Sports therapy helps heal wounds that might otherwise be not just physically but mentally devastating, military rehab experts say.
By Johanna Neuman
Los Angeles Times, 09 January 2006
WASHINGTON — Sgt. 1st Class Daniel L. Gubler was on foot patrol in Ramadi, Iraq, when he noticed the rusty truck hood on top of a mound of dirt beside the road. Seconds later, the mound exploded and the 37-year-old National Guardsman fell to the ground, blinded and with his left arm severed. Now, less than two months later, instead of languishing, he's preparing for a hunting trip in February.
Gubler's plans to go hunting so soon after suffering such devastating wounds reflect a recovery strategy that, at first glance, might seem like exactly the wrong approach.
The Army's rehabilitation experts are pushing soldiers and Marines who have lost arms and legs to take up activities that demand just the physical capabilities they've lost. That is, downhill skiing, cycling, rock climbing, even stalking wintry landscapes in search of game — sports that many people would consider especially demanding.
Why? Because the evidence suggests that such activities, properly supervised, not only yield physical benefits but are a powerful mechanism for helping amputees regain one of the most important things they lost on the battlefield: belief in themselves as complete, functioning human beings.
"Sports are an integral part of the rehabilitation process, an incredible tool," said John Register, 38, who directs the U.S. Olympic Committee Paralympic Military Program. An Army veteran, his left leg was amputated after a sports accident. "If you've lost a limb, your first question is, 'Am I still a husband? A soldier?' Sports gives you a sense of normalcy."
The issue is especially important in the Iraq and Afghanistan wars, where terrorism and suicide attacks are producing a new generation of war wounded: Shielded by body armor and helmets, soldiers are surviving potentially lethal wounds, only to face the challenge of rehabilitation, both physical and mental, after losing limbs.
Most are treated at Walter Reed Army Medical Center in Washington or at Brooke Army Medical Center at Ft. Sam Houston in San Antonio.
As the number of amputee soldiers has grown — more than 300 have come through Walter Reed — military doctors and therapists have pushed to adopt the latest trends in rehabilitative medicine.
They are designing splints with guitar strings and rubber bands to keep fingers in place while bones and nerves heal. They are customizing prostheses that can be controlled electronically, guided by impulses from remaining muscles.
But they are also pressing their patients to get into sports, especially sports that utilize just what the wounded veterans have lost.
Ryan Hollin, a U.S. Military Academy graduate from Redding, Calif., saw how the process worked when he returned from Iraq, where he had lost his right leg below the knee.
"They can get you all better physically," he said, "but there's something about sports therapy that helps rebuild your confidence."
In Gubler's case, within a month of being wounded, he was at Walter Reed, where doctors worked to restore his sight, reconstructing first his right eye and later his left. His wife and four children — Ericka, 13; Joshua, 9; Kyle, 8; and Caleb, almost 3 — were on their way to visit from Idaho Falls, Idaho, over Christmas break.
But what Gubler was being pushed to do by Capt. Jon Verdoni, an occupational therapist, was get ready for hunting in February.
That meant hooking him up to an electronic device that helped flex the biceps and triceps muscles on the remains of his left arm. Both see hunting as a step toward making the wounded soldier the kind of person he was before.
"I can go home and have a fake hand for family occasions and going to church," Gubler said as Verdoni hooked him up to a laptop computer with software to teach him to flex. "Or I can have my life back, fishing and shooting and teaching my kids the things I learned as a kid."
Among advocates of sports therapy is Harvey Naranjo, an Army reservist from Brooklyn. He had just completed training as a combat medic when he was assigned to Walter Reed's occupational therapy wing in 2003. When U.S. Surgeon General Richard H. Carmona held a sports clinic there, inviting disabled athletes to address therapists and patients, Naranjo was inspired.
"I started taking some patients skiing and saw that they came back recharged, ready to go, to take on their therapy," said Naranjo, now coordinator of the sports and activity rehab program. "They saw that if you can ski down the mountain on one leg, you can definitely walk. From there it just progressed.
"The key to having them do this together is that these guys are very competitive," Naranjo said. "If we take one guy on the slopes and he's unsuccessful, he may not try again. If he sees another going down the mountain, he thinks he can too."
There's another psychological lift that can come with the sports rehab programs: sometimes they involve activities once reserved for the well-to-do.
Aided by the nonprofit groups the Wounded Warrior Project and Disabled Sports USA, Walter Reed recently took about 70 soldiers and their families to the resort community of Breckenridge, Colo., for a week of skiing instruction and competition.
Skiing has helped Heath Calhoun, 26, adjust to being a double amputee. Coming home to a wife and a son not yet 2, he knew he had something to live for. But he was unsure about who he was or whether he could be excited about living again.
"I'll never walk the same as I did. I'll never get to run the bases with my son," Calhoun said, "but I can teach my son to ski. I can go cycling with my wife."
The idea of using sports to rehabilitate soldiers traces to 1948, when Dr. Ludwig Guttmann, treating World War II veterans who had spinal cord injuries, held the Stoke Mandeville Games for the Paralyzed to coincide with the Olympic Games.
"We really credit the World War II vets, especially, with starting the Paralympics," said Ann Cody, a lobbyist for the U.S. Paralympics Committee.
In the 1970s, she said, returning Vietnam veterans, many of them amputees, gave new impetus to sports rehab.
"They were the first ones to establish adaptive ski programs," said Cody, who has a spinal cord disease and uses a wheelchair. "They pushed for development of new sports equipment."
For some, taking up sports was life-changing.
"I've seen people go from being quite upset about the fact that they are missing limbs to streaming down the mountain and realizing they can have a life," said Disabled Sports USA's executive director, Kirk Bauer, a Vietnam veteran who was ambushed in the Mekong Delta and lost a leg. "It's a real life-turner."
Wounded Warriors Project co-founder John Melia, a veteran who was medically retired after being injured in Somalia, agrees that sports are able to heal the spirit as much as the body.
"Sports gives them a way to be competitive again, to use their bodies in a competitive way again and in some ways to feel whole," he said.
For Gubler, hunching over a computer screen straining to rebuild muscle control by moving little video cars through smaller and smaller openings, physical challenge looks like the best route not only to that hunting trip but to the rest of his life.
"I think it's just a matter of time before they'll have fully articulated hands," he said. "I'll be able to play the piano. That's coming down the road. When the train comes through, I want to be ready for it."
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Citation: Johanna Neuman. "Amputee Veterans Learning to Deal With Loss by Defying It," Los Angeles Times, 09 January 2006.
Original URL: http://www.latimes.com/news/nationworld/iraq/complete/la-na-wounded9jan09,1,322334.story?coll=la-iraq-complete
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