A T C~arious stretching techniques have traditionally been used in an attempt to improve hamstring flexibility. Researchers have compared the effectiveness of different techniques to improve hamstring flexibility, including proprioceptive neuromuscular facilitation relaxation techniques (20,29), modifications of proprioceptive neuromuscular facilitation relaxation techniques (7,l l-l3,15,22,24,25,27,33), ballistic stretching (12,15,25), and static stretching (7,ll-13,15,22,24,25, 27,29,33). Use of nonballistic, active range of motion exercises has been advocated as more effective than static stretching for increasing range of motion (23), yet no published data exist to support this view.Gajdosik (8) pointed out that along with the hamstrings, the deep fascia of the lower limb and the soft tissues of the pelvis, including neurologic tissue (4,10,31), could limit a straight leg raise test. In the same way, these noncontractile tissues can come under tension during passive or active movements of hip flexion or knee extension. If tension of noncontractile tissue limits indirect measures of hamstring flexibility, ie., straight leg raise or active knee extension tests, then use of a stretching technique that emphasizes these tissues, along with the hamstrings, may be justified. Maitland (1 6-18) described a neural tension test (ie., slump test) in which active knee extension is performed by subjects in a sitting position while maintaining cervical and thoracolumbar flexion. This position effectively tensions the dura, spinal cord, and lumbosacral nerve roots (3). A normal response of limited knee extension and ankle dorsiflexion range of motion occurred in the flexed, or slumped posture, but full range was achieved after cervical flexion was released and the head returned to the upright position (16,17). Rather than shortened ham-

Regenerative rehabilitation is the synergistic integration of principles and approaches from the regenerative medicine and rehabilitation fields, with the goal of optimizing form and function as well as patient independence. Regenerative medicine approaches for repairing or replacing damaged tissue or whole organs vary from utilizing cells (e.g., stem cells), to biologics (e.g., growth factors), to approaches using biomaterials and scaffolds, to any combination of these. While regenerative medicine offers tremendous clinical promise, regenerative rehabilitation offers the opportunity to positively influence regenerative medicine by inclusion of principles from rehabilitation sciences. Regenerative medicine by itself may not be sufficient to ensure successful translation into improving the function of those in the most need. Conversely, with a better understanding of regenerative medicine principals, rehabilitation researchers can better tailor rehabilitation efforts to accommodate and maximize the potential of regenerative approaches. Regenerative rehabilitative strategies can include activity-mediated plasticity, exercise dosing, electrical stimulation, and nutritional enhancers. Critical barriers in translating regenerative medicine techniques into humans may be difficult to overcome if preclinical studies do not consider outcomes that typically fall in the rehabilitation research domain, such as function, range of motion, sensation, and pain. The authors believe that encouraging clinicians and researchers from multiple disciplines to work collaboratively and synergistically will maximize restoration of function and quality of life for disabled and/or injured patients, including U.S. Veterans and Military Service Members (MSMs). Federal Government agencies have been investing in research and clinical care efforts focused on regenerative medicine (NIH, NSF, VA, and DoD), rehabilitation sciences (VA, NIH, NSF, DoD) and, more recently, regenerative rehabilitation (NIH and VA). As science advances and technology matures, researchers need to consider the integrative approach of regenerative rehabilitation to maximize the outcome to fully restore the function of patients.

Between 2015 and 2017, the US Department of Veterans Affairs and the US Department of Defense developed a clinical practice guideline for rehabilitation of lower limb amputation to address key clinical questions. A multidisciplinary workgroup of US Department of Veterans Affairs and US Department of Defense amputation care subject matter experts was formed, and an extensive literature search was performed which identified 3685 citations published from January 2007 to July 2016. Articles were excluded based on established review criteria resulting in 74 studies being considered as evidence addressing one or more of the identified key issues. The identified literature was evaluated and graded using the National Academies of Science GRADE criteria. Recommendations were formulated after extensive review. Eighteen recommendations were confirmed with four having strong evidence and workgroup confidence in the recommendation. Key recommendations address patient and caregiver education, consideration for the use of rigid and semirigid dressings, consideration for the use of microprocessor knees, and managed lifetime care that includes annual transdisciplinary assessments. In conclusion, this clinical practice guideline used the best available evidence from the past 10 yrs to provide key management recommendations to enhance the quality and consistency of rehabilitation care for persons with lower limb amputation.

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