Million Dollar Wound
For those of us who watched the popular 1970s television shows
The Million Dollar Man or
The Bionic Woman, one of the most notable facets was the integration of technology and biology.
Both shows featured a main character who incurred loss of function in a limb and was given a second chance to regain full independence thanks to the advancements of technology and health. The show appealed to lay and scientific people because the main characters were restored to full independence - with the added benefit of supernatural abilities.
This concept was once seen as pure fantasy, but in the modern times of research, biomechanical limbs are not far-fetched. In fact, they are increasing in common use. Research is the driving force to push advances in healthcare. For more than 60 years, the Department of Veterans Affairs has conducted research for veterans in its own division, the Office of Research and Development.
In April 2009, I had the opportunity to attend the first annual Veteran Affairs Research and Development Forum in Washington, DC. Facilitated by the Office of Research and Development, a subdivision of the Veterans Health Administration, researchers from VA medical centers throughout the U.S. were invited to present research conducted at their facilities. The forum featured notable people such as the Secretary of Veterans Affairs and the Under Secretary for Health. They spoke about the importance of investing resources to conduct research.
Collaborative projects from other agencies such as the National Institute of Health and the Department of Defense discussed the impact of collaborative research in military veterans' healthcare. Recognizing achievements in research, the forum focused on how research improved veterans' health. Key areas addressed included prosthetics, stroke rehabilitation, mental health.
Returning to civilian life and readjusting to daily activities without full function of all limbs creates new problems. In the past, prosthetic limbs have been cumbersome and heavy, and limited independent functioning. Often, newly amputated veterans abandoned their prosthetic devices due to the difficulties in manipulating and wearing them. Researchers at the VA had recognized this and conducted research to improve the efficiency of prosthetic devices.
The DEKA arm, for example, is a bionic arm that resulted from the collaborative efforts of researchers in the Department of Defense, the VA and private company owner/inventor Dean Kamen. What makes this device revolutionary is the greater range of motion and control that past prosthetic arms have not achieved. Previous electronically controlled prosthetic hands were limited to opening and closing. Delicate tasks, such as picking up a grape, were impossible.
The DEKA arm is a prosthetic arm with a hand that attaches securely to the amputated limb. Using small control buttons, the user is able to manipulate the arm and hand to perform a range of tasks. Sensing how much pressure is needed to pick up an object, the arm and hand allows the user to pick up heavy objects, such as a power drill, and delicate objects, such as a grape.
This 9-pound device is driving advancement in technology to improve healthcare. But certain medical conditions can result in loss of function in an arm.
Stroke, a leading cause in disability, is debilitating because of the lasting effects of the loss of usage in an arm and leg. More than 15,000 veterans who have a stroke are hospitalized annually. Veterans who have had a stroke face a long road, with rehabilitation as the focus.
The Baltimore VA is one of a handful of VA medical centers using robotics to rehabilitate stroke patients. Veterans who participate in this research are introduced to exercise equipment driven by robotic technology. Tasks are presented on a computer screen and the veterans, using their weakened limbs, completes the tasks on a robotic assistive device. Similar to a video game, tasks might include touching a moving ball. This repetition assists in recovery of function and strength in the affected limb. Recovering from a stroke takes physical and mental strength.
Always overlooked as a wound, nonphysical injuries sustained from combat are overwhelming to the veteran and the family. A two-star general who spoke of his experiences battling post-traumatic stress disorder gave "multiple combat tours with insufficient time to recover" as a leading component to mental distress in military personnel. The stigma of reporting a need for mental healthcare is apparent in the military due to the "...tremendous pressure to suck it up."
VA researchers have observed an increase in the number of veterans reporting post-traumatic stress and attempted suicides. The VA is conducting studies on effectiveness of using psychotherapeutic techniques such as cognitive processing therapy and prolonged exposure therapy. Both are types of cognitive behavior therapies, and require the veteran to address their thought processes when recounting the traumatic events.
I heard the phrase "million dollar wound" during the research forum. It can be applied to any healthcare need described here. Any wound incurred from serving in a combat zone cannot be repaired with a simple cloth bandage. Combat wounds are million dollar wounds because it takes VA research and other VA resources to help a veteran return to an optimal and independent functioning level.
For additional information:
VA Office for Research and Development: http://www.research.va.gov/
DEKA arm: http://www.cbsnews.com/stories/2009/04/10/60minutes/main4935509.shtml
Robotic-assistive rehabilitation: http://www.seattlepi.com/local/349981_robot05.html
PTSD research:
http://www.research.va.gov/news/features/ptsd.cfm