control harness issues, 611

description, 610

elbow units, 617

interscapulothoracic amputations and, 629

maintenance issues, 611

residual limb length and, 610

styloid disarticulation and, 626

terminal devices and, 614

transhumeral amputations and, 628

wrist units, 616

Body symmetry

techniques for, 498

Bone scans

heterotopic ossification diagnosis, 209

physical therapy and, 479

Bones

future research needs, 736

guidelines for skeletal treatment (table), 621

issues in lower limb prosthetics, 577

surgical principles for, 620

Booth, D.M.

neuroma research, 161

Borgeat, A.

regional anesthesia and analgesia research, 236, 238

Botulinum toxin

spasticity treatment, 438

Boulias, C.

upper limb amputation research, 601

Bowel management programs

spinal cord injury and, 432

Bowling

opportunities available to amputees, 673

Box and block test, 15

Boylan, J.F.

regional anesthesia and analgesia research, 236

BPPV. See Benign paroxysmal positioning vertigo

Bradbrook, D.

acupuncture research, 249

Bradley, Gen. Omar

Veterans Administration head, 6

Bradycardia

spinal cord injuries and, 429

Brain-machine interfaces

advantages and disadvantages of, 724

Braun, J.A.

pressure ulcer research, 434

Breckenridge Outdoor Education Center

contact information, 683

Bronchospasm

perioperative regional anesthesia and analgesia risk, 238

Brooke Army Medical Center, San Antonio, TX

center of excellence for burn patients, 3–4

occupational therapy and, 494

“Targeted Reinnervation in Upper Limb Amputees to Improve 
xxxii

Care of the Combat Amputee 

Myoelectric Prosthesis Function,” 530

Brooks, Rep. Jack B.

sponsor of the bill making the VA an executive department, 68

Browder, N.

chart for estimating burn size (figure), 284

rule of nines for burn severity, 282

Brown, Col. (Ret.) Paul W.

heterotopic ossification research, 209

rehabilitation of amputees and, 33, 35

“Rehabilitation of the Combat-Wounded Amputee,” 6–7

Brown, D.L.

regional anesthesia and analgesia research, 236

Brown-Séquard syndrome

description, 420

Brown University

VA Prosthetic and Sensory Aids Service collaboration with, 72

Buckley, J.

gait analysis and training research, 546

Bupivacaine

burn casualties and, 298

epidural anesthesia and, 240, 244

Burd, A.L.

characteristics of burn scars, 351

Burgess technique

transtibial amputations, 166, 169

Burial and interment allowances

Veterans Benefits Administration, 79

Burn casualties

average burn size, 169

burn patient mortality graph (figure), 279

burn terminology (table), 285

burn wound excision, 307–309

characteristic hospital course, 298

chemical injuries, 280–281

classifying and assessing burns, 280–282

complications associated with rehabilitation, 345–349

critical care of, 286–296

electrical injuries, 281–282, 346

evacuation to Brooke Army Medical Center, 3–4

first aid basics and, 287

fluid resuscitation program, 279–280

hearing loss and, 359, 360, 384

impediments to the healing process, 279

improvement in survival, 279

in-theater management of, 169

incidence of associated trauma (table), 287

inflammatory response and shock, 279

Injury Severity Score, 280

interdisciplinary rehabilitation plan for, 279

interim phase of upper limb prosthetic rehabilitation and, 

634–635

medical evaluation boards and, 360–361

mortality rate from burn injuries, 169

pain management, 297–299

pathophysiology of burns, 279–280

perioperative challenges, 298

plastic and reconstructive surgery, 358–359

rehabilitation of, 299–349

scar management, 349–358

severity of burns, 282–286

special considerations, 359–361

special senses and, 359–360

summary of issues, 361

synthetic skin substitutes and, 307, 312–313

thermal injuries, 280

thermoregulation and, 360

Burn edema

acute phase management, 301–304

chronic, residual edema, 305

circumferential measurement of, 300

complications from, 301

compression with elastic wraps and, 302

evaluation of, 300–301

figure-of-eight measurement of, 301

intermediate phase management, 305

long-term management, 305–306

management of, 301–306

mechanism of, 299–300

pathogenesis of tissue edema, 300

positioning and, 302

positioning and splinting devices used to manage edema 

(table), 303–304

postoperative splinting and positioning (table), 306

volumetry and, 300–301

Burn-related amputations

electrical burns and, 345–346

lower limb joint contracture and, 173

Operation Enduring Freedom/Operation Iraqi Freedom and, 

345

phantom limb pain and, 346

preserving length of limbs and, 346

prosthetic fitting and, 170–171, 346

surgical principles, 169–170

Burn shock

description, 279

Burn wound excision

excision to fascia, 309

full-thickness burns, 307–309

tangential, 308–309

Bursitis

aspiration and, 181, 182

description, 180

diagnostic difficulties, 181

myodesis and, 180–181

surgical considerations, 182

treatment, 181–182

Bush, Pres. George H.W.

comments on the US Department of Veterans Affairs, 68

C

C-Leg

compared with mechanical knee and RHEO KNEE, 547–548

description and uses, 726

Cable-driven prostheses. See Body-powered upper limb prosthetics

CAD. See Computer-aided design

Calcitonin

heterotopic ossification treatment, 158

phantom limb pain treatment, 248

CAM. See Computer-aided manufacturing

Camping

opportunities available to amputees, 673–674

wheelchair designs for, 709

Canalith repositioning therapy

benign paroxysmal positioning vertigo, 392

Canoeing

opportunities available to amputees, 674

upper limb prosthetic considerations, 646

CAP. See Computer and Electronic Accommodation Program

Caplan, R.

regional anesthesia and analgesia research, 234

Carbamazepine

burn casualties and, 297

phantom limb pain treatment, 246

Carbapenems

multidrug-resistant organism treatment, 195

Cardiac arrest
Index

xxxiii

spinal cord injuries and, 429

Cardiovascular conditioning. See Strength training and cardiovascular conditioning

Cardiovascular disease

silent myocardial infarction, 430

spinal cord injuries and, 430

Cardiovascular system. See also Deep venous thrombosis; Strength 

training and cardiovascular conditioning

autonomic dysreflexia, 429–430

bradycardia, 429

cardiac arrest, 429

cardiovascular disease, 430

critical care of burn casualties and, 292–293

heart rate and rhythm, 293

hemodynamic therapy, 293

Karvonen method for determining heart rate range (exhibit), 

332

myocardial contractility, 293

orthostatic hypotension, 421, 430

physical activity during rehabilitation and, 293

preload augmentation, 293

regional anesthesia and analgesia risks to, 236–237

spinal cord injuries and, 429–430

topics of concern for amputees, 218

vasopressor use, 293

ventricular afterload, 293

ventricular preload, 292–293

Caregivers

involvement with the rehabilitation process, 47–48

CARFs. See Commission on Accreditation of Rehabilitation Facilities

Carlson, D.E.

relationship between burn size and energy expenditure, 

295–296

Carpus amputations. See Hand and carpus amputations

Case managers

description and role, 45, 47, 48

Case studies

an experience of the preventive medical psychiatry service 

(exhibit), 269

family intervention (exhibit), 273

use of empathic exposure (exhibit), 270

use of hypnosis in treating phantom limb pain (exhibit), 270

using reframing and affirming techniques (exhibit), 270

wheelchair use (exhibit), 716

Casting

acute phase of burn casualty rehabilitation, 325–326

intermediate phase of burn casualty rehabilitation, 326

long-term phase of burn casualty rehabilitation, 319, 326

Plaster of Paris advantages, 325

serial casting for burn casualties, 325–326

uses of, 325

Cauda equina syndrome

description, 420

pain presentation, 439

prognosis, 420–421

CDC. See Centers for Disease Control and Prevention

Cefazolin

surgical prophylaxis, 194

surgical site infection treatment, 196

Cefotetan

surgical site infection treatment, 196

Cefuroxime

surgical prophylaxis, 194

Cellulitis

pressure ulcers and, 436

Center for the Intrepid

description, 10, 20

fundraising campaign for, 20

Centers for Disease Control and Prevention

contact precaution guidelines, 198

estimate of the number of persons in the United States living 

with major limb amputation in 1996, 7

Healthcare Infection Control Practices Advisory Committee 

MDRO guidelines, 194

increasing rates of drug-resistant Acinetobacter as a cause for 

bloodstream infections, 194

monetary cost of traumatic brain injury, 400

physical activity effect on physical and mental well-being, 642

traumatic brain injury case estimates, 400

work-related amputation data, 601

Centers of excellence. See also specific centers

creation of, 6

future research needs, 738

level V care and, 3–4

Central auditory processing disorders. See Central auditory 

system damage

Central auditory system damage

assessment of, 390–391

auditory training and, 392

blast exposure and, 387

“cortical deafness,” 387

general management strategies, 392–393

treatment and diagnosis challenges, 387

treatment and rehabilitation, 392–393

Central cord syndrome

description, 420

Central vestibular damage

traumatic brain injury and, 386–387

Cephalosporins

surgical prophylaxis, 194

Cernak, I.

traumatic brain injury research, 403

Certified Rehabilitation Counselors

competencies included, 96–97

CFI. See Center for the Intrepid

Challenge Aspen

contact information, 683

Challenge magazine, 525

Challenged Athletes Foundation

contact information, 684

Paralympic Games and, 36

Chemical burns

causes, 280

incidence of, 280

mechanism of damage, 281

treatment, 280–281

Child care

phase of the upper limb amputee protocol of care and, 

520–521

Chlorpromazine

dysautonomia treatment, 407

Cholesteatomas

complications of, 385

tympanic membrane perforation and, 385

Chopart amputations

description, 135–136

equinus deformity and, 133–134, 155

Christopherson, R.

regional anesthesia and analgesia research, 235

Cisplatin

ototoxicity of, 388, 389

Citalopram

depression treatment, 271

Civil War

amputations performed, 21, 118

Invalid Corps of the Union Army, 54

mortality risk from fractures, 193
xxxiv

Care of the Combat Amputee 

prosthetics advances, 23

survival rate for amputation procedures, 21

US Sanitary Commission and, 23–24, 26

volunteer role, 24, 26

Whitman’s observations and philanthropic work, 21–22

Cleveland, Mather

description of the need for amputation, 30

Clindamycin

surgical site infection treatment, 196

Clinical Practice Recommendations for Issuance of Recreational 

and Sports Equipment, 671, 715

Clinton, Pres. Bill

National Cemetery Administration creation and, 82

Clonidine

autonomic dysreflexia treatment, 430

combined with mexiletene, 247

dosage considerations, 247

phantom limb pain treatment, 233, 247

residual limb or stump pain treatment, 233

Closure of wounds

contamination and, 121

dry dressings and, 121–122

heterotopic ossification and, 123–124

indications and timing for definitive closure, 121–124

infection and, 121–122

negative pressure dressings, 121

nutritional support and, 122

topical wound care solutions, 122

treatment of retained fragments or foreign bodies and, 123

Clotting bandages

development of, 5

Coalition to Salute America’s Heroes

support programs, 111

Cobot concept

description, 727

Cochlear injuries

blast exposure and, 385–386

initial presentation of, 386

mechanism of, 385

sensorineural hearing loss and, 385–386

signs of, 385

sound pressure levels and, 385

Cognitive function

domains of cognitive functioning and representative neuropsychological tests (table), 409

traumatic brain injury and, 404, 405, 408–409

Colchicine

heterotopic ossification treatment, 158

Colon

neurogenic bowel, 432

Colorado Discover Ability Integrated

contact information, 684

Colostomy

spinal cord injury and, 432

Combat amputee care

advances in firepower and, 20

Civil War and, 21–26

current conflicts, 37

current military transport and patient evacuation, 20–21, 608

historical background, 5–7, 20–37

interwar period and, 29

Korean conflict and, 33

technological innovations in the field of medicine and, 20

transportation advances and, 20

Vietnam War and, 33–37

World War I and, 26–28

World War II and, 30–33

Combat casualty care mission of MHS, 2–4

Combat-related special compensation

basis for, 62

Combat support hospitals

level III care and, 3

Combat veterans

documents to substantiate combat service, 77

National Defense Authorization Act VA healthcare package, 

77

Commissary privileges

eligibility for, 85

Commission on Accreditation of Rehabilitation Facilities

directory of rehabilitation providers, 49

VA agreement with, 43

Communication

activities of daily living issues, 335, 338

augmentative and alternative communication, 713–714

Community reintegration of burn casualties

acute phase of burn casualty rehabilitation, 343

discharge from the hospital and, 344

intermediate phase of burn casualty rehabilitation, 344

long-term phase of burn casualty rehabilitation, 344

purpose of programs for, 344

Community reintegration of upper limb amputees

anxiety and, 523

occupational therapy considerations, 522–523

survey of, 530

therapeutic outings, 523

Community residential care

Veterans Health Administration and, 73

Compensated work therapy

description, 101

Compensation. See Retirement and disability compensation; 

Veterans Benefits Administration

Complications associated with rehabilitation of burn casualties

neurologic, 346–348

orthopaedic, 345–346

psychological, 348–349

Complications associated with rehabilitation of individuals with 

spinal cord injuries

cardiovascular, 429–430

dermatologic, 433–436

endocrinologic, 433

gastrointestinal, 430–433

genitourinary, 440–442

health maintenance, 442–443

musculoskeletal, 436–438

neurologic, 438

pain, 438–440

psychological, 442

pulmonary, 427–429

Compression. See also Body garments

burn edema and, 302, 305, 306

burn scars and, 352, 353–354

skin grafts and, 172

Compression dressings

benefits of, 462

compliance with, 462–463

stump shrinker socks and, 462

Compressorgrip sleeves

description, 497

Computed tomography

heterotopic ossification diagnosis, 209

infection monitoring, 197

three-dimensional modeling, 211–213

Computer-aided design

limb interface systems, 722

Computer-aided manufacturing

limb interface systems, 722

“Squirt Shape” technique, 722

Computer and Electronic Accommodation Program
Index

xxxv

description, 108, 522

Computer-Assisted Rehabilitation Environment

future research needs, 737–738

Computerized dynamic posturography

description and uses, 389

Computerized dynamic visual acuity test

description and uses, 389

Computerized gait assessment

compared with observational gait assessment, 536

data collection, 538–539

description, 538

electromyography findings, 539

energy expenditure, 539

process of, 538–539

Computers. See also Software

accessibility issues, 714

spinal cord injuries and, 426

Consolidated Appropriations Act, 43

“Constructive training” program

goals of, 5

Contact dressings

burn casualties, 307

Contact precautions

CDC guidelines, 198

communication and education, 199–200

environmental cleaning, 198

hand hygiene, 198–199

Continuing education element of amputee care, 12

Continuous passive motion devices

burn casualties and, 327–328

Continuous peripheral nerve blocks

benefits of, 243–244

burn casualties and, 298–299

historical background, 230

studies demonstrating benefits, 240–241

studies demonstrating no benefit, 241

Continuously variable transmission

description, 728

Contract home healthcare

Veterans Health Administration and, 72–73

Contractures. See Joint contractures; Tissue contractures

Control systems

functional level and, 723

Conus medullaris syndrome

description, 421

Convalescent leave

limiting, 6

Conventional prostheses. See Body-powered upper limb prosthetics

Cooper, Rory A., Ph.D.

“Rehabilitation of the Combat Amputee—Consensus Conference and Creating a Roadmap for the Future,” 733

wheelchair activity patterns, 701

Cooperative Wilderness Handicapped Outdoor Group

contact information, 684

Core stabilization

advanced exercises, 479

benefits of, 454, 456

examples of early/level-1 exercises, 457

examples of more challenging exercises, 469, 473

focus of, 454

goals of, 456

neutral spine and, 456–457

plyometrics, 479

progression of exercises, 469

Corticosteroids

bursitis treatment, 182

heterotopic ossification treatment, 158

impaired healing response and, 204

Courage Center

contact information, 684

COX-2 inhibitors. See Cyclooxygenase-2 inhibitors

Coyle, C.P.

therapeutic benefits of sports and recreations for the disabled, 

670

CPMs. See Continuous passive motion devices

CPNBs. See Continuous peripheral nerve blocks

Critical care of burn casualties

cardiac considerations, 292–293

early life support evaluation and management, 286–288

first aid basics and, 287

fluid resuscitation, 288–289

gastrointestinal considerations, 291–292

hematological considerations, 294

metabolic considerations, 292

nutritional considerations, 294–296

renal considerations, 292

respiratory considerations, 289–291

skin considerations, 286

CRSC. See Combat-related special compensation

CSHs. See Combat support hospitals

CT. See Computed tomography

Cucchiaro, G.

continuous peripheral nerve block research, 243–244

Cultured autologous keratinocyte (epidermal) skin grafts

artificial dermal replacement, 312

biological dressings, 312–313

burn casualties and, 312–313

Cunningham, Pvt. Oscar

description of injuries and death, 22–23

Curling

opportunities available to amputees, 674

Curreri, P.W.

energy need estimation, 295

CVT. See Continuously variable transmission

CWT. See Compensated work therapy

Cycling

adaptations for hand propulsion, 673

handcycles, 709–710

lower limb prosthesis and, 588–589

opportunities available to amputees, 673

recumbent hand cycles, 709–710

wheelchair designs for, 709

Cyclooxygenase-2 inhibitors

heterotopic ossification treatment, 210, 211

multimodal pain management and, 233

residual limb or stump pain treatment, 232–233

Cyclooxygenase-2-selective nonsteroidal antiinflammatory agent

heterotopic ossification prophylaxis and treatment, 13

D

D-dimer

deep venous thrombosis and, 429

DA Form 199

physical evaluation boards and, 60

Dakin moist-to-dry dressings

infected residual limbs and, 180

DASH. See Disabilities of the Arm Shoulder Hand questionnaire

DASH questionnaire. See Disabilities of the Arm Shoulder Hand 

questionnaire

Databases

for patient population information, 12

Datta, D.

upper limb amputation research, 601

Davidson, J.H.

over-use injuries in unilateral amputees, 514

upper limb amputation research, 600, 601
xxxvi

Care of the Combat Amputee 

Davis, R.W.

clonidine research, 247

Day treatment programs

description, 47

DD 214 form

description, 55

VA benefits and, 55, 77

de Visme, V.

regional anesthesia and analgesia research, 234

Deathe, A.B.

upper limb amputation research, 602

Debridement

autolytic and enzymatic, 204–205

contraindications for, 205

importance of, 193

infection and, 178, 179

insufficient versus excessive, 202

mechanical, 205

restoring moisture balance and, 205–206

sharp, 204

techniques for, 204–205

wound care and management and, 202, 204–205

Deep brain stimulation

phantom limb pain treatment, 248

Deep partial-thickness burns

compression garments and, 322, 324

description, 282

dressing considerations, 307

range-of-motion exercises and, 330

treatment, 282

Deep venous thrombosis

burn casualties and, 294

consequences of, 206

incidence in trauma patients, 206–207

individuals with spinal cord injuries and, 429

medical prophylaxis, 12–13, 207, 429

minimizing immobilization and, 207

physical prophylaxis, 207

risk factors, 12, 206, 429

traumatic brain injury and, 406

treatment, 429

Defense Advanced Research Projects Agency

partnerships with, 12

upper limb prosthetics research, 527–528

Defense and Veterans Brain Injury Center

database of individuals who have received care, 49

description and role, 49

educational materials, 406

number of US service members sustaining TBI, 400

screening for TBI, 272

traumatic brain injury centers, 42

VA PSC collaboration with, 48–49

Deffer, P.A.

osteomyoplastic transtibial amputation technique case studies, 

166

Definitions. See Terminology; specific terms

Dental services

combat veterans and, 77

Dependency and indemnity compensation

Veterans Benefits Administration, 79

Dependents Educational Assistance Program

description, 81

Depression

burn casualties and, 349

pharmacological treatment, 271

spinal cord injuries and, 442

traumatic brain injury and, 405

Dermatologic issues. See also Skin; Skin disorders

pressure ulcers, 433–436

spinal cord injuries, 433–436

upper limb amputations, 599

Desensitization

compression techniques, 497

desensitization programs, 346–347

multiple exposure/progressive desensitization, 530–531

Desipramine

phantom limb pain treatment, 247

Diabetes mellitus

spinal cord injuries and, 433

Diazepam

spasticity treatment, 438

Dichotic speech tests

description and uses, 390

Dillingham, Dr. Timothy

care of amputees as a major problem for the military, 494

motivational therapeutic programs and, 35–36

upper limb amputation research, 598

Diphenhydramine

pruritus treatment, 347–348

Disabilities of the Arm Shoulder Hand questionnaire

description and uses, 15, 601–602

Disability compensation

Veterans Benefits Administration, 79

Disabled American Veterans

creation of, 29

description and programs, 111, 524

Paralympics sponsor, 15

present-day role, 29

Disabled Archery, USA

archery regulations, 672

contact information, 686

Disabled Sports, USA

aerobics/physical fitness videotapes, 672

contact information, 686

Nordic and Alpine skiing regulation, 678

Disabled Sports USA

Paralympics sponsor, 15, 36, 524

Disabled Veterans Act, 96

Discharge planning

follow-up care, 525

resources for patients, 525

Disease-related amputations, 4, 7

Diuretics

ototoxicity of, 388

Divorce

spinal cord injuries and, 442

DoD. See US Department of Defense

Doffing prostheses. See Donning/doffing prostheses

Dole-Shalala Commission. See President’s Commission on Care 

for America’s Returning Wounded Warriors

Domiciliary care

Veterans Health Administration and, 73–74

Donning/doffing prostheses

bilateral upper extremity prosthetic sample donning and doffing strategies and considerations (table), 514

bilateral upper limb amputees and, 630–631

body-powered, 511

goals of, 509

interim phase of upper limb prosthetic rehabilitation and, 623

myoelectric type, 509–511

phase three of the upper limb amputee protocol of care and, 

509–511, 512, 513

range of methods for, 509

sample donning method for a transhumeral amputee (figure), 

513

sample donning methods for a transradial amputee with a 

body-powered pin lock suspension prosthetic system (figure), 512
Index

xxxvii

Dragon Naturally Speaking software, 529

Dressings. See also Compression dressings

biological, 312–313

bolster, 307

burn wounds, 307

contact, 307

Dakin moist-to-dry, 180

for donor sites, 313–314

dry dressings, 121–122

heterotopic ossification and, 158

immediate postoperative prosthesis, 129–130

negative pressure dressings, 121, 315

pressure ulcers and, 435

rigid dressings, 128–129, 137–138, 173

silver-nylon, 307

soft dressings, 128

subatmospheric pressure dressings, 158, 172, 180

synthetic skin substitutes, 307

Driving

car adaptations, 425

driver’s training for individuals with spinal cord injuries, 425

phase four of the upper limb amputee protocol of care and, 

521

prosthetic examples, 659–660

upper limb amputations and, 601

upper limb prosthetic considerations, 646–647

wheelchair use and, 711–712

DSUSA. See Disabled Sports, USA

Duodenum

spinal cord injury and, 431

superior mesenteric artery syndrome, 431

DVBIC. See Defense and Veterans Brain Injury Center

DVT. See Deep venous thrombosis

Dynamic response feet

energy storage and return design, 555–556

vertical, shock-absorbing pylons for, 556–558

Dynamic splints

corrective, 324

description, 324

long-term phase of burn casualty rehabilitation and, 324–325

uses for, 319, 324

Dysphagia

spinal cord injuries and, 431

E

EADLs. See Electronic aids to daily living

Early postoperative prosthesis

interim phase of upper limb prosthetic rehabilitation and, 

622–623

surgical considerations, 623

Eastern Amputee Golf Association

contact information, 686

Edelstein, J.E.

upper limb amputation research, 600

Edema. See also Burn edema

residual limb management, 622, 636

Education programs

Veterans Benefits Administration, 80–81

“Effects of Regional Anesthesia on Phantom Limb Pain Are 

Mirrored in Changes in Cortical Reorganization” (Birbaumer), 

240–241

Elbow and humerus amputations. See also Elbow units for upper 

limb prosthetics

general surgical considerations, 131–133

handling of the median, radial, and ulnar nerves, 133

interim phase of upper limb prosthetic rehabilitation and, 

626–627

prosthetic recommendations (table), 630

shoulder disarticulations, 133

transhumeral amputations, 132–133

Elbow disarticulation

advantages and disadvantages of, 131–132

surgical considerations, 619

Elbow units for upper limb prosthetics. See also Elbow and humerus amputations

description, 617

transhumeral amputations and, 627–628

Electric-powered wheelchairs

description and uses, 422–423, 425

foot and leg supports, 706

goal of, 701

power-base design, 702

seat elevation systems, 708

seating system, 702

sensory-motor impairments and, 701

tilt frames and reclining backrests, 707

traditional frame design, 701–702

Electric Wheelchair Hockey Association

contact information, 687

Electrical burns

amputations and, 346

burn casualty reconstructive surgery, 359

causes, 281

mechanism of damage, 281–282

mortality from, 281

muscle damage from, 281–282

Electrically powered upper limb prosthetics. See also Myoelectric 

prostheses

advantages/disadvantages of (table), 610

battery maintenance, 610

bilateral upper limb amputees and, 631

control methods, 609–610

description, 609

early postoperative prosthesis and, 622

elbow units, 617

interscapulothoracic amputations and, 629

repair issues, 610

styloid disarticulation and, 625–626

terminal devices and, 614–615

transhumeral amputations and, 628

transradial amputations and, 626

wrist units, 616

Electromyography

gait analysis, 537

knee prosthesis comparison, 547

Electronic aids to daily living

burn casualties and, 335

commercial availability, 715

description, 714

evaluation for, 714–715

spinal cord injuries and, 426

use display and user control interface, 714

Electronic pumps

patient-controlled analgesia and, 244

Electrophysiologic tests

description and uses, 390–391

late-latency response, 390

middle-latency response, 390

Elizaga, A.M.

continuous peripheral nerve block research, 241

EMEDS. See Expeditionary medical support

Emergency medical care

Veterans Health Administration and, 74

Emerging consciousness programs

description, 46

EMG. See Electromyography

Endocrine system
xxxviii

Care of the Combat Amputee 

spinal cord injuries and, 433

topics of concern for amputees, 219

Energy expenditure

average energy costs of prosthetic ambulation (table), 546

gait analysis and training and, 536, 539, 546

Environmental controls. See Electronic aids to daily living

Ephedrine sulfate

orthostatic hypotension treatment, 430

Epidermal burns

description, 282

Epidural analgesia

evidence-based studies demonstrating benefits, 239–240

evidence-based studies demonstrating no benefit, 240

mechanism of, 233

Epidural anesthesia

benefits of, 234–236

catheter placement, 242

risks of, 236–239

solutions for, 244

techniques for, 242

Epinephrine

dosage considerations, 237

Epinephrine toxicity

perioperative regional anesthesia and analgesia risk, 238

Epoetin alfa

red blood cell stimulation, 13

EPOP. See Early postoperative prosthesis

EPWs. See Electric-powered wheelchairs

Equipment for sports and recreation. See also Sports and recreation opportunities; specific sports

basketball wheelchairs, 708–709

camping, 709

cycling, 709–710

hiking, 709

hockey, 710

racing, 709

skiing, 710

tennis, 709

track and field sports, 709

waterskiing, 710

wheelchair rugby, 709

Ertl, Janos

osteomyoplastic transtibial amputation technique, 165–169

ESBL. See Extended-spectrum beta-lactamase

Esophagitis

spinal cord injuries and, 431

Esophagus

dysphagia, 431

esophagitis, 431

Etidronate disodium

heterotopic ossification treatment, 345, 437–438

Evaluation of the less-than-successful amputee

medical history, 155–156

physical examination, 156–157

Exchange privileges

eligibility for, 85

Expeditionary medical support

level II care and, 3

Extended-spectrum beta-lactamase

carbapenem treatment, 195

F

Faber, A.W.

principles of psychological treatment of burn casualties, 348

Face masks

burn scar management and, 354

Facial burns

burn casualty reconstructive surgery and, 359

burn scar management, 354

sensory issues, 359–360

Family intervention

purpose of, 273

support group therapy sessions, 273

Family members

assistance for, 47

family intervention (exhibit), 273

future research needs, 735

Heimlich maneuver training and, 428–429

involvement with the rehabilitation process, 47–48, 268, 349

as nonmedical attendants, 14, 268

preexisting conflicts among, 273

spinal cord injuries and, 426–427

support for, 273

support from, 268

support group therapy sessions, 273

traumatic brain injury and, 272, 406

FATS. See Firearm Training System

FCEs. See Functional capacity evaluations

Federal Aviation Administration

hand controls for flying, 675

Fencing

opportunities available to amputees, 674–675

Fentanyl

burn casualties and, 297

epidural anesthesia and, 244

phantom limb pain treatment, 245

transdermal, 245

Fertility

polytrauma patients and, 219

spinal cord injuries and, 441–442

Finger, thumb, and partial hand amputations. See also Hand and 

carpus amputations

interim phase of upper limb prosthetic rehabilitation and, 625

Finucane, B.T.

regional anesthesia and analgesia research, 236

Firearm Training System

description, 528

firearms training simulator data (table), 529

Firearms

air guns/shooting, 672

prosthetic examples, 663–664

safety issues, 648

trap and skeet shooting, 679

upper limb prosthetic considerations, 648

Fisher, Arnold

Center for the Intrepid and, 20

continuous peripheral nerve block research, 240

Fisher, Ken

Center for the Intrepid and, 20

Fisher House Foundation

assistance for families and caregivers, 48, 111

description, 20

Fishing

competitive bass fishing, 675

opportunities available to amputees, 675

prosthetic examples, 660–662

upper limb prosthetic considerations, 647–648

Fishing Has No Boundaries

contact information, 687

Fitzgerald, S.G.

wheelchair activity patterns, 701

Fitzsimons General Hospital, Denver CO

Brown’s career, 6

reluctance of staff to send patients to VA hospitals, 7

Five Function Wrist units

description, 527

Flap grafts
Index

xxxix

burn casualties and, 311

Flaps

burn reconstructive surgery and, 358–359

“flaps of opportunity” for lower limb amputations, 134

pressure ulcer surgery and, 435–436

skin grafts and, 311

transtibial amputations and, 136–137

Fleet hospitals

level III care and, 3

Fletchall, S.

upper limb amputees fitted with prostheses, 527

Flexibility

phase one of the physical therapy rehabilitation program and, 

454

phase one of the upper limb amputee protocol of care and, 

497–498

phase two of the physical therapy rehabilitation program and, 

465

phase two of the upper limb amputee protocol of care and, 503

Flowers, K.R.

static progressive splints, 325

Fluid resuscitation program for burn casualties

abdominal compartment syndrome and, 288, 289

burn shock and, 288

compartment syndrome and, 288–289

components, 280

consequences of over resuscitation, 288–289

equations for, 288

eschar syndrome and, 288–289

formulas (table), 280

reduction in mortality rates and, 280

sodium ion and, 279–280

Starling equation (exhibit), 288

Fluoroquinolone

surgical site infection treatment, 196

Flying

opportunities available to amputees, 675

Foot amputations

Chopart, 135–136

Lisfranc-level, 135

partial foot, 134–136

postoperative casting, 135–136

transmetatarsal, 134–135

Football

opportunities available to amputees, 675

Ford, R.P.

regional anesthesia and analgesia research, 235

Forearm. See Wrist and forearm amputations

Forward surgical teams

level II care and, 3

“4” profile designators

medical evaluation boards and, 58

Fractures

phase four of the physical therapy rehabilitation program and, 

481

spinal cord injuries and, 433, 436–437

Franco, C.D.

regional anesthesia and analgesia research, 237

Franco-Prussian War

mortality risk from fractures, 193

Franks, Gen. (Ret.) Frederick

return to duty after limb amputation, 54

Franks, Gen. (Ret.) Frederick, Jr.

success of Vietnam-era amputee care example, 7

Free flaps

burn casualty reconstructive surgery and, 358–359

Freedom’s Wings International

contact information, 687

Friberg, O.

low back pain research, 251

Frierson, R.L.

social isolation after limb loss, 268

Full-thickness burns

average total body-surface area and, 283

compression garments and, 322, 324

description, 282

dressing considerations, 307

excision of, 307–309

range-of-motion exercises and, 330

split-thickness skin grafts and, 308

treatment, 282

Full-thickness pinch grafts

usefulness of, 171

Full-thickness skin grafts

burn casualties and, 310

donor sites, 310

healing time, 310

Fuller, George R.

prosthetics development, 23

Functional assessment and activities

ambulation, 476

arm swing, 476

ascending and descending stairs, 473

assistive devices, 477–478

backward walking, 479

bed mobility, 453

benefits to recovery, 465

description, 100–101

excessive lateral trunk movement, 478

falls/recovery, 471–472

floor to standing position, 472

gait training, 477–478

multidirectional movements, 479

pelvic rotation, 476

phase one of the physical therapy rehabilitation program and, 

453–454

phase two of the physical therapy rehabilitation program and, 

470

phase three of the physical therapy rehabilitation program 

and, 471–479

picking up objects, 473

resistive rollover drills, 478

sidestepping, 479

standing progression with prosthetic limb, 474–475

stride length, width, and cadence, 476–477

transfers, 453

trunk rotation, 476

weight-shifting progression, 474

wheelchair management, 453–454

Functional capacity evaluations

custom FCE protocols, 521–522

description, 521

flexibility of, 521

medical evaluation boards and, 522

Functional Status Outcomes Database

description, 49

Furosemide

hypercalcemia treatment, 433

G

Gabapentin

burn casualties and, 297

phantom limb pain treatment, 246

side effects, 246

Gage, J.R.

gait assessment research, 536

Gailey, R.S.
xl

Care of the Combat Amputee 

amputee mobility predictor, 15

Gait analysis and training. See also Ambulation

able-bodied (“normal”) gait, 539–540

advanced gait training, 476

ankle kinematics and kinetics, 541–542, 543–544

assistive devices and, 477–478

average energy costs of prosthetic ambulation (table), 546

backward walking, 479

computerized gait assessment, 538–539

effect of, 548

energy expenditure, 546

evolutionary change from quadruped to biped locomotion, 

536

excessive lateral trunk movement and, 478

external joint moments, 536, 538

gait cycle, 536

gait deviations in lower limb amputations, 540–541

gait laboratory dependent therapeutic interventions, 548

hip disarticulation and, 576

hip kinematics and kinetics, 542, 545

historical background, 536

importance of evaluating, 218

initial contact through midstance, 541–545

intent of amputee gait assessment, 536

internal joint moments, 536

knee kinematics and kinetics, 542, 544–545

myodesis failure and, 162

observational assessment, 538

Ovid database review, 548

pre-swing, 543, 544

prosthetic components and, 547–548

prosthetic feet and, 555

prosthetic mass and, 546–547

resistive gait training, 476

resistive rollover drills and, 478

self-selected walking velocity, 536

sidestepping, 479

six determinants of gait, 540

stance period definition, 536

standardized assessment, 541

stride length, width, and cadence, 476–477, 536

summary of issues, 548

swing, 536, 543

swing-through gait, 423

temporal and spatial measurements, 536

terminal stance heel strike, 545

terminology of, 536–538

time dimensions of the gait cycle (figure), 537

transfemoral amputees and, 544–545

transpelvic amputations and, 576

transtibial amputees and, 541–544

trunk and pelvic kinematics, 542–543, 545

walking speed parameter, 536

Gallbladder

cholelithiasis and, 431–432

spinal cord injury and, 431–432

Galsworthy, John

philanthropic support for disabled World War I soldiers, 26–27

Ganesh, A.

continuous peripheral nerve block research, 243–244

Gaps-in-Noise Test

description and uses, 390

Gastric ulcers

spinal cord injury and, 431

Gastrointestinal system

acute abdomen, 432–433

bowel problems, 432

colon problems, 432

critical care of burn casualties and, 291–292

Curling’s ulcer incidence, 292

duodenum problems, 431

enteral feedings, 291

esophagus problems, 431

gallbladder problems, 431–432

ileum problems, 432

oral cavity problems, 430–431

pancreas problems, 431

spinal cord injuries and, 430–433

stomach problems, 431

Gel liners

description and uses, 563

General surgical principles for casualties with limb loss. See also

Special surgical considerations for casualties with limb loss; 

Surgical considerations

amputee counselors/visitors, 142–143

delayed amputation versus limb salvage, 141–147

dressings, 128–130

elbow and humerus, 131–133

energy expenditure for amputation (table), 133

hand and carpus, 130–131

hip disarticulation and hemipelvectomy, 140

historical background, 118

immediate postoperative prosthesis, 129–130

indications and timing for definitive closure, 121–124

limb salvage versus amputation, 118–119

lower limb amputations, 133–140

multiple injured limb amputees, 141

muscle tension, 125

myodesis, 124–125, 164–165

myofascial closure, 124–125

myoplasty, 124

nerve management, 120–121, 127

open wound management, 121

partial foot amputation, 134–136

partners/mentors and, 142

rigid dressings, 128–129

skin traction, 126

soft dressings, 128

soft tissue and muscle management, 120, 122, 124–126

surgical goals, 119–120

Syme ankle disarticulation, 136

tenodesis, 125

through-knee and transfemoral amputation, 138–140

tourniquet use, 118

transtibial amputation, 136–138

upper limb amputations, 130–133

upper versus lower extremity considerations, 121

wound management at point of injury, 118–121

wrist and forearm, 131

Genitourinary system

bladder and renal calculi, 441

bladder carcinoma, 441

bladder management, 440–441

sexual function and fertility, 441–442

spinal cord injuries and, 440–442

urinary tract infection, 441

Geriatric evaluation and management

Veterans Health Administration and, 73

Geriatric research, education, and clinical centers

Veterans Health Administration and, 73

“Get up and go” test, 15

Giaufre, E.

peripheral nerve block research, 234

Gitter, A.J.

gait analysis and training research, 546–547

Glasgow Coma Scale

traumatic brain injury assessment, 400

Glenohumeral amputations
Index

xli

interim phase of upper limb prosthetic rehabilitation and, 629

prosthetic recommendations (table), 633

surgical considerations, 620

Global war on terror. See also Operation Enduring Freedom/Operation Iraqi Freedom

advances in amputee care, 732

blast exposure injuries, 402–403

challenges for US military forces, 2

launching of, 2

National Guard and reserve soldiers and, 4

Navy Safe Harbor program and, 107

return to duty after limb amputation and, 54

Gloves

compression gloves for hand burn management, 357

Isotoner edema gloves, 305

GMEs. See Graduate medical education

Goldthwait, Joel

vocational rehabilitation work, 28

Golf

lower limb prosthesis and, 591

opportunities available to amputees, 676

prosthetic examples, 654–655

upper limb prosthetic considerations, 645

Gottschalk, F.

adductor mechanism repair technique, 163

Graduate medical education

importance of, 4, 11

programs, 4

Graham, L.

upper limb amputation research, 600

Grass, J.

regional anesthesia and analgesia research, 235

Green, H.

cultured autologous keratinocyte (epidermal) skin grafts and, 

312

Grief

burn casualties and, 349

grieving process after limb loss, 267–268

phase two of the upper limb amputee protocol of care and, 500

Grieger, T.A.

psychiatric disorder association with trauma, 266

Guides to Evaluation of Permanent Impairment, 63

Guinard, J.P.

regional anesthesia and analgesia research, 235

Gulf War veterans

presumptive conditions considered for disability compensation, 77

Gunawardena, N.S.

physical profiles for combat-injured soldiers with unilateral 

transtibial amputations, 155

Guttmann, Sir Ludwig

wheelchair sports, 36, 670, 674–675

GWOT. See Global war on terror

H

H2H. See Heroes to Hometowns

Hafner, B.J.

prosthetic feet research, 586

Halo splints

neck immobilization and, 322

Hand and carpus amputations. See also Finger, thumb, and partial 

hand amputations; Transcarpal and transmetacarpal level 

amputations

decision between metacarpophalangeal joint disarticulation 

and ray amputation, 130–131

general surgical considerations, 130–131

multiple digits, 131

range of severity, 130

thumb importance, 131

tissue preservation and, 131

Hand burns

compression and, 352, 357–358

continuous passive motion devices and, 328

custom hand and wrist splints (table), 323

depth and location importance, 283

dorsal hand as most common site for, 283

location issues, 283, 284

long-term phase of burn casualty rehabilitation, 317

peripheral neuropathies and, 347

plastic and reconstructive surgery issues, 359

range-of-motion exercises and, 357–358

splinting issues, 320–321, 322–324

vascular support for, 352

Hand Rehabilitation Center

adaptive splints for burn casualties, 325

Handcycling

opportunities available to amputees, 673

recumbent hand cycles, 709–710

Handicapped Scuba Association

contact information, 687

Hanger, James Edward

prosthetics development, 23

Hard sockets

description and uses, 563–564

Harmonic drives

efficiency rates, 728

Harris, W.W.

osteomyoplastic transtibial amputation technique case studies, 

166

Harvey, C.

family support group therapy sessions, 273

Head, Henry

mirror therapy research, 250

Headphones

hearing loss prevention, 393

Health education mission of MHS, 4–5

Healthcare Cost and Utilization Project, Nationwide Inpatient 

Sample

categorization of data, 598

Healthcare services to active duty and military beneficiaries mission of MHS, 4

Hearing aids

alternatives for individuals with upper limb amputations, 392

classification of, 391

digital programmable type, 391–392

FM system for, 392

remote control options, 392

selection criteria, 392

tinnitus and, 393

Hearing conservation

headphones and, 393

hearing protectors, 393

Hearing Handicap Inventory for Adults

description, 388

Hearing loss

audiologic injury from blast exposure, 383–384

audiometric evaluation of, 388

blast injuries to the ear (figure), 384

burn casualties and, 359, 360, 384

causes, 382

central auditory system damage, 387, 392–393

concurrent traumatic brain injury, 382, 386, 388, 389, 390, 391

diagnostic tests, 388–391

incidence in combat veterans, 382

inner ear injury, 385–386

interim phase of upper limb prosthetic rehabilitation and, 633

middle ear injury, 384–385
xlii

Care of the Combat Amputee 

noise-induced, 382–383

ototoxic monitoring protocol, 388–389

ototoxicity, 383, 386, 388–389

outer ear injury, 384

patient questionnaires, 388

peripheral hearing loss, 391–392

prevention of, 393

reevaluation of, 391

summary of issues, 393–394

tinnitus, 387, 393

treatment and rehabilitation, 391–393

types of, 382–387

vestibulary injury, 386–387, 392

Hearing protectors

hearing loss prevention, 393

Heat

scar management and, 353

Hematologic considerations

critical care of burn casualties, 294

Hematoma

perioperative regional anesthesia and analgesia risk, 238

Hemipelvectomy

general surgical considerations, 140

Hemostatic bandages

description, 37

Heparin. See Low-molecular-weight heparin

Herndon, Dr. James

Gen. Franks’ care and, 7

Heroes to Hometowns

description, 109

Heterografts

burn casualties and, 313–314

donor sites, 313–314

Heterotopic ossification

active range-of-motion exercises and, 329

burn casualties and, 329, 345

conservative treatment recommendation, 159

description, 157, 345, 437

diagnosis of, 209, 406

future research needs, 736

grading for, 159

historical background, 157, 209

incidence of, 13, 209, 211, 437

infection and, 178–179

lower limb amputations and, 134

mechanism of, 208

pathogenesis, 157, 406

percentage of combat-related amputees with, 157

postinjury onset of, 210–211

presentation of, 437

prevalence of, 157, 437

prophylactic and prevention modalities, 158–160

prosthesis considerations, 577

rehabilitation challenges, 208–209

risk factors for, 157–158, 209–210, 406

secondary effects of, 13

spinal cord injuries and, 437–438

surgical considerations, 159–161, 211–213

three-dimensional modeling and, 211–213

traumatic brain injury and, 210, 211, 406

treatment, 159, 208, 210–211, 345, 406, 437–438

upper limb prosthetics and, 637

vacuum-assisted closure devices and, 126

wound closure and, 123–124

wound infection and, 210

WRAMC experience with, 209–211

Hiking

lower limb prosthesis and, 591

wheelchair designs for, 709

Hines Veterans Administration Hospital

spinal cord injury center, 416

Hip disarticulation

alignment and, 576

gait and, 576

hip and knee joint considerations, 576

prosthesis biomechanics, 576

prosthesis socket design, 575

Hip disarticulations

general surgical considerations, 140

wound complications, 140

Hirai, M.

residual limb pain research, 155

Hirstein, W.

phantom limb pain research, 232

Historical background. See also Medical history

combat amputee care, 5–7, 20–37, 494

gait analysis and training, 536

heterotopic ossification, 157, 209

mortality risk from fractures, 193

pain management, 230

return to duty, 54

spinal cord injuries, 416

sports and recreation opportunities, 670

sports-related prostheses, 642

surgical amputations, 118

HO. See Heterotopic ossification

Hoagland, F.T.

socket problems research, 156

Hockey

opportunities available to amputees, 676

sled hockey, 676, 710

upper limb prosthetic considerations, 648

Hoge, C.W.

psychiatric disorder association with trauma, 266

traumatic brain injury research, 404–405

Holistic care

team approach to, 7, 8

Home-based primary care

Veterans Health Administration and, 72

Home hospice care

Veterans Health Administration and, 73

Home repair responsibilities

phase of the upper limb amputee protocol of care and, 519

Homeless veterans

Veterans Health Administration and, 76

Homemaker and home health aide program

Veterans Health Administration, 73

Homografts

burn casualties and, 313

Hook-style terminal devices

description, 614

programming of, 615

Hoover, A.

wheelchair activity patterns, 701

Horlocker, T.T.

regional anesthesia and analgesia research, 235

Horseback riding

opportunities available to amputees, 676

Huang, L.

characteristics of burn scars, 351

HUD. See US Department of Housing and Urban Development

Human Engineering Research Laboratories

partnerships with, 12

Humeral neck amputations

interim phase of upper limb prosthetic rehabilitation and, 629

prosthetic recommendations (table), 633

surgical considerations, 620

Humerus. See also Elbow and humerus amputations
Index

xliii

humeral osteotomy technique, 174–176

Hunt, J.L.

hand burn outcomes, 283

Hunting

opportunities available to amputees, 676

Hybrid upper limb prosthetics

advantages/disadvantages of (table), 612

description, 612

Hydralazine

autonomic dysreflexia treatment, 430

Hydraulic prosthetic knees

description, 559

Hydromorphone

phantom limb pain treatment, 245

Hypercalcemia

spinal cord injuries and, 433

Hyperpigmentation

burn casualties and, 351

Hypertension

walking in a prosthesis and, 218

Hypertrophic scarring

burn casualties and, 350, 351–352

Hypnosis

case study (exhibit), 272

components of, 271

description of technique, 271–272

I

iBOT transporters

advantages and disadvantages, 703

description and uses, 703

Iceross Seal-In liners

description and uses, 722

IDTs. See Interdisciplinary teams

Ileum

loss of gastrointestinal mobility and, 432

spinal cord injury and, 432

Immediate postoperative prosthesis

advantages and disadvantages, 129–130

Improvised explosive devices

amputation injuries and, 118, 345, 608

devastating injuries from, 42, 345

multisystem comorbidities, 118

traumatic brain injury and, 400

use in current conflicts, 37

In Motion magazine, 525

Inadvertent epidural spread

perioperative regional anesthesia and analgesia risk, 238

Individuals with Disabilities Education Act

provisions, 710

Individuals with limb amputations. See also Amputee care programs; specific types of limb amputations

active duty service and, 2

cardiovascular and metabolic topics of concern, 218

changes in patient population, 7

disease-related amputations, 4

endocrine system topics of concern, 219

evaluation of the less-than-successful amputee, 155–157

future research needs, 734–738

grieving process after limb loss, 267–268

hearing loss and, 382–394

long-term effects, 217–219

musculoskeletal topics of concern, 218

outcomes research needs, 734

psychiatric interventions, 266–273

spinal cord injuries and, 424–425

“tactical athletes” description, 452, 732

traumatic brain injury and, 7, 219, 272, 404–405, 494

types of postamputation pain, 155–156

Infection. See also Methicillin-resistant Staphylococcus aureus;

Multidrug-resistant organisms; specific types of infection

antibiotic susceptibility testing, 194–195

blood transfusions and, 200

classification of, 177–178

contact precautions, 198

control and surveillance in returning warriors, 197–198

debridement and, 178, 179

differentiating between colonization and true infection, 195

fever in returning service members, 200

fracture characteristics and, 193

heterotopic ossification and, 178–179, 210

high incidence of, 177

hospital management of, 179

inflammatory markers, 197

laboratory evaluation, 178

local wound adjuncts and, 180

management at military tertiary care centers, 194–195

nutrition and, 177

osseointegration and, 723

osteomyoplastic transtibial amputations and, 168

perioperative regional anesthesia and analgesia risk, 239

postoperative infections in heterotopic ossification, 159–161

presentation, 178

prophylactic antibiotics and, 193–194

protocol for management of infections for amputee/extremity 

trauma patients, 196–197

signs and symptoms of, 203

skin loss in burn patients and, 307

surgical considerations, 179

surgical infection management and follow-up, 195–196

Surgical Infection Prevention Project guidelines for antibiotic 

prophylaxis, 193–194

surgical site infections, 195–196

treatment, 177–179

tympanic membrane perforation association with ear infections, 385

wound closure and, 121–122

Infectious Diseases Society of America

treatment guidelines for surgical site infections, 195–196

Inferior vena cava filters

deep venous thrombosis treatment, 429

Inner ear injuries

cochlear injury, 385–386

Inserts

burn scar management, 356–358

elastomers and, 357

hot and cold gel pads, 357

pressure and, 356

silicone gel sheeting, 357

silicones and, 356–357

wound healing and, 356, 357

Institute of Rehabilitation, New York University

Rusk’s principles of rehabilitation and, 33

Insurance programs

family service members’ group life insurance, 80

service-disabled veterans insurance, 80

Service Members Group Life Insurance, 79–80

service members’ traumatic injury protection, 80

Veterans Benefits Administration and, 79–80, 82

veterans’ group life insurance, 80

veterans’ mortgage life insurance, 80

Interdisciplinary teams

amputee care program, 10–11, 608

composition of, 44–45, 554

Polytrauma System of Care and, 44–45

role of, 44

Interim phase of upper limb prosthetic rehabilitation
xliv

Care of the Combat Amputee 

bilateral amputee considerations, 629–632

burn casualties and, 634–635

donning and doffing prostheses, 623

early postoperative prosthesis fitting, 622–623

fabrication of the definitive prosthesis, 624

hearing loss and, 633

level-specific recommendations, 625–629

lower extremity injury/loss and, 634

maintenance tasks, 624–625

transition from EPOP to preparatory version of the prosthesis, 

623–624

traumatic brain injury and, 634

visually impaired persons, 632–633

International Amputee Soccer Association

prosthesis requirements, 584

International Classification of Functioning, Disability, and Health, 601

International Committee of the Red Cross

length-preserving amputation techniques, 122

war wound treatment discussion, 121

International Paralympic Committee

use of assistive devices in the water, 583–584

International Shooting Committee for the Disabled

shooting regulations, 672

International Sports Organization for the Disabled

classification system, 671

International Standards for Neurological Classification of Spinal Cord 

Injury, 418

International Standards Organization

wheelchair standards, 698

International Wheelchair and Amputee Sports Federation

fencing regulations, 675

International Wheelchair Aviators

contact information, 687

Internet. See also Web sites

career guidance, 99

military support systems Internet addresses (table), 110

Interscapulothoracic amputations

interim phase of upper limb prosthetic rehabilitation and, 629

prosthetic recommendations (table), 633

surgical considerations, 620

Interwar period

military “reconstruction centers,” 29

Intrepid Fallen Heroes Fund

description, 20

IONSYS

patient-controlled analgesia and, 245

IPOP. See Immediate postoperative prosthesis

Iraq. See also Operation Enduring Freedom/Operation Iraqi 

Freedom

US Armed Forces Amputee Patient Care Program work with 

Iraqi prosthetic and rehabilitation specialists, 554–555

Iraq War Veterans

support programs, 111

ISOD. See International Sports Organization for the Disabled

Isotoner edema gloves

burn edema management, 305

Israeli wars

spinal cord injuries and, 416

Iverson, G.L.

traumatic brain injury research, 404

J

Jaeger, H.

calcitonin research, 248

Jahangiri, M.

epidural analgesia research, 239

James A. Haley VA Hospital

vocational rehabilitation model program, 96, 103

Jebsen-Taylor hand function test, 15

John’s Golf Course

contact information, 687

Johns Hopkins Bloomberg School of Public Health

Limb Loss Research and Statistics Program, 598

Joint Commission on Accreditation of Healthcare Organizations

outcomes-based practices recommendations, 15

pain management recommendations, 13

Joint contractures. See also Tissue contractures

lower extremity contracture, 172–173

positioning and, 454

spinal cord injuries and, 438

upper extremity contracture, 173

Joint War Committee of the British Red Cross

description and role, 28

Jones, L.E.

over-use injuries in unilateral amputees, 514

upper limb amputation research, 601

K

Kastner, J.

gait analysis and training research, 547

Katsuly-Liapis, I.

epidural analgesia research, 239–240

Kayak Adventures

contact information, 688

Kayaking

opportunities available to amputees, 676

prosthetic examples, 657

upper limb prosthetic considerations, 646

Keloid scarring

burn casualties and, 350–351

Kerrigan, D.C.

gait assessment research, 540

Ketamine

burn casualties and, 297, 298

dosage considerations, 247

mechanism of action, 247

phantom limb pain treatment, 247

residual limb pain treatment, 233

Kielhofner, Gary

Model of Human Occupation, 494

Kinesiotherapists

description and role, 45

Kirk, Maj. Gen. Norman Thomas

Army Surgeon General role, 33

multidisciplinary amputee centers and, 33

Kishbaugh, D.

study of return to duty after limb amputation, 54

Kissin, I.

regional anesthesia research, 241

Knee disarticulation prostheses

benefits of disarticulation, 570

knee selection considerations, 571

socket design, 570

suspension, 570–571

Knee instability. See also Through-knee amputations

anterior cruciate ligament deficiency and, 176–177

short residual limb with an unstable fibula and, 176, 177

Korean conflict

number of amputations and reasons for, 33

survival rate for casualties, 400

Veterans Readjustment Assistance Act and, 96

Koren, D.
Index

xlv

posttraumatic stress disorder research, 405

psychiatric disorder association with trauma, 266

Krebs, D.E.

gait assessment research, 536

L

Labyrinthine damage

benign paroxysmal positioning vertigo and, 386

blast exposure and, 386

causes of, 386

Ménière’s disease and, 386

noise exposure and, 386

ototoxicity and, 386

symptoms of, 386

Lambert, A.W.

epidural analgesia research, 240

Landstuhl (Germany) Regional Medical Center

level IV care and, 3, 107

Language representation methods

description and uses, 713–714

LaNoue, Gen. (Ret.) Alcide

heterotopic ossification research, 209

osteomyoplastic transtibial amputation technique case studies, 

166

Laxatives

spinal cord injury and, 432

Lazzaro, J.J.

electronic bill of rights for the physically challenged, 529

LEAP. See Lower Extremity Assessment Project

LeBlanc, M.

upper limb amputation research, 600–601

Legro, M.W.

prosthesis evaluation questionnaire, 15

Lehmann, J.F.

gait analysis and training research, 547

Leishmaniasis

fever cause, 200

Level I care

description, 3

Level II care

description, 3

Level III care

description, 3

Level IV care

description, 3

Level V care

description, 3–4

Level VI care

description, 4

Levetiracetam

posttraumatic seizure prophylaxis, 13

Levi, L.

traumatic brain injury research, 403

Lidocaine

burn casualties and, 298

dosage considerations, 236–237, 247

phantom limb pain treatment, 247

Lierz, P.

continuous peripheral nerve block research, 241

Life insurance. See Insurance programs

Limb interface systems

artificial condyles, 722–723

sockets and liners, 722

Limb Loss Research and Statistics Program

amputation estimates, 598

focus of, 599

outcomes data, 599

“use” and “satisfaction” measurements, 599–600

Limb salvage

achieving equal limb length and, 145–147

amputation after attempted limb salvage, 143–145

amputee counselors/visitors and, 142–143

bilateral amputation and, 145–147

bone defects or nonunion of fractures and, 145

compared with amputation, 118–119

decision debate, 141

degree of muscle loss and, 119

delayed amputation compared with, 141–147

factors impacting, 119

goal of, 119, 126

hospital resources and, 119

injuries to joints above the level of amputation and, 145

modern medical advances and, 118

partners/mentors and, 142

scoring systems, 118

upper limbs, 130

vascular injury and, 145

Lippmann, S.R.

social isolation after limb loss, 268

Lisfranc-level amputations

description, 135

Lithium ion batteries

power source for artificial limbs, 726

Lithium polymer batteries

power source for artificial limbs, 726–727

Liu, S.S.

regional anesthesia and analgesia research, 236

Livneh, H.

coping response research, 102

Loan guaranty program

servicing assistance, 81

specially adapted housing grants, 81, 82

Local anesthesia

burn casualties and, 297

Local anesthesia toxicity

regional anesthesia and analgesia risk, 236–237

treatment, 237

Locomotor capabilities index, 15

Loeser, J.D.

opioid research, 246

Long, C.L.

ebb and flow phases of burn casualties, 294

Lovenox

deep venous thrombosis prophylaxis, 207

Low back pain

incidence in individuals with amputations, 218, 250

leg length and, 251

Low molecular weight heparin

deep vein thrombosis prophylaxis, 12–13, 206, 207, 294, 429

Lower Extremity Assessment Project

limb salvage and, 119

through-knee amputations, 138

Lower extremity joint contracture

causes, 172

functional return and, 172

preventing, 172–173

prosthetic fitting and, 172

treatment, 172

Lower limb amputations. See also Lower limb prosthetics; Physical 

therapy

achieving equal limb length and, 145–147

bilateral transfemoral amputations, 141

bilateral transtibial amputations, 141
xlvi

Care of the Combat Amputee 

bone defects or nonunion of fractures and, 145

cardiovascular topics of concern, 218

changes in patient population, 7

closure, 134

energy expenditure for amputation (table), 133

“flaps of opportunity,” 134

gait deviations and, 540–541

hemipelvectomy, 140

heterotopic ossification and, 134

hip disarticulation, 140

injuries to joints above the level of amputation and, 145

interest of amputees in sports and recreation activities, 582

interim phase of upper limb prosthetic rehabilitation and, 634

musculoskeletal concerns, 218

optimizing functional outcome, 133

partial foot amputation, 134–136

pneumatic tourniquets and, 134

preoperative prophylactic antibiotics and, 134

progressive equinus and inversion foot deformities and, 

133–134

prosthetic demands and, 121

severe upper extremity injury and, 141

spinal cord injury and, 424

surgical considerations, 133–140

Syme and long transtibial amputations, 136

through-knee, 138

transfemoral, 138–140

transtibial amputations, 136–138

Lower limb joint contracture

burn amputees and, 173

management of, 173

rigid dressings and, 173

surgery and, 173

Lower limb prosthetics

active duty military protocols, 578–579

advances in, 14

blind individuals and, 577

bone issues, 577

combined torsion and vertical shock units, 562

comorbidities affecting the rehabilitation prescription, 576–577

component overview, 555–564

four-phase rehabilitative process, 577–578

gel liners, 563

goals of, 554

hard sockets, 564

hip disarticulation and transpelvic socket design, 575–576

joint function and condition and, 577

knee disarticulation, 570–571

knee units, 558–561

multidisciplinary team approach and, 554

multiple limb loss and, 576–577

orthotist role, 554

positional rotators, 562

prosthetic feet, 555–558

prosthetic socks, 563–564

prosthetist role, 554–555

quick release couplings, 562

recommendations for daily use prosthesis, 578–579

skin issues, 577

socket interfaces, 563–564

soft tissue issues, 577

summary of issues, 579

Syme prosthesis, 564–565

torsion units, 561–562

transfemoral flexible liner with rigid frame, 564

transfemoral prostheses, 571–575

transtibial prostheses, 565–569

Lower limb prosthetics for sports and recreation. See also Upper 

limb prosthetics for sports and recreation

alignment considerations, 585

capabilities of the user and, 582

component choices, 585–586

cycling, 588–589

general-use utility prosthesis, 584

goal setting and, 582–583

golf, 591

hiking, 591

injuries and, 592

long-term effects, 592

mechanism of amputation and, 583

participation without the prosthesis, 583–584

performance considerations, 583

physical factors associated with the injury and, 583

prosthetic feet and, 584, 585–586

rock climbing, 589–590

service members compared with the general population, 582

skin tolerance to high activity, 584–585

summary of issues, 592

survey of disabled competitors in the 1996 Paralympic Games, 

582

transfemoral running, 587–588

transtibial running, 586–587

understanding the functional and biomechanical demands of 

a sport, 592

value of sports and recreation, 582

water sports, 590

when to provide a sports-specific prosthesis, 582–584

winter sports, 590

LRMs. See Language representation methods

LTI Boston Digital Arm System

description, 728

Lund, C.

chart for estimating burn size (figure), 284

rule of nines for burn severity, 282

M

M4L. See Marine Wounded Warrior Regiment

Madden, J.H.

scar tissue research, 318

Mafenide acetate

topical treatment of skin grafts, 315–316

Magnetic resonance imaging

heterotopic ossification diagnosis, 209

identification of inflammation-related pathology, 157

osteomyelitis, 436

posttraumatic syringomyelia, 439

Magnetorheologic prosthetic knees

description, 559–560

Maier, C.

calcitonin research, 248

Malaria

returning service members and, 200

Malcolm Grow Medical Center

PDES Joint Pilot Program and, 56

Malone, J.M.

upper limb amputees fitted with prostheses, 527

Manual wheelchairs

arm support, 706

armrests and footrests, 699–700

back height, 699

design importance, 698

foot and leg supports, 706

propulsion and skills, 700–701

rear axle position, 700

rear wheel camber, 700

seat and back angles, 699

seat depth, 699
Index

xlvii

seat height, 699

seat support, 705

seat width, 699

skills training importance, 701

sling seats, 705

standard type, 698

tilt frames and reclining backrests, 707

ultralight type, 698–699

wheels and tires, 700

Marine Corps League

support for wounded veterans, 107

support programs, 111

Marine Wounded Warrior Regiment

description and services, 106–107

hometown link locations, 114–115

Marjolin’s ulcer

chronic recurring draining fistulae and, 183

Marks, A.A.

prosthetics development, 23

Marquardt, E.

humeral osteotomy technique, 175

Marquardt humeral osteotomy

motion and control improvements, 175

postoperative management, 175–176

Marx, Capt. Robert S.

Disabled American Veterans of the World War I and, 29

Massachusetts Institute of Technology

VA Prosthetic and Sensory Aids Service collaboration with, 72

Massage

burn edema and, 305

burn scar management, 352–353

MDROs. See Multidrug-resistant organisms

Meal preparation

phase of the upper limb amputee protocol of care and, 520

MEBs. See Medical evaluation boards

Mecamylamine

autonomic dysreflexia treatment, 430

Mechanism of pain

phantom sensations and phantom limb pain, 231–232

residual limb pain, 232–233

Mechatronics

actuators, 727

power sources, 726–727

sensors and controls, 728

transmissions, 727–728

Medal of Honor

pension payments for recipients, 82

Medical evaluation boards

burn casualties and, 360–361

current legacy system, 56–58

description and role, 56

“fitness” determination, 56

functional capacity evaluations and, 522

membership of, 59

narrative summary and, 59

option for soldiers who do not agree with MEB findings, 59

proposed pilot system, 58–59

“3” or “4” profile designators, 58

VA Schedule for Rating Disabilities and, 56

Medical history

evaluation of less-than-successful amputees, 155–156

phase one of the upper limb amputee protocol of care and, 

495–496

range-of-motion exercises and, 326–327

types of postamputation pain, 155–156

Medical issues. See also specific injuries and issues

infectious disease issues, 193–200

long-term effects of limb amputation, 217–219

musculoskeletal topics of concern, 218

pulmonary embolism, 206–207

weight-bearing progression, 207–208

wound care management, 200–206

Medical management

element of amputee care programs, 12–13

Medical military occupational specialty retention boards

description and role, 59–60

membership of, 60

“3” profile and, 60

Medical Outcomes Study Short Form 36-Item Health Survey, 15

Medications. See also specific medications, classes of medications, and 

disorders

ototoxicity, 383

for pain management, 245–248, 297

psychiatric disorders, 270–271

Melendez, D.

upper limb amputation research, 600–601

Meller, Y.

continuous peripheral nerve block research, 240

Melzack, R.

mirror therapy research, 250

“neuromatrix theory” of phantom limb pain, 232

Ménière’s disease

causes, 386

symptoms, 386

Mentors

limb amputation and, 142

Meperidine

phantom limb pain treatment, 245

Mepivacaine

burn casualties and, 298

Meshed skin grafts

burn casualties and, 310

Metabolic system

critical care of burn casualties and, 292

protein needs of burn casualties, 296

topics of concern for amputees, 218

Methadone

burn casualties and, 297

phantom limb pain treatment, 245

Methanol fuel cells

power source for artificial limbs, 727

Methicillin-resistant Staphylococcus aureus

antibiotic treatment, 196

prevalence of, 194

Methylprednisolone

neuroprotection for spinal cord injuries, 417

Metoclopramide

slow gastric emptying treatment, 431

Mexiletene

administration of, 247

combined with clonidine, 247

dosage considerations, 247

phantom limb pain treatment, 247

residual limb or stump pain treatment, 233

MHS. See Military Health System

Microprocessor prosthetic knees

description, 560

Midazolam

dysautonomia treatment, 407

Middle ear injuries

ossicular disruption, 385

tympanic membrane perforation, 384–385

Midodrine

orthostatic hypotension treatment, 430

Mild traumatic brain injury

acute effects, 404

athletes and, 405

blast exposure and, 402–403
xlviii

Care of the Combat Amputee 

cognitive function and, 404, 408

description, 405

educational and psychological therapies, 405–406

functional recovery and, 402

Operation Enduring Freedom/Operation Iraqi Freedom and, 

400

pathophysiology, 401

persistent symptoms after, 404

postconcussion symptoms, 404

symptom treatment, 405

Military and veteran support systems. See Support programs

Military Health System

biomedical research mission, 5

combat casualty care mission, 2–4

health education mission, 4–5

healthcare services to active duty and military beneficiaries 

mission, 4

levels of care, 2–4

military readiness mission, 4

missions of, 2–5

need for flexibility within, 2

Military medical disability system

challenges of navigating, 15

Military readiness mission of MHS, 4

Military Severely Injured Center

description, 107–108

programs, 107–109

Military Severely Injured Service Center

description and role, 48

Military treatment facilities

level V care and, 3–4

multidisciplinary team approach to amputee care, 554, 608

Military war tasks

examples of, 480

Firearm Training System and, 528

firearms training simulators, 480, 529

immediate action drills and reacting to combat, 480

phase four of the physical therapy rehabilitation program and, 

480

phase four of the upper limb amputee protocol of care and, 

519

rescues and buddy carries, 480

road marching, 480

site picture drills and room clearing drills, 480

Millbank, Jeremiah

philanthropic work, 28

Miniaturized resuscitation devices

description, 37

Minimal Data Set

description and uses, 602

Mirror therapy

basis for, 250

phantom limb pain treatment, 250

Mirtazapine

residual limb pain treatment, 233

sleep problem treatment, 271

Mittenberg, W.

mild traumatic brain injury treatment, 405–406

MMRBs. See Medical military occupational specialty retention 

boards

Mobility issues for burn casualties

acute phase of burn casualty rehabilitation, 338–340

categories of mobility activities, 339

continuum of mobility activities throughout the phases of 

burn rehabilitation (figure), 339

factors in determining appropriate mobility activities, 339

intermediate phase of burn casualty rehabilitation, 340

long-term phase of burn casualty rehabilitation, 340

Mobility issues for individuals with spinal cord injuries

description, 421

Mobility issues in physical therapy

bed mobility, 453

transfers, 453

wheelchair management, 453–454

Model of Human Occupation (Kielhofner), 494

Modig, J.

regional anesthesia and analgesia research, 235

Moll, J.H.

osteomyoplastic transtibial amputation technique case studies, 166

Monaural low-redundancy speech tests

description and uses, 390

Montgomery GI Bill

active duty service members, 80

Selected Reserve, 80

Morgan, C.A.

psychiatric disorder association with trauma, 266

Morphine

burn casualties and, 298

dysautonomia treatment, 407

epidural anesthesia and, 244

phantom limb pain treatment, 245

Mortgage life insurance, 80

Motorized prosthetic knees

description, 560

Mountaineering

prosthetic examples, 666–667

upper limb prosthetic considerations, 650

MRI. See Magnetic resonance imaging

MRSA. See Methicillin-resistant Staphylococcus aureus

MTBI. See Mild traumatic brain injury

Mulroy, M.

regional anesthesia and analgesia research, 235

Multidrug-resistant organisms. See also specific organisms

antibiotic choice and, 194

antibiotic susceptibility testing and, 194–195

clearing protocol summary chart (table), 199

contact precautions, 198–200

definition of, 194

soldiers returning from Operation Enduring Freedom/Operation Iraqi Freedom and, 197–198

successful control measures, 198

Multifunctional wheelchairs

description, 703

iBOT transporters, 703

Multimodal pain management

American Society of Anesthesiologists practice guidelines, 

233–234

basis for, 233–234

medications, 245–248

multiple sites of action (figure), 233

nontraditional therapies, 248–250

rationale for, 233–234

regional anesthesia and analgesia, 234–244

treatment modalities, 234–244

Murdoch, G.

gait assessment research, 536

Murray, C.K.

extremity wounds with concomitant infection, 194

Muscle tension

description, 125

Muscles. See also Musculoskeletal system; Strength training and 

cardiovascular conditioning

“four Cs,” 120, 121

guidelines for muscle attachment (table), 620

importance to ultimate function, 120, 124

management of, 124–126

muscle tension, 125
Index

xlix

myodesis, 124–125, 620

myofascial closure, 124–125

myoplasty, 124, 620

strength training for, 330–332

surgical guidelines for muscle attachment, 620

tenodesis, 125

Musculocutaneous flaps

burn casualty reconstructive surgery and, 358

Musculoskeletal system. See also Heterotopic ossification; Muscles

chronic upper limb disorders, 438

contractures, 438

fractures, 433, 436–437

spinal cord injuries and, 436–438

topics of concern for amputees, 218

weight-bearing restrictions and, 207–208

Mustard agent

burns from, 281

MWWR. See Marine Wounded Warrior Regiment

Myodesis

adductor mechanism repair and, 162–163

bursitis and, 180–181

description, 124–125, 620

failure in transfemoral amputations, 162–164

failure in transradial amputations, 165

failure in transtibial amputations, 164–165

physical examination features of failure of, 162, 164

revision surgery, 164–165

Myoelectric prostheses. See also Electrically powered upper limb 

prosthetics

advances in, 724

controls training for myoelectric prosthesis by level of amputation (figure), 517

donning/doffing issues, 509–511

intuitive use of, 723–724

sensory feedback and, 724

targeted muscle reinnervation and, 725–726

“Targeted Reinnervation in Upper Limb Amputees to Improve 

Myoelectric Prosthesis Function,” 530

unilateral and bilateral amputee goals for myoelectric and 

body-powered prostheses (exhibit), 507–508

Myoplasty

description, 124, 620

failure in transhumeral amputations, 165

failure in transradial amputations, 165

failure in transtibial amputations, 164–165

Myosite testing and training

electrode attachment, 506

electrode site identification, 504–505

initial training, 505–506

MyoSoft software, 505

prosthesis fit timing, 504

MyoSoft software

description and uses, 505

N

N-methyl-d-aspartate

traumatic brain injury neuroprotection, 406

Narrative summaries

medical evaluation boards, 59

NARSUMs. See Narrative summaries

National Ability Center

contact information, 688

National Alliance for Accessible Golf

contact information, 688

National Amputee Golf Association

contact information, 688

National Archery Association

oversight of archers with disabilities, 672

National Association of State Directors of Veterans Affairs

State Benefits Seamless Transition Program, 111

National Call to Service

educational assistance, 81

National Cemetery Administration

description and mission, 82

program areas, 82–83

National Collegiate Athletic Association

regulations for disabled basketball players, 673

regulations for disabled football players, 675

National Defense Authorization Act

VA healthcare package, 77

National Disabled Veterans Summer Sports Clinic, 14–15

National Disabled Veterans Winter Sports Clinic

description and activities, 11, 14, 36

opportunities available to amputees, 676

National Electronic Injury Surveillance System All Injury Program

upper limb amputation incidence, 598–599

National Guard soldiers

MHS military readiness mission and, 4

physical disability evaluation system and, 55

Servicemembers Group Life Insurance and, 79

Veterans Benefits Administration and, 78

National Health Interview Survey–Disability

estimates of amputation prevalence, 598

limitations of, 598

National Institute on Disability and Rehabilitation Research

spinal cord injury care, 416

study of late seizures in traumatic brain injury, 406

National Naval Medical Center

PDES Joint Pilot Program and, 56

physical medicine and rehabilitation residency program, 5

National Park Service

Office of Special Populations, 673

National recreational events

Veterans Health Administration and, 74, 75

National Research Council

location of VA hospitals near medical schools recommendation, 6

prosthetic devices committee, 33

National Rifle Association Disabled Shooting Services

contact information, 688

National Sports Center for the Disabled

contact information, 688

National Veterans Foundation

support programs, 111

National Veterans Wheelchair Games

description, 11, 15, 36, 524, 670

description and activities, 676–677

eligibility for, 676–677

wheelchair activity patterns studies, 700–701

National Wheelchair Basketball Association

contact information, 689

description and activities, 673

National Wheelchair Poolplayers Association

contact information, 689

National Wheelchair Shooting Federation

contact information, 689

shooting regulations, 672

National Wheelchair Softball Association

contact information, 689

Native Americans

direct home loans, 81

Naturalization

N-400 Application for Naturalization, 83

preference for veterans, 83–84

Navy Safe Harbor program

description, 107

NCA. See National Cemetery Administration
l

Care of the Combat Amputee 

Neff, G.

humeral osteotomy technique, 175

Negative pressure dressings

burn casualties and, 315

description, 121, 497

Nerve injuries. See also Peripheral nerve injuries

prevention of, 238

regional anesthesia and analgesia risk, 237–238

sources of, 238

treatment of, 238

Nerve management

cauterization of the nerve end, 127

end loop anastomosis, 127

ligation, 127

nerve capping, 127

neuroma prevention, 120, 127

retaining as much nerve function in the residual limb as possible, 120–121

sciatic nerve, 127

targeted reinnervation, 127

traction neurectomy, 127

transection of nerves, 120

Neural-machine interfaces

brain-machine interfaces, 724

peripheral nerve interfaces, 724–725

targeted muscle reinnervation, 725–726

Neurogenic bowel

spinal cord injury and, 432

Neuroleptic drugs. See also specific drugs

anxiety treatment, 271

Neurologic complications

spinal cord injuries and, 438

Neurological issues in burn casualties

changes in reflexes and tactile information, 346

desensitization programs, 346–347

peripheral neuropathies, 347

temperature desensitization, 347

texture desensitization, 346–347

Neuromas

blood vessel proximity and, 162

evaluation of, 161

formation of, 161

pain from, 155

percentage of amputees experiencing, 161

peroneal nerve, 161

phantom limb pain and, 232

prevention of, 120, 127

prosthetic socket modifications and, 161

sciatic nerve, 161–162

superficial radial nerve, 161

treatment, 636–637

upper limb prosthetics and, 636–637

Neuromonics Tinnitus Treatment

description and uses, 393

Neurophysiology of pain

modulation, 231

nociceptive pathway, 230–231, 233, 297

perception, 231

transduction, 231

transmission, 231

Neuropsychologists

description and role, 45

NHIS-D. See National Health Interview Survey–Disability

Nickel cadmium batteries

power source for artificial limbs, 726

Nikolajsen, L.

epidural analgesia research, 240

ketamine research, 233, 247

“Randomised Trial of Epidural Bupivacaine and Morphine 

in Prevention of Stump and Phantom Pain in Lower-Limb 

Amputation,” 240

Nitroglycerine

autonomic dysreflexia treatment, 430

Noise-induced hearing loss

intermittent exposure to loud noise and, 382

mechanism of, 382

steady-state exposure to loud noise and, 382–383

Nonsteroidal antiinflammatory drugs

adverse effects, 248, 297

burn casualties and, 297

heterotopic ossification treatment, 158, 160, 208, 209, 210, 345, 

438

impaired healing response and, 204

limitations of, 248

mechanism of action, 248

multimodal pain management and, 233

phantom limb pain treatment, 248

residual limb or stump pain treatment, 232–233

Nontraditional pain therapies

acupuncture, 249

deep brain stimulation, 248

mirror therapy, 250

spinal cord stimulation, 248

sympathetic blocks, 249

transcutaneous electrical nerve stimulation, 248

North American Riding for the Handicapped Association

contact information, 689

Northeast Passage

contact information, 690

Northwestern University

“Squirt Shape” technique, 722

Nortriptyline

phantom limb pain treatment, 247, 248

NSAIDs. See Nonsteroidal antiinflammatory drugs

Nursing home care

Veterans Health Administration and, 73

NuStep machines

rehabilitation of burn casualties and, 332

Nutrition

amino acids and, 296

available energy stores (table), 295

carbohydrate needs of burn casualties, 296

critical care of burn casualties, 291, 294–296

energy need estimation, 295

enteral feedings, 291

goals of nutrition support, 294

importance to wound management and rehabilitation, 294

initiating support early, 294–295

protein needs of burn casualties, 296

trace element requirements of burn casualties, 296

vitamin and mineral requirements of burn casualties, 296

wound closure and, 122

O

Observational gait assessment

compared with computerized gait assessment, 536

description, 538

inaccuracies in, 536

Occupational Therapist Upper Extremity Functional Evaluation

description and uses, 601

Occupational therapists

description and role, 45, 494

preprosthetic phase of upper limb prosthetic rehabilitation 

role, 622

spinal cord injuries rehabilitation role, 425–426, 427

traumatic brain injury rehabilitation role, 408

vocational rehabilitation and, 97
Index

li

wound care and dressing and, 497

Occupational therapy

adaptive sports program, 524

community reintegration survey, 530

concomitant injuries and, 525–526

discharge planning, 525

Firearm Training System, 528

focus of, 494

four-phase upper limb amputee protocol of care, 494–523

goal of, 494

importance of, 494

multiple exposure/progressive desensitization, 530–531

overlap between phases of, 494

phase one: initial management and protective healing, 495–498

phase two: preprosthetic training, 499–506

phase three of the upper limb amputee protocol of care, 

506–515

phase four of the upper limb amputee protocol of care, 

515–523

recent advancements in prosthetic development and their 

impact on treatment, 527–531

rehabilitation factors, 525–527

research updates, 528

summary of issues, 531

targeted reinnervation, 527, 530

voice recognition software, 528–530

O’Donnell, M.L.

psychiatric disorder association with trauma, 266

OEF. See Operation Enduring Freedom/Operation Iraqi Freedom

OEF/OIF program

description, 48

Office of Vocational Rehabilitation and Education

description and services, 102–103

OH. See Orthostatic hypotension

OIF. See Operation Enduring Freedom/Operation Iraqi Freedom

OIH. See Opioid-induced hyperanalgesia

On-Q pumps, 244

ONET career guidance Web site, 99

Ong, B.Y.

regional anesthesia and analgesia research, 239

Operation Enduring Freedom/Operation Iraqi Freedom. See also

Global war on terror; OEF/OIF program

Acinetobacter baumannii-calcoaceticus infections and, 197

common causes of injuries, 400

deep venous thrombosis incidence, 206–207

early postoperative prosthesis and, 623

five leading diagnoses for veterans, 71

hearing loss incidence, 382

heterotopic ossification and, 197, 208, 209, 211

importance of graduate medical educational programs and, 4

incidence of concomitant spinal cord injury and amputations, 

424

launching of, 2

level IV care and, 3

limb amputation data, 7, 494

multidrug-resistant organism prevalence, 196

number of patients sustaining major limb loss, 118

osteomyoplastic transtibial amputations and, 167–168

posttraumatic stress disorder prevalence, 405

psychological issues, 342

Q fever and, 200

reduction in mortality from combat injuries, 42

spinal cord injuries and, 416

support programs, 111

survival rate for casualties, 400

traumatic brain injury estimates, 400, 405

upper limb damage, 600

US prosthetic and rehabilitation specialists and, 554–555

VHA usage data, 71

Operation First Response

description, 111

Operation Helping Hand

assistance for families and caregivers, 48

Operation Iraqi Freedom. See also OEF/OIF program; Operation 

Enduring Freedom/Operation Iraqi Freedom

Operation Warfighter program

description and goals, 108

Opioid-induced hyperanalgesia

description, 233

Opioids. See also specific drugs

burn casualties and, 297, 298

epidural anesthesia and, 244

future research needs, 737

narcotic conversion chart (table), 246

opioid-induced hyperanalgesia, 233

oral choices, 245–246

phantom limb pain treatment, 245–246

short- and long-term sequelae, 246

side effects, 298

OPUS-UE. See Orthotics and Prosthetics Use Survey--Upper 

Extremity

Oral cavity

dental caries, 430–431

periodontal disease, 430–431

Oral hygiene

phase one of the upper limb amputee protocol of care and, 496

phase two of the upper limb amputee protocol of care and, 500

Order of St John

description and role, 28

Orthostatic hypotension

risk factors, 430

spinal cord injuries and, 421, 430

treatment, 430

wheelchair use and, 421

Orthotic and Prosthetic Assistance Fund

Paralympic Games and, 36

Orthotics and Prosthetics Use Survey--Upper Extremity

description and uses, 602

Orthotists

role of, 554

Osseointegration

benefits and challenges of, 723

description, 723

future research needs, 736

Ossicular disruption

prevalence, 385

tympanic membrane perforation and, 385

Ossur

Iceross Seal-In liners, 722

RHEO KNEE, 547–548, 726

Osteoarthritis

incidence in amputations, 218

Osteomyelitis

posttraumatic, 197

pressure ulcers and, 436

treatment difficulties, 196–197

Osteomyoplastic transtibial amputations

benefits of, 169

bone-bridging and, 166–167

controversy over, 166–167, 168–169

current wars and, 167–168

description, 165–166

infection risk, 168

proponents of, 166

Osteoporosis

spinal cord injuries and, 433

Otoprotectants

description, 393
lii

Care of the Combat Amputee 

Ototoxicity

clinical symptoms, 383

individual susceptibility to, 383

labyrinthine damage and, 386

monitoring protocol, 388–389

previous noise exposure and, 383

Outcome measures

Functional Status Outcomes Database, 49

future research needs, 734

performance-based measurement tools and devices, 15

self-reporting measures, 15

Outer ear injuries

blast exposure and, 384

burn patients and, 384

Outpatient services

Blind Rehabilitation Service, 76

Polytrauma System of Care and, 46–47

Veterans Health Administration and, 74

Outpatient therapy

description, 46–47

Oxacillin

surgical site infection treatment, 196

Oxandrolone

wound healing and, 292

Oxycodone

burn casualties and, 297

phantom limb pain treatment, 245

P

PACT program. See Preservation-Amputation Care and Treatment 

program

Pain management. See also specific medications

acute phase of burn management and, 298

benefits of, 230

burn casualties and, 297–299, 348

chronic pain, 230, 297

element of amputee care programs, 13–14

future research needs, 251, 736–737

group therapy and counseling, 297

historical background, 230

impacts of pain, 297

interdisciplinary approach, 297

low back pain, 250–251

mechanisms of pain, 231–232

multimodal pain management, 233–250

neurophysiology of pain, 230–231, 297

noncompliance with medical treatment plans and, 297

nontraditional therapies, 248–250, 297

pain definition, 297

phase one of the upper limb amputee protocol of care and, 498

posttraumatic stress disorder and, 409

predictors of burn pain, 297

regional anesthesia and analgesia, 234–244

spinal cord injuries and, 438–440

summary of, 251

traumatic brain injury and, 409

treatment modalities, 234–244

Pancreas

spinal cord injury and, 431

Panerai, A.E.

antidepressant research, 248

Paralympic Games

affiliated nonprofit organizations, 36

description, 36, 677

guiding principles, 677

sponsors, 15, 36

survey of disabled competitors in the 1996 games, 582

Paralyzed Veterans of America

Bass Tour, 675

contact information, 690

description and activities, 110, 524

National Trapshoot Circuit, 679

National Veterans Wheelchair Games sponsor, 676

Paralympics sponsor, 15, 36

partnerships with, 12

present-day role, 29

programs, 110–111, 524

Partridge, B.L.

regional anesthesia and analgesia research, 238

Pasquina, Col. Paul F., M.D.

Advisory Committee of the Secretary of Veterans Affairs on 

Prosthetics and Special Disability Populations head, 7–8

“Rehabilitation of the Combat Amputee--Consensus Conference and Creating a Roadmap for the Future,” 733

Passive/cosmetic restoration option for upper limb prosthetics

advantages/disadvantages of (table), 613

description, 612

materials for, 612

Passive range-of-motion exercises

burn edema and, 301, 304

comatose casualties and, 327

considerations for use of (exhibit), 328

continuous passive motion devices, 327–328

large burns and, 327

skin grafts and, 315

Patient-controlled analgesia

advantages of, 245

electronic pumps and, 244

IONSYS, 245

modalities (table), 245

Patzakis, M.J.

antibiotic prophylaxis research, 193

PCA. See Patient-controlled analgesia

PDES. See Physical disability evaluation system

PDES Joint Pilot Program

challenges, 63

customer satisfaction and, 63

description, 56

disability evaluation system Joint Pilot Program timeline 

overview (figure), 57

PDR. See Permanent disability retirement

Peak performance training

description, 500

PEBs. See Physical evaluation boards

Peer support programs

description, 14–15

phase two of the upper limb amputee protocol of care and, 500

Peer visitors, 20, 142–143, 500, 735

Peleg, K.

traumatic brain injury research, 403

Pension programs

Veterans Benefits Administration, 79

Pereira, C.P.

ebb and flow phases of burn casualties, 294

Perioperative regional anesthesia and analgesia

avoiding general anesthesia side effects and, 234

benefits of, 234–236

bronchospasm and, 238

burn casualties and, 298

continuous peripheral nerve block studies demonstrating 

benefits, 240–241

continuous peripheral nerve block studies demonstrating no 

benefit, 241

continuous peripheral nerve blocks, 240–241, 243–244

decreasing blood loss and, 235

decreasing deep vein thrombosis and, 235

decreasing hospital costs and, 235
Index

liii

electronic pumps for, 244

epidural catheter technique, 242

epidural studies demonstrating benefits, 239–240

epidural studies demonstrating no benefit, 240

epinephrine toxicity and, 238

evidence-based medicine in the prevention of phantom limb 

pain, 239–241

failure of the technique, 238

hematoma and, 238

improved postoperative analgesia and, 235

improving early recovery period and, 235

improving operating room efficiency and, 235

improving patient outcome and, 235–236

improving patient satisfaction and, 236

inadvertent epidural spread and, 238

infection and, 239

intraoperative hemodynamic stability and, 234

local anesthesia toxicity and, 236–237

localization techniques, 243

nerve injury and, 237–238

peripheral catheters for, 244

peripheral nerve blocks, 242

phrenic blockade and, 238

pneumothorax and, 237

risks of, 236–239

routine volumes and rates for regional anesthesia techniques 

in adults (table), 242

solutions used for, 244

techniques of, 241–244

Peripheral catheters

description, 244

Peripheral nerve blocks

benefits of, 234–236

burn casualties and, 298

complications of, 299

hematoma and, 238

historical background, 230

local anesthesia toxicity and, 236–237

lower extremity blocks, 242

mechanism of, 233

nerve injury and, 237–238

nerve stimulation technique, 243

outpatient follow-up, 299

risks of, 236–239

safety of, 234

techniques for, 242

upper extremity blocks, 242

Peripheral nerve entrapment

risk factors, 439–440

spinal cord injuries and, 439–440

Peripheral nerve injuries. See also Nerve injuries

clinical evaluation, 213–215

electrodiagnostic evaluation, 215–216

mechanism of recovery, 216–217

patient identification, 213

physical therapy and, 481

presentation of, 213

rehabilitation intervention, 217

surgical intervention, 217

Peripheral nerve interfaces

description, 724

problems with, 724–725

Peripheral neuropathies

burn casualties and, 347

causes of, 347

hand injuries and, 347

muscle testing and, 347

prevention of, 347

pruritus and, 347–348

Permanent disability retirement

physical evaluation boards and, 61

Pet care

phase four of the upper limb amputee protocol of care and, 

520–521

Peterson, K.

major pathogens from war trauma-associated infections, 194

Pezzin, L.E.

upper limb amputation research, 600

Phantom limb pain

burn-related amputations and, 346

duration of, 231

evidence-based medicine in the prevention of, 239–241

future research needs, 737

historical background, 230

incidence of phantom limb pain (tables), 239, 240

management of, 13–14

mechanism of, 231–232

“neuromatrix theory,” 232

origin of the term, 230

percentage of amputees experiencing, 155

possible causes of, 232

significance of, 230

treatment, 233, 245–248

use of hypnosis in treating phantom limb pain (exhibit), 270

“Phantom Limb Pain in Amputees During the First 12 Months 

Following Limb Amputation, After Preoperative Lumbar Epidural Blockade” (Bach), 239

Phantom sensations

description, 155

duration of, 231

mechanism of, 231

percentage of amputees experiencing, 155

telescoping, 231–232

Pharmacological interventions. See Medications; specific medications and classes of medications

Phase one of the physical therapy rehabilitation program

ambulation with assistive devices, 461–462

balance, 460

bed mobility, 453

bedside calisthenics, 458

cardiovascular endurance, 458

compression dressing education, 462–463

core stabilization, 454, 456–457

early postoperative rehabilitation guidelines, 455

flexibility, 454

functional activities, 453–454

goals for progression to phase 2, 463

lower body ergometer exercises, 458

muscle strengthening, 454, 456–457

transfers, 453

treadmill use, 458

upper body ergometer exercises, 458

wheelchair management, 453–454

WRAMC military amputee rehabilitation protocol, 462–463

Phase one of the upper limb amputee protocol of care

activities of daily living, 496–497

basic rehabilitation goals (exhibit), 495

body symmetry, 498

desensitization, 497

evaluation, 495–496

exercise, 498

flexibility, 497–498

functional evaluation, 496

pain management, 498

prehension evaluations, 496

psychological support, 498

wound healing, 497

Phase two of the physical therapy rehabilitation program
liv

Care of the Combat Amputee 

cardiovascular endurance, 470

flexibility, 465

functional activities, 465

goals for progressing to phase three, 470

muscle strengthening, 465–469

Phase two of the upper limb amputee protocol of care. See also

Preprosthetic phase of upper limb prosthetic rehabilitation

myosite testing and training, 504–506

postural exercises and strengthening, 503–504

psychological support, 499–500

unilateral and bilateral amputee rehabilitation goals (exhibit), 

499

Phase three of the physical therapy rehabilitation program

functional activities, 471–479

goals for progressing to phase four, 479

Phase three of the upper limb amputee protocol of care

activities of daily living, 511–514

controls training for body-powered prosthesis by level of 

amputation (figure), 516

controls training for myoelectric prosthesis by level of amputation (figure), 517

donning/doffing prostheses, 509–514

focus and goals of, 506

initiation of controls training, 511

muscle strengthening and endurance, 515

operational prosthetic knowledge and performance, 508–509

residual limb tolerance/care, 509

unilateral and bilateral amputee goals for myoelectric and 

body-powered prostheses (exhibit), 507–508

“Unilateral Upper Extremity Amputation: Activities of Daily 

Living Assessment” (figure), 517

Phase four of the physical therapy rehabilitation program

abdominal/visceral trauma and, 480

comorbidity considerations, 480–482

core stabilization, 479

fractures and, 481

military task training/military operations, 480

multiple limb loss issues, 481–482

peripheral nerve injuries and, 481

recreational/sports activities, 479

traumatic brain injury and, 482

vestibular damage and, 481

Phase four of the upper limb amputee protocol of care. See also

Advanced phase of upper limb prosthetic rehabilitation

adaptive equipment and environmental modifications, 522

advanced prosthetic training: unilateral and bilateral, all levels 

(exhibit), 519

characteristics of advanced prosthetic rehabilitation, 515–519

child care and pet care, 520–521

driver’s training, 521

exercise prescription considerations, 522

goals of, 515

meal preparation, 520

military warrior tasks, 519

outcome of, 515

recreational and sports activities, 523

shopping, 519–520

timing of, 515

vocational planning and training, 521–522

yard work, home repair, and maintenance, 519

Phenol

spasticity treatment, 438

Phenoxybenzamine

autonomic dysreflexia treatment, 430

Philanthropy

definition of, 20

role in the care of the combat amputee, 20–37

Phrenic blockade

perioperative regional anesthesia and analgesia risk, 238

Physiatrists

description and role, 45

role of, 8

Physical Disability Evaluation System

burn casualties and, 360

goals of, 360

Physical disability evaluation system

continuation on active duty, 61

Joint Pilot Program, 56, 57, 63

medical evaluation boards and, 56–59

medical military occupational specialty retention boards, 

59–60

overview, 55–56

physical evaluation boards and, 55, 60–61

Physical evaluation boards

DA Form 199 and, 60

description and role, 56

“fitness” determination, 56

formal meeting, 60–61

informal meeting, 60

legacy system and, 56–58

membership of, 59, 60

permanent disability retirement list and, 61

temporary disability retirement list and, 61, 63

US Army Physical Disability Agency authority and, 56

VA disability compensation and, 62

Physical examination of the less-than-successful amputee

donning and doffing the prosthesis and, 156

MRI for identification of inflammation-related pathology, 157

passive and active range-of-motion and, 156

radiographic examination, 156–157

Physical medicine and rehabilitation. See also Physical therapy

partnering with orthopaedic specialists for inpatient and 

outpatient care, 8

residency program at WRAMC, 5, 11

Physical therapists

description and role, 45, 452

prosthetic training role, 452

traumatic brain injury rehabilitation role, 407–408

Physical therapy

bedside management, 453

bilateral transfemoral amputees, 453, 461, 491–492

bilateral transtibial amputees, 453

body image issues and, 482

Dexa Scans and, 479

four-phase rehabilitation program, 452–482, 486–490

phase one: initial management, 453–464, 486–487

phase two: preprosthetic phase, 465–470, 487–488

phase three: prosthetic/ambulation phase, 470–479, 488–489

phase four: progressive activities/return to active duty, 

479–482, 489–490

physical therapy evaluation, 452–453

role, 452

summary of issues, 482

WRAMC military amputee rehabilitation protocol, 486–491

Physically Challenged Bowhunters of America, Inc.

contact information, 690

Pinto, M.A.

osteomyoplastic transtibial amputation technique case studies, 166

Pinzur, M.S.

continuous peripheral nerve block research, 241

osteomyoplastic transtibial amputation technique case studies, 166

upper limb amputation research, 600

Pittelkow, M.R.

cultured autologous keratinocyte (epidermal) skin grafts and, 

312

Planetary gears
Index

lv

efficiency rates, 727

Plastic and reconstructive surgery

burn casualties, 358–359

hand burns, 359

reconstructive process, 358

skin flaps, 358–359

timing of, 358, 359

PLP. See Phantom limb pain

PMP service. See Preventive medical psychiatry service

PM&R. See Physical medicine and rehabilitation

PNBs. See Peripheral nerve blocks

Pneumatic prosthetic knees

description, 559

Pneumonia

mortality from, 428

spinal cord injuries and, 428

Pneumothorax

regional anesthesia and analgesia risk, 237

PNSs. See Polytrauma network sites

Polymyxins

multidrug-resistant organism treatment, 194–195

Polytrauma

Army Medical Department VA polytrauma liaison program, 

88

concerns of the service member with polytrauma and limb 

loss, 267–268

definition, 42

future research needs, 736

hearing loss and, 382

psychiatric interventions and, 267–268

rehabilitation challenges, 494

Polytrauma and Blast-Related Injuries Quality Enhancement 

Research Initiative

description, 48

priority research areas, 48

Polytrauma network sites

description and role, 43, 44

Polytrauma points of contact

description and role, 43, 44

Polytrauma rehabilitation centers

Army and Marine liaisons at, 48

description and role, 43–44

family and caregiver support and, 47–48

Polytrauma support clinic teams

description and role, 43, 44

Polytrauma System of Care

acute rehabilitation program, 46

case management, 47, 48

components, 43–44

Consolidated Appropriations Act and, 43

coordination of care, 47

day treatment program, 47

development of, 42–43

emerging consciousness program, 46

family and caregiver support, 47–48

interdisciplinary teams, 44–45

outcome measures, 49–50

outpatient therapy, 46–47

polytrauma network sites, 43, 44

polytrauma points of contact, 43, 44

polytrauma rehabilitation centers, 43–44, 47–48

polytrauma support clinic teams, 43, 44

polytrauma telehealth network, 43, 47

research collaborations, 48–49

residential transitional rehabilitation program, 46

scope of services, 44–47

specialized programs, 46–47

subacute rehabilitation program, 46

Web site, 48

Polytrauma telehealth network

description and role, 43, 47

Ponsford, J.

mild traumatic brain injury treatment, 406

Positional rotators

description and uses, 562

Positioning

burn edema and, 302

burn scar management, 353

intermediate phase of burn casualty rehabilitation and, 319

joint contractures and, 454

long-term phase of burn casualty rehabilitation and, 319–320

positioning and splinting devices used to manage edema 

(table), 303–304

postoperative splinting and positioning (table), 306

repositioning techniques, 304

Post-9/11 GI Bill

educational assistance, 80

Post-Vietnam Era Veterans’ Educational Assistance Program

description, 80

Posttraumatic stress disorder

alcohol and substance abuse and, 349

blast-related injuries and, 403

burn casualties and, 349

cognitive function and, 408

incidence in combat injured soldiers, 266

Operation Enduring Freedom/Operation Iraqi Freedom and, 

400, 405

pain management and, 297, 409

response to polytrauma and limb loss, 267

risk factors, 405

stress reduction strategies, 349

treatment, 271

Posttraumatic syringomyelia

orthostatic hypotension and, 430

peripheral nerve entrapment and, 440

spinal cord injuries and, 439

treatment, 439

Power-assisted wheelchairs

pushrim-activated systems, 702–703

user safety and, 703

Power soccer

opportunities available to amputees, 677

Power sources

characteristics of, 726

lithium polymer batteries, 726–727

methanol fuel cells, 727

nickel cadmium batteries, 726

PPOCs. See Polytrauma points of contact

PRAA. See Perioperative regional anesthesia and analgesia

Prazosin

autonomic dysreflexia treatment, 430

posttraumatic stress disorder treatment, 271

sleep problem treatment, 271

PRCs. See Polytrauma rehabilitation centers

Pregabalin

burn casualties and, 297

phantom limb pain treatment, 246

side effects, 246

Pregnancy

spinal cord injuries and, 442

Preprosthetic phase of upper limb prosthetic rehabilitation. See 

also Phase two of the upper limb amputee protocol of care

exercise options, 643

occupational therapist role, 622

patient education, 621

prosthetic assessment and rehabilitation team formation, 621

rehabilitation team, 618

residual limb management, 622
lvi

Care of the Combat Amputee 

surgical considerations, 618–621

Preservation-Amputation Care and Treatment program

description, 12, 42

Preservation of Upper Limb Function Following Spinal Cord Injury,

438

President’s Commission on Care for America’s Returning 

Wounded Warriors

PDES Joint Pilot Program and, 56

recommendations, 63

Pressure ulcers

causes, 434

checking skin daily for, 434

clinical practice guideline, 433

complications from, 436

cost of treating, 433–434

deep body wall tissue location, 434

external forces and, 434

morbidity and mortality and, 433

National Pressure Ulcer Advisory Panel pressure ulcer stages 

(table), 435

risk factors, 434

specialized wheelchair cushions and, 434

spinal cord injuries and, 416, 433–436

surgical treatment, 434–436

treatment, 434–436

Preventive medical psychiatry service

case study (exhibit), 269

contemporary model of intervention and, 269

evolution of, 269

follow-up and, 273

role, 268–269

“Therapeutic Intervention for the Prevention of Psychiatric 

Stress Disorders,” 269–270

traumatic brain injury and, 272–273

Priority groups

Veterans Healthcare Administration and, 77

Prisoners of war

presumptive conditions considered for disability compensation, 76

Project Healing Waters

description, 524

PROM. See Passive range-of-motion exercises

Promoting Amputee Life Skills program

description, 500

Prosthetic and Sensory Aids Service

adaptive equipment for sports and recreation, 715

collaboration with DoD and non-DoD organizations, 72

description and goals, 71–72

home adaptations and, 72

Web site, 72

Prosthetic feet

articulated, 557–558

dynamic response, 555–558

energy storage and return design, 555–556

foot shells, 555

function classification, 555

gait and, 555

golf and, 591

heel height adjustability, 558

hiking and, 591

inversion/eversion and, 558

microprocessor ankle/foot, 558

rock climbing and, 589–590

specialty feet for running, 555

sports and recreation and, 584, 585–586

Syme amputations and, 565

transtibial prosthesis and, 568

winter sports and, 590

Prosthetic knees

axis issues, 558–559

cadence control, 559–560

constant friction and, 559

geometric locks, 560–561

microprocessor, 560

motorized, 560

pneumatic/hydraulic/magnetorheologic, 559–560

polycentric, 559

single axis, 558–559

stance flexion and, 560–561

user-activated locks, 561

Prosthetic Profile of the Amputee

description and uses, 602

Prosthetic rehabilitative process

phase one: preprosthetic, 577–578, 618–622

phase two: initial prosthetic, 578

phase three: basic prosthetic, 578

phase four: advanced prosthetic, 578, 635–637

Prosthetic socks

description and uses, 563–564

Prosthetics. See also Artificial limb research; Donning/doffing 

prostheses; Lower limb prosthetics; Lower limb prosthetics 

for sports and recreation; Upper limb prosthetics; Upper limb 

prosthetics for sports and recreation

advanced prosthetic training: unilateral and bilateral, all levels 

(exhibit), 519

advances in, 14, 642

average energy costs of prosthetic ambulation (table), 546

balance between physical, psychological, and prosthetic rehabilitation, 642–643

bilateral upper limb amputees and, 526–527

biomechanics and human movement considerations, 643

C-Leg compared with mechanical knee and RHEO KNEE, 

547–548

chest expansion and, 508–509

Civil War and, 23

controls training, 511

controls training for body-powered prosthesis by level of 

amputation (figure), 516

controls training for myoelectric prosthesis by level of amputation (figure), 517

donning/doffing, 509–514

fitting issues with burn casualties, 170–171, 346

future research needs, 735–736

gait analysis and training and, 546, 547–548

operational prosthetic knowledge and performance, 508–509

phase of the upper limb amputee protocol of care and, 

515–523

physical therapist role in training, 452

prehensile terminal devices for body-powered systems, 508

preprosthetic training, 465–470, 499–506

prosthesis fit timing, 504

radiographs for prosthesis fit and alignment, 157

reasons for low prosthetic use by patients, 174–175

recent advancements in prosthetic development and their 

impact on treatment, 527–531

scapular depression and shoulder extension and abduction 

and, 508

scapular protraction, retraction, and shoulder flexion and, 508

standing progression with prosthetic limb, 474–475

targeted reinnervation, 527, 530

“Targeted Reinnervation in Upper Limb Amputees to Improve 

Myoelectric Prosthesis Function,” 530

terminology, 509

type of prosthesis and its effect on functional activities, 530

unilateral and bilateral amputee rehabilitation goals (exhibit), 

499

wearing schedule, 509

Prosthetics Clinical Management Program
Index

lvii

description, 72

Prosthetists

educational requirements, 554

interim phase of upper limb prosthetic rehabilitation and, 623

preprosthetic phase of upper limb prosthetic rehabilitation 

and, 618

role of, 554–555

PSAS. See Prosthetic and Sensory Aids Service

PSC. See Polytrauma System of Care

Psychiatric disorders. See also specific disorders

“battle mind mentality” and, 266

body image concerns and, 267

case studies (exhibits), 269, 270, 272, 273

concerns of the service member with polytrauma and limb 

loss, 267–268

defense mechanisms and, 267

factors interfering with recovery, 268

family interventions, 273

follow-up to interventions, 273

grieving process after limb loss, 267–268

hypnosis and, 271–272

importance of sleep, 271

pharmacology and other treatment interventions for anxiety, 

depression, and pain, 270–271

preventive medical psychiatry service, 268–273

response to polytrauma and limb loss, 267–268

risk factors, 266

separation anxiety and, 266–267

summary of interventions, 274

“survivor guilt” and, 266–267

therapeutic intervention for preventing, 269–270

traditional responses to combat and injury and, 266–267

trauma as a risk factor for, 266

traumatic brain injury associated with polytrauma and amputation and, 272

Psychological considerations for burn casualties

anxiety, 348

challenges of treatment for psychological effects of combat 

burns, 348

delirium, 348–349

grief and depression, 349

pain management and, 348

posttraumatic stress disorder, 349

principles of psychological treatment, 348

sleep problems and nightmares, 348

Psychological considerations for individuals with spinal cord 

injuries

associated traumatic brain injury, 442

marital adjustment and discord, 442

premorbid personality, 442

reactive depression and suicide, 442

support services, 442

Psychological support

methods of, 498

phase one of the upper limb amputee protocol of care and, 498

phase two of the upper limb amputee protocol of care and, 

499–500

Psychologists

vocational rehabilitation and, 97

Psychosocial adaptation to amputation

description, 102

upper limb prosthetics and, 637

Psychosocial aspects of burn casualty rehabilitation

acute phase, 340–342

anticipation of pain, 341

dealing positively with symptoms, 343

desensitization techniques, 341

emotional adjustment to acute burns, 341

intermediate phase of burn casualty rehabilitation, 342

leaving the burn unit and, 342

long-term phase of burn casualty rehabilitation, 342–343

losses and changes related to the injury, 341

normal responses to major burn injuries, 342

psychological shock reaction to severe burns, 341

relaxation techniques, 341–342

return to duty, 340–341, 342–343

returning to routine life, 342–343

returning to work in the area where the injury occurred, 343

sensory deprivation and, 342

trauma survivors’ groups, 343

Psychosocial issues in traumatic brain injury

cognitive changes and, 404

functional limitations and, 403–404

Psychosocial support programs

description, 14–15

PT/BRI QUERI. See Polytrauma and Blast-Related Injuries Quality Enhancement Research Initiative

PTN. See Polytrauma telehealth network

PTSD. See Posttraumatic stress disorder

Pulmonary system. See Respiratory system

PVA. See Paralyzed Veterans of America

Q

Q fever

returning service members and, 200

Q-TFA. See Questionnaire for persons with a transfemoral amputation

Quad rugby

opportunities available to amputees, 677

Questionnaire for persons with a transfemoral amputation, 15

Quetiapine fumarate

sleep disturbance treatment, 13, 271

Quick release couplings

description and uses, 562

Quick Speech-in-Noise Test

description and uses, 390

R

Radcliffe, C.W.

transfemoral prosthesis research, 571, 572

Radiation

presumptive conditions considered for disability compensation for veterans exposed to, 76–77

Radiation therapy

heterotopic ossification, 158, 160, 209, 345, 438

Radiographs

heterotopic ossification diagnosis, 209

infection monitoring, 197

neuroma evaluation, 161

osteomyelitis and, 436

prosthesis fit and alignment and, 157

residual limb examination, 156–157

weight-bearing, 157

Ramachandran, V.S.

mirror therapy research, 250

phantom limb pain research, 232

Rancho Los Amigos

full body observational gait analysis form, 536

Random or local flaps

burn casualty reconstructive surgery and, 359

“Randomised Trial of Epidural Bupivacaine and Morphine in 

Prevention of Stump and Phantom Pain in Lower-Limb Amputation” (Nikolajsen), 240

Range-of-motion

preventing loss of, 454

Range-of-motion exercises. See also specific types

acute phase of burn casualty rehabilitation, 326–330
lviii

Care of the Combat Amputee 

burn edema and, 301–302, 305, 306

burn scars and, 351, 353, 357–358

categories (exhibit), 327

heterotopic ossification and, 345, 406

intermediate phase of burn casualty rehabilitation, 319, 329–330

long-term phase of burn casualty rehabilitation, 330, 332

mental concentration and energy and, 329–330

relaxation techniques and, 329–330

showering and dressing changes and, 328–329

skin grafts and, 314, 315

Reagan, Pres. Ronald

signing of the bill making the VA an executive department, 68

REALifelines program. See Recovery and Employment Assistance 

Lifelines program

Recovery and Employment Assistance Lifelines program

description, 108

Recreational/motivational activities. See also Lower limb prosthetics for sports and recreation; Sports and recreation opportunities; Upper limb prosthetics for sports and recreation

criticism of, 7

development of programs, 6–7

phase four of the physical therapy rehabilitation program and, 

482

phase four of the upper limb amputee protocol of care and, 

523

Recreational therapists

description and role, 45

Red Cross Institute for Crippled and Disabled Men

description and role, 28, 29

Reduced Friction Donning System

donning sock and socket design for, 509–511

Reed, Maj. Walter

yellow fever research, 5

Regional anesthesia and analgesia. See Perioperative regional 

anesthesia and analgesia

Rehabilitation Act, 96

Rehabilitation counseling

Certified Rehabilitation Counselor designation, 96

competencies included, 96–97

description, 96

Rehabilitation Engineering and Assistive Technology Society of 

North America

credential levels, 697

wheelchair standards, 698

Rehabilitation nurses

description and role, 45

Rehabilitation of burn casualties. See also Physical therapy

activities of daily living and, 319, 333–338

biomechanics of skin and scar, 317–320

bone and joint changes, 345

burn edema, 299–306

cardiovascular conditioning, 330–332

casting issues, 325–326

community reintegration, 343–344

complications associated with rehabilitation, 345–349

goal of, 343

interaction between medical care and rehabilitation of burn 

casualties (figure), 300

mobility issues, 338–340

psychosocial aspects, 340–343

range-of-motion exercises, 301–302, 305, 306, 314, 315, 319, 

326–330, 353

risk of overheating and, 332

sexuality issues, 344–345

skin grafts, 309–317

splinting issues, 320–325

strength training, 330–332

transitioning to outpatient programs, 332

wound and skin care, 306–309

Rehabilitation of spinal cord injuries. See also Physical therapy

activity-based therapy, 423–424

functional outcome, 421

mobility, 421

walking, 423

wheelchair use, 421–423

“Rehabilitation of the Combat Amputee--Consensus Conference 

and Creating a Roadmap for the Future,” 733

“Rehabilitation of the Combat-Wounded Amputee” (Brown), 6–7

Rehabilitation of traumatic brain injury patients. See also Physical 

therapy

challenges of, 407

cognitive function and, 408–409

early rehabilitation importance, 408

life-long need for, 407

mental health assessment and, 408

multidisciplinary teams, 407

neuropsychological evaluation and, 408

occupational therapist role, 408

physical therapist role, 407–408

Rehabilitation psychologists

description and role, 45

Rehabilitation robotics

benefits and disadvantages of, 712

categories of, 712

manipulation aids, 712–713

Renal considerations

acute renal failure, 292

critical care of burn casualties and, 292

renal replacement therapy, 292

Report to Congress on the Current Status of the Department of Defense 

and Department of Veterans Affairs Disability Evaluation System 

Pilot Program, 63

Research. See also specific areas of research and study authors

advancement of medical interventions, 736–737

advancement of surgical interventions, 736

amputee care centers of excellence, 738

artificial limbs, 722–729

challenges of current research, 733

consensus conference results, 733–738

DoD partnership with the VA, 11

formal measures, 601–602

future research needs, 732–738

geriatric research, 73

hearing loss and, 393

importance of, 11

informal measures, 601

outcomes research and cost-effectiveness studies, 734

Polytrauma System of Care research collaborations, 48–49

programmatic goals and opportunities, 732–733

rehabilitation and therapeutic interventions, 734–736

reliability issues, 601

summary of issues, 738

support programs, 737

technology, 737–738

traumatic brain injury outcomes, 402

upper limb prosthetics, 527–531, 637

“use” and “satisfaction” measurements, 599–600

validity issues, 601

Reserve soldiers

education programs, 80–81

MHS military readiness mission and, 4

physical disability evaluation system and, 55

retirement and disability compensation and, 62

Servicemembers Group Life Insurance and, 79

Social Security and, 84

Veterans Benefits Administration and, 78

Residential transitional rehabilitation programs

description, 46
Index

lix

Residual limb pain

causes of, 232

future research needs, 737

localized and chronic, 155

management of, 13–14

mechanism of, 232–233

myodesis failure and, 162

percentage of amputees experiencing, 155

prevalence of, 232

treatment, 232–233

Residual limbs

advanced phase of upper limb prosthetic rehabilitation and, 

635–636

edema management, 622, 636

future research needs, 736

hypertrophy and, 635

length in bilateral upper limb amputees, 526

phase three of the upper limb amputee protocol of care and, 

509

preprosthetic phase of upper limb prosthetic rehabilitation, 

622

surgical considerations, 619–620

weight gain and, 635

RESNA. See Rehabilitation Engineering and Assistive Technology 

Society of North America

Respiratory system

acute respiratory failure, 428

atelectasis, pneumonia, aspiration, impaired cough, 428–429

critical care of burn casualties and, 289–291

endotracheal intubation, 289–290

importance of securing an airway, 289

mobilization out of bed and, 291

monitoring ventilation and oxygenation, 290

oxygenation determination, 290

pulmonary hygiene, 291

pulse oximetry and, 290–291

spinal cord injury complications, 427–429

ventilator-associated pneumonia, 291

ventilatory support modes, 290

Respite care

Veterans Health Administration and, 73

Retirement and disability compensation. See also Veterans Benefits 

Administration

combat-related injury and rehabilitation pay, 108–109

combat-related special compensation, 62

concurrent receipt, 62

continuation on active duty and, 61–62

tax issues, 62

Return to duty. See also Active duty service

burn casualties and, 340–341, 342–343

characteristic traits of amputees seeking, 54

factors involved, 54

historical background, 54

phase four of the physical therapy rehabilitation program and, 

479–482, 489–490

research areas, 63

US Army process, 54–55

Web site addresses of organizations helpful to injured service 

members (table), 55

Revolutionizing Prosthetics 2007 initiative

description, 527–528

Revolutionizing Prosthetics 2009 initiative

description, 528

Rheinwald, J.G.

cultured autologous keratinocyte (epidermal) skin grafts and, 

312

RHEO KNEE

compared with mechanical knee and C-Leg, 547–548

description and uses, 726

Richardson, C.

phantom limb pain research, 231

Rifampin

multidrug-resistant organism treatment, 194–195

Rigid dressings

basic principles, 128–129

drawbacks to, 129

transtibial amputations and, 128, 137–138, 173

Road racing

wheelchair designs for, 709

wheelchair racing, 677

Robotics. See Rehabilitation robotics

Rock climbing. See also Technical climbing

lower limb prosthesis and, 589–590

popularity of, 589

Rofecoxib

heterotopic ossification treatment, 210, 211

ROM exercises. See Range-of-motion exercises

Roosevelt, Pres. Franklin D.

US Army rehabilitation program and, 5

Ropivacaine

burn casualties and, 298

epidural anesthesia and, 244

Rose, H.G.

hypertension research, 218

Rossi, S.

mirror therapy research, 250

Rotary chair test

description and uses, 389

Rugby

quad rugby, 677

wheelchairs for, 709

Rumsfeld, Secretary of Defense Donald

comments on the US Army, 11

Running

prosthetic feet for, 555

transfemoral prosthesis and, 587–588

transtibial prosthesis and, 586–587

Rusk, Dr. Howard

“whole patient” concept, 31, 33

Rusk, Howard A., M.D.

“constructive training” program, 5

A World to Care For: The Autobiography of Howard A. Rusk, M.D.,

5

Rybarczyk, B.

body image association with adjustment problems, 267

S

SAEJ2249: Wheelchair Tie-Downs and Occupant Restraint Systems for 

Use in Motor Vehicles, 711

Sailing

opportunities available to amputees, 677

Saleh, M.

gait assessment research, 536

Salomaki, T.E.

regional anesthesia and analgesia research, 235

Sato, R.M.

hand burn outcomes, 283

Saunders, J.B.

gait assessment research, 540

SBA. See US Small Business Administration

Scars

acute phase of burn casualty rehabilitation, 318–319

appearance of scar tissue, 357

biomechanics of, 317–320

characteristics of burn scars, 351–352

compression and, 352, 353–354

custom garments for, 354–355
lx

Care of the Combat Amputee 

graph displaying the difference in various strain rates of tissue 

(figure), 319

graph displaying the relationship between total body surface 

area burned and the incidence of burn scar contractures 

(figure), 287

heat and, 353

hyperpigmentation, 351

hypertrophic scarring, 350, 351–352

inserts for, 356–358

keloid scarring, 350–351

management issues, 349–358

management of, 349–358

massage and, 352–353

positioning and, 353

range-of-motion exercises and, 353

scar tissue compared with normal dermis, 318

serial casting for, 325–326

splinting and, 353

strain rate and, 318

stress relaxation of tissue (figure), 319

stress relaxation principle and, 318

tissue contractures and, 349–350

tissue creep (figure), 319

transparent face masks and, 354

vibration therapy, 353

SCDs. See Sequential compressive devices

Schmalz, T.

gait analysis and training research, 546

Schoppen, T.

functional outcome in geriatric amputees, 405

SCI. See Spinal cord injuries

Scott, R.E.

cultured autologous keratinocyte (epidermal) skin grafts and, 

312

Scuba diving

opportunities available to amputees, 678

upper limb prosthetic considerations, 649–650

Seating systems

arm support, 706

back supports, 705–706

body dynamics and, 704

custom, 705

foot supports, 706

head support, 706–707

leg supports, 706

modular, 705

physical-motor assessment and, 704

prefabricated, 704–705

reclining backrests, 707

seat elevation systems, 708

seat support, 705

standing systems, 707–708

tilt frames, 707

Seizures

regional anesthesia and analgesia and, 236

Selective serotonin reuptake inhibitors

posttraumatic stress disorder treatment, 271

Self-care. See Activities of daily living

Self-feeding

burn casualties and, 333–334, 336

phase one of the upper limb amputee protocol of care and, 496

phase two of the upper limb amputee protocol of care and, 500

Self-selected walking velocity

energy expenditure and, 536

Selles, R.W.

gait analysis and training research, 546

Semper Fi Fund

support programs, 111

SensorHand Speed hand

description and uses, 726

Sensors and controls

microcontrollers, 728

Sensory deficits. See also Hearing loss; specific deficits

acute phase of burn casualty rehabilitation and, 360

burn casualties and, 359–360

intermediate phase of burn casualty rehabilitation and, 360

long-term recovery and, 360

safety issues, 360

September 11, 2001

Global War on Terror and, 2

Sequential compressive devices

deep venous thrombosis and, 206, 207

Sertraline

depression treatment, 271

Servicemembers Group Life Insurance

program description, 79–80

Servicemen’s Readjustment Act, 96

Severity of burns

age and, 282

associated illnesses and injuries, 284

body diagrams of equal size burn depicting the difference that 

location of burn has on functional areas (figure), 287

burn depth, 282–284, 308

burn size, 282

burn terminology (table), 285

clinical relevance, 285–286

deep partial-thickness burns, 282

development and number of burn scar contractures relation to 

extent of TBSA, 285–286

epidermal burns, 282

full-thickness burns, 282

graph displaying the relationship between total body surface 

area burned and the incidence of burn scar contractures 

(figure), 287

hand burns, 283

impact on survival, 285

location issues, 284

Lund and Browder chart for estimating burn size (figure), 284

rule of nines body chart for estimating burn size (figure), 283

rule of nines for, 282, 283

subdermal burns, 282

Sexual function

concerns of individuals with limb amputations, 267

external appliances and, 441

polytrauma patients and, 219

rehabilitation of burn casualties and, 344–345

spinal cord injuries and, 441–442

SGLI. See Servicemembers Group Life Insurance

Sheet grafts

burn casualties, 309

Shepherd’s Bush Military Orthopaedic Hospital, London

vocational rehabilitative work, 27–28

Sheridan, R.

community reintegration of burn casualties, 343

Sherman, R.A.

phantom limb pain research, 231

Shinseki, Gen. (Ret.) Eric

return to duty after limb amputation, 54

Shopping

phase of the upper limb amputee protocol of care and, 

519–520

Short Form-36 Health Survey

upper limb amputations and, 601

Shoulder units for upper limb prosthetics

description, 618

Sickness impact profile, 15

Silver-nylon dressings

burn casualties, 307
Index

lxi

Silver sulfadiazine

topical treatment of skin grafts, 316

6-minute walk test, 15

Skiing

adaptive sports equipment for, 710

monoskis, 710

outriggers for, 710

Skin. See also Dermatologic issues

biomechanical components, 317–318

collagen network, 317

intermediate phase of burn casualty rehabilitation and, 319

long-term phase of burn casualty rehabilitation and, 319–320

properties of, 317

prosthesis considerations, 577

successive length induction curves (figure), 317

tissue elongation and, 318

tissue hysteresis (figure), 317

tolerance to high activity, 584–585

Skin care

burn casualties and, 306–309, 317–320

Skin disorders. See also Dermatologic issues

challenges of, 182

chronic conditions requiring surgery, 183

common disorders in individuals with limb amputations, 156

physical examination and, 156

soft tissue coverage and, 183–184

squamous cell carcinoma, 183

surgical scars and, 156

terminal edema, 182–183

verrucous hyperplasia, 183

Skin grafts

adherence of, 310–311

allografts, 313

burn casualties, 309–317

chronic nonhealing wounds, 317

covering fresh grafts, 311

cultured autologous keratinocyte (epidermal), 312–313

dressing changes and, 315

flap grafts, 311

full-thickness, 310

full-thickness pinch grafts, 171

graft-bolstering techniques, 171–172

heterografts, 313–314

homografts, 313

immediate post operative period and, 311

interim phase of upper limb prosthetic rehabilitation and, 

634–635

intermediate phase of burn casualty rehabilitation and, 

314–316

late wound problems after, 172

long-term phase of burn casualty rehabilitation, 316–317

lower limb joint contracture and, 173

meshed, 310

recurrent complications from, 171

rejection of, 313

sheet grafts, 309

shrinker compression stockings and, 172

splints and, 311

split-thickness, 171, 308, 309–310

topical treatments, 315–316

Skin traction

benefits of, 126

vacuum-assisted closure devices and, 126

Slalom

opportunities available to amputees, 678

Sled hockey. See Hockey

Sleep disorders

burn casualties and, 348

pharmacological treatment, 13, 271

Smallpox vaccine

development of, 5

Smith, D.G.

review of a large cohort of transtibial amputees, 155

Snow skiing

opportunities available to amputees, 678

prosthetic examples, 665

upper limb prosthetic considerations, 649

Soccer

power soccer, 677

prosthetic examples, 658

upper limb prosthetic considerations, 646

Social Security Administration

benefits for veterans and dependents, 84–85

Supplemental Security Income, 84, 85

Web site, 84

Social workers

case managers, 45, 47, 48

individuals with spinal cord injuries, 427

vocational rehabilitation and, 97

Society of Automotive Engineers

Adaptive Devices Subcommittee, 711

Socket interfaces

gel liners, 563

hard sockets, 564

prosthetic socks, 563–564

transfemoral flexible inner liner with rigid frame, 564

Soft dressings

advantages and disadvantages, 128

application of, 128

Soft tissue

effect of condition of on the level of amputation, 145

final level of amputation and, 122

importance to ultimate function, 120

management of, 124–126

myofascial closure, 124–125

prosthesis considerations, 577

retained bone and, 123

skin disorders and, 183–184

socket interfaces and, 723

surgical considerations, 620–621

transfemoral amputations and, 164

Softball

competitive wheelchair softball, 678

Software

Dragon Naturally Speaking, 529

MyoSoft software, 505

voice recognition, 528–530

Soldiers Rehabilitation Act, 96

Spanish Civil War

importance of debridement of wounds, 193

Spasticity

presentation of, 438

spinal cord injuries and, 417–418, 438

surgical treatment, 438

traumatic brain injury and, 406–407

treatment, 417–418, 438

Special surgical considerations for casualties with limb loss. See 

also General surgical principles for casualties with limb loss; 

Surgical considerations

burn management, 169–171

bursitis, 180–182

Ertl procedure, 165–169

evaluation of the less-than-successful amputee, 155–157

heterotopic ossification, 157–161

history and, 155–156

infection, 177–180

joint contractures, 172–174

knee instability, 176–177
lxii

Care of the Combat Amputee 

Marquardt humeral osteotomy, 174–176

myodesis failure and lack of soft tissue padding, 162–165

neuromas, 161–162

osteomyoplastic transtibial amputation, 165–169

physical examination, 156–157

skin grafts, 171–172

skin problems, 156, 182–184

Speech language pathologists

description and role, 45

Spina bifida allowance

Veterans Benefits Administration, 79

Spinal cord injuries

activity-based therapy, 423–424

anterior decompression and, 417

bowel management program, 432

cardiovascular complications, 429–430

clinical syndromes, 420–421

common causes, 416

common neurological category of, 416

common sites of, 416

complete injuries, 418, 423, 425–426

complication prevention and management, 427–443

concomitant traumatic amputation and, 424–425

continuing education, 75

deep venous thrombosis and, 206

demographics of, 416

dermatologic complications, 433–436

driver’s training and community mobility, 425

educational topics for patients, family members, and caregivers, 427

endocrine system issues, 219

endocrinologic complications, 433

examples of activities available to individuals with spinal cord 

injuries (exhibit), 426

expected functional outcome for complete spinal cord injury 

(table), 422

functional outcome, 421

gastrointestinal complications, 430–433

genitourinary complications, 440–442

gray matter damage, 417

health maintenance, 442–443

heterotopic ossification and, 210, 345

historical background, 416

housing, finances, and community reintegration, 427

incomplete injuries, 418

initial rehabilitation, 421–427

life expectancy, 416

living skills, 426

men and, 416

mobility issues, 421

mortality from, 416, 427

musculoskeletal disorders, 436–438

national recreational events, 75

nerve root injury, 417

neurologic evaluation: myotomal levels (table), 418

neurological assessment and classification, 418–421

neurological disorders, 438

nonpenetrating type, 416–417

organization of a spinal cord injury unit, 443

pain and, 438–440

pathophysiology of, 416–418

patient and family education, 426–427

penetrating type, 416, 417

percentage of the US population experiencing, 416

prevalence, 416

psychological issues, 442

pulmonary complications, 427–429

secondary processes and, 417

self-care, 425–426

spasticity and, 417–418, 438

spinal cord injury clinical syndromes (table), 420

“spinal shock,” 421

standard neurological classification of spinal cord injury worksheet (figure), 419

summary of issues, 443

types of, 416–417

Veterans Health Administration services, 74–75

vocational and avocational pursuits, 426

walking goals, 423

wheelchair use, 421–423

white matter damage, 417

zone-of-injury recovery, 418

Spinal cord stimulation

phantom limb pain treatment, 248

Splinting

acute phase of burn casualty rehabilitation, 320–321

assessing skin integrity and, 320

axilla splints, 322

burn casualties and, 319, 320–325, 353

burn edema and, 304, 306

burn scar management, 353

custom hand and wrist splints (table), 323

definition, 320

dynamic, 319, 324

ear grafts and, 321

elbow splints, 322

goal of, 321

heterotopic ossification and, 345

intermediate phase of burn casualty rehabilitation, 321–324

knee and ankle splints, 324

long-term phase of burn casualty rehabilitation, 324–325

long-term phase of burn-patient rehabilitation and, 319

mouth appliances, 321

neck immobilization, 321–322

positioning and splinting devices used to manage edema 

(table), 303–304

postoperative splinting and positioning (table), 306

prefabricated splints, 320, 321

skin grafts and, 311

static splints, 322, 324

wrist and hand splints, 320–321, 322–324

Split-thickness skin grafts

complications from, 171

donor sites, 309

full-thickness burns and, 308

healing time, 309

Sports. See Athletics; Lower limb prosthetics for sports and recreation; Sports and recreation opportunities; Upper limb prosthetics for sports and recreation; specific sports

Sports and recreation opportunities. See also Equipment for sports 

and recreation

aerobics/physical fitness, 672

air guns/shooting, 672

archery, 672

assistive technology, 671–672

availability of individual assessments for adaptive recreation 

and sports equipment, 671–672

basketball, 673

bicycling/handcycling, 673

billiards, 673

bowling, 673

camping, 673–674

canoeing, 674

classification of disabled athletes, 671

Clinical Practice Recommendations for Issuance of Recreational and Sports Equipment, 671

curling, 674

fencing, 674–675
Index

lxiii

fishing, 675

flying, 675

football, 675

golf, 676

historical background, 670

hockey, 676

horseback riding, 676

hunting, 676

kayaking, 676

National Disabled Veterans Winter Sports Clinic, 676

National Veterans Wheelchair Games, 676–677

organizations promoting sports and recreation for persons 

with disabilities, 682–694

Paralympic Games, 677

power soccer, 677

quad rugby, 677

road racing, 677

sailing, 677

scuba diving, 678

skiing, 678

slalom, 678

softball, 678

summary of issues, 680

swimming, 679

table tennis, 679

tennis, 679

therapeutic benefits, 670

track and field, 679

trap and skeet shooting, 679

waterskiing, 680

weightlifting, 680

Squamous cell carcinoma

chronic recurring draining fistulae and, 183

“Squirt Shape” technique

description, 722

SSA. See Social Security Administration

SSIs. See Surgical site infections

SSWV. See Self-selected walking velocity

Stairs

step-by-step method for ascending/descending, 473

step-over-step method for ascending/descending, 473

Staphylococcus aureus. See also Methicillin-resistant Staphylococcus 

aureus

battle wounds and, 194

surgical site infections and, 196

State Benefits Seamless Transition Program

description, 111

States

public vocational rehabilitation system, 103

state veterans’ home programs, 73

Static splints

static progressive, 324, 325

uses for, 322, 324

Steering. See Driving

Step activity monitor, 15

Stoke Mandeville Games

description, 36

Stomach

spinal cord injury complications, 431

Strength training and cardiovascular conditioning

acute phase of burn casualty rehabilitation, 330–332

bedside chairs and, 331

considerations for burn casualties, 330–332

core stabilization, 454, 456–457, 469, 473

dynamic stump exercises, 465–467

early ambulation and, 332

intermediate phase of burn casualty rehabilitation, 332

Karvonen method for determining heart rate range (exhibit), 

332

long-term phase of burn casualty rehabilitation, 332

multiple planes of motion and, 466

phase one of the physical therapy rehabilitation program and, 

454, 456–458

phase one of the upper limb amputee protocol of care and, 498

phase two of the physical therapy rehabilitation program and, 

465–470

phase two of the upper limb amputee protocol of care and, 

503–504

phase three of the upper limb amputee protocol of care and, 

515

postural positions that strengthen the hip musculature, 

465–466

progressive resistive exercise for uninvolved limbs, 468

risk of overheating and, 332

semisupine resisted pelvic rotation drills, 467

therapeutic exercise (bedside and/or mat), 454

tilt tables and, 331–332

Streptococcus spp

battle wounds and, 194

Stress reduction strategies

posttraumatic stress disorder and, 349

Stryker pumps, 244

STSGs. See Split-thickness skin grafts

Stump pain. See Residual limb pain

Styloid level amputations

interim phase of upper limb prosthetic rehabilitation and, 

625–626

prosthetic recommendations for (table), 627

surgical considerations, 619

Subacute rehabilitation programs

description, 46–47

Subatmospheric pressure dressings

heterotopic ossification and, 158

infected residual limbs and, 180

skin grafts and, 172

Subdermal burns

description, 282

excision of, 309

treatment, 282

Subjective visual vertical test

description and uses, 389

Succinylcholine

individuals with spinal cord injuries and, 429

Sufentanyl

epidural anesthesia and, 244

Suicide

burn casualties and, 349

spinal cord injuries and, 427, 442

Superficial partial-thickness burns

description, 282

range-of-motion exercises and, 330

Superior mesenteric artery syndrome

spinal cord injury and, 431

Supplemental Security Income

eligibility, 84, 85

Support programs

Air Force Wounded Warrior Program, 107

Army Wounded Warrior program, 106, 113, 737

combat-related injury and rehabilitation pay, 108–109

Computer and Electronic Accommodation Program, 108

future research needs, 737

Heroes to Hometowns, 109

Marine Wounded Warrior Regiment, 106–107, 114–115, 737

Military Severely Injured Center, 107–109, 737

military severely injured support systems, 106–110

military support systems Internet addresses (table), 110

Navy Safe Harbor program, 107, 737

Operation Warfighter program, 108
lxiv

Care of the Combat Amputee 

Paralyzed Veterans of America, 110–111

REALifelines program, 108

regional resources and support organizations, 113–116

resources at WRAMC, 116

services offered by, 109–110

Traumatic Servicemembers’ Group Life Insurance, 108

travel authorizations for family members, 109

useful resources and organizations for veterans, 116

veteran service organizations and other opportunities, 110–111

vocational rehabilitation and, 102–103

Surgical considerations. See also General surgical principles for 

casualties with limb loss; Plastic and reconstructive surgery; 

Special surgical considerations for casualties with limb loss

anticipated functional outcome, 12

artificial condyles, 723

burn casualties, 307–309

future research needs, 736

goals of surgery, 119–120

guidelines for residual limb length, 619–620

heterotopic ossification, 159–161

limb-salvaging decisions, 12

mangled extremity severity scores, 12

muscle attachment guidelines, 620

osseointegration, 723

preprosthetic phase of upper limb prosthetic rehabilitation, 

618–621

pressure ulcers, 434–436

spasticity, 438

Surgical Infection Prevention Project

guidelines for antibiotic prophylaxis, 193–194

Surgical site infections

categorization of, 195

diagnosis of, 195

implant infections, 196

Infectious Diseases Society of America treatment guidelines, 

195–196

“Survivor guilt”

role in psychological adjustment, 266–267

Swimming

opportunities available to amputees, 679

prosthetic examples, 658–659

swimming without a prosthesis, 646

upper limb prosthetic considerations, 646

Syme amputations

abnormal keratosis and, 155

general surgical considerations, 136

Syme prosthesis

biomechanics and socket strength, 565

foot options, 565

socket design and suspension, 564

Sympathetic blocks

phantom limb pain treatment, 249

Syndrome of inappropriate antidiuretic hormone

spinal cord injuries and, 433

Synthetic skin substitutes

burn casualties and, 307, 312–313

T

Table tennis

opportunities available to amputees, 679

Tactical Combat Casualty Course, 5

TAPES. See Trinity Amputation and Prosthetic Experience Scale

description and uses, 602

Targeted muscle reinnervation. See also Targeted reinnervation

combined with advanced signal processing techniques, 

725–726

description, 725

EMG control signals and, 725

sensory feedback and, 726

Targeted reinnervation. See also Targeted muscle reinnervation

description, 527

future research needs, 736

goal of, 530

nerve management technique, 127

“Targeted Reinnervation in Upper Limb Amputees to Improve 

Myoelectric Prosthesis Function,” 530

“Targeted Reinnervation in Upper Limb Amputees to Improve 

Myoelectric Prosthesis Function,” 530

Task-specific upper limb prosthetics

advantages/disadvantages of (table), 613

description, 613

Taylor, M.B.

gait analysis and training research, 546

Taylor, S.M.

functional outcome in amputees, 405

TBI Model Systems Program

VA collaboration with, 49

TBSA. See Total body-surface area

TDRL. See Temporary disability retirement list

TDs. See Terminal devices

Team River Runner

Paralympics sponsor, 15

TEC Interface

Vacuum-Assisted Socket System, 722

Technical climbing. See also Rock climbing

prosthetic examples, 666–667

upper limb prosthetic considerations, 650

TED hose

deep venous thrombosis and, 206, 207

Telehealth services

Veterans Health Administration and, 73

Telemedicine and Advanced Technology Research Center

pilot study on voice recognition software, 529

Temperature regulation

burn casualties and, 360

Temporary disability retirement list

physical evaluation boards and, 61

policy change, 63

Tennis

opportunities available to amputees, 679

wheelchairs for, 709

Tenodesis

description, 125

TENS. See Transcutaneous electrical nerve stimulation

Terminal devices

bilateral upper limb amputees and, 503, 527

interchangeability issues, 614

prehensile, 508

upper limb prosthetics, 614–615

Terminal edema

description and monitoring of, 182–183

Terminology

amputation level nomenclature, 608

burn terminology (table), 285

gait analysis and training, 536–538

prosthetics, 509

Tetanus immunization

wound infection and, 193

Texas Assistive Devices

description, 527

TFAs. See Transfemoral amputations

Thera-Band

description and uses, 504

“Therapeutic Intervention for the Prevention of Psychiatric Stress 

Disorders”

components, 269–270

empathic exposure and, 270
Index

lxv

intervention timing, 270

Thermal burns

causes, 280

percentage of military burn casualties, 280

Three-dimensional gait and motion analysis, 15

“3” profile designators

medical evaluation boards and, 58

medical military occupational specialty retention boards and, 

58

Through-knee amputations

general surgical considerations, 138

Thumb amputations. See Finger, thumb, and partial hand amputations; Hand and carpus amputations

Tilt tables

burn casualty rehabilitation and, 331–332

orthostatic hypotension and, 421

Tinnitus

causes, 387

characteristics of, 387

evaluation of, 391

related health problems, 387

treatment and rehabilitation, 393

Tinnitus Handicap Inventory

description, 388

Tinnitus Retraining Therapy

description and uses, 393

Tissue contractures. See also Joint contractures

burn casualties and, 327, 330, 349–350

inflammatory phase of wound healing and, 350

range-of-motion exercises and, 330

Tizanidine

spasticity treatment, 406–407, 438

TM perforation. See Tympanic membrane perforation

TMR. See Targeted muscle reinnervation

Tobacco use

impaired healing response and, 204

oral cavity problems and, 430

respiratory complications in individuals with spinal cord 

injuries and, 429

Toileting skills

burn casualties and, 335, 337

phase one of the upper limb amputee protocol of care and, 496

phase two of the upper limb amputee protocol of care and, 500

Tolerico, M.L.

wheelchair activity patterns, 700–701

Torsion components

combined torsion and vertical shock, 562

description, 561–562

Total body-surface area

development and number of burn scar contractures relation to 

extent of TBSA, 285–286

full-thickness burns and, 283

graph displaying the relationship between total body surface 

area burned and the incidence of burn scar contractures 

(figure), 287

Touch Bionic elbow

description, 728

Tourniquets

pneumatic, 134

use and application of, 118

Track and field sports

opportunities available to amputees, 679

wheelchair designs for, 709

Transcarpal and transmetacarpal level amputations. See also Hand 

and carpus amputations

surgical considerations, 619

Transcutaneous electrical nerve stimulation

phantom limb pain treatment, 248

Transfemoral amputations. See also Bilateral transfemoral amputees; Transfemoral prostheses

gait analysis and training, 544–545

general surgical considerations, 138–140

hip flexion and, 140

joint contracture and, 172

low back pain and, 250

myodesis failure, 162–164

osteoarthritis and, 218

physical therapy issues, 454

soft tissue padding and, 164

stair ascending/descending techniques, 473

Transfemoral prostheses. See also Transfemoral amputations

alignment, 574–575

biomechanics, 574

cycling and, 589

elastic belt suspension, 573–574

hip joint and pelvic band suspension, 574

ischial containment sockets, 571–572

locking gel liners, 573

quadrilateral sockets, 572

running and, 587–588

sealing liners, 573

Silesian belt suspension, 573

socket design, 571–572

sports and recreation and, 585

suction by skin contact, 572–573

suspension, 572–574

winter sports and, 590

Transfemoral prosthetics

flexible liners with rigid frame, 564

Transhumeral amputations

elbow or shoulder instability above, 177

interim phase of upper limb prosthetic rehabilitation and, 

627–628

myoplasty failure, 165

prosthetic recommendations (table), 632

surgical considerations, 620

Transition Assistance Online, 99

Transmetatarsal amputations

description, 134–135

Transmissions

characteristics, 727

continuously variable transmissions, 729

harmonic drives, 729

planetary gears, 727, 728

Transpelvic amputations

alignment and, 576

gait and, 576

prosthesis biomechanics, 576

prosthesis socket design, 575

Transportation issues

accessibility, 710

Transportation Security Administration

Military Severely Injured Center assistance, 109

Transradial amputations

elbow or shoulder instability above, 177

interim phase of upper limb prosthetic rehabilitation and, 626

myodesis failure, 165

myoplasty failure, 165

prosthetic recommendations (table), 628

surgical considerations, 619

Transtibial amputations. See also Bilateral transtibial amputees; 

Transtibial prostheses

advantages of, 136

Burgess technique, 166, 169

distal bone bridge synostosis technique, 137

flaps for, 136–137

gait analysis and training, 541–544

general surgical considerations, 136–138
lxvi

Care of the Combat Amputee 

joint contracture and, 172–173

knee instability and, 177

low back pain and, 250

myodesis failure, 164–165

myoplasty failure, 164–165

osteoarthritis and, 218

physical therapy issues, 453, 454, 466

radiographs needed, 136

rigid dressings for postoperative care, 137–138

stair ascending/descending techniques, 473

studies of patients with, 155

Transtibial prostheses. See also Transtibial amputations

alignment of, 568, 569

biomechanics, 568–569

correct height for, 568–569

foot selection and, 568

mechanical lock mechanisms, 567

patellar tendon-bearing sockets, 565

running and, 586–587

sealing liners, 567

sleeves for suspension, 566

socket design, 565–566

suction suspension, 567

supracondylar/supracondylar suprapatellar socket design, 

566–567

suspension, 566–568

total surface bearing sockets, 565–566

vacuum-assisted suction, 567–568

winter sports and, 590

Transverse tarsal amputations

description, 135–136

Trap and skeet shooting

opportunities available to amputees, 679

Traumatic brain injury. See also Mild traumatic brain injury

acceleration/deceleration injuries, 402

acute medical care, 406–407

assistive devices for ambulation and, 461

behavioral effects, 272, 403–404

blast effects, 402–403

brain injury severity levels (table), 402

CDC estimates of cases in the United States, 400

closed, 400

cognitive function and, 404, 405, 408–409

complications from, 272

contact injuries, 402

cumulative blast exposures and, 400

decompressive craniectomy and, 406

deep venous thrombosis and, 406

definition of, 400

delayed diagnosis of, 400

Department of Defense consensus on traumatic brain injury 

definition (exhibit), 401

description, 400

domains of cognitive functioning and representative neuropsychological tests (table), 409

drug-based neuroprotection, 406

dysautonomia and, 407

educational resources for families, 48

emergency preadmission care, 406

endocrine system concerns, 219

family support and, 272, 406

hearing loss and, 382, 386, 388, 389, 390, 391

heterotopic ossification and, 210, 211, 406

hyperarousal and, 272

impact on the military, 400

interim phase of upper limb prosthetic rehabilitation and, 634

inventories and questionnaires and, 408

limb amputations and, 7, 219, 272, 404–405, 494

military service members compared with civilians, 400

monetary cost estimate, 400

mood and emotional problems and, 272

occupational therapist role, 408

outcomes research needs, 402

pain management, 409

pathophysiology of, 400–402

penetrating, 400

physical therapy and, 480–482

polytrauma and, 46, 272

polytrauma centers and, 272

posttraumatic seizure prophylaxis, 13, 406

rehabilitation and, 272, 407–409

screening for, 272, 388

spasticity and, 406–407

summary of issues, 409

survival rate, 400

treatment, 405–406

“treatment failure” and, 408–409

VA centers, 42, 272

venous thromboembolisms and, 207

Traumatic Servicemembers’ Group Life Insurance

description and coverage, 108

Travel expenses

travel authorizations for family members, 109, 268

Veterans Health Administration and, 76

Trazodone

sleep problem treatment, 271

Treatment modalities for multimodal pain management

medications, 245–248

nontraditional therapies, 248–250

regional anesthesia and analgesia, 234–244

Trees, D.

mobility activities for burn casualties, 339

TRICARE

military medical disability system coordination, 15

President’s Commission on Care for America’s Returning 

Wounded Warriors recommendations, 63

Trinity Amputation and Prosthetic Experience Scale, 15

Trudeau, D.L.

cognitive function research, 408

Truman, Pres. Harry S

prosthesis improvements and, 6

TSA. See Transportation Security Administration

TTAs. See Transtibial amputations

Tubegrip

description, 497

Tuman, K.J.

regional anesthesia and analgesia research, 235, 236

Tupper, J.W.

neuroma research, 161

Turo, N.

phantom limb pain research, 231

Tympanic membrane perforation

cholesteatomas and, 385

ear infections and, 385

mechanism of injury, 384–385

ossicular disruption and, 385

prevalence of, 385

U

Ultrasound

benefits of, 243

perioperative regional anesthesia and analgesia and, 243

“Unilateral Upper Extremity Amputation: Activities of Daily Living Assessment” (Atkins), 513, 519

United Kingdom

Joint War Committee of the British Red Cross, 28

Order of St John, 28
Index

lxvii

Shepherd’s Bush Military Orthopaedic Hospital, London, 

27–28

Universal Wheelchair Football Association

contact information, 693

University of Pittsburgh

partnerships with, 12

Upper Extremity Prosthetic Functional Activity Checklist

description and uses, 601

Upper limb amputations. See also Bilateral upper limb amputees

analysis of outcomes, 602

blind amputees and, 141

changes in patient population, 7

complexity of rehabilitation, 506

cost of care research, 599

effect on employment, driving, and participation in society, 

601

elbow and humerus, 131–133

Firearm Training System, 528

four-phase upper limb amputee protocol of care, 494–523

future research needs, 735

hand and carpus, 130–131

hearing aids and, 392

incidence, 598–599

large zone of injury and, 130

limb salvage versus amputation or residual limb length, 130

measures research, 601–602

outcomes research, 599–601

prevalence, 598

prosthetic demands and, 121

reasons to wear a prosthesis, 506

research issues, 598–602

research updates, 528

spinal cord injury and, 424–425

surgical considerations, 618–621

targeted reinnervation, 527, 530

wrist and forearm, 131

Upper limb amputee protocol of care. See specific phases, i.e., Phase 

one of the upper limb amputee protocol of care

Upper limb joint contracture

evaluation and treatment of, 174

heterotopic ossification and, 174

scar revision/excision and, 174

wound-healing complications, 174

Upper limb pain and dysfunction

spinal cord injuries and, 438

Upper limb prosthetics

advanced prosthetic phase, 635–637

advances in, 14

amputation level nomenclature, 608

body-powered prostheses, 610–611, 723

components, 614–618

early fitting and, 600

elbow systems, 617

electrically powered prostheses, 609–610

future innovations, 637

hybrid prostheses, 612

interim prosthetic phase, 622–635

nomenclature and classifications, 608–618

passive/cosmetic restoration, 612–613

preprosthetic phase, 618–622

prosthetic options, 608–614

research issues, 598–602

self-selection of, 614, 636

sequential provision of five categories of, 622

shoulder joints, 618

summary of issues, 638–639

task-specific prostheses, 613–614

terminal devices, 614–615

“use” and “satisfaction” considerations, 599–600

wrist units, 616–617

Upper limb prosthetics for sports and recreation. See also Lower 

limb prosthetics for sports and recreation

archery, 644, 651–652

baseball, 645, 655–657

basketball, 646, 657

biomechanics and, 643–644

canoeing, 646, 657

firearms, 648, 663–664

fishing, 647–648, 660–662

golf, 645, 654–655

hockey, 648, 664

kayaking, 646, 657

mountaineering, 650, 666–667

safety issues, 644

scuba diving, 649–650

snow skiing and snowboarding, 649, 665

soccer, 646, 658

summary of issues, 650

swimming, 646, 658–659

vehicle control, 646–647, 659–660

volleyball, 646, 658

water-skiing, 648–649, 665

weight training, 644–645, 652–654

windsurfing, 649

Urinary tract infections

antibiotic prophylaxis, 441

spinal cord injuries and, 416, 441

US Adaptive Recreation Center

contact information, 691

US Air Force

Air Force Wounded Warrior Program, 107

air medical evacuation improvements, 5

MHS levels of care and, 3–4

US Army. See also Physical disability evaluation system

Army Wounded Warrior program, 106

MHS levels of care and, 2–4

return to duty process, 54–55

specialty amputee rehabilitation program creation, 5–6

warrior transition units, 54–55

US Army Institute of Surgical Research

equation for determining calorie needs (exhibit), 295

US Army Medical Department

Center and School at Fort Sam Houston, 5

Tactical Combat Casualty Course, 5

VA polytrauma liaison program, 88

US Army Physical Disability Agency authority

burn casualties and, 360

description, 56

US Army Surgeon General

Office of Scientific Research and Development, 33

US Army Surgeon General’s Office

criticism of recreational/motivational activities, 7

US Bureau of Labor Statistics

upper limb amputation incidence, 599

work-related amputation data, 601

US Christian Commission

role of, 24

US Department of Agriculture

contact information, 83

loans for farms and homes for veterans, 83

US Department of Defense

Advisory Committee of the Secretary of Veterans Affairs on 

Prosthetics and Special Disability Populations, 7–8

biomedical research emphasis, 5

collaboration with the US Department of Veterans Affairs, 733

Computer and Electronic Accommodation Program, 108, 522

creation of a specialized system of care for combat amputees, 

7–8
lxviii

Care of the Combat Amputee 

Department of Defense consensus on traumatic brain injury 

definition (exhibit), 401

developing an amputee program within, 7–8

establishment of an amputee patient care program, 2

focus of research after the Vietnam War, 732

identification and treatment of psychological issues stemming from Operation Enduring Freedom/Operation Iraqi 

Freedom, 342

Memorandum of Understanding with the VA, 42

military liaisons, 45

Military Severely Injured Center, 107–108

mission and vision statements for the amputee program, 8

nonmedical attendants and, 14, 268

Operation Warfighter program, 108

prosthetist classification, 554

relationship with VA, 4, 72

research partnership with the VA, 11

Reservists Education Assistance Program eligibility and, 81

vocational rehabilitation and, 102–103

US Department of Health and Human Services

Uniform Data System, 49

US Department of Homeland Security

Reservists Education Assistance Program eligibility and, 81

US Department of Housing and Urban Development

contact information, 83

Veteran Resource Center, 83

US Department of Labor

Recovery and Employment Assistance Lifelines program, 108

US Department of Orthopaedics and Rehabilitation

“centers of excellence” concept, 10

creation of, 8

interdisciplinary teams, 10–11

organizational structure, 9–10

physiatrist role, 8

prosthetist classification, 554

staffing ratios, 11

suggested staffing ratios for amputee care (table), 11

US Department of Veterans Affairs. See also Polytrauma System 

of Care; VA Schedule for Rating Disabilities; Veterans Benefits 

Administration

Advisory Committee of the Secretary of Veterans Affairs on 

Prosthetics and Special Disability Populations, 7–8

application for health and other benefits, 86

benefits provided by other agencies, 83–85

central office, 68

challenges of navigating the system, 68

Clinical Practice Recommendations for Issuance of Recreational and Sports Equipment, 671, 715

collaboration with the US Department of Defense, 733

Commission on Accreditation of Rehabilitation Facilities and, 

43, 49

contact information, 684

creation of a specialized system of care for combat amputees, 

7–8

current budget, 68

description, 68–69

disease-related amputations and, 4

eligibility for adaptive recreation and sports equipment, 672

focus of research after the Vietnam War, 732

“hostilities” definition, 77

identification and treatment of psychological issues stemming from Operation Enduring Freedom/Operation Iraqi 

Freedom, 342

key VA programs and personnel, 87–88

location of VA hospitals near medical schools recommendation, 6

Memorandum of Understanding with DoD, 42

mission, 68

National Cemetery Administration, 68, 82–83

need for flexibility within, 2

OEF/OIF program, 48

Office of Seamless Transition, 107

organization of, 68–69

organizational chart (figure), 69

overview, 68–89

Paralympics sponsor, 15

perception of transfer to VA hospitals as a decrement in care, 7

Preservation Amputation Care and Treatment program, 12, 42

Prosthetic and Sensory Aids Service, 71–72, 715

Prosthetics and Sensory Aids Service, 672

quality of care recognition, 49–50

Rehabilitation Research and Development Service, 11

relationship with DoD, 4, 72

research partnership with DoD, 11

specialized training in rehabilitation techniques, 42–43

sports and recreation opportunities and, 671–672

State Benefits Seamless Transition Program, 111

traumatic brain injury centers, 42, 272

Veterans Benefits Administration, 68, 78–82

Veterans Health Administration, 68, 70–78

vocational rehabilitation specialists and, 98

Web site, 86

what every veterans affairs beneficiary needs to know, 85–87

what military healthcare providers need to know, 87–88

US Disabled Alpine Ski Team

contact information, 691

US Fencing Association

contact information, 691

US Golf Association

contact information, 691

US Handcycling Federation

contact information, 691

regulations for disabled cyclers, 673

US Marine Corps

Marine Wounded Warrior Regiment, 106–107

MHS levels of care and, 3–4

number of wounded per month, 107

US Military Academy

Peak performance training, 500

US National SCI Statistical Center

spinal cord injury data, 416

US Navy

MHS levels of care and, 3–4

Navy Safe Harbor program, 107

US Olympic Committee/US Paralympics

contact information, 691–692

US Paralympics

Paralympics sponsor, 15

US Quad Rugby Association

contact information, 692

US Sanitary Commission

historical background and role, 23–24, 26

US Sled Hockey Association

contact information, 692

US Small Business Administration

outreach to veterans, 84

US Table Tennis Association

competitive table tennis regulation, 679

US Tennis Association

competitive wheelchair tennis regulation, 679

contact information, 692

US Wheelchair Swimming, Inc.

contact information, 693

US Wheelchair Weightlifting Association

weightlifting regulation, 680

US Wheelchair Weightlifting Federation
Index

lxix

contact information, 693

USA Swimming

competitive and recreational swimming governance, 679

USA Volleyball

contact information, 693

USAISR. See US Army Institute of Surgical Research

UTIs. See Urinary tract infections

V

VA. See US Department of Veterans Affairs

VA Schedule for Rating Disabilities

medical evaluation boards and, 56

recommended reform of, 63

VA Voluntary Services

assistance for families and caregivers, 48

VACs. See Vacuum-assisted closure devices

Vacuum-assisted closure devices

skin traction and, 126

uses of, 126, 497

Vacuum-Assisted Socket System

description and uses, 722

van der Linde, H.

gait analysis and training research, 547

Vancomycin

MRSA infection treatment, 196

surgical prophylaxis, 194

Vascular surgery

failure rate, 33

improvements in during the Vietnam War, 33, 35

Korean conflict and, 33

VASRD. See VA Schedule for Rating Disabilities

VBA. See Veterans Benefits Administration

Vehicle control. See Driving

Vehicle purchases

financial assistance for, 82

Venous thromboembolisms

combat amputees with concomitant fractures and, 207

Verrucous hyperplasia

description and management of, 183

Vertigo. See Labyrinthine damage

Vestibular system injuries. See also Assessment of the vestibular 

system

central vestibular damage, 386–387

importance of early diagnosis, 382

labyrinthine damage, 386

misdiagnosis of, 382

physical therapy and, 481

treatment and rehabilitation, 392

Vet Centers

description and Web site, 74

Veterans benefits. See also Veterans Benefits Administration

DD 214 form and, 62, 77

list of, 62

Veterans Benefits Administration

active duty personnel benefits, 81–82

area offices, 78

compensation and pension programs, 79

education programs, 80–81

insurance programs, 79–80

loan guaranty program, 81

mission, 78

Office of Vocational Rehabilitation and Education, 102–103

vocational rehabilitation and employment program, 79, 82, 

102–103

Web site, 78

Veterans Claims Act, 86

Veterans Health Administration

accessories for adaptive equipment, 715

adaptive sports equipment eligibility, 715

assistive technology, 71–72

authorization for, 70

Blind Rehabilitation Service, 75–76

changes in the veteran population, 71

combat veterans and, 77

community-based outpatient clinics, 74

continuing education, 75

current OEF/OIF VA population compared with the general 

VHA population, 71

domiciliary care, 73–74

emergency medical care in external facilities, 74

enrollment in, 78

foreign medical program, 77

healthcare programs, 72–74

homeless veterans, 76

long-term care, 72

mission, 71

national rehabilitation special events, 74

noninstitutional care, 72–73

nursing homes, 73

presumptive conditions considered for disability compensation, 76–77

priority groups, 78

Prosthetic and Sensory Aids Service, 71–72, 715

Prosthetics Clinical Management Program, 72, 715

“recreational leisure equipment” definition, 715

“recreational sports equipment” definition, 715

rehabilitation centers, 4

role of, 70

spinal cord injury and, 74–75

things to remember about VHA (exhibit), 78

travel expenses and refunds, 76

usage data, 71

vet centers, 74

veterans integrated service networks, 70–71

Veterans integrated service networks

description and locations, 70–71

Veterans’ Medical Programs Amendments, 42

Veterans of Foreign Wars

support programs, 111

Veterans on the Lake Resort

contact information, 693

Veterans Programs Enhancement Act

National Cemetery Administration creation and, 82

Veterans Readjustment Assistance Act, 96

VHA. See Veterans Health Administration

Vibration therapy

burn scar management, 353

Vicodin

phantom limb pain treatment, 245

VICTORS. See Visual Impairment Center to Optimize Remaining 

Sight Program

Videonystagmography/electronystagmography

description and uses, 389

Vieira, Z.E.

regional anesthesia and analgesia research, 237

Vietnam Veterans of America Foundation

present-day role, 29

Vietnam War

advances in amputee care, 6–7

benefits for children of female Vietnam veterans born with 

certain defects, 79

circular amputations and, 118

improvements in resuscitation and vascular surgery, 33, 35

lower extremity wounds and reasons for, 33

motivational therapeutic programs and, 35–36
lxx

Care of the Combat Amputee 

osteomyoplastic transtibial amputation and, 166

rehabilitative athletics and, 36

spinal cord injuries and, 416

survival rate for casualties, 400

VISNs. See Veterans integrated service networks

VISOR. See Visual Impairment Services Outpatient Program

Visual impairment. See also Blind persons

prosthesis considerations, 577, 632–633

Visual Impairment Center to Optimize Remaining Sight Program

description, 75–76

Visual Impairment Services Outpatient Program

description, 75

Vitamin K

heterotopic ossification treatment, 158

Vloka, J.D.

regional anesthesia and analgesia research, 236

Vocational rehabilitation

age issues, 98

assessment and career exploration phase, 98–99

background for, 96–98

baseline function and, 99–100

basic components, 98–101

compensated work therapy, 101

cultural values and, 96

definition, 96

development of the rehabilitation plan, 99

follow-up services, 101

functional assessment and, 100–101

functional capacity evaluations, 521–522

future research needs, 734

individual choice and, 101

individual’s strengths and weaknesses and, 97–98

intervention strategies and training, 101

legislation involving, 96

long-term needs and outcomes and, 98

model system for, 96, 103

outcomes, 97

phase of the upper limb amputee protocol of care and, 

521–522

planning pragmatically for employment, 97

preinjury character traits and, 97

process of, 98–101

psychosocial adaptation to amputation, 102

public vocational rehabilitation system, 103

rehabilitation counselors and, 96–97

rehabilitation professionals, 96–97

spinal cord injuries and, 426

supports and systems for, 102–103

tenets of, 97–98

transferring past work experience to future employment options, 98

Veterans Benefits Administration and, 79, 82, 102–103

Voice recognition software

description and uses, 528–530

Volleyball

prosthetic examples, 658

upper limb prosthetic considerations, 646

Vollum, Dr. Edward P.

evacuation of soldiers after the battle of Gettysburg, 24

VR. See Vocational rehabilitation

VR&E. See Office of Vocational Rehabilitation and Education

VTEs. See Venous thromboembolisms

W

Walking. See Ambulation

Wall, P.D.

mirror therapy research, 250

Wall-Alonso, E.

activity factor for weight maintenance, 296

Walter Reed Army Hospital

specialty amputee rehabilitation program, 5–6

Walter Reed Army Medical Center

bilateral transfemoral protocol, 491–492

center of excellence for service members with amputations, 4

designation as the primary site for amputee care in the United 

States, 8

Military Advanced Training Center, 10

military amputee rehabilitation protocol, 486–491

occupational therapy and, 494

patient flow chart at WRAMC’s amputee service (figure), 9

PDES Joint Pilot Program and, 56

physical medicine and rehabilitation residency program, 5

PM&R residency program, 11

preventive medical psychiatry service, 268–273

resources at, 116

“Targeted Reinnervation in Upper Limb Amputees to Improve 

Myoelectric Prosthesis Function,” 530

traumatic brain injury treatment, 400

Warfarin

deep venous thrombosis treatment, 429

Warrior transition units

DD214 document and, 55

description and role, 54–55

medical evaluation board proposed pilot system and, 58

Water Skiers With Disabilities Association

contact information, 693

Water sports. See also specific sports

lower limb prosthesis and, 590

Waters, J.H.

regional anesthesia and analgesia research, 234

Waterskiing

adaptive sports equipment for, 710

opportunities available to amputees, 680

prosthetic examples, 665

upper limb prosthetic considerations, 648–649

Waxman, K.

formula for the protein needs of burn casualties, 296

Web sites. See also Internet

American Council on Education military training programs, 

99

American Society of Regional Anesthesia, 238

Marine Wounded Warrior Regiment hometown link locations, 

114–115

ONET, 99

Polytrauma System of Care, 48

Social Security Administration, 84

Transition Assistance Online, 99

US Department of Veterans Affairs, 86

useful resources and organizations for veterans, 116

VA Prosthetic and Sensory Aids Service, 72

Vet Centers, 74

Veterans Benefits Administration, 78

Veterans Health Administration foreign medical program, 77

Web site addresses of organizations helpful to injured service 

members (table), 55

Weight-bearing restrictions

bone stimulators, 208

energy requirements and, 208

fracture healing and, 208

timely and thorough musculoskeletal system evaluations and, 

207–208

tolerance determination, 208

ultrasound, 208

Weight training

opportunities available to amputees, 680
Index

lxxi

prosthetic examples, 652–654

upper limb prosthetic considerations, 644–645

Wheelchair Athletics of the USA

slalom competition regulation, 678

Wheelchair Dancesport USA Association

contact information, 694

Wheelchair Poolplayers Association

regulations for disabled players, 673

Wheelchair Sports, USA

air gun/shooting competition, 672

contact information, 694

description, 670

establishment of, 670

regulations for disabled cyclers, 673

slalom competition regulation, 678

Wheelchair Track & Field, USA

contact information, 694

track and field regulation, 679

Wheelchairs

automatic docking systems for, 711

case presentation (exhibit), 716

driving controls for vehicles and, 711–712

electric-powered, 422–423, 425, 701–702

extra features for, 422

manual, 698–701

mobility during early rehabilitation and, 453–454

motor vehicle safety, 710–712

multifunctional, 703

orthostatic hypotension and, 421

power-assisted, 702–703

pressure ulcers and, 434

propulsion options, 422

reclining wheelchairs, 421, 423

RESNA standards for, 698

seat anchors for, 710–711

selection criteria, 421–423

spinal cord injuries and, 421–423

sports and recreation uses, 708–709

tipping prevention, 453–454

vehicle access technology, 712

Whitman, Walt

Civil War observations and philanthropic work, 21–22

Wilbur, Dr. Ray Lyman

Baruch Committee on Physical Medicine and, 33

Wilderness Inquiry

contact information, 694

Wilderness on Wheels

contact information, 694

Williams, B.A.

regional anesthesia and analgesia research, 235

Windsurfing

upper limb prosthetic considerations, 649

Winter, D.A.

gait assessment research, 540

Winter sports. See also specific sports

lower limb prosthesis and, 590

Wood, Col. R.C.

US Sanitary Commission and, 23–24

WorkForce Investment Act, 96

World Cup in Curling

for wheelchair players, 674

World Curling Federation/US Curling Federation

contact information, 694

World Health Organization

International Classification of Functioning, Disability, and Health,

601

mild traumatic brain injury outcomes study, 404

traumatic brain injury definition, 400

A World to Care For: The Autobiography of Howard A. Rusk, M.D.

(Rusk), 5

World War I

blast-related injuries, 403

Galsworthy’s philanthropic work, 26–27

importance of debridement of wounds, 193

international conference on “after-care” of disabled soldiers, 

26

mortality risk from fractures, 193

“reconstruction aides” role, 28

rehabilitation programs, 27–28

World War II

Baruch’s role, 33

blast-related injuries, 403

improvements in surgical technique, blood transfusions, and 

antibiotics, 30

Kirk’s role, 33

number of amputations and reasons for, 30, 118

percentage of lower extremity wounds, 30

prosthesis improvements, 6

rehabilitation schedule, 30–31

Rusk’s role, 5, 31, 33

spinal cord injuries and, 416

survival rate for casualties, 400

upper extremity injuries, 30

Wound care and management. See also Closure of wounds; Dressings

abnormal wound healing, 202–204

acute phase of healing and, 306–309

burn casualties and, 306–309, 315

burn wound excision, 307–309

chronic inflammation, 202

debridement and, 202

desiccation versus maceration, 203

dressings, 307

epithelialization and, 202–203

granulation and, 202–203

hemostasis phase, 201

impaired healing response, 203–204

importance of, 200

infection related to skin loss, 307

inflammation phase, 201

open wounds, 121

phase one of the upper limb amputee protocol of care and, 497

pressure ulcers, 435

proliferation phase, 201–202

rehabilitation goals, 306

remodeling phase, 202

signs and symptoms of infection, 203

wound healing phases, 201–202

wound treatment, 204–206

Wounded, Ill, and Injured Overarching Integrated Product Team

Report to Congress on the Current Status of the Department of 

Defense and Department of Veterans Affairs Disability Evaluation 

System Pilot Program, 63

Wounded Warrior Project

adaptive sports, 111

description, 111

goals of, 111

motto of, 111

Paralympics sponsor, 15

Wounded Warriors

description and role, 48

WRAMC. See Walter Reed Army Medical Center

Wrist and forearm amputations

general surgical considerations, 131

Wrist units for upper limb prosthetics

actuation methods, 616–617
lxxii

Care of the Combat Amputee 

bilateral upper limb amputees and, 631

capabilities of, 616

co-contraction control method, 617

“quick-slow” or “fast access” control methods, 616–617

WSUSA. See Wheelchair Sports, USA

WTUs. See Warrior transition units

Wu, C.L.

clonidine research, 247

opioid research, 246

regional anesthesia and analgesia research, 236

Y

Yard work responsibilities

phase of the upper limb amputee protocol of care and, 519

Yeager, M.P.

regional anesthesia and analgesia research, 236

Yellow Ribbon Fund

Paralympics sponsor, 15

Z

Z-plasty

burn casualty reconstructive surgery and, 359

Zolpidem

sleep problem treatment, 271

Zone of injury

spinal cord injury recovery and, 418

upper limb amputations and, 130
Index

lxxiii

Major David Rozelle had his foot amputated due to injuries incurred from an improvised explosive device blast 

that struck his Humvee while he was serving as a company commander in Iraq. After undergoing surgery and 

rehabilitation at Walter Reed Army Medical Center (WRAMC), Major Rozelle asked to continue on active duty 

and return to Iraq to complete his tour. His request was granted, and this photograph was taken on his second 

tour. Major Rozelle was the first soldier with a major limb amputation to return to the theater of combat operations. After completing his tour in Iraq, Major Rozelle returned to WRAMC to work within the Armed Forces 

Amputee Care Program, helping other service members injured in Iraq or Afghanistan to maximize their potential. He also helped lead the design and construction of the Military Advanced Training Center at WRAMC. 

After completing this assignment, he served as aide-de-camp for the Surgeon General of the Army, and later 

attended the Marine Corps University. At the time of printing, Major Rozelle had returned to the Cavalry Corps 

and was once again assigned to a combat unit. In addition to Major Rozelle’s many military accomplishments, 

he has also completed the Iron Man Triathlon and several marathons.

Photograph: Courtesy of Major David Rozelle.
lxxiv

Care of the Combat Amputee 
Index

lxxv
lxxvi

Care of the Combat Amputee