Therapeutic Management of the Posttraumatic Stiff Elbow After Open Osteocapsular Release.

Arthrofibrosis is an inevitable consequence of elbow trauma that oftentimes requires surgical release to restore range of motion and function. Although the surgical procedure for elbow osteocapsular release can result in marked improvement in elbow motion, postrelease rehabilitation is paramount to maintaining and even improving the gains achieved in surgery. There are a variety of rehabilitation protocols and modalities that can be implemented that can be divided into an early versus late stage of rehabilitation after surgery.

A Stimulus-Response Framework to Investigate the Influence of Continuous Versus Interval Walking Exercise on Select Serum Biomarkers in Knee Osteoarthritis.

Objective: The aim of the study was to compare changes in the concentration of serum biomarkers in response to continuous versus interval walking exercise in participants with knee osteoarthritis.

Design: This study used a two-phase sequential design. Twenty-seven participants with unilateral knee osteoarthritis completed two separate treadmill walking sessions: (1) continuous 45-min walking exercise and (2) three 15-min bouts of walking exercise separated by 1-hr rest periods for a total of 45 mins in an interval format.

Mechanical and dynamic characterization of prosthetic feet for high activity users during weighted and unweighted walking.

Many Service members and Veterans with lower-limb amputations have the potential for high function and the desire to resume physically demanding occupations that require them to carry heavy loads (e.g., military service, firefighters, farmers, ranchers, construction workers).

Sexual Dimorphism in Immunity to Oral Bacterial Diseases: Intersection of Neutrophil and Osteoclast Pathobiology.

Sex is a biological variable that affects immune responses to bacterial and other types of infectious agents. Males and females are known to have differential oral bacterial disease burden in periodontal and endodontic disease. Understanding that there is a contribution from both sex and gender to these oral diseases, we discuss in this review recent sex-based findings that provide a pathobiological basis for differences observed between males and females.

Muscle Function and Coordination of Amputee Stair Ascent.

Ascending stairs is challenging following transtibial amputation due to the loss of the ankle muscles, which are critical to human movement. Efforts to improve stair ascent following amputation are hindered by limited understanding of how prostheses and remaining muscles contribute to stair ascent. This study developed a three-dimensional muscle-actuated forward dynamics simulation of amputee stair ascent to identify contributions of individual muscles and passive prosthesis to the biomechanical subtasks of stair ascent.

Associations between trunk postural control in walking and unstable sitting at various levels of task demand.

Trunk postural control (TPC) has been investigated in several populations and tasks. Previous work observed targeted training of TPC via isolated trunk control tasks may improve performance in other activities (e.g.

Function, quality of life, and community integration of DEKA Arm users after discharge from prosthetic training: Impact of home use experience.

Background:: Research on adaptation to advanced upper limb prostheses is needed.

Objectives:: To (1) examine change in function, quality of life and community integration after prosthetic training, (2) determine whether change in outcomes varied by prosthesis complexity, and (3) compare patterns of change at 1 month for those who withdrew from the study and those who did not.

Study Design:: Quasi-experimental time series.

Knee adduction moment peak and impulse do not change during the first six months of walking with a prosthesis.

Background: Individuals with unilateral lower limb loss are at increased risk for developing knee osteoarthritis in their contralateral limb. The mechanisms underlying this phenomenon are unknown, but large or unusual loads on the limb are thought to contribute to osteoarthritis development. Yet, to our knowledge, there have been no longitudinal assessments of knee joint kinetics to assist with identifying the origin or progression of such loads.

Transfemoral amputee intact limb loading and compensatory gait mechanics during down slope ambulation and the effect of prosthetic knee mechanisms.

Background: Intact limb knee osteoarthritis is a prevalent secondary disability in transfemoral amputees. Walking down a ramp may increase this risk due to excessive limb loading. We sought to determine whether intact limb loading differed between transfemoral amputees and controls during down slope ambulation, and the compensatory strategies transfemoral amputees used to modify intact limb loading.

Risk Factors for Training-Related Injuries During U.S. Army Basic Combat Training.

Background: Injuries during basic combat training (BCT) impact military health and readiness in the U.S. Army.

Trunk muscle activation patterns during walking among persons with lower limb loss: Influences of walking speed.

Persons with lower limb amputation (LLA) walk with altered trunk-pelvic motions. The underlying trunk muscle activation patterns associated with these motions may provide insight into neuromuscular control strategies post LLA and the increased incidence of low back pain (LBP). Eight males with unilateral LLA and ten able-bodied controls (CTR) walked over ground at 1.

Healthy individuals are more maneuverable when walking slower while navigating a virtual obstacle course.

Introduction: Maintaining stability, especially in the mediolateral direction, is important for successful walking. Navigating in the community, however, may require people to reduce stability to make quick lateral transitions, creating a tradeoff between stability and maneuverability. Walking slower can improve stability during steady state walking, but there remains a need to better understand how walking speed influences maneuverability.

Measurement of attentional reserve and mental effort for cognitive workload assessment under various task demands during dual-task walking.

Previous work focused on cognitive workload assessment suggests EEG spectral content and component amplitudes of the event-related potential (ERP) waveform may index mental effort and attentional reserve, respectively. Although few studies have assessed attentional reserve and mental effort during upper-extremity performance, none have employed a combined approach to measure cognitive workload during locomotion. Therefore, by systematically considering ERPs, spectral content and importantly their combination, this study aimed to examine whether concurrent changes in spectral content and ERPs could collectively serve as an index of cognitive workload during locomotion.

Trunk and pelvic dynamics during transient turns among individuals with unilateral traumatic lower limb amputation.

Prior work has identified alterations in trunk-pelvic dynamics with lower limb amputation (LLA) during in-line walking; however, evaluations of other ambulatory tasks are limited. Turns are ubiquitous in daily life but can be challenging for individuals with LLA, prompting additional or unique proximal compensations when changing direction, which over time may lead to development of low back pain. We hypothesized such proximal kinematic differences between persons with and without LLA would exist in the sagittal and frontal planes.

Maintenance of muscle strength retains a normal metabolic cost in simulated walking after transtibial limb loss.

Recent studies on relatively young and fit individuals with limb loss suggest that maintaining muscle strength after limb loss may mitigate the high metabolic cost of walking typically seen in the larger general limb loss population. However, these data are cross-sectional and the muscle strength prior to limb loss is unknown, and it is therefore difficult to draw causal inferences on changes in strength and gait energetics. Here we used musculoskeletal modeling and optimal control simulations to perform a longitudinal study (25 virtual "subjects") of the metabolic cost of walking pre- and post-limb loss (unilateral transtibial).

Walking speed differentially alters spinal loads in persons with traumatic lower limb amputation.

Persons with lower limb amputation (LLA) perceive altered motions of the trunk/pelvis during activities of daily living as contributing factors for low back pain. When walking (at a singular speed), larger trunk motions among persons with vs. without LLA are associated with larger spinal loads; however, modulating walking speed is necessary in daily life and thus understanding the influences of walking speed on spinal loads in persons with LLA is of particular interest here.

Psychosocial reactions to upper extremity limb salvage: A case series.

Study Design: Case series.

Introduction: A salvaged limb is one that has undergone a major traumatic injury, followed by repeated surgical attempts in order to avoid amputation. Psychological recovery for individuals with lower extremity limb salvage has been examined in a number of studies.

Creative prosthetic foot selection enables successful ambulation in stiletto high heels.

Background: Walking in high heels presents biomechanical challenges, yet they remain part of many women's attire. However, women with a lower limb amputation are limited in available footwear options. Case description and methods: This case study is in response to one patient's assertion that she walked better and more symmetrically in heels than flat shoes with her below-knee prosthesis.

Modulation of Vertical Ground Reaction Impulse With Real-Time Biofeedback: A Feasibility Study.

Given its apparent representation of cumulative (vs peak) loads, this feasibility study investigates vertical ground reaction impulse (vGRI) as a real-time biofeedback variable for gait training aimed at reducing lower limb loading. Fifteen uninjured participants (mean age = 27 y) completed 12 2-min trials, 1 at each combination of 4 walking speeds (1.0, 1.

Biopsychosocial risk factors associated with chronic low back pain after lower limb amputation.

Low back pain is a common secondary health condition after lower limb amputation with important implications related to functional capabilities and overall quality of life. Despite the high prevalence of low back pain after lower limb amputation, the underlying etiologies of the disorder remain unknown. This hypothesis-driven communication provides evidence in support of using the multifactorial, biopsychosocial model of low back pain experience in the general population for identification of potential risk factors and rehabilitation targets for low back pain after lower limb amputation.

Effects of altering heel wedge properties on gait with the Intrepid Dynamic Exoskeletal Orthosis.

Background: The Intrepid Dynamic Exoskeletal Orthosis is a custom-made dynamic response carbon fiber device. A heel wedge, which sits in the shoe, is an integral part of the orthosis-heel wedge-shoe system. Because the device restricts ankle movement, the system must compensate to simulate plantarflexion and allow smooth forward progression during gait.

Impact of Traumatic Lower Extremity Injuries Beyond Acute Care: Movement-Based Considerations for Resultant Longer Term Secondary Health Conditions.

Advances in field-based trauma care, surgical techniques, and protective equipment have collectively facilitated the survival of a historically large number of service members (SMs) following combat trauma, although many sustained significant composite tissue injuries to the extremities, including limb loss (LL) and limb salvage (LS). Beyond the acute surgical and rehabilitative efforts that focus primarily on wound care and restoring mobility, traumatic LL and LS are associated with several debilitating longer term secondary health conditions (, low back pain [LBP], osteoarthritis [OA], and cardiovascular disease [CVD]) that can adversely impact physical function and quality of life. Despite recent advancements in prosthetic and orthotic devices, altered movement and mechanical loading patterns have been identified among persons with LL and salvage, which are purported risk factors for the development of longer term secondary musculoskeletal conditions and may limit functional outcomes and/or concomitantly impact cardiovascular health.

Gait and Functional Outcomes for Young, Active Males With Traumatic Unilateral Transfemoral Limb Loss.

Objective: Altered body structures that occur with the loss of a lower limb can impact mobility and quality of life. Specifically, biomechanical changes that result from wearing a prosthesis have been associated with an increased risk of falls or joint degeneration, as well as increased energy demands. While previous studies describing these outcomes are typically limited by number of outcome measures and/or small, diverse patient groups, recent military conflicts present a unique opportunity to collect outcomes from a relatively homogenous, active patient population with limb loss.

Psychosocial reactions to upper extremity limb salvage: A cross-sectional study.

Study Design: Descriptive cross-sectional survey study.

Introduction: Limb salvage spares an extremity at risk for amputation after a major traumatic injury. Psychosocial recovery for individuals with lower extremity limb salvage has been discussed in the literature.

Multimodality Imaging Approaches for Evaluating Traumatic Extremity Injuries: Implications for Military Medicine.

Military service members are susceptible to traumatic extremity injuries that often result in limb loss. Tremendous efforts have been made to improve medical treatment that supports residual limb function and health. Despite recent improvements in treatment and novel prosthetic devices, many patients experience a wide range of clinical problems within residual limbs that can negatively impact the progress of rehabilitation programs while also impairing functional capacity and overall quality of life.