Fall Prevention Training for Service Members With an Amputation or Limb Salvage Following Lower Extremity Trauma.

Introduction: Recent military conflicts have resulted in a significant number of lower extremity injuries to U.S. service members that result in amputation or limb preservation (LP) procedures.

Are Gait Parameters for Through-knee Amputees Different From Matched Transfemoral Amputees?

Background: Through-knee amputation is a common amputation level after battlefield injuries during the medical evacuation process. However, there are limited data comparing through-knee amputation with transfemoral amputation as a definitive amputation level in terms of gait parameters.

Questions/purposes: (1) Does through-knee amputation result in improved gait velocity when compared with matched transfemoral amputees? (2) Do through-knee amputees have a faster gait cadence than matched transfemoral amputees? (3) Do through-knee amputees have a different stride length or stride width than matched transfemoral amputees? (4) Does through-knee amputation result in decreased work of ambulation when compared with matched transfemoral amputees?

Methods: Between January 2008 and December 2012, six male active-duty military patients who had undergone unilateral through-knee amputations as a result of trauma underwent gait studies at our institution.

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Background: Surgical attempts at lower limb preservation after trauma may be complicated by pain and gait disturbances, which can impact the activity level of a military service member. It is unclear how later transtibial amputation (TTA) might affect patients who elect this option after attempts at limb preservation.

Questions/purposes: The purposes of the study were to compare preamputation and postamputation (1) the numeric rating scale for pain and pain medication use; (2) self-reported activity level, Four Square Step Test (FSST) results, and assistive device use; and (3) spatiotemporal variables measured with instrumented gait analysis in individuals who elected TTA after multiple attempts at limb preservation.

Do Spatiotemporal Gait Parameters Improve After Pilon Fracture in Patients Who Use the Intrepid Dynamic Exoskeletal Orthosis?

Background: Pilon fractures are high-energy fractures about the ankle observed commonly in both civilian and military trauma populations. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries.

High-Level Performance After the Return to Run Clinical Pathway in Patients Using the Intrepid Dynamic Exoskeletal Orthosis.

Background: Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge.

Objective: To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility.

Methods: Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review.

Measuring Abnormality in High Dimensional Spaces with Applications in Biomechanical Gait Analysis.

Accurately measuring a subject's abnormality using high dimensional data can empower better outcomes research. Utilizing applications in instrumented gait analysis, this article demonstrates how using data that is inherently non-independent to measure overall abnormality may bias results. A methodology is then introduced to address this bias and accurately measure abnormality in high dimensional spaces.

Performance of an attention-demanding task during treadmill walking shifts the noise qualities of step-to-step variation in step width.

Background: The fractal scaling evident in the step-to-step fluctuations of stepping-related time series reflects, to some degree, neuromotor noise.

Research Question: The primary purpose of this study was to determine the extent to which the fractal scaling of step width, step width and step width variability are affected by performance of an attention-demanding task. We hypothesized that the attention-demanding task would shift the structure of the step width time series toward white, uncorrelated noise.

Limb Salvage With Intrepid Dynamic Exoskeletal Orthosis Versus Transtibial Amputation: A Comparison of Functional Gait Outcomes.

Objectives: To determine if there is a difference in functional gait outcomes between patients with limb injuries treated with either transtibial amputation or limb preservation with the Intrepid Dynamic Exoskeletal Orthosis.

Design: Retrospective prognostic study.

Setting: Tertiary referral military hospital.

A Narrative Review of the Prevalence and Risk Factors Associated With Development of Knee Osteoarthritis After Traumatic Unilateral Lower Limb Amputation.

Introduction: Young military Service Members with traumatic unilateral lower limb amputations may be at a high risk for developing knee osteoarthritis (OA). There is growing evidence for potential influence and predictive value of nonsystemic risk factors on development and progression of primary knee OA in older adults. Proposed factors include chronic knee pain, obesity, abnormal knee joint mechanics, muscle weakness, previous knee trauma, and altered physical activity level.

The Center for Rehabilitation Sciences Research: Advancing the Rehabilitative Care for Service Members With Complex Trauma.

The Center for Rehabilitation Sciences Research (CRSR) was established to advance the rehabilitative care for service members with combat-related injuries, particularly those with orthopedic, cognitive, and neurological complications. The center supports comprehensive research projects to optimize treatment strategies and promote the successful return to duty and community reintegration of injured service members. The center also provides a unique platform for fostering innovative research and incorporating clinical/technical advances in the rehabilitative care for service members.

The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium: Reaching in Partnership for Optimal Orthopaedic Rehabilitation Outcomes.

The Bridging Advanced Developments for Exceptional Rehabilitation (BADER) Consortium began in September 2011 as a cooperative agreement with the Department of Defense (DoD) Congressionally Directed Medical Research Programs Peer Reviewed Orthopaedic Research Program. A partnership was formed with DoD Military Treatment Facilities (MTFs), U.S.

The Extremity Trauma and Amputation Center of Excellence: Overview of the Research and Surveillance Division.

Congress authorized creation of the Extremity Trauma and Amputation Center of Excellence (EACE) as part of the 2009 National Defense Authorization Act. The legislation mandated the Department of Defense (DoD) and Department of Veterans Affairs (VA) to implement a comprehensive plan and strategy for the mitigation, treatment, and rehabilitation of traumatic extremity injuries and amputation. The EACE also was tasked with conducting clinically relevant research, fostering collaborations, and building partnerships across multidisciplinary international, federal, and academic networks to optimize the quality of life of service members and veterans who have sustained extremity trauma or amputations.

Mechanical testing for three-dimensional motion analysis reliability.

The purpose of this study was to use simple mechanical tests to evaluate the reliability of three-dimensional motion analysis systems and biomechanical models. Three different tests were conducted at four motion analysis laboratories where clinical care and research studies are routinely performed. The laboratories had different motion capture systems, different types and number of cameras, different types and numbers of force plates and different biomechanical models.

Reliability of 3D gait data across multiple laboratories.

The aim of this study was to analyze the repeatability of gait analysis studies performed across multiple trials, sessions, and laboratories. Ten healthy participants (6 male/4 female, mean age of 30, mean BMI of 24kg/m(2)) were assessed in 3 sessions conducted at each of the three Centers of Excellence for Amputee Care within the Department of Defense. For each test session, kinematic and kinetic parameters were collected during five walking trials for each limb.

Do patients with bone bridge amputations have improved gait compared with patients with traditional amputations?

Background: Two surgical techniques for performing a transtibial amputation include a traditional approach and a bone bridge approach. To date, there is no conclusive evidence of superiority of either technique in terms of temporal-spatial, kinetic, and mechanical work parameters.

Questions/purposes: We sought to compare instrumented three-dimensional gait parameters and mechanical work measurements of patients who had undergone a traditional or bone bridge amputation at the transtibial level.

Task-specific fall prevention training is effective for warfighters with transtibial amputations.

Background: Key factors limiting patients with lower extremity amputations to achieve maximal functional capabilities are falls and fear of falling. A task-specific fall prevention training program has successfully reduced prospectively recorded trip-related falls that occur in the community by the elderly. However, this program has not been tested in amputees.

Method for evoking a trip-like response using a treadmill-based perturbation during locomotion.

Because trip-related falls account for a significant proportion of falls by patients with amputations and older adults, the ability to repeatedly and reliably simulate a trip or evoke a trip-like response in a laboratory setting has potential utility as a tool to assess trip-related fall risk and as a training tool to reduce fall risk. This paper describes a treadmill-based method for delivering postural perturbations during locomotion to evoke a trip-like response and serve as a surrogate for an overground trip. Subjects walked at a normalized velocity in a Computer Assisted Rehabilitation Environment (CAREN).

Integrated musculoskeletal rehabilitation care at a comprehensive combat and complex casualty care program.

Objective: The purpose of this study is to describe the musculoskeletal rehabilitation model used to care for combat and severely wounded or ill US military service members at an integrated Comprehensive Combat and Complex Casualty Care center located at Naval Medical Center San Diego.

Methods: Through a collaborative and iterative process, providers from the various services included at the Comprehensive Combat and Complex Casualty Care program developed a description of the integration of services provided at this location.

Results: After construction of the facility in 2007, the program has provided services for approximately 2 years.