Development of a multidimensional military readiness assessment.

There is a need to be able to accurately evaluate whether an injured service member is able to return to duty. An effective assessment would challenge and measures physical and cognitive performance in a military-relevant context. Current assessments are lacking in one or more of these aspects.

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.

Flotation-Restricted Environmental Stimulation Technique: A Proposed Therapy for Improving Performance and Recovery in Special Forces Operators - A Narrative Review.

The flotation-restriction environmental stimulation technique (FR) may have utility as a recovery tool for improving performance in elite competitive athletes and Special Operations Forces Operators (SOs). Studies suggest that FR may ameliorate various neurophysiological disorders and improve performance in recreational and elite athletic populations. We sought to understand whether there is evidence to support the use of FR to enhance physiological and psychological performance parameters in the SO population and to provide postulations as to the mechanisms of action of FR therapy.

Military training alters the fractal behavior of step width.

Non-linear analyses have been successfully applied to gait with evidence that fractal behavior of gait-related variables provide insights into function. Specifically, shifts in the fractal behavior of step width from pink toward white noise reflects a loss of complexity and diminished adaptive capacity and functionality. We previously reported an apparent difference in the fractal behavior of step width during treadmill walking between Service members with transtibial amputations and able-bodied civilian.

Common fall-risk indicators are not associated with fall prevalence in a high-functioning military population with lower limb trauma.

Background: Persons with lower limb trauma are at high risk for falls. Although there is a wide range of measures used to assess stability and fall-risk that include performance measures, temporal-spatial gait parameters, and nonlinear dynamic stability calculations, these measures are typically derived from fall-prone populations, such as older adults. Thus, it is unclear if these commonly used fall-risk indicators are effective at evaluating fall-risk in a younger, higher-functioning population of Service members with lower limb trauma.

Novel Metrics for Assessing Mobility During Ground-Standing Transitions.

Introduction: Transitioning between the ground and standing is a required activity for many professions including skilled trades, law enforcement, and military service. However, available assessments are limited and focus primarily on quality of movement. Thus, we developed two novel assessments of functional mobility specific for ground-to-standing transitions: Stand-Prone-Standx2 (SPS2) and Stand-Kneel-Standx2 (SKS2-L/R) tests.

Physiological and Psychological Stressors Affecting Performance, Health, and Recovery in Special Forces Operators: Challenges and Solutions. A Scoping Review.

Introduction: Special Operations Forces (SOF) Operators (SOs) are exposed to high levels of physiological and cognitive stressors early in their career, starting with the rigors of training, combined with years of recurring deployments. Over time, these stressors may degrade SOs' performance, health, and recovery.

Objectives: (1) To evaluate sources identifying and describing physiological and psychological stressors affecting performance, health, and recovery in SOs, and (2) to explore interventions and phenomena of interest, such as the biological mechanisms of overtraining syndrome (OTS).

IMU filter settings for high intensity activities.

Background: Recommendations for cut-off frequencies for inertial measurement units (IMU) are either based on marker-based motion analysis or based on low intensity activities. The selection of filter cut-off frequencies can impact the extracted variables from the filtered signal. There are no recommendations for IMU filter settings when collecting biomechanical data of high intensity activities.

Assessments of trunk postural control within a fall-prevention training program for service members with lower limb trauma and loss.

Background: Trunk postural control (TPC) is critical in maintaining balance following perturbations (i.e., avoiding falls), and impaired among persons with lower extremity trauma, contributing to elevated fall risk.

Inclusion of a Military-specific, Virtual Reality-based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma.

Introduction: Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands.

A novel assessment for Readiness Evaluation during Simulated Dismounted Operations: A reliability study.

Objective: To determine the intersession reliability of the Readiness Evaluation during Simulated Dismounted Operations (REDOp), a novel ecologically-based assessment for injured Service Members, provide minimal detectable change values, and normative reference range values. To evaluate the ability to differentiate performance limitations between able-bodied and injured individuals using the REDOp.

Design: Repeated measures design and between group comparison.

Healthy individuals are more maneuverable when walking slower while navigating a virtual obstacle course.

Introduction: Maintaining stability, especially in the mediolateral direction, is important for successful walking. Navigating in the community, however, may require people to reduce stability to make quick lateral transitions, creating a tradeoff between stability and maneuverability. Walking slower can improve stability during steady state walking, but there remains a need to better understand how walking speed influences maneuverability.

A manual physical therapy intervention for symptoms of knee osteoarthritis and associated fall risk: A case series of four patients.

Background And Purpose: Patients with knee osteoarthritis (OA) are at an increased risk of falling. Further, the symptoms associated with knee OA are correlated with fall risk. A manual physical therapy (MPT) approach consisting of mobilizing techniques and reinforcing exercise improves the symptoms and functional limitations associated with knee OA.

Use of Perturbation-Based Gait Training in a Virtual Environment to Address Mediolateral Instability in an Individual With Unilateral Transfemoral Amputation.

Background And Purpose: Roughly 50% of individuals with lower limb amputation report a fear of falling and fall at least once a year. Perturbation-based gait training and the use of virtual environments have been shown independently to be effective at improving walking stability in patient populations. An intervention was developed combining the strengths of the 2 paradigms utilizing continuous, walking surface angle oscillations within a virtual environment.

Ramp Angle, Not Plateau Height, Influences Transition Strategies.

In a previous study, we found that participants modified how they transitioned onto and off of ramp configurations depending upon the incline. While the transition strategies were originally attributed to ramp angles, it is possible that the plateau influenced the strategies since the final surface height also differed. Ultimately, for the current study, we hypothesized that an individual's transition strategies would have significant main effects for ramp angle, but not plateau height.

Mediolateral angular momentum changes in persons with amputation during perturbed walking.

Over 50% of individuals with lower limb amputation fall at least once each year. These individuals also exhibit reduced ability to effectively respond to challenges to frontal plane stability. The range of whole body angular momentum has been correlated with stability and fall risk.

Older Adult Hill Transition Strategies are Determined by Task Demands and Cautious Gait Patterns.

Falls are the leading cause of injury for all age groups. However, adults over 65 are at a higher risk, with one-third falling each year. Transitioning between level and hill surfaces poses a greater fall risk than walking on either surface alone.

Segment lengths influence hill walking strategies.

Segment lengths are known to influence walking kinematics and muscle activity patterns. During level walking at the same speed, taller individuals take longer, slower strides than shorter individuals. Based on this, we sought to determine if segment lengths also influenced hill walking strategies.

Pregnant women exaggerate cautious gait patterns during the transition between level and hill surfaces.

Falls are the leading cause of nonfatal injury across all age groups and a common incident for pregnant women. Thus, there is a critical demand for research to evaluate if walking strategies in pregnant women change throughout pregnancy in order to effectively intervene and minimize the incidence rate. The aim of the present study was to analyze modifications in temporal-spatial parameters as well as muscle activity during hill walking transitions in pregnant women between gestational week 20 and 32.

Preferred step frequency during downhill running may be determined by muscle activity.

It is well established that metabolic cost is minimized at an individual's running preferred step frequency (PSF). It has been proposed that the metabolic minimum at PSF is due to a tradeoff between mechanical factors, however, this ignores muscle activity, the primary consumer of energy. Thus, we hypothesized that during downhill running, total muscle activity would be greater with deviations from PSF.

Walking strategies change with distance from hill transition and scale with hill angle.

Individuals must constantly modify their gait patterns to safely transition between different surfaces. The goal of the current study was to determine if gait changes could be detected two steps from a transition, and whether these changes scaled with the angle of the hill. We hypothesized that during the anticipation of uphill walking and the aftereffect of downhill walking, the magnitude of kinetic and electromyography changes would be greatest at steep hill angles and fewer steps from the transition.

Muscle activity patterns of the tensor fascia latae and adductor longus for ramp and stair walking.

Walking on both outdoor and indoor surfaces requires the ability to negotiate connections between vertical distances, simply known as hills and stairs. Therefore, the purpose of the present study was to evaluate the muscle activity patterns of the TFL and ADL during both hill and stair walking. We hypothesized that TFL and ADL activity during initial swing, initial stance, and late stance of up-ramp and up-stair walking would be greater than level walking.

At similar angles, slope walking has a greater fall risk than stair walking.

According to the CDC, falls are the leading cause of injury for all age groups with over half of the falls occurring during slope and stair walking. Consequently, the purpose of this study was to compare and contrast the different factors related to fall risk as they apply to these walking tasks. More specifically, we hypothesized that compared to level walking, slope and stair walking would have greater speed standard deviation, greater ankle dorsiflexion, and earlier peak activity of the tibialis anterior.

Stair walking transitions are an anticipation of the next stride.

According to the CDC, the majority of fall-related accidents occur during stair walking. It is likely that the required increases in range of motion and muscle activity during stair walking contribute to increased fall risk. In addition, compared to level walking, the transition strides before and after stair walking demonstrate increased fall risk.