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.

How persons with transtibial amputation regulate lateral stepping while walking in laterally destabilizing environments.

Background: Persons with lower limb amputation often experience decreased physical capacity, difficulty walking, and increased fall risk. To either prevent or recover from a loss of balance, one must effectively regulate their stepping movements. It is therefore critical to identify how well persons with amputation regulate stepping.

Dexterity, activity performance, disability, quality of life, and independence in upper limb Veteran prosthesis users: a normative study.

Purpose: To present population data on standardized measures of dexterity, activity performance, disability, health-related quality of life (HRQoL) and community integration for persons with upper limb amputation (ULA), compare outcomes to normative values, and examine differences by prosthesis type and laterality (unilateral vs. bilateral amputation).

Materials And Methods: Multi-site, cross-sectional design, with in-person evaluations, functional performance, and self-report measures.

COX-2 inhibition does not alter wound healing outcomes of a volumetric muscle loss injury treated with a biologic scaffold.

Volumetric muscle loss (VML) injuries are characterized by a heightened immune response that alters canonical wound healing outcomes and results in a chronic reduction of both total myofiber number and functional capacity. Preclinical and clinical investigations aimed at repairing VML injuries have largely utilized biologic scaffolds (BSs) as a potential therapeutic intervention. BSs rely on the recruitment of a myriad of host-derived immune, stem, and stromal cells to induce a wound healing response that has been routinely characterized as largely fibrous matrix deposition and limited myofiber regeneration at the site of the defect.

Ten-Year Outcomes of a Systems-Based Approach to Longitudinal Amputation Care in the US Department of Veteran Affairs.

Background: The goal of the US Department of Veterans Affairs (VA) Amputation System of Care (ASoC) is to enhance the quality and consistency of amputation rehabilitation care for veterans with limb loss.

Objective: The ASoC provides specialized expertise in amputation rehabilitation incorporating the latest practices in medical management, rehabilitation, and artificial limbs in order to minimize disability and to enable the highest level of social, vocational, and recreational success for veterans with amputation.

Discussion: The ASoC serves veterans with limb amputation from any etiology.

Safety and Efficacy of Blood Flow Restriction Therapy after Operative Management of Distal Radius Fractures: A Randomized Controlled Study.

 Blood flow restriction (BFR) therapy is an emerging addition to rehabilitative programs that allows patients to increase strength at lower loads over shorter time periods. Therefore, we conducted a study to evaluate the safety and efficacy of a rehabilitation program using BFR to a traditional rehabilitation protocol following operative fixation of distal radius fractures.  A randomized controlled study was conducted comparing a standardized rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients treated with volar plate fixation following a displaced distal radius fracture.

Volumetric muscle loss disrupts length-dependent architectural and functional characteristics of skeletal muscle.

: Skeletal muscle architecture is a primary determinant of function. Volumetric muscle loss (VML) injury is destructive; however, the impact on muscle architecture is uncharacterized. : Architectural and functional effects of VML were assessed in rat tibialis anterior (TA) muscle model 4 weeks post-injury.

Pleiotropic actions of Vitamin D in composite musculoskeletal trauma.

Composite tissue injuries are the result of high energy impacts caused by motor vehicle accidents, gunshot wounds or blasts. These are highly traumatic injuries characterized by wide-spread, penetrating wounds affecting the entire musculoskeletal system, and are generally defined by frank volumetric muscle loss with concomitant segmental bone defects. At the tissue level, the breadth of damage to multiple tissue systems, and potential for infection from penetration, have been shown to lead to an exaggerated, often chronic inflammatory response with subsequent dysregulation of normal musculoskeletal healing mechanisms.

Prevalence of Low Back Pain and Relationship to Mental Health Symptoms and Quality of Life After a Deployment-related Lower Limb Amputation.

Study Design: Retrospective, cross-sectional study.

Objective: To assess the prevalence and association of low back pain (LBP) with psychosocial factors in Service members with amputations.

Summary Of Background Data: LBP is a common secondary health condition after amputation with important implications related to function and quality of life.

Muscle Contributions to Balance Control During Amputee and Nonamputee Stair Ascent.

Dynamic balance is controlled by lower-limb muscles and is more difficult to maintain during stair ascent compared to level walking. As a result, individuals with lower-limb amputations often have difficulty ascending stairs and are more susceptible to falls. The purpose of this study was to identify the biomechanical mechanisms used by individuals with and without amputation to control dynamic balance during stair ascent.

The Influence of Tobacco Use, Alcohol Consumption, and Weight Gain on Development of Secondary Musculoskeletal Injury After Lower Limb Amputation.

Objectives: To evaluate whether tobacco use, alcohol consumption, and weight gain are associated with the diagnosis of overuse musculoskeletal injuries within the first 12 months after lower limb amputation.

Design: Retrospective cohort study.

Setting: Military treatment facilities.

Low back pain, mental health symptoms, and quality of life among injured service members.

Objective: Pain is a significant public health issue that may be particularly problematic among injured service members who are at high risk of chronic physical and mental health conditions. The goals of this study were to describe the prevalence and types of low back pain (acute vs. recurrent) among service members injured while on combat deployments, and to examine the differences in posttraumatic stress disorder (PTSD) and depression prevalence and severity, as well as quality of life, for individuals with low back pain compared with those without.

Single-Legged Hop and Single-Legged Squat Balance Performance in Recreational Athletes With a History of Concussion.

Context: Researchers have suggested that balance deficiencies may linger during functional activities after concussion recovery.

Objective: To determine whether participants with a history of concussion demonstrated dynamic balance deficits as compared with control participants during single-legged hops and single-legged squats.

Design: Cross-sectional study.

Design and fabrication of the radial and ulnar wrist articulating control orthoses.

Study Design: Case series.

Introduction: Pain and injury at the radial and ulnar aspects of the wrist due to overuse or trauma are commonly treated in hand therapy clinics.

Purpose Of Study: Describe two orthoses that allow targeted rest and recovery of involved anatomical structure(s) while preserving function of surrounding uninvolved structures in patients who have sustained overuse or traumatic injury at the radial or ulnar aspect of the wrist.

Impedance Control Strategies for Enhancing Sloped and Level Walking Capabilities for Individuals with Transfemoral Amputation Using a Powered Multi-Joint Prosthesis.

Introduction: Powered prostheses are a promising new technology that may help people with lower-limb loss improve their ability to perform locomotion tasks. Developing active prostheses requires robust design methodologies and intelligent controllers to appropriately provide assistance to the user for varied tasks in different environments. The purpose of this study was to validate an impedance control strategy for a powered knee and ankle prosthesis using an embedded sensor suite of encoders and a six-axis load cell that would aid an individual in performing common locomotion tasks, such as level walking and ascending/descending slopes.

Suturable mesh better resists early laparotomy failure in a cyclic ball-burst model.

Purpose: The small bites surgical technique supported by the STITCH trial has been touted as a strategy for preventing early laparotomy dehiscence through greater force distribution at the suture-tissue interface. However, this hernia prevention strategy requires an alteration in the standard closure technique that has not been widely adopted in the USA. This study seeks to determine whether incorporating a mid-weight polypropylene mesh material into a hollow-bore surgical suture material will effectively increase the force distribution at the suture-tissue interface and potentially help prevent early laparotomy dehiscence in an ex vivo model.

Taking the Next Steps in Regenerative Rehabilitation: Establishment of a New Interdisciplinary Field.

The growing field of regenerative rehabilitation has great potential to improve clinical outcomes for individuals with disabilities. However, the science to elucidate the specific biological underpinnings of regenerative rehabilitation-based approaches is still in its infancy and critical questions regarding clinical translation and implementation still exist. In a recent roundtable discussion from International Consortium for Regenerative Rehabilitation stakeholders, key challenges to progress in the field were identified.

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.

Conversion to a rearfoot strike pattern during running for prevention of recurrent calf strains: A case report.

Background: Running-related injuries are prevalent musculoskeletal complaints in the United States military. Although, run retraining is an extensively researched method for reducing pain and improving function in runners, its clinical utility remains low.

Case Description: The patient had a seven-year history of recurrent right calf strains.

Author Correction: Lower Extremity Joint Contributions to Trunk Control During Walking in Persons with Transtibial Amputation.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Characterizing and Understanding the Low Back Pain Experience Among Persons with Lower Limb Loss.

Objective: This study preliminarily characterizes and compares the impact of lower limb loss and development of chronic low back pain (cLBP) on psychosocial factors, as well as the relationship between these factors and low back pain-related functional disability.

Design: Cross-sectional study.

Methods: Participants were adults, active duty or retired military, with traumatic lower limb loss with and without chronic low back pain.

A more compliant prosthetic foot better accommodates added load while walking among Servicemembers with transtibial limb loss.

Selecting an optimal prosthetic foot is particularly challenging for highly active individuals with limb loss, such as military personnel, who need to seamlessly perform a variety of demanding activities/tasks (often with and without external loads) while minimizing risk of musculoskeletal injuries over the longer term. Here, we expand on prior work by comparing biomechanical and functional outcomes in two prosthetic feet with the largest differences in mechanical response to added load (i.e.