What happens when thousands of healthy young men and women return from combat with altered abilities? Since the American Civil War, governments have been actively involved in a long process to return veterans with disabilities to productive, active lives.

In the beginning, the focus was on offering those who survived their injuries medical devices and pensions, then work, and finally, a focus on quality of life and sport. Every war offers new technologies in protection and life-saving medical advances, all to counteract the new and different mechanisms that create the damages to soldiers.

With each war, including current ones, medical advances have changed the type of injuries that wounded warriors can sustain and still survive. The medical goal of saving the lives of those fighting at all costs has not changed, but the abilities of those who survive have changed over the decades. For these young men and women, their goal has not been just surviving the disability, but the return to happy, productive, and active lives.

Historically, different wars provided medical advances that have created a diverse population of veterans with disabilities. This list shows a few of the groups of soldiers who survived their war injuries with different functional ability losses, who owe their quality of life to technological advances.

•    American Civil War—30,000+ veterans survived with amputations
•    World War I—continuation of soldiers surviving with amputations, this time affecting populations in many different countries
•    World War II—soldiers survived with thoracic wounds and spinal cord injuries
•    Korean and Vietnam Wars—soldiers with high-velocity penetrating brain injuries survived
•    Iraq war—soldiers acquired closed head injuries.

American Civil War Veterans
During the American Civil War, medical practices for amputations resulted in a mortality rate of 35 percent. The soldiers who survived the gruesome amputation processes during this war received incredible support from Congress and President Lincoln, making it the responsibility of the government to care for those veterans who acquired permanent physical disabilities during the war.

One of the first of the 30,000 plus veterans with an amputation, James Edward Hanger, created an advanced prosthetic leg for himself. The high demand for quality prostheses during the war led him to start a prosthetic manufacturing business. Hanger’s company and other prosthetic businesses benefited from the government’s program for war veterans with amputations, and his business, named after the founder, remains today. The government support also included pensions to these veterans, since it was thought that many could not return to work (even though people like James Edward Hanger somehow managed).

World War I Veterans
World War I offered continued growth in the prosthetic field, with medical advances and the introduction of physiotherapists. WWI surgeons had more hygienic practices and knowledge of safer methods for amputation, which resulted in greater numbers of veterans who survived the process. The large population of individuals with amputations shifted away from America, and the prosthetic manufacturing industry became global.

Europe suffered far greater losses than America, with more than 20 times as many soldiers with amputations during the War. This, combined with the heavy losses of both civilians and soldiers during the war, put Europe in the lead in the prosthetic industry, by necessity.

Unlike combatants of the American Civil War, European soldiers with amputations did not have the opportunity to receive pensions and be idle following the war. They were needed to return to productive lives because they constituted such a large proportion of the limited population. The veterans were retrained by physiotherapists for work, and prosthetic devices were redesigned to achieve this goal.

World War II Veterans
Moving forward to World War II, a new group of individuals with disabilities would survive. Soldiers that would have been passed over by earlier triage teams because of severe wounds were rescued from the field and treated during WWII. With continued medical advances and the introduction of antibiotics, soldiers with spinal cord injuries survived for the first time. Medical advances were not the only requirement for these soldiers to survive. A rehabilitation process was developed to include the introduction of rigorous physical activity and sport.

Sir Ludwig Guttmann at the Stoke Mandeville Hospital in England found that offering competitive sport for the veterans with spinal cord injuries was the best way to ensure continued activity and health. Eventually the competitive nature of the sports would spur different groups of individuals with spinal cord injuries to compete internationally. The development of competitive sports among this community led to the present-day Paralympic Games.

Korean War and Vietnam War Veterans
The Korean War and Vietnam War introduced the helicopter for moving wounded soldiers from the battlefield to advanced field medical centers. Frontline triage decisions were again changed to include soldiers having wounds more severe than they would have been expected to survive in the past.

Penetrating brain injuries caused by high-velocity bullets no longer meant certain death for soldiers. The resulting effects from this type of brain injury was different depending on the location of injury. These wounded warriors could have losses to memory, sight, hearing, paralysis, or many other maladies, but they would also be able to find groups that would help them return to active lives.  

The current war in Iraq has introduced a huge growth in a particular type of brain injury due to the body armor available for soldiers and the mechanism of injury. When blasts from improvised explosive devices (IED) go off near soldiers, their armor usually protects their core body from harm. The blast, though, can damage the brain as well as exposed body parts.

These blasts often create closed head injuries, which might not even present themselves until later in life. The shock waves from the blast cause serious damage to the brain similar to that of a heavyweight boxer or football player receiving multiple concussions over several years of sport. How will these injuries affect quality of life?

What we do know now is that after successful rehabilitation programs, many wounded warriors chose sport to assist in reconnecting to their past lives, which aids in their mental recovery. In the past, disabled veterans would often reach out to other vets to create social sport groups, and many of the sporting groups lead to the formation of non-profit organizations that exist today.

A WWII veteran with an amputation, Dale Bourisseau began golfing for physical and mental benefits as well as pride. His passion for the game inspired others to play, and by 1954, the National Amputee Golf Association was created.

Another wounded warrior from yet another war, Vietnam veteran Doug Pringle founded the National Amputee Ski Association. Participating in a sport he did not care for before his injury, Doug and other veterans started with alpine skiing for amputees and eventually the program evolved into Disabled Sports USA with over 80 chapters, serving multiple disabilities, offering year round sport and recreational opportunities.

Iraq War Veterans
Today, disabled veterans returning home from the Iraq War have more choices to reintegrate into sport and recreation than ever before. Programs started by veterans, such as Disabled Sports USA, have been building sporting opportunities for several decades now, and in combination with new organizations like The Wounded Warrior Project, the non-profits of the United States ensure that soldiers returning home from Iraq will have plenty of opportunities to take part in the sports and recreational activities of their choice.

It does not matter what functional ability change the individual has incurred. If they now live with a visual impairment, hearing impairment, amputation, spinal cord injury, brain injury, etc., programs and equipment exists to help any soldier return to the recreational activity he or she chooses.

It probably sounds odd to people who haven’t thought about the many changes that have occurred over the last several decades, but my wife (who acquired a spinal cord injury 18 years ago) often says it’s a “great time to be disabled.”  No longer is the goal only to keep soldiers and civilians alive following traumatic events, but the goal includes returning them to a high quality of life. The effect of these large numbers of returning veterans has impacted all individuals with disabilities positively because of the resulting expansion of adaptive sport opportunities. 

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Tomas Young was only 22 when he was paralyzed after a bullet hit his spine while on duty in Afghanistan.  Discover the documentary, "Body of War", he made about his experience, in Disabled Veteran Makes Body of War: Iraq Documentary with Insight into Paralysis.