Military Advanced Training Center Rehabilitates the Whole Body
New physical therapy lab puts soldiers back together, function by function, injury by injury

by Zach Mortice
Associate Editor

How do you . . . design a rehabilitation center that focuses on a very specific injury type?

Summary: Ellerbe Becket’s Military Advanced Training Center in Washington, D.C., offers soldiers recovering from amputee wounds suffered in Iraq and Afghanistan a variety of state-of the-art environmental simulators and gait-monitoring systems that help them regain their former abilities and re-enter civilian life. Spurred on by a rapid design and construction schedule, upcoming base closings, a modest budget, and the technically intricate and functional nature of the site, the architects opted for a simple and bare bones design.

The Ellerbe Becket-designed Military Advanced Training Center (MATC) is a world-class rehabilitation center that trains soldiers to adjust to life after the loss of a limb, whether that life finds them at home, in a new career, or returning to duty with the military. Since the wars in Afghanistan and Iraq have began, 65 amputee soldiers have gone back into duty, several of them returning to the theater of combat. The MATC and its high-tech physical therapy simulators could increase this number, but Charles Scoville, the facility’s chief of amputee care, says that isn’t the military’s goal: It’s about giving choices and options back to the soldiers who have lost them. “Returning is a decision they make on their own,” he says. “We give them back control in their lives.”

On budget, ahead of schedule
The MATC began in 2003 when Congress asked the Walter Reed medical campus to produce a plan to improve their amputee care infrastructure in the wake of a rapid influx of limb loss patients from the wars in the Middle East. Walter Reed determined that the best way to deal with this deluge was to construct a separate rehabilitation center adjacent to its main hospital in northwest Washington, D.C.

Initially, another firm had completed the design for the MATC, but by the construction documents stage the project had gone too far beyond its modest $8.6 million budget. By the time Ellerbe Becket gave the military a simplified design that met their cost constraints, they (and their construction partners Turner Construction) had only a year to construct it. They began in November of 2006 and finished two months early, in September 2007.

This rushed schedule, modest budget, and the extremely functional programmatic details of the site pushed the facility's design towards unassuming simplicity. The rectangular 31,000-square-foot, two-story building is adjacent to the Brutalist tiered and shelved main hospital. The MATC’s low horizontal profile and matching beige tones make it seem as if it could be slid into the hospital’s horizontal volumes. A skywalk connects the top floor of the MATC to the main hospital’s prosthetics clinic. The courtyard below is shaded by the hospital’s cantilever. (The military’s now-scuttled decision in 2005 to move the entire Walter Reed campus to the National Naval Medical Center in Bethesda, Md., by 2011, as well as revelations last February by the Washington Post of decrepit and substandard conditions on the medial campus both post-date the decision to build the MATC.)

System by system
Tom Anglim, AIA, Ellerbe Becket’s director of Government Services, says he hopes this modest design will make it easy to repurpose it as an office building or athletic facility. There’s quite a bit there today to indicate that it is a regular gym, but beyond the stock treadmills and free weights is a collection of rehabilitation equipment superior to all but a few such sites in the world. “We designed this center on functionality,” says Anglim in a press release. “By separating the areas by extremities, we increased the effectiveness of their treatment. Therapists can focus on specific injuries and allow patients to rehabilitate with relevant machinery all in one room.”

The MATC gait lab uses a system of 23 cameras that record patients’ movements on six force-plate treadmills. While the treadmills measure how limb-loss patients alter their stride and apply their weight, the cameras record how the rest of their body moves, allowing therapists to deconstruct completely how amputees deal with missing legs and assemble personalized prosthetics and treatment regimens.

A firing range simulator (equipped with some weapons altered for upper extremity amputees) lets patients re-establish their tactical skills. Scoville says that this feature is a boon even to soldiers who may not want to return to the military. “For some of them, there are psychological benefits to knowing that they’re capable of still doing their old job even if they plan never to do it again,” he says. “It’s a sense of self that you restore by allowing them to do that.”

The facility’s top technical marvel is its Computer Assisted Rehab Environment (CAREN). It places patients in front of a curving I-MAX-style screen that envelopes their entire field of vision. Beneath them, a treadmill moves along with any variety of dynamic, interactive video images (an urban streetscape, a forest trail, an aquatic scene) projected onto the screen with accompanying sounds. As the treadmill moves forward, the platform it’s placed on can incline up to 18 degrees in any direction to simulate inclines, declines, and varied terrain. A system of cameras above tracks the patient’s position on the treadmill and speeds up or slows down accordingly

In these projected scenarios, therapists can add level after level of environmental stressors to test how well patients are able to cope with potential surroundings. To a typical urban streetscape, the therapists could “start adding cars and traffic, then we start adding cars that backfire—things that can trigger some PTSD [post traumatic stress disorder],” says Scoville.

The top floor of the MATC is a large room with a 208-foot ceiling-mounted track walking system that runs along the perimeter. It harnesses amputees re-learning how to walk so that physical therapists don’t need to hover near them in case they fall. Long rows of windows flood the upper level with natural light. One end looks out to a gymnasium they’ll use when they leave. “That’s kind of the next step,” says Scoville. “They get the vision of the future.”

Welcome refuge
Both Kenny Lyon, 22, and Marcus Wilson, 31, patients at Walter Reed, say the track is their favorite part of the facility. Lyon, a Marine, lost a leg after he was struck by a mortar north of Fallujah. Wilson, also a Marine, had a leg amputated when an improvised explosive device exploded under his vehicle. They both say the track offers a welcome refuge from walking through crowded and chaotic hallways.

Lyon and Wilson are both deep into long stays (a typical amputee rehabilitation program is about a year long), and the vast majority of their time in hospitals has been at Walter Reed. It’s this type of adversity and the courage needed to move past it that causes Anglim humbly to downplay his own contributions to the project. It may not be architecture with a capital A, he says, but “it’s the environment inside that’s important.”