Ottawa Citizen

From injury to independen­ce

Edmonton’s state-of-the-art rehab centre helps injured veterans push their limits

- JODIE SINNEMA

EDMONTON

Paul Franklin says he was in the best shape of his life when he nearly died. He was a 200-pound marathoner, mountain climber, medic and master corporal in Afghanista­n when a bomb exploded his G-wagon on Jan. 15, 2006, killing diplomat Glyn Berry and ripping off Franklin’s left leg and mangling his right. Tourniquet­s and his team saved him.

By the time he reached Edmonton two months later, Franklin had gone through 26 surgeries, including amputation of his second leg, and weighed only 132 pounds.

Franklin’s loss could have left him a defeated man.

Instead, he chose his next training operation: physical rehab at Edmonton’s Glenrose Rehabilita­tion Hospital.

“As a medic, I knew we were going to have other soldiers come back wounded,” Franklin said. “We knew that things had to change and we knew we couldn’t keep sending our guys to the States.”

Six years later, the Glenrose has become the gold standard in physical therapy for the military.

At the Glenrose, wounded soldiers have pushed the prosthetic­s and orthotics team to test the boundaries of artificial limbs and braces. War has brought millions of dollars in technology, including an entire computeriz­ed therapeuti­c room that projects virtual worlds onto huge screens to test the ability of the injured to walk.

When Franklin arrived at the Glenrose, his fellow patients were seniors who had lost their limbs through diabetes and other diseases. The treatment team, led by physical medicine and rehabilita­tion specialist (or “physiatris­t”) Dr. Jacqueline Hebert, aimed to teach the older patients basic life skills: transferri­ng from their wheelchair­s to the toilet, walking and getting in and out of their vehicles. Franklin wanted far more. “We challenged each other,” he said of Hebert. “She had a patient who was stubborn, wouldn’t listen, and wouldn’t accept that I would only get six to eight weeks of treatment. In other words, I was willing to say, ‘I want to learn to run, I want to learn to have a life again and I want to continue to serve in the military.’”

Hebert’s first response: “Your expectatio­ns are way off-base.” Especially considerin­g Franklin had to relearn how to sit up. He had to stand using his hips and core muscles, balancing as if on a gyroscope on bendy metal stilts that had no feeling of the floor and no flex in the ankle. That alone took him a month.

“When you have a patient who is highly motivated and wants to get back to 200 per cent, you need to temper their expectatio­ns, so we spend time doing that, slowing them down, calming them down and reminding them that rehab is a step-by-step process,” Hebert said.

But she’s also learned from military people to dream bigger.

“I actually think that maybe, sometimes, we would stop too early in the steps in the past,” Hebert said. “What we realized is we could go on with their desires rather than tempering them. We tend to let people try more often now. I say ‘ no’ much less than I used to (and) you let them sometimes fail.”

Walking with artificial legs was crucial for Franklin, even though he will likely never use them without canes, substantia­l nerve pain and occasional falls. He largely uses them at public speaking engagement­s and to travel.

“I just saw it as a new challenge, as a new way to train,” Franklin said. “That’s one of the reasons I was successful at it, because it was a new me, a new normal. … It gives me a huge sense of freedom that

‘The real tweak is that (the American military therapists) treat their patients all like athletes and they treat even their severe injuries and amputation­s like sports injuries. So they would take their trans-tibial (below the knee) amputees and treat them like they had an ankle sprain. And their above-knee amputees, they treat them like they’ve had a blown ACL (anterior cruciate ligament) repair.’ DR. JACQUELINE HEBERT Physiatris­t at Edmonton’s Glenrose Rehabilita­tion Hospital

someone using a wheelchair will never have.”

Franklin admits running was beyond his new normal, since he had to swing the carbon fibre Cheetah blades awkwardly with each stride, with no knee to pull them up and under.

But he said the specialize­d technology at the Glenrose taught him to walk with some grace. He watched himself walking on video recordings and computers, his movement tracked through adhesive markers on his skin.

“If I didn’t have that, I wouldn’t be able to walk as well as I do today,” Franklin said. “I would be much more clunky, much more ineffectiv­e, with much less ability, to be honest.”

While the gait technology was available before Afghanista­n and without military dollars, the military bumped up its efforts at the Glenrose as more injured returned home, even paying for a parttime prosthetic and orthotist technician for three years.

“Ten years ago was pre-Afghanista­n. Ten years ago was pre-iraq, the big involvemen­t,” said Mike Stobbe, who started working as a prosthetis­t at the Glenrose a decade ago. Military interest rose in 2004, when American casualties spiked, Stobbe said. That changed the goal in rehab from getting a person back to an acceptable level of function to helping young soldiers move beyond.

“These guys are all athletes,” Stobbe said. “They’ve worked really hard. They’ve protected us. They’ve represente­d us in dangerous ways. What can we do to help them the maximal way?”

Following a visit to Washington’s Walter Reed Army Medical Center by a Glenrose rehab team and military contingent, soldiers became eligible for three prosthetic­s rather than one.

Many patients who had legs that didn’t function properly turned down traditiona­l hard plastic ankle and foot orthotics made for walking. Some soldiers demanded the light carbon-fibre version that would allow them to run.

More therapeuti­c tools became available when Hebert and her team asked the military for equipment used commonly by American therapists. The list included more treadmills, rowing and biking machines and balancing devices that pushed patients further.

“The real tweak is that (the American military therapists) treat their patients all like athletes and they treat even their severe injuries and amputation­s like sports injuries,” Hebert said. “So they would take their trans-tibial (below the knee) amputees and treat them like they had an ankle sprain. And their above-knee amputees, they treat them like they’ve had a blown ACL (anterior cruciate ligament) repair.”

“It’s a different way of looking at your patient, not as missing a body part but as having a new body part,” Hebert said. “That’s what opened our eyes the most.”

In June 2011, $1.5 million from the Department of National Defence equipped the Glenrose with a computeras­sisted rehabilita­tion environmen­t system, called the CAREN. Another went to Ottawa for eastern Canadians.

Cpl. Brock Blaszczyk, 22, uses the Edmonton system every week, strapped in as he stands on a round movable platform in front of a giant video screen.

No need to head outside in -30 C to climb snow hills and risk falling. Patients practise walking along virtual paths, driving virtual boats and reaching for virtual tools in their garages as their physiother­apists monitor progress.

Blaszczyk’s running orthotic on his left leg isn’t the problem. His foot was blown off April 3, 2010, when his team was walking along mud walls in search of explosives.

Doctors later amputated the leg halfway through the knee.

The blast took 55 per cent of the soft tissue and 88 per cent of the nerves on the calf of his right leg. To make his right foot work, his Achilles tendon had to be lengthened and his tibia and fibula shortened.

“I’m doing this Terry Fox thing right now, the Terry Fox hop,” Blaszczyk said. “It’s just a flat trail, and it’s run as hard as you can for 200 metres.”

Blaszczyk wasn’t a runner before, but he misses being able to dash to catch a runaway grocery cart. He’s progressed to a fast walk.

‘I just saw it as a new challenge, as a new way to train. That’s one of the reasons I was successful at it, because it was a new me, a new normal. … It gives me a huge sense of freedom that someone using a wheelchair will never have.’

PAUL FRANKLIN

Army medic and double-leg amputee

“I look a little more like I’m jogging than a penguin hobble. The form is getting better.”

But will such technologi­cal leaps fall back as Canada pulls out of Afghanista­n?

“With Vietnam, which was a similar experience, they did taper off,” Stobbe said, noting that studies on amputees and prosthetic­s changed dramatical­ly between 1968 and 1973.

“We glided on that for years and years and years. That could happen, but I think now there is so much more awareness in society of disabled people, period, that they don’t disappear anymore.”

Andreas Donauer, an orthotist who builds and modifies braces, said while the push isn’t as strong, the promise of possibilit­y is.

“It’s like you open a door to a new world (and) you realize, OK, there’s more to explore yet,” Donauer said. “What the military did is just open that door. We have to explore the new world.”

That’s already happening at the Glenrose, where Hebert and a group are testing bionic limbs through what is called targeted muscle and sensory reinnervat­ion.

Operations have already been carried out on amputees, including on a military veteran who lost his arm following a car crash.

Surgeons find the nerves that formerly opened and closed the hand, then plug them into the patient’s biceps and triceps to regrow.

The veteran is then literally armed with an intuitive prosthesis. When he thinks about moving his arm, the action happens instinctiv­ely.

Similar work is being done to give patients the sensation of feeling and touch when they pick something up.

“We are within reach of having real bionic arms that can feel,” Hebert said.

“It’s unbelievab­le. It’s a far greater level of advancemen­t than we ever would have seen, and we do have the U.S. military to thank for that and their extensivel­y funded research programs.”

 ?? CANDACE ELLIOTT, POSTMEDIA NEWS ?? Keith Ross, physical therapist at the Canadian Forces base, has been working with Pte. Brock Blaszczyk since he returned wounded from Afghanista­n. Below, physiatris­t Dr. Jacqueline Hebert of the Glenrose Rehabilita­tion Hospital in Edmonton.
CANDACE ELLIOTT, POSTMEDIA NEWS Keith Ross, physical therapist at the Canadian Forces base, has been working with Pte. Brock Blaszczyk since he returned wounded from Afghanista­n. Below, physiatris­t Dr. Jacqueline Hebert of the Glenrose Rehabilita­tion Hospital in Edmonton.
 ?? JOHN LUCAS, POSTMEDIA NEWS ??
JOHN LUCAS, POSTMEDIA NEWS

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