Background: The proposed follow-on study responds directly to the FY14 Orthotics and Prosthetics Outcomes Research Program (OPORP). It addresses the Orthotics and Prosthetics Outcomes Research Award (OPORA) by conducting research aimed at the 'Development of new materials and technologies for use in orthotics and prosthetics to improve quality of life and health outcomes for patients with limb trauma or limb loss.' Overseas Contingency Operations have produced many U.S. Warfighters with extremity injuries. Although the U.S. military has access to state-of-the-art treatment and devices, Warfighters with extremity trauma still struggle to regain full functional capabilities. Advanced technology does not solve all the issues faced by this population: 'high tech' does not always equate to 'high function.' A key factor that limits the ability of individuals with lower extremity trauma to achieve maximum functional capabilities is falls. Falls have serious consequences including loss of confidence, fear of falling, and injury. Therapy is guided at increasing functional levels. In addition to walking and changing direction on a variety of surfaces, Warfighters need to be able to manage uneven terrain, crowded environments, stairs, ramps, and slopes. Warfighters with lower extremity trauma need to face the risk of falling and overcome that fear.Objective/Hypothesis: The overall hypothesis for the proposed study is: Warfighters who have sustained lower extremity trauma can be treated with an advanced, secondary training program and achieve improved postural stability and, consequently, reduce falls. The proposed follow-on study is a logical continuation of the previous funded research program, 'Improved Training Method for Rapid Rehabilitation of Lower Extremity Amputees,' which developed a demonstrably effective, clinically relevant, and scientifically based method for training Warfighters with unilateral lower extremity amputations. The proposed effort will build on these previous successes by extending the program to additional patient populations and additional medical treatment facilities. The proposed project describes a secondary rehabilitation program, implemented after traditional therapy, designed to reduce falls in Warfighters with amputations or salvaged limbs.Specific Aims: Three specific aims are proposed: (1) Expand a currently successful rehabilitation program to additional patient populations. (2) Determine if the motor skills acquired as a result of the task-specific training are retained. (3) Validate the performance of a low-cost motion tracking system to quantify trunk kinematics.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 rehabilitation of Warfighters following lower extremity trauma. Aim 1: An advanced 2-week task-specific training program that has proven successful for preventing falls in Wounded Warriors with unilateral transtibial amputations will now be extended to eligible active duty, retired, or Veterans who have suffered combat-related lower limb trauma, specifically those with transfemoral amputations, bilateral amputations, or salvaged limbs who were treated at a Department of Defense Advanced Rehabilitation Center. These individuals will be trained with multi-directional postural perturbations. Testing will be conducted before and after training using the Computer Assisted Rehabilitation Environment system to test training efficacy. We anticipate that Warfighters with lower extremity trauma will respond to the rehabilitation program by demonstrating reduced falls. Aim 2: Biomechanical measures of postural stability at 3 and 6 months will be compared to those measured upon completion of 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. Aim 3: A low-cost method for assessing trunk control, such as an inertial measurement unit will be identified, implemented, and assessed to generate valid and reliable measures of trunk kinematics.Military Benefit: American Soldiers today have a greater chance of surviving their battlefield wounds and returning home than any other Soldiers in history. While body armor and advances in medical triage have increased the survival rate, these improvements have also greatly increased the likelihood of trauma to exposed limbs, which result in increased need for limb salvage and amputations. After standard rehabilitation for amputation or limb salvage, many Warfighters still struggle with falls, which can exacerbate physical and emotional injury and delay return to active duty or to a productive, active civilian life. 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 limb trauma and reduce medical care costs.
|Effective start/end date||9/30/15 → 9/29/18|
- Congressionally Directed Medical Research Programs: $3,145,058.00