Helping forgotten heroes

"Army hospitals do an exceptional job of healing the bodies of soldiers who suffer traumatic amputations, but nobody has much information about the long-term health outcomes for these men, and that makes follow-up and long-term support difficult to provide."
— Mark Sothman

When it comes to Vietnam, forgetting has become a national reflex. What remains most vivid about the conflict in our collective mind are war movies and the dramatic Vietnam Memorial in Washington, D.C., containing the more than 58,000 names of those who died on the far side of the world.

But to Mark Sothmann and his team of IUPUI researchers, it's time to remember-and provide help for-America's other victims of that conflict, the men who suffered traumatic amputation in battle.

Information is incomplete

Daniel Vreeman, Mark Sothman, and Craig Robbins

"Army hospitals do an exceptional job of healing the bodies of soldiers who suffer traumatic amputations," says Sothmann, dean of the School of Health and Rehabilitative Services. "But nobody has much information about the long-term health outcomes for these men, and that makes follow-up and long-term support difficult to provide."

That gap is at the heart of the Indiana-Ohio Collaboration for Traumatic Amputee Rehabilitation Research project that links Sothmann and his IUPUI team with counterparts from Ohio State University in a $1 million grant project that could run up to five years. Locally, the grant will be administered by the Indiana Center for Rehabilitation Sciences and Engineering Research (ICRSER).

"The records the armed services kept in the war only listed loss of limbs and amputation as 'major injuries,' and didn't specify what those injuries were," says Sothmann, whose team includes Daniel Vreeman and Craig Robbins from his school, plus School of Medicine researcher and faculty member Brad Doebbeling, representing the Roudebush Veterans Administration Hospital on the IUPUI campus.

The project's first phase will create a Web site and a national registry of Vietnam veterans with traumatic amputations. The second phase will use focus groups to determine the most accurate indicators of the health and quality of life of those veterans. The third phase will feature a nationwide survey of the veterans in the databank.

The database also will help the Department of Defense (DOD) and the Veterans Administration (VA) communicate more effectively. "One of the big factors that contributed to the problems we face is that both the DOD and the VA have very different information systems and different coding," says Sothmann.

The IUPUI and Ohio State research teams are eagerly pursuing help from veterans' groups as key resources.

"We need their (veterans) help as partners in conducting our research," says Sothmann. "With their partnership, we can reach a larger segment of the veteran population and our project can reach its full potential."

The groups could help in several ways: by providing links to the project's Web site on their own home pages; by publicizing the project in their newsletters; by inviting research team members to speak at national and regional conventions, conferences and meetings; and by networking among themselves.

Long-term perspective needed

Using Vietnam veterans instead of servicemen from either of the Gulf wars was a conscious choice for the IUPUI-Ohio State research teams. "Soldiers who have suffered these types of injuries in the Gulf wars have had access to more current, effective equipment and treatments," says Sothmann. "But Vietnam-era vets didn't, and they also have had 30 years of life experiences with amputation affecting everyday life." Those men are likely to have critical insights researchers need to assess and that might help the government provide more effective treatments and support.

"We have two critical questions we need to consider," says Sothmann. "The first: how can we help the Vietnam-era traumatic amputees and others from past wars as they age? And the second: what information on the outcomes from Vietnam-era amputees will help us develop better long-term rehabilitation practices for amputees in present and future wars?"

The defense department supports the project and "is very interested in what information we can gather," the dean says. "Building an accurate database will be a big step. But imagine if we are able to provide the DOD with up-to-date information about problems these men have encountered with prosthetics, access to health care and psychosocial issues.

"Our work may help the Army improve its current care, provide more help for both older and current troops, and develop new methods to meet their needs," Sothmann adds.

Sothmann believes the Web site could prove even more vital than the database.

"Right now, we have no easy means of communication with the men who belong on this list," he says. "An interactive web site could provide them with the means to keep up with our work, to know their participation is valued and that the results will make a difference."

IUPUI a 'good fit'

Sothmann believes the IUPUI campus is a "good fit" for projects like this one.

"We have a wide variety of people and talents here that a lot of other campuses don't," he says. "Our school knows the rehabilitation side, but we also have experts in technology to gather this information and manage it, medical people to help us assess the soldiers' health concerns, even the biomedical engineering experts to help us test new equipment and techniques to help our soldiers live fuller, richer lives."

The combined expertise of IUPUI schools and their Ohio State counterparts is likely to help defense department and VA officials develop new approaches to health care for American soldiers.

"I think the information we gather from veterans could give the biomedical experts here and at Ohio State ideas on how to create better prosthetics, and give our surgeons and therapists ideas on how to improve field care," says Sothmann. "The potential benefits are enormous."

The benefits of the partnership-the largest grant in Health and Rehabilitation Services' history-extend to the school's future, as well.

"The project establishes ICRSER as our school's portal to the outside world," says Sothmann. "It will give us the infrastructure we need to tap into about $600 million in national funding that has gone untapped previously by the state of Indiana."

The center also has become a major recruiting tool for Sothmann and his staff.

"Thanks to this grant we have a story to tell to talented young Ph.D. candidates who are being recruited by some of the top schools in the nation," the dean adds. "This grant and the whole Life Sciences Initiative makes it clear to them: this is a climate where they can flourish!"

For more information, visit the Indiana-Ohio Collaboration for Traumatic Amputee Rehabilitation Research Web site at: www.vietnamwaramputee.org