Story and photo by Rachael Tolliver/Turret
FORT KNOX, Ky. (TRADOC News Service, Aug. 29, 2005) – While the Army is pushing to revamp itself into a stronger, more efficient fighting force by forming combined-arms units, it’s also looking at better ways to take care of injured Soldiers still in training.
Company B of Fort Knox’s 46th Adjutant General Training Battalion is one of only two Physical Training and Rehabilitation Program companies in Training and Doctrine Command to have a physical therapist as the company commander. The only other TRADOC post where a therapist is in charge of PTRP is Fort Jackson, S.C.
According to Lt. Col. Mark Rado, the 46th AG commander, this step is in the right direction.
“I’d like to think this is something that will be brought throughout TRADOC,” he said. “Having a physical therapist as a company commander helps to reduce attrition and acts as a combat multiplier for this brigade and the Army. It has a direct impact on readiness.”
Rado believes the PT serves as a combat multiplier, because instead of an injured Soldier who wants to remain in the military being discharged, the Soldier can now be physically rehabilitated and returned to training.
For example, this year Company B returned about 60 percent of its injured Soldiers to training. Companies without PTs as company commanders average just below 50 percent, Rado said.
“Of those Soldiers who get back to training, studies in (the publication) Military Medicine show the attrition rate after a year or two is the same as those Soldiers who were not injured or who were not in this program, he added.
The mission of the PTRP company is twofold. Rado said it provides an environment where Soldiers can rehabilitate injuries and then return to training. But it also provides the brigades with a medical-hold facility for Soldiers who are severely ill or seriously injured and can’t train in any environment.
Since 2000, when a physical therapist was first put in charge of the PTRP, there have been three company commanders. Capt. Tim Cass is the current one.
“The company commander does not conduct physical therapy,” Rado said. “He is what I call the ‘honest broker’ between the medical community and the training community.”
In this way the goals of each community are met, and the injured Soldier is successfully rehabilitated before he or she returns to training, Rado explained.
Cass, who has been a PT for eight years and is also an orthopedic-certified specialist, said the most common injuries he sees are stress fractures.
“About 75 percent of the injuries we get are lower extremities, and this year not quite half of those are stress fractures,” he said. “Beyond that we see shoulder separations, knee strains, severe ankle sprains and some people with traumatic injuries.”
Cass said the Army is investigating the program to see if all TRADOC posts should have similar programs.
He said his PTRP company has an average of 70-100 Soldiers, and as a PT his job is not to work with each Soldier on his or her diagnosis and individual rehabilitation but to manage the overall program.
“I develop the physical-training programs here and supervise the cadre in these programs to make sure they take place properly,” Cass explained. “I do one-on-ones (counseling) with Soldiers who have problems with injuries or confusion with what the health providers are telling them, and I make a lot of phone calls to hospital staff to see what’s really going on.
“We see more here in the company than the provider sees in one or two visits with (the Soldier),” he added. “With my training and background, I can tell pretty much if an injury can be rehabbed and a trainee can make it in a combat environment.”
As far as rehabilitation within the company, Cass said he and the cadre review the physical profile of each Soldier to see what limitations exist and then form an exercise program around the profile. They then teach each Soldier how to do the exercises in the gym to make sure what’s allowed is done correctly.
The injured Soldiers go to a gym located in the company several days a week to work out with the free weights, weight machines and aerobic equipment. The fitness programs Cass puts together incorporate all those devices so the Soldiers can strengthen and rehabilitate without doing further harm to their injuries.
Once a week, the company is scheduled to go to the pool for physical training and rehabilitation in the pool, and once a week personnel train on their Army common tasks.
“Training is different with different profiles, but we try to do some basic common-task training to keep them involved,” Cass said. “We also do a lot of counseling and hip-pocket training to help keep Soldiers motivated. A Soldier has a target date of graduation (as a goal), and now they are here and don’t know what’s going to happen to them and when they will get out.”
Cass emphasized that a huge part of his program deals with the emotional well-being of the Soldiers.
“We are very concerned about their emotional well-being here,” he said. “We went to a Bats game (in Louisville); sometimes we’ll go to a movie, post football games, graduations and retirement ceremonies – we try to keep their spirits up.”
The Soldiers are also encouraged to take correspondence courses and may use computers in the company dayroom for that purpose, and Cass said they are allowed to check their emails occasionally.
There is a
TV on which they may watch a movie on the weekends, and they are given
a block of time in the evenings to watch the news so they can keep up
with current events.
But Cass cautioned that those are privileges and can be revoked at any
time.
“The chaplain comes in once a week and will talk one-on-one off-line (to Soldiers), but he talks to them as a group, too. And (Army Community Services) comes in once a week and gives classes on things like building self-esteem, stress management, effective communication, management and group conflict, ” he added.
Rado also expressed concern for the emotional and mental well-being of the PTRP Soldiers.
“Some of them were days away from graduation, were injured, and they could not continue,” he explained. “So we have to attend to (the Soldier’s) physical needs and emotional needs as their buddies literally march past the company on the way to graduation, and the Soldier could be there with them if not for falling in a pothole or something.
“We have to care for the whole Soldier, not just the injured Soldier … nobody signed up to be in a reception battalion for more than four or five days,” he said.
Drill sergeants figure prominently into the Soldier’s daily life, but in a little different way than in the average trainee’s life. Rado said a drill sergeant’s presence in the company is not related only in their traditional role but also as a link back to training.
“When (the Soldiers) get back to training, (having drill sergeants around) is not new; there is continuity and recognizable leadership,” he said.
Cass trains the drill sergeants in how injured Soldiers can do various exercises and how to make sure a Soldier is doing exercises around a profile.
“The drill sergeants are (the Soldiers’) link to the operational Army, and the Soldiers love to sit and talk about what the Army is like and hear the drill sergeants’ experiences,” Cass said.
Company B’s senior drill sergeant, Sgt. 1st Class Ernest McGee, said one of his biggest challenges is keeping Soldiers motivated so they want to get better and go back to training.
“There are lots distractions, even with the training we provide,” he said. “We do everything we can to keep their head in the game. They go through the whole gamut of emotions while here, and we have a close association with the chaplains and behavioral health.”
Drill sergeant Staff Sgt. Michael Player also sees motivation as a problem, but his role in Company B is different than his role “downrange.” He said it is a transition from the “in your face” methods most drill sergeants are used to.
“Here we teach, coach and mentor,” he said. “Being a drill (sergeant) here is different then downrange. This is more a mentorship, and every drill here was successful downrange.”
Both drill sergeants spoke highly of the need to have a PT in charge of the PTRP program, and their part in it.
“If a guy comes here from sick call with a slip, I don’t know what it is and how to rehab it, but the commander does. Because of his intimate working knowledge of medicine and injuries, he can define what ‘walk at own pace’ is vs. ‘walk’ or ‘sit at desk,’” McGee commented. “Someone off the line doesn’t have the knowledge or know-how to properly rehab. The commander is approachable, and he knows we aren’t medical experts … so he’s more receptive to us asking questions and giving info.
“Anyone else isn’t in their comfort level and doesn’t know (about physical therapy and rehab.) The commander is somehow involved in every one of these guys’ care,” McGee said.
For an injured Soldier to be assigned to the PTRP company, he or she must be referred by orthopedic, physical therapy or podiatry clinics at Fort Knox, Cass said. But this is not a decision made on one or two visits to the provider, and the company commander can help with such a determination.
“Part of the determination of who is a good candidate is deciding if that Soldier is motivated and does not have secondary behavioral-health issues or is displaying other issues,” Cass said. “This is a place for Soldiers with legitimate health issues, and medical personnel who have the authority to recommend PTRP, or medical hold, need to look at the total-Soldier concept with the help of company commanders to see if (injured Soldiers) are good candidates for rehab.”
Spc. Josh Becker was assigned to Company B after suffering a stress fracture to his ankle.
“My favorite part of the program is that we get to use the gym for two hours a day,” he said. “That allows us to get back to training faster and stronger than we were. It’s a lot better than sitting in a supply room wondering what’s going to happen. This way I have an active role in my recovery and something to look forward to.”
But giving Soldiers another chance is what this program is designed around, and Pvt. Quinton Morrissey realizes it. Morrissey was pulled from basic training in Week 7 by his first sergeant because of stress fractures and shin splints.
“I wasn’t mad – just disappointed – but I understood,” he said. “Second chances are great because that’s what this is. Not too long ago if you were injured, you were out. But now, there’s a second chance.”