Current State, Needs, and Opportunities for Wearable Robots in Military Medical Rehabilitation and Force Protection.

Despite advances in wearable robots across various fields, there is no consensus definition or design framework for the application of this technology in rehabilitation or musculoskeletal (MSK) injury prevention. This paper aims to define wearable robots and explore their applications and challenges for military rehabilitation and force protection for MSK injury prevention. We conducted a modified Delphi method, including a steering group and 14 panelists with 10+ years of expertise in wearable robots.

The development and reliability testing of the Functional Lower-Limb Amputee Gait Assessment.

Objective: The study purpose was three-fold: (a) to describe the development of the Functional Lower-Limb Amputee Gait Assessment, (b) to determine its reliability with two groups of raters, physical therapists, and certified prosthetists, and (c) to determine the agreement on its results between the two groups.

Design: A reliability study.

Setting: Institution for higher education.

Development of an item bank for measuring prosthetic mobility in people with lower limb amputation: The Prosthetic Limb Users Survey of Mobility (PLUS-M).

Background: Achieving mobility with a prosthesis is a common post-amputation rehabilitation goal and primary outcome in prosthetic research studies. Patient-reported outcome measures (PROMs) available to measure prosthetic mobility have practical and psychometric limitations that inhibit their use in clinical care and research.

Objective: To develop a brief, clinically meaningful, and psychometrically robust PROM to measure prosthetic mobility.

Modifying the five-time sit-to-stand test to allow use of the upper limbs: Assessing initial evidence of construct validity among lower limb prosthesis users.

The Five-time Sit-to-Stand (5xSTS) Test is a performance-based measure used by clinicians and researchers to assess the body functions needed to accomplish sit-to-stand transitions (e.g., lower limb strength, balance, and trunk control).

Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation.

Background: Over a million people live with lower limb amputation (LLA) in the United States, and many of them will experience a fall in the next year. The aim of this study was to use existing theoretical frameworks in an attempt to organize the complex interactions of reported fall history and prosthetic mobility in community-ambulating people with LLA.

Methods: Self-reported fall rate and fall circumstances were recorded in a cross-section of people with unilateral LLA due to nondysvascular causes.

Clinical Resources for Assessing Mobility of People with Lower-Limb Amputation: Interviews with Rehabilitation Clinicians.

Introduction: Mobility tests are increasingly used in prosthetic rehabilitation to evaluate patient outcomes. Knowledge of the space, equipment, and time resources available to clinicians who work in different settings can guide recommendations for which tests are most clinically-feasible and promote coordination of mobility testing among members of the rehabilitation team. The primary aim of this study was to characterize the different resources available to clinicians for measuring mobility of people with lower limb amputation.

Use of Standardized Outcome Measures for People With Lower Limb Amputation: A Survey of Prosthetic Practitioners in the United States.

Objective: To assess the clinical resources available for the assessment of health outcomes in people with lower limb amputation and to understand barriers and facilitators associated with use of standardized outcome measures in clinical practice.

Design: Cross-sectional survey.

Setting: General community (online).

Variations in 2-Minute Walk Test outcomes for people with lower limb amputation in the outpatient clinic and research settings.

Background: This study determined the differences in 2-Minute Walk Test (2MWT) distances between people with lower limb amputations in clinical and research settings and described variations in test administration in various clinical settings.

Study Design: Retrospective Cross-sectional design.

Methods: The 2MWT for 290 patients with lower limb amputations were obtained from a medium-sized prosthetic company with locations within the central United States.

A Comparison of the Two-Minute Walk Test (2MWT) and Comprehensive High-level Activity Mobility Predictor (CHAMP) in People with a Leg Prosthesis.

Objective: To determine if the two-minute walk test (2MWT) could serve as an alternative measure of high-level mobility in lower limb prosthesis users when circumstances preclude administration of the Comprehensive High-level Activity Mobility Predictor (CHAMP).

Design: Cross-sectional study.

Setting: Indoor recreational athletic field and gymnasium.

Usability Assessment of the Rehabilitation Lower-limb Orthopedic Assistive Device by Service Members and Veterans With Lower Limb Loss.

Introduction: Telehealth is an increasingly common approach to improve healthcare delivery, especially within the Veterans Health Administration and Department of Defense (DoD). Telehealth has diminished many challenges to direct access for clinical follow-up; however, the use of mobile telehealth for specialty rehabilitative care is emerging and is referred to as telerehabilitation. As early adopters of telehealth, the Veterans Affairs and DoD have supported collaborated efforts for programs designed to increase the access and quality of rehabilitative care while improving the functional ability of our service members (SMs) and veterans with lower limb amputation (LLA).

Accuracy of the Region of Limb Stability in Predicting Risk for Lower Limb Injury.

Purpose: This study aimed to determine whether a measure of lower limb segment stability derived from body-worn inertial measurement units can predict risk for lower limb musculoskeletal injury in Division I Collegiate Football Players (D1CFP).

Methods: The region of limb stability (ROLS) values were collected in a cohort of D1CFP during preseason. ROLS is a measure of knee joint stability, defined by thigh and shank excursion (cm) in the anterior-posterior and medial-lateral direction during single limb stance.

The Relationship Between Vestibular Sensory Integration and Prosthetic Mobility in Community Ambulators With Unilateral Lower Limb Amputation.

Objective: The modified Clinical Test of Sensory Interaction and Balance (mCTSIB) is used to clinically assess vestibular sensory integration (VSI), the process by which the central nervous system integrates vestibular afference to maintain balance. The rate and effects of impaired VSI (IVSI) on prosthetic mobility in people with lower limb amputation (LLA) is unknown. The objective of this study was to use the mCTSIB to classify VSI in active community ambulators with LLA and to examine the relationship between IVSI and prosthetic mobility, as measured by the Component Timed Up and Go (cTUG) test.

The Utility of the 2-Minute Walk Test as a Measure of Mobility in People With Lower Limb Amputation.

Objectives: To establish reference values for the 2-minute walk test (2-MWT) distance and gait speed in people with a lower limb amputation (LLA) who are prosthetic ambulators. Also, to describe the differences in distance and gait speed between sexes, causes of amputation, levels of amputation, health risk classification, functional levels, and age groups.

Design: Cross-sectional study.

The Effectiveness of the DoD/VA Mobile Device Outcomes-Based Rehabilitation Program for High Functioning Service Members and Veterans with Lower Limb Amputation.

Introduction: The objective was to determine if the Mobile Device Outcomes-based Rehabilitation Program (MDORP) improved strength, mobility, and gait quality in service members (SMs) and Veterans with lower limb amputation (LLA).

Methods: Seven SMs and 10 Veterans with LLA enrolled and were trained to use a mobile sensor system, called Rehabilitative Lower Limb Orthopedic Analysis Device (ReLOAD). ReLOAD provided participants with real-time assessment of gait deviations, subsequent corrective audio feedback, and exercise prescription for normalizing gait at home and in the community.

Effectiveness of an Evidence-Based Amputee Rehabilitation Program: A Pilot Randomized Controlled Trial.

Background: Despite the prevalence of lower limb amputation (LLA), only a small percentage of people with LLA actually receive physical therapy post amputation and are rehabilitated to their full potential level of function. There is a need for the development of a rehabilitation program that targets impairments and limitations specific to people with LLA.

Objective: The objective of this study was to determine whether the Evidence-Based Amputee Rehabilitation program would improve functional mobility of people with unilateral transtibial amputation (TTA) who have already completed physical therapy and prosthetic training.

Inertial sensor-based measures of gait symmetry and repeatability in people with unilateral lower limb amputation.

Background: People with lower limb amputation often walk with asymmetrical gait patterns potentially leading to long-term health problems, ultimately affecting their quality of life. The ability to discreetly detect and quantify the movement of bilateral thighs and shanks using wearable sensor technology can provide additional insight into how a person walks with a lower limb prosthesis. This study investigated segmental symmetry and segmental repeatability of people with unilateral lower limb amputation, examining performance of the prosthetic and intact limbs.

Variables that Influence Basic Prosthetic Mobility in People With Non-Vascular Lower Limb Amputation.

Background: There exists a dearth of evidence on rehabilitation factors that influence prosthetic mobility in people with lower limb amputation (LLA). Examining variables that contribute to prosthetic mobility can inform rehabilitation interventions, providing guidance in developing more comprehensive care for these individuals.

Objective: To determine the influence of modifiable and non-modifiable variables related to LLA and their impact on prosthetic mobility, using the International Classification of Functioning, Disability and Health (ICF) model.

Quantification of Agility Testing with Inertial Sensors after a Knee Injury.

Introduction: A common criterion in decision making regarding return to sport (RTS) after knee ligament injury is that athletes should achieve symmetrical bilateral movement between the injured limb and the noninjured limb. Body-worn wireless inertial measurement units (IMU) can provide clinicians with valuable information about lower-limb kinematics and athletic performance.

Methods: The IMU-based novel kinematic metrics were developed.

POST-CONCUSSIVE CHANGES IN BALANCE AND POSTURAL STABILITY MEASURED WITH CANESENSE™ AND THE BALANCE ERROR SCORING SYSTEM (BESS) IN DIVISION I COLLEGIATE FOOTBALL PLAYERS: A CASE SERIES.

Introduction: Impairments in postural stability have been identified following sports-related concussion. CaneSense™ is a recently developed mobile lower limb motion capture system and mobile application for movement assessment which provides an objective measure of postural stability. One of the components within CaneSense™ is the Post-Concussive Excursion Index (PCEI), a measure of postural stability expressed as a percentage of symmetry between lower limbs.

Construct validation of lower limb segmental excursion as a measure of potential risk for lower limb injury in Division I women's basketball players.

The region of limb stability (ROLS) is an inertial sensor-based measure of static knee joint stability, defined by thigh and shank movements of the supporting limb during single limb stance. Changes in thigh and shank movements and/or symmetry differences between limbs may predict risk of injury to the less stable limb or the need for rehabilitation. In this study, construct validity of the ROLS metrics was examined in twelve Division I women's basketball players during pre-season in preparation for their exercise training program.

A Novel Method for Estimating Knee Angle Using Two Leg-Mounted Gyroscopes for Continuous Monitoring with Mobile Health Devices.

Tele-rehabilitation of patients with gait abnormalities could benefit from continuous monitoring of knee joint angle in the home and community. Continuous monitoring with mobile devices can be restricted by the number of body-worn sensors, signal bandwidth, and the complexity of operating algorithms. Therefore, this paper proposes a novel algorithm for estimating knee joint angle using lower limb angular velocity, obtained with only two leg-mounted gyroscopes.

The development and internal consistency of the comprehensive lower limb amputee socket survey in active lower limb amputees.

Background:: Prosthetic socket fit is an important element associated with successful ambulation and use of a prosthesis. Prosthetists and rehabilitation clinicians would benefit from an assessment tool that discriminates between and quantifies the multiple determinants that influence the lower limb amputee's performance and satisfaction of a prosthetic socket.

Objectives:: To determine the internal consistency of the comprehensive lower limb amputee socket survey, a new self-report measure of prosthetic socket satisfaction that quantifies suspension, stability, comfort, and appearance.

Temporal-Spatial Values During a 180° Step Turn in People with Unilateral Lower Limb Amputation.

Background: Daily ambulation with a prosthesis often involves turning to negotiate within the home and community environments, however how people with lower limb loss perform turns is infrequently studied. Administering a common clinical outcome measure to capture turn performance data provides a convenient means of assessing this ubiquitous activity.

Research Question: What temporal-spatial parameters are exhibited by people with unilateral lower limb amputation while performing a 180˚ turn task?

Methods: Forty community-ambulating subjects with unilateral lower limb amputation (20 transtibial amputees, 20 transfemoral amputees) performed the Component Timed-Up-and-Go (cTUG) test turning once in each direction, both toward the intact and toward the prosthetic limb.

Measurement of lower limb segmental excursion using inertial sensors during single limb stance.

Advances in wearable technology have afforded health scientists and clinicians the ability to quantify clinically meaningful kinematic data with performance-based outcome measures in a variety of environments. However, no method for assessing segmental excursion of the lower limb during single limb stance (SLS) with wearable technology has been described in the literature nor has its clinical meaning been explored. This study introduces a clinically friendly measure to quantify lower limb segmental excursion during SLS with inertial measurement units (IMUs) which called the region of limb stability (ROLS).