Identifying Improvements in Treating Extremity Musculoskeletal Injuries During Prolonged Care.

Introduction: In prolonged care scenarios, where medical evacuations are significantly delayed, the treatment and transport of casualties with extremity musculoskeletal injuries will drain combat units' human resources. Developing enhanced splinting techniques to restore casualty mobility and function can alleviate this drain. To guide this development, a panel of tactical combat and wilderness medicine experts was assembled to determine which extremity musculoskeletal injuries had the greatest impact on unit capabilities, and the materials available for splinting these injuries.

Selective orthotic constraint of lower limb movement during walking reveals new insights into neuromuscular adaptation.

Introduction: A concern expressed by the clinical community is that the constraint of motion provided by an ankle foot orthosis (AFO) may lead the user to become dependent on its stiffness, leading to learned non-use. To examine this, we hypothesized that using an experimental AFO-footwear combination (exAFO-FC) that constrains ankle motion during walking would result in reduced soleus and tibialis anterior EMG compared to free (exAFO-FC) and control (no AFO, footwear only) conditions.

Method: A total of 14 healthy subjects walked at their preferred speed (1.

Leveraging Digital Workflows to Transition the Orthotics and Prosthetics Profession Toward a Client-Centric and Values-Based Care Model.

The orthotics and prosthetics (O&P) profession has a history of responding to market demands in a reactive rather than proactive manner. This has created significant impacts including shrinkage in scope of practice and constraint in remuneration for professional services due to a fee-for-device third party payer system. Rapid changes in technology and healthcare combined with an outdated device-centric reimbursement system are creating unprecedented challenges that threaten sustainability of the O&P profession.

Testing the Reliability of Optical Coherence Tomography to Measure Epidermal Thickness and Distinguish Volar and Nonvolar Skin.

In persons with limb loss, prosthetic devices cause skin breakdown, largely because residual limb skin (nonvolar) is not intended to bear weight such as palmoplantar (volar) skin. Before evaluation of treatment efficacy to improve skin resiliency, efforts are needed to establish normative data and assess outcome metric reliability. The purpose of this study was to use optical coherence tomography to (i) characterize volar and nonvolar skin epidermal thickness and (ii) examine the reliability of optical coherence tomography.

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.

Exoskeletal solutions to enable mobility with a lower leg fracture in austere environments.

The treatment and evacuation of people with lower limb fractures in austere environments presents unique challenges that assistive exoskeletal devices could address. In these dangerous situations, independent mobility for the injured can preserve their vital capabilities so that they can safely evacuate and minimize the need for additional personnel to help. This expert view article discusses how different exoskeleton archetypes could provide independent mobility while satisfying the requisite needs for portability, maintainability, durability, and adaptability to be available and useful within austere environments.

Post-concussion Return to Shooting Progression for Military Service Members: A Scoping Review and Conceptual Framework.

Introduction: There are established protocols for staged return to physical activity in sport and military settings following concussion. Currently, there is no evidence-based staged return to shooting protocol in use by the U.S.

The development of rating scales to evaluate experiential prosthetic foot preference for people with lower limb amputation.

Background: Selection of a foot is an important aspect of prosthetic prescription and vital to maximizing mobility and functional goals after lower limb amputation. Development of a standardized approach to soliciting user experiential preferences is needed to improve evaluation and comparison of prosthetic feet.

Objective: To develop rating scales to assess prosthetic foot preference and to evaluate use of these scales in people with transtibial amputation after trialing different prosthetic feet.

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.

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.

Relationship between phantom limb pain, function, and psychosocial health in individuals with lower-limb loss.

Introduction: The adverse influence of chronic pain on function and psychological health in the general population is well understood. However, the relationship between phantom limb pain (PLP) after limb loss with function and psychological health is less clear. The study purpose was to assess the influences of PLP presence and intensity on function and psychosocial health in individuals with lower-limb loss (LLL).

Management of Upper Limb Amputation Rehabilitation: Synopsis of the 2022 US Department of Veterans Affairs and US Department of Defense Clinical Practice Guideline for Acquired Amputation.

Upper limb amputation can result in significant functional impairment necessitating a comprehensive rehabilitation approach throughout the continuum of care. In 2022, the Departments of Veteran Affairs and Defense completed an updated clinical practice guideline for the management of upper limb amputation rehabilitation. This practice guideline was developed by a workgroup of subject-matter experts from a variety of disciplines.

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.

The relationship between residual limb health, motion within the socket, and prosthetic suspension.

Residual limb health is critical for continued prosthesis use; however, many prosthesis users experience skin-related breakdown. The interface between the residual limb and the prosthetic socket sets the local mechanical environment and plays a role in skin stresses. Motion of the residual limb in the socket adds additional mechanical strain on the limb.

Running Gait Training Improves Outcomes at United States Air Force Basic Military Training.

Introduction: The aim is to investigate the impact of large-group, motor learning-based running gait training on injury risk in United States Air Force (USAF) Basic Military Training (BMT).

Design: A prospective quasi-experimental program evaluation is used.

Materials And Methods: Medical providers taught running gait form to groups of trainees in the first week of training of BMT from August 2020 to March 2021.

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.

Kinematic analysis of speed transitions within walking in younger and older adults.

The ability to adapt to environmental and task demands while walking is critical to independent mobility outside the home and this ability wanes with age. Such adaptability requires individuals to acutely change their walking speed. Regardless of age, changes between walking speeds are common in daily life, and are a frequent type of walking adaptability.

Back squat mechanics in persons with a unilateral transtibial amputation: A case study.

Case Description: A 30-year-old person with a unilateral transtibial amputation (TTAmp) was assessed performing an Olympic-style back squat with an energy storage and return prosthetic foot.

Objective: Determine joint-level movement strategies of an individual with TTAmp while performing an Olympic-style back squat.

Study Design: Case study design.

AAOS/Major Extremity Trauma and Rehabilitation Consortium Clinical Practice Guideline Summary for Evaluation of Psychosocial Factors Influencing Recovery From Orthopaedic Trauma.

The Clinical Practice Guideline for Evaluation of Psychosocial Factors Influencing Recovery from Adult Orthopaedic Trauma is based on a systematic review of current scientific and clinical research. The purpose of this clinical practice guideline is to improve outcomes after adult orthopaedic trauma by evaluating, and addressing, the psychosocial factors that affect recovery. This guideline contains one recommendation to address eight psychosocial factors after military and civilian adult orthopaedic trauma that may influence clinical, functional, and quality of life recovery.

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.

Characteristics of phantom limb pain in U.S. civilians and service members.

Objectives: The population of Americans with limb loss is on the rise, with a different profile than in previous generations (e.g., greater incidence of amputation due to diabetes).

Altering the tuning parameter settings of a commercial powered prosthetic foot to increase power during push-off may not reduce collisional work in the intact limb during gait.

Background: Increased knee osteoarthritis risk in patients with unilateral lower extremity limb loss is attributed to increased intact limb loading. Modulating powered ankle prosthesis push-off power may be an effective way to modulate intact limb loading. We examined how changes in the parameter settings of a commercial prosthetic ankle affect power delivery during push-off and the resulting collisional work experienced by the intact limb in persons with unilateral lower extremity limb loss.

Upper limb prosthesis users: A longitudinal cohort study.

Background: No previous studies have followed prosthesis users with upper limb loss or limb deficiency using their own prostheses to assess change over time.

Objectives: (1) To describe prostheses and terminal device types used at baseline and 1-year follow-up; (2) to examine changes in functional outcomes and device satisfaction over time; and (3) to examine whether changes in outcomes varied across level of amputation and type of prosthesis used.

Study Design: Multisite, observational time series design with in-person functional performance and self-report data collected at baseline and 1-year follow-up.