Improved Training Program for Fall Prevention of Warfighters with Lower Extremity Trauma

Limb trauma sustained by U.S. Warfighters often results in significant long-term disability. During a 6-month period, Warfighters made approximately 10,280 visits to 33 Department of Defense outpatient clinics for complex wound care and limb salvage. Many patients that underwent these procedures quickly learned that a prosthetic leg or an orthosis is not a good substitute for their uninjured limb, although they provide a means of getting around unaided. After World Wars I and II, a focused effort was made to improve prosthetic legs and, in doing so, the quality of life of a large number of people with amputations. While improved prosthetic legs require less energy to walk than their more primitive predecessors, the designs are still not without problems. Studies have shown that persistent gait asymmetry of Warfighters following lower extremity trauma results in greater demand being placed on their non-injured limb. This higher demand leads to significantly higher rates of osteoarthritis. Further, the reduced demand on the injured limb leads to osteoporosis and, consequently, increased fracture risk. Advances in orthotic and prosthetic design over the past century have been used widely and successfully. Recently, more sophisticated orthotic and prosthetic joints have appeared on the market. People who have received these sophisticated devices have reported that it is easier for them to walk and that they are able to walk with less difficulty. It is thought that these devices result in a more symmetrical gait along with reduced energy required for walking.

After standard rehabilitation for amputation or limb salvage, many Warfighters still struggle with falls, which can exacerbate physical and emotional injury and delay healing. When individuals trip or slip, they are still likely to fall and injure themselves, in spite of advances in rehabilitation care. The proposed project describes a secondary rehabilitation program, implemented after traditional therapy, designed to reduce falls in Warfighters with amputations or salvaged limbs. In our previously funded research program, we showed that through training with a novel technology and method, it is possible to significantly reduce fall risk and the probability of fall-related injuries in active duty Service members with unilateral amputations, a population that endures considerable morbidity and cost due to falls and fall-related injuries. The goals of this work are to augment existing rehabilitation by providing fall-prevention training, to help Warfighters return to full high-level functional capabilities and emotional wellness, and to shorten the time required to return to active duty or to a productive, active civilian life.

The goal of this proposed effort is to build on these previous successes by extending the program to additional military patient populations. Our study has three main objectives, which will be achieved over a 3-year timeframe. First, we will expand the currently successful rehabilitation protocol to active duty Service members who have suffered other combat-related lower limb trauma, specifically those bilateral amputations or salvaged limbs. Second, we will assess whether the benefits of improved motor skills can be retained following training. Third, we will identify, evaluate, and implement existing low-cost methods for measuring trunk control that can be used in lieu of expensive fixed motion capture systems. This will be done so that the rehabilitation program can be transitioned to clinical settings.