On the road to recovery

Story by Jacqueline M. Hames, Soldiers Live

 

“You haven’t seen ‘Fried Green Tomatoes?’” Staff Sgt. Christopher Walker asked, glancing into the rear-view mirror as he drove down a winding back road in Bethesda, Md. I grinned and shook my head from the back seat of the van. Walker’s occupational therapist, Capt. Tammy Phipps, looked over her shoulder reiterating how great the movie was, and encouraging me to watch it.

A pair of cyclists appeared on the road before us. Phipps continued to chat about another movie while Walker passed the cyclists in one smooth motion. We stopped at the Metro station so I could get out. I thanked them for dropping me off and shook the captain’s hand. I went to do the same with Walker before I remembered he had no hands. Walker is a triple amputee.

I said my goodbyes and went into the Metro station, thinking how great of a driver he was—I would have stressed about the cyclists. He took them in stride.

Walker is a patient participating in the Driving Rehabilitation Program at the Walter Reed National Military Medical Center. The program, run by Phipps, is a comprehensive and holistic “one-stop shop” for driving rehabilitation, catering to any active duty service member. It’s also the only program of its kind in the entire Department of Defense.

Phipps, a Reserve Soldier, was deployed to Iraq in 2007-2008, where she met retired Lt. Gen. Eric Schoomaker, former surgeon general of the Army, and his aid de camp, Maj. David Rosell.

“I met the two of them, and then through conversation and interaction, Maj. Rosell actually discovered that my background is driving rehabilitation,” Phipps said.  “They asked that I come to Walter Reed and develop a program for them. So, long story short, I came in the fall of 2008 to Walter Reed Army Medical Center in D.C., and then I developed the program from there.”

Phipps’ office is buried deep within the hospital, through a maze of corridors populated with enlisted Navy selling pizza, a charity fair complete with balloons and patients traveling to their next appointment. Hang a right at the giant rock garden and you’re nearly there.

There’s a driving simulator and a light board in the office, which are used to help assess problem areas before patients get on the road, Phipps explained — the board tests hand-eye coordination and reaction times, specifically. Though the simulators are there to help with patient assessment, she emphasized that the real rehabilitation takes place on the road.

“First of all, (through) this program, we are able to see any active duty military service member who has an injury that could impair driving,” Phipps said.  “So, that can be, obviously, amputations or a physical injury. It can also be traumatic brain injuries or sometimes we have stress injuries, like PTSD, so any injury that could impair driving that’s identified as an issue we will be able to see here at Walter Reed.”

Phipps develops a treatment plan once a patient has been identified and evaluated. The amputee population she works with is pulled from the Military Advanced Training Center, a center of excellence for amputee care. Service members are pulled from the MATC within 30 days of becoming outpatients.

Treatment begins with an administrative foundation.

“We do an administrative foundation, which means we make sure driver’s licenses are current and updated, and that they are hooked in and have applied for their VA auto grant benefits,” Phipps said. “It is through the (Department of Veterans Affairs) that we are able to do the final stage of driving, which is the modification and adaptation.”

The program can be broke into six basic components: the administrative foundation; education on vehicle choice and modification needs; behind-the-wheel training; holistic and multi-disciplinary methods which consider adaptive needs; assistance with use of benefits and vehicle purchase, as needed; and finally, the vehicle modification phase.

“You will go from an evaluation to a treatment plan, which will involve adaptive equipment or adaptive techniques — whatever the injury calls for. And in the physical limitation world, we’ll then take them through the process of understanding the world of vendors, how to do all that paperwork with the VA, and then we go to the modifier and put it all together.”

Because each person is different, Phipps has to be a good observer to determine if patients are having confidence or stress issues. She determines her approach to treatment through trial and error and a series of different environments.

“I have routes that allow me to see if we have a problem solving and judgment issue, and then usually, their treatment approach is a little bit different,” Phipps said. “So, we’ll do driving and expose them to that, but we’ll also bring them into the clinic and give them other opportunities to work on like reaction time or motor planning or stress-management techniques … and then we’ll take that back out into the car and see if we can get some improvement in their driving behavior.”

Walker said he is on his seventh or eighth driving rehab session with Phipps. He’s already been on major highways and several different local routes. On the day of the interview, he and Phipps were fine-tuning adaptive driving equipment.

“It’s nerve wracking at first, but then once you start driving, it’s more like, ‘Oh, I’m driving.’ It’s the same, (only) without hands,” he said.

Walker joined the Army in 2003 as an explosive ordinance technician. While serving with the 706th Explosive Ordnance Disposal Company, 303rd EOD Battalion, 45th Sustainment Brigade in Afghanistan, he was attempting to disable an improvised explosive device under a damaged vehicle when a second one went off. “I ended up losing both arms and the left leg as a result, and other numerous little things,” he said.

He met Phipps in the parking garage after a prosthetic consultation to begin his driving session in a conversion van. The van is manufactured to accommodate wheelchairs, and Phipps has modified it further with secondary signal light controls, specialized braking and acceleration controls and steering wheel adapters. She also modified a four-door sedan in the same manner.

Walker maneuvered his power chair into the van, hit a button on the driver’s seat so it scooted back, and sat down unassisted. He grinned as Phipps awkwardly guided the power chair back out of the van and into a waiting shed, where it would stay for the session. Phipps joked that using the power chair was harder than most things she did during the workday.

Phipps brought an adaptive device to the steering wheel, a holster for the remainder of Walker’s right arm, which had been amputated just below the elbow, and attached it before helping him buckle the seatbelt and start the car.

“Things like this definitely make it easier for me. There’s no way I can sit at the steering wheel and drive,” he said.

The driving session went smoothly, Walker noting pressure points on his steering wheel adapter. Phipps said the sessions also provide good one-on-one time with patients, without the interruptions they might receive while sitting in her office.

Walker has decided to purchase his own conversion van at the end of the program, Phipps explained, and it will be fully outfitted with adaptive devices so he can be completely independent.

“There’s no other program that teaches you different things, at least you try different things,” Walker said. “I’ve tried different ways to mount, use my prosthetics and other things to drive, (and through) just trial and error, we actually worked it out. Pretty much, if it hadn’t been for this program, it would have been like, ‘OK, here’s money for a van, you go figure out what you need.’ And that could have ended up freakin’ terrible.”

“Whatever barrier pops up that would prevent you from driving, we’re going to problem solve it and resource it,” Phipps said.

She estimated about 95 percent of her patients return to driving after the program. However, there are still some service members with injuries that prevent them from driving at all, like those with a seizure disorder or significant loss of vision. For that population, the treatment plan involves education on public transportation and community mobility, Phipps said.

The driving program is a vital contribution to service members’ independence after an injury, be it physical or invisible, Phipps said. One of the first questions a Soldier asks is whether he will be able to drive again.  The rehabilitation process and its final product, service members driving safely and independently in their own vehicle, allow them to have old roles back.

“They get to be independent and get into work, if they have a spouse, their spouse no longer has to provide transportation all the time,” Phipps said.  “I’ve had service members just be able to engage in a parent role again, dropping their kids off at school, picking them up from daycare, so it gives the independence, freedom and their ability to start pulling back some of those roles that they lost due to the injury and having to be taken care of.”

Being able to drive again is a big stress relief on the individual as well as the family, Phipps added. Sometimes family members are apprehensive, but once the service member and family are immersed in the program, things become more relaxed. The family is able to see their loved one driving safely and independently, and the holistic approach of the program eases stress over how to use benefits and navigate the world of adaptive vendors.

“You don’t really look at (driving) until you can’t do it,” Walker said. “And then you realize how much freedom that actually gave you, like when you first got your car at 16, ‘Yeah, I’m awesome!’ Now, it’s like I can’t go to Wal-Mart if I want to. But this program is helping me get set up and able to get around, drive back and forth from my wife’s apartment to here, and things like that, instead of having to ask all the time, ‘Hey, can you take me here?’”

Phipps said that the hardest part about learning to drive often isn’t the actual driving. Sometimes, the hardest part is figuring out how to use all the benefits, how to marry all the different agencies involved and how to fit into and adapt a vehicle.

“The biggest component of this program that makes it … successful is education. Everything that they are going to learn in this clinic … they’re going to be able to use for their entire life,” she said.

There is no other program that teaches the same things as this one, Walker said. The holistic approach makes it one of the easiest things he’s done while recovering at Walter Reed. And the best part, according to Walker:

“I can drive!”