Physical Performance Limitations After Severe Lower Extremity Trauma in Military Service Members

Abstract

Objectives: To characterize the type and magnitude of lower extremity physical performance deficits in military service members who have undergone rehabilitation after limb salvage or transtibial amputation. Design: Cross-sectional prospective. Setting: Level I trauma military medical and rehabilitation center. Patients/Participants: Service members with lower extremity trauma resulting in limb salvage (n = 20) or unilateral transtibial amputation (n = 14) compared with uninjured actively training service members (n = 123). Intervention: Control participants and individuals with amputation were tested during a single session. Participants with limb salvage were tested with and without the use of a custom carbon fiber orthosis. Main Outcome Measurements: Physical performance as measured using four-square step, sit-to-stand 5 times, and timed stair ascent tests. Secondary outcomes included the associations between these lower extremity activity measures to determine the interrelationship of activity limitations. Results: The ability of service members to rapidly ascend stairs, a demanding lower limb mobility task, is limited after amputation and limb salvage. However, performance on an agility test similar to the four-square step test approximated normative levels. Differences between individuals with amputation or limb salvage were less than 1 second for all tests and were not statistically significant. Correlations were observed among the physical performance measures in the tested patient populations, particularly between the sit-to-stand and timed stair ascent tests. Conclusions: Severe limb trauma significantly affects performance, particularly during tasks requiring lower extremity strength and power. Individuals with amputation or limb salvage who were provided a custom carbon fiber orthosis and intensive rehabilitation had similar performance. Level of Evidence: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Passive-dynamic ankle-foot orthosis improves medium-term clinical outcomes after severe lower extremity trauma

“…Our findings suggest PDAFO users who complete MDT rehabilitation are able to demonstrate comparable functional and pain responses to elective BKA with advanced prosthesis provision (Figure 3 and Table 3). This observation has recently been demonstrated by US military rehabilitation centres 21…”

Adapting the Wii Fit Balance Board to Enable Active Video Game Play by Wheelchair Users: User-Centered Design and Usability Evaluation

“…Had the participant conducted the trials without her prosthetic leg, however, we would expect that she would have rated the usability of the adapted board more highly. As noted in one study, individuals with unilateral transtibial amputation who used a custom-fit prosthetic leg were able to perform similarly to individuals without amputation on a variety of physical performance measures [ 42 ].…”

Limb Salvage and Recovery After Severe Blast Injury: Eighth Department of Defense International State-of-the-Science Meeting on Blast Injury Research

“…Studies have shown that patients who underwent amputation had shorter time until full weight bearing (Saddawi-Konefka, Kim, and Chung, 2008), could walk greater distances, were more likely to be able to run (Ladlow et al, 2016), and had fewer gait deficiencies with more time spent on the affected limb (Mangan et al, 2016) compared with those who underwent reconstructive surgery. However, another study that examined longer-term mobility (an average of two years following surgery)-as measured by sit-to-stand, four-square step, and timed stair-ascent tests-found no difference between patients who underwent amputation and those who underwent limb salvage (Wilken et al, 2018).…”

“…All of the studies we identified focused on lower-limb amputation versus salvage, and most studies examined multiple or unspecified levels or degrees of amputation and salvage. The most-common specified levels of amputation and reconstruction were transtibial (Penn-Barwell et al, 2015;Saddawi-Konefka, Kim, and Chung, 2008;Wilken et al, 2018) and foot (Bennett et al, 2018;Sheean, Krueger, and Hsu, 2014). Those who underwent transtibial amputation were significantly more likely to return to active duty than those who underwent all other amputation levels .…”