Background: The US Global War on Terrorism has resulted in many US warfighters sustaining extremity injuries. The US military is currently fitting amputees with state-of-the-art prosthetic devices. Although the amputee may try to focus on the high technology to try to solve some of the adjustment issues, 'high tech' does not always equate to 'high function.' Key factors that limit the ability of amputees to achieve maximum functional capabilities are falls. Falls in lower limb amputees can have serious consequences including loss of confidence, fear of falling, and injury. Therapy is guided at increasing the amputee's functional levels. In addition to walking and changing direction on a variety of surfaces, patients need to be able to manage uneven terrain, crowded environments, stairs, ramps, and incline. Amputees need to face the risk of falling and overcome that fear.Objective/Hypothesis: The overall hypothesis for the proposed study is that amputees treated with a treadmill training program will demonstrate improved dynamic postural stability. We have been performing research to reduce fall-related injuries to older adults since the late 1980s. Specifically, this work has included a novel experimental method to induce unexpected trips under controlled laboratory conditions, identification of biomechanical variables that are causally related to the success or failure in avoiding a fall after a trip, development of a treadmill-based intervention, and a randomized controlled clinical trial that demonstrated efficacy. We have recently demonstrated in a pilot study that it is also possible to increase amputee confidence in a prosthetic limb through task-specific training.Specific Aims: Using the treadmill training program for lower extremity amputees, we will pursue the following aims. Aim 1: Assess improvements in functional performance of lower extremity amputees. Aim 2: Evaluate ability of the training system to promote more rapid amputee rehabilitation. Aim 3: Determine if amputees can retain the motor skills acquired by the task-specific training. Study Design: The proposed effort combines the biomedical and clinical strengths of a multi-institutional and interdisciplinary team to address a significant but understudied issue: advanced gait rehabilitation of lower extremity amputees following traumatic limb loss. Aim 1: Wounded Warriors who have graduated from the Naval Medical Center, San Diego (NMCSD) Comprehensive Combat and Complex Casualty Care (C5) program will be tested using the Computer Assisted Rehabilitation Environment system at the Naval Health Research Center to provide a laboratory-induced trip. Subsequently, the Wounded Warriors will participate in a 2-week task-specific training protocol. Following training, the Wounded Warriors will again be tested using the laboratory-induced postural disturbance. Aim 2: Functional improvements at 3 months following attainment of independent ambulation will be compared between the proposed task-specific training protocol and current clinical practice. We anticipate that the dynamic stability of the Wounded Warriors who participate in the task-specific training protocol will be significantly better than those who complete current rehabilitation treatment. Aim 3: Biomechanical measures of dynamic stability at 3, 6, and 12 months will be compared to those measured upon completion of the training. Individuals will be subjected to large postural disturbances, and their ability to maintain dynamic balance will be quantified. We anticipate that the motor skills acquired during the task-specific training will not be significantly degraded.Impact: Most amputees do not resume a completely normal lifestyle. Many adaptations are necessary, which drive up the cost of providing medical care. The proposed novel training method has the potential to change the standard of care for lower extremity amputees, reduce rehabilitation time, and reduce medical care costs. Project/Task Area: The proposal addresses the priority research area of Rehabilitation-Neuromuscular Injuries.
|Effective start/end date||3/1/11 → 3/31/15|
- Congressionally Directed Medical Research Programs: $2,359,000.00