Ajit B. Pai, MD; Nicholas R. Jasper, MD; David X. Cifu, MD

Rehabilitation of injured U.S. servicemember with traumatic brain injury, stroke, spinal cord injury, and bilateral amputations: A case report Ajit B. Pai, MD; Nicholas R. Jasper, MD; David X. Cifu, MD

Aim • Describe combat-injured servicemember with highly complex rehabilitation needs who was successfully returned to community. • Relevance • Complexity of injuries arising from combat situations (particularly Operations Iraqi & Enduring Freedom) is challenging. • Injured troops are treated by interwoven system of care that includes Department of Defense (DOD) and Veterans Health Administration (VHA).

Case • 32-year old Army medic who survived blast while stationed in Afghanistan. Resulting injuries included: • Severe traumatic brain injury with multiple facial fractures. • Middle cerebral artery distribution infarction. • Bilateral anterior cerebral artery watershed infarctions. • Bilateral below-knee amputations. • Spinal cord injury. • Superior endplate compression fracture. • Left transverse process lumbar fractures. • Coccyx fracture. • Lung middle and posterior segment lobe contusions.

Patient was aeromedically evacuated to Bagram Airfield military hospital (Afghanistan), and then transferred to Landstuhl Regional Medical Center (Germany), Walter Reed Army Medical Center, National Naval Medical Center, Hunter Holmes McGuire and Boston VA Medical Centers, and finally, to Center for the Intrepid, San Antonio Military Medical Center. • Video teleconferences, shared radiologic imaging databases, and scheduled telephone conversations allowed for increasingly seamless transition between various care sites.

Conclusion • This case demonstrates coordination required to seamlessly navigate combined DOD/VHA system and vital role of rehabilitation services in optimal recovery after blast injury. • Physicians across institutions must understand medical care undertaken at each institution along continuum. • Importance of communication among providers cannot be overstated.

Ajit B. Pai, MD; Nicholas R. Jasper, MD; David X. Cifu, MD

Ajit B. Pai, MD; Nicholas R. Jasper, MD; David X. Cifu, MD

Presentation Transcript

David R. Byrd, MD Chair, AJCC

Daniele Tognetto MD, Pia Leon MD, Paolo Cecchini MD, Silvia Rinaldi MD, Giuseppe Ravalico MD

Greggory R. DeVore MD

William H. Geerts, MD, FCCP; Graham F. Pineo, MD; John A. Heit, MD; David Bergqvist, MD, PhD, FRCS; Michael R. Lassen,

Stephen B. Hanauer, MD

J. Varon, MD, FCCP , W.F. Peacock, MD, N. Garrison, MD, R. Ebrahimi, MD, L. Dunbar, MD, P. Acosta, MD, and C. Pollack, M

Puneet Bhargava MD 1 Adeel Seyal MD 2 Chandana Lall MD 3 Sadhna Verma MD 4 Nicholas Bodmer MD 5 Sarah Bastawrous

Elias R. Melhem, MD

Glenn R. Buttermann, MD

David G. Binion , MD Bruce E. Sands, MD, MS

A Kheirkhah MD, A Izadi MD, R Nazari MD H Hashemi MD, M Jabbarvand MD, H Hashemian MD

Dr. S.Chakravarty MBBS, MD MD

David Barounis , MD 1 Catherine Knight, MD 2 Ben-Paul Umunna , MD 2

Michael R. Folkert, MD PhD, Samuel Singer, MD, Murray F. Brennan, MD,

Alexander I. Kraev , MD Andrew Nguyen, MD R Anthony Perez-Tamayo, MD PhD Gregg Landis, MD

Glenn R. Buttermann, MD

R. Cionni, MD

Peter Pronovost, MD John R. Combes, MD

Ataei .B , MD. MPH.

Ahmet ALANAY, MD Cagatay OZTURK, MD Meric ENERCAN, MD Ibrahim ORNEK, MD Mehmet TEZER, MD

Laurence de Leval, MD, PhD,* David Waltregny, MD, PhD,w Jacques Boniver, MD, PhD,*

Moderators: David Cort, MD Alex Denes, MD Panelists: Stephen Swisher, MD, PhD Edward Lin, MD