Amputee Virtual Environment Support Space-A Vision for Virtual Military Amputee Support

The war in Iraq is the largest and longest sustained combat operation by the U.S. military since the Vietnam war. An estimated nearly 2 million U.S. military personnel have been deployed for Operation Iraqi Freedom and Operation Enduring Freedom [1]. Dr. Chuck Scoville, Col. Ret., Chief of Amputee Patient Care at Walter Reed Army Medical Center, stated that as of November 2009, 937 war fighters have suffered an amputation as a result of a battle injury. The successful recovery from a traumatic injury resulting in an amputation largely depends on care from clinical providers as well as peer support. CURRENT AMPUTEE CARE--STAGES OF RECOVERY As outlined by Berke, following amputation, five stages of care occur, during which an amputee interacts with clinical providers [2] (Table 1). Although the current standard of amputation care mainly focuses on healing the physical wounds and returning the patient to a desirable functional level, more attention needs be focused on the psychological needs and social/peer support. As discussed by Hashemi et al., after the initial trauma from an amputation, patients commonly experience denial, anger, depression, disconnection, disempowerment, and vulnerability [3]. These feelings usually produce a sense of pragmatic acceptance that life will be different for them. If patients recover psychologically and realize that things could have been worse, they are considered to be on the path toward acceptance with resilience. However, if they do not recover from their mental wounds, they fall into acceptance with resignation. At this stage, patients might feel abnormal and suffer from depression. This generally occurs because of a lack of social support, a severe physical condition, and/or poverty. SOCIAL AND PEER SUPPORT Physical rehabilitation alone is not sufficient for a full recovery. A full recovery from limb loss requires deep psychological and social support that includes patience, tenacity, and help from friends, family, and the community [4]. Peer support potentially can provide information and education not achieved in any other team relationship. Various aspects of peer support, such as peer visitation, amputee support groups, and consumer awareness, have all been proven useful resources [2]. The literature suggests that peer support has been a salient factor in the successful recovery of amputees. In a study of land mine survivors who underwent amputations, Sperber-Richie et al. report descriptions from landmine survivors from various countries on the impact of family and community on their recovery [4]. They found that the interaction with other survivors provided a peer support network that empowered them to persevere despite their injuries. One survivor attributed the ongoing visits from other amputees as the first step in drawing himself out of a severe mental crisis. Many of the newer amputees found that seeing other recovered soldiers integrated back into society was helpful. VIRTUAL WORLDS The Internet has the potential to greatly affect the social bonds and independence of people with various disabilities. A Harris Poll in 2000 found that people with disabilities were less likely to be online than those without disabilities (43% and 57%, respectively), but those who did go online spent twice as much time online as those without disabilities [5]. Since this poll was conducted, the advent of Web 2.0 in 2004 has stimulated new opportunities on the World Wide Web (WWW). Gorini et al. write, "The introduction of Web 2.0 has facilitated the development of new forms of collaborative interaction between multiple users based on 3-D [three-dimensional] virtual worlds" [6]. These virtual world interactions far exceed historical WWW capabilities such as emails, chat rooms, and video conferences. In short, a virtual world is a 3-D simulated environment accessed through a commercial Internet connection [6-7]. In these virtual worlds, people appear as avatars, which are computer users' 3-D self-representations [8]. …