Occupational Therapy Practice Patterns for Military Service Members With Upper Limb Amputation.

Introduction: Military Service Members (SMs) with upper limb (UL) amputation have unrestricted access to occupational therapy (OT) services. Identifying OT interventions used based on clinical rationale and patient needs can provide insight toward developing best practice guidelines. The purpose of this retrospective observational study was to identify preferred OT practice patterns for U.

Chronic low back pain influences trunk neuromuscular control during unstable sitting among persons with lower-limb loss.

Background: Persons with unilateral lower-limb loss are at increased risk for developing chronic low back pain. Aberrant trunk and pelvis motor behavior secondary to lower-limb loss potentially alters trunk postural control and increases demands on the trunk musculature for stability. However, it is unclear whether trunk postural control is associated with the presence or chronicity of low back pain within this population.

Changes in Trunk and Pelvis Motion Among Persons With Unilateral Lower Limb Loss During the First Year of Ambulation.

Objective: To retrospectively investigate trunk-pelvis kinematic outcomes among persons with unilateral transtibial and transfemoral limb loss with time from initial independent ambulation with a prosthesis, while secondarily describing self-reported presence and intensity of low back pain. Over time, increasing trunk-pelvis range of motion and decreasing trunk-pelvis coordination with increasing presence and/or intensity of low back pain were hypothesized. Additionally, less trunk-pelvis range of motion and more trunk-pelvis coordination for persons with more distal limb loss was hypothesized.

A Comparison of Mental Workload in Individuals with Transtibial and Transfemoral Lower Limb Loss during Dual-Task Walking under Varying Demand.

Objectives: This study aimed to evaluate the influence of lower limb loss (LL) on mental workload by assessing neurocognitive measures in individuals with unilateral transtibial (TT) versus those with transfemoral (TF) LL while dual-task walking under varying cognitive demand.

Methods: Electroencephalography (EEG) was recorded as participants performed a task of varying cognitive demand while being seated or walking (i.e.

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

Controlled trunk motion is crucial for balance and stability during walking. Persons with lower extremity amputation often exhibit abnormal trunk motion, yet underlying mechanisms are not well understood nor have optimal clinical interventions been established. The aim of this work was to characterize associations between altered lower extremity joint moments and altered trunk dynamics in persons with unilateral, transtibial amputation (TTA).

Blood Flow Restriction Therapy after Closed Treatment of Distal Radius Fractures.

 Blood flow restriction (BFR) therapy is an innovative rehabilitative program that enables patients to increase strength at a fraction of the weight typically necessary in endurance exercises. Therefore, we conducted a pilot study evaluating patient outcomes with a BFR therapy program for closed management after a distal radius fracture compared to a traditional rehabilitation protocol.  A randomized-controlled study was conducted comparing a standardized hand therapy rehabilitation protocol alone to a combined protocol with the use of BFR therapy in patients who were initially treated with closed reduction and short arm cast immobilization for a displaced distal radius fracture between May 1, 2015 and August 1, 2016.

Joint power distribution does not change within the contralateral limb one year after unilateral limb loss.

Background: To assist with forward progression during gait, persons with unilateral lower-limb amputation typically perform more work within the unaffected versus affected limb. However, prior cross-sectional (>2years post-amputation) studies cannot necessarily elucidate the origin or evolution of these compensatory mechanics.

Research Question: Do lower limb joint kinetics change during the initial stages of independent ambulation among persons with lower-limb amputation?

Methods: Nine males with unilateral lower-limb amputation (6 transtibial; 3 transfemoral) completed instrumented gait analyses (speed = 1.

Biomechanical improvements following foot strike biofeedback training for a patient using a passive dynamic ankle-foot orthosis during running.

Background And Purpose: Passive dynamic ankle-foot orthoses have potential to facilitate return to running after a lower limb trauma. However, transitioning patients to new movement patterns that enhance passive dynamic ankle-foot orthoses benefits can pose a challenge. The purpose of this case study was to report biomechanical and functional outcomes for a patient utilizing a passive dynamic ankle-foot orthoses following completion of a session-based, midfoot strike run training program.

Development and validation of a kinematically-driven discrete element model of the patellofemoral joint.

Quantifying the complex loads at the patellofemoral joint (PFJ) is vital to understanding the development of PFJ pain and osteoarthritis. Discrete element analysis (DEA) is a computationally efficient method to estimate cartilage contact stresses with potential application at the PFJ to better understand PFJ mechanics. The current study validated a DEA modeling framework driven by PFJ kinematics to predict experimentally-measured PFJ contact stress distributions.

Trunk muscle forces and spinal loads in persons with unilateral transfemoral amputation during sit-to-stand and stand-to-sit activities.

Background: Alterations and asymmetries in trunk motions during activities of daily living, involving lower extremities, are suggested to cause higher spinal loads in persons with unilateral lower limb amputation. Given the repetitive nature of most activities of daily living, knowledge of the amount of increase in spinal loads is important for designing interventions aimed at prevention of secondary low back pain due to potential fatigue failure of spinal tissues. The objective of this study was to determine differences in trunk muscle forces and spinal loads between persons with and without lower limb amputation when performing sit-to-stand and stand-to-sit tasks.

Do Gait and Functional Parameters Change After Transtibial Amputation Following Attempted Limb Preservation in a Military Population?

Background: Surgical attempts at lower limb preservation after trauma may be complicated by pain and gait disturbances, which can impact the activity level of a military service member. It is unclear how later transtibial amputation (TTA) might affect patients who elect this option after attempts at limb preservation.

Questions/purposes: The purposes of the study were to compare preamputation and postamputation (1) the numeric rating scale for pain and pain medication use; (2) self-reported activity level, Four Square Step Test (FSST) results, and assistive device use; and (3) spatiotemporal variables measured with instrumented gait analysis in individuals who elected TTA after multiple attempts at limb preservation.

Do Spatiotemporal Gait Parameters Improve After Pilon Fracture in Patients Who Use the Intrepid Dynamic Exoskeletal Orthosis?

Background: Pilon fractures are high-energy fractures about the ankle observed commonly in both civilian and military trauma populations. Despite surgical management, outcomes are predictably poorly characterized by functional deficits secondary to pain and stiffness. The Intrepid Dynamic Exoskeletal Orthosis (IDEO) and Return-to-Run clinical pathway were initially designed to treat military service members after complex battlefield lower extremity injuries.

Clinical Outcomes with the Intrepid Dynamic Exoskeletal Orthosis: A Retrospective Analysis.

Introduction: Severe lower limb injuries have a negative impact on many aspects of an individual's life. One rehabilitative option for patients who have undergone limb salvage is the Intrepid Dynamic Exoskeletal Orthosis (IDEO). The IDEO is a custom-made dynamic response device which is used to restore function for patients with a wide variety of injuries.

Impact of Fire Arms Training in a Virtual Reality Environment on Occupational Performance (Marksmanship) in a Polytrauma Population.

Introduction: Polytrauma, to include major limb amputation, in a military population presents unique rehabilitation challenges with the overarching goal of restoring function leading to the primary question, "Is this Service Member (SM) capable of returning to duty following rehabilitation?" The US military has a vested interest in maximizing injured SMs occupational performance to allow for return to duty. The purpose of this report is to describe marksmanship (shot grouping and weapon qualification) and return to duty outcomes following a course of VRE-based firearm training in a polytrauma patient population.

Methods: The medical records, stored in the Armed Forces Health Longitudinal Technology Application (AHLTA), of all patients who received rehabilitative care at the Center for the Intrepid (CFI) to include VRE-based firearms training between 01OCT2015 and 01AUG2016 were manually reviewed for inclusion.

Ankle-foot orthosis alignment affects running mechanics in individuals with lower limb injuries.

Background: Individuals with severe lower extremity injuries often require ankle-foot orthoses to return to normal activities. Ankle-foot orthoses alignment is a key consideration during the clinical fitting process and may be particularly important during dynamic activities such as running.

Objective: To investigate how 3° changes in sagittal plane ankle-foot orthoses alignment affect running mechanics.

Statistical analysis of timeseries data reveals changes in 3D segmental coordination of balance in response to prosthetic ankle power on ramps.

Active ankle-foot prostheses generate mechanical power during the push-off phase of gait, which can offer advantages over passive prostheses. However, these benefits manifest primarily in joint kinetics (e.g.

The Relationship Between Gait Symmetry and Metabolic Demand in Individuals With Unilateral Transfemoral Amputation: A Preliminary Study.

Introduction: Temporal-spatial symmetry allows for optimal metabolic economy in unimpaired human gait. The gait of individuals with unilateral transfemoral amputation is characterized by temporal-spatial asymmetries and greater metabolic energy expenditure. The objective of this study was to determine whether temporal-spatial asymmetries account for greater metabolic energy expenditure in individuals with unilateral transfemoral amputation.

Risk of post-traumatic knee osteoarthritis after knee injury in military service members.

Purpose: The aims of the present study were: (a) to identify the incidence of osteoarthritis (OA) after a traumatic knee injury; (b) identify the risk of post-traumatic osteoarthritis (PTOA) based on the type of injury; and (c) identify the time from injury to OA diagnosis.

Patients And Methods: The Expeditionary Medical Encounter Database, containing healthcare utilization for all deployment injuries sustained by military service members, was queried for traumatic knee injuries between 2001 and 2016. Subsequent diagnosis of knee OA was identified, defined as PTOA.

Upper Extremity Amputation and Prosthetics Care Across the Active Duty Military and Veteran Populations.

The hand and arm are exceptionally dexterous, exquisitely sensitive, and proficient in performing tasks and functions. Given the invaluable functions of the upper extremity in daily life, replacement of a missing limb through prosthetic substitution is challenging. Prosthetic and rehabilitation needs of injured Service members from recent military conflicts have brought upper extremity amputation to the forefront, which has led to an increase in attention and resource allocation.

Experimental comparisons of passive and powered ankle-foot orthoses in individuals with limb reconstruction.

Background: Ankle-foot orthoses (AFO) are commonly prescribed to provide functional assistance for patients with lower limb injuries or weakness. Their passive mechanical elements can provide some energy return to improve walking ability, but cannot restore plantar flexor push-off. Powered AFOs provide an assistive torque about the ankle to address the limitations of passive devices, but current designs have yet to be implemented on a large scale clinically.

Biomechanical and neurocognitive performance outcomes of walking with transtibial limb loss while challenged by a concurrent task.

Individuals who have sustained loss of a lower limb may require adaptations in sensorimotor and control systems to effectively utilize a prosthesis, and the interaction of these systems during walking is not clearly understood for this patient population. The aim of this study was to concurrently evaluate temporospatial gait mechanics and cortical dynamics in a population with and without unilateral transtibial limb loss (TT). Utilizing motion capture and electroencephalography, these outcomes were simultaneously collected while participants with and without TT completed a concurrent task of varying difficulty (low- and high-demand) while seated and walking.

Dynamic knee joint stiffness and contralateral knee joint loading during prolonged walking in patients with unilateral knee osteoarthritis.

Background: Long duration walking, a commonly recommended treatment option for knee osteoarthritis (OA), may lead to increased knee joint loading.

Research Question: To evaluate the effects of prolonged walking on dynamic knee joint stiffness and contralateral knee joint contact forces (KCFs) in individuals with unilateral symptomatic knee OA.

Methods: Twenty-six older adults with knee OA completed a 45-minute bout of walking on a treadmill.

Association of Specific Lower Extremity Injuries With Delayed Amputation.

Introduction: Despite medical interventions to preserve viability and functionality of injured limb(s) among combat-injured service members, delayed amputations may occur. The goal of this study was to determine whether specific lower extremity (LE) injuries were associated with delayed amputations.

Methods: The Expeditionary Medical Encounter Database was queried for combat-related LE injuries between 2003 and 2015.

Modified Constraint-Induced Movement Therapy for persons with unilateral upper extremity amputation: A case report.

Study Design: Pretest/posttest case series design.

Introduction: Rates of prosthetic device abandonment are highest among persons with upper extremity (UE) amputation. Modified Constraint-Induced Movement Therapy (mCIMT), which has been extensively studied in patients with chronic, subacute, and acute stroke, is an under-utilized approach to treat persons with UE amputation.