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INTRODUCTION: Transitioning between the ground and standing is a required activity for many professions including skilled trades, law enforcement, and military service. However, available assessments are limited and focus primarily on quality of movement. Thus, we developed two novel assessments of functional mobility specific for ground-to-standing transitions: Stand-Prone-Standx2 (SPS2) and Stand-Kneel-Standx2 (SKS2-L/R) tests. The purpose of this study was to determine the psychometrics of these two new measures in able-bodied (AB) service members and in service members with unilateral lower extremity injury (LEI). MATERIALS AND METHODS: A total of 57 AB service members and 31 service members with a traumatic unilateral LEI wearing a custom carbon-fiber ankle-foot orthosis participated in this study. In total, 36 AB and 18 LEI participants returned for a second session to assess intersession reliability. Intraclass correlation coefficients were calculated for intersession and inter-rater comparisons (two-way random model for consistency and single measure). Additionally, performance was compared between legs and groups. RESULTS: The SPS2 and SKS2 assessments demonstrated excellent inter-rater and intersession reliability in both the AB and LEI groups with all intraclass correlation coefficient values greater than 0.8. Further, the tests were responsive to deficits associated with LEI, with the LEI group having significantly longer times on all assessments compared to the AB group. CONCLUSIONS: The SPS2 and SKS2 performance measures were found to have excellent inter-rater and intersession reliability in both AB participants and participants with LEI. Further, participants with LEI performed significantly slower than the AB participants. Excellent reliability and responsiveness to deficits associated with LEI support the use of the SPS2 and SKS2 to assess mobility in individuals with LEI. Transitions between the ground and standing occur in many occupational and daily tasks. These reliable performance measures that assess ground-to-stand transitions can be applied widely, in many populations beyond highly functioning service members with LEI.
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OBJECTIVE: To compare the metabolic demands of walking in individuals with lower limb injury with and without ankle-foot orthosis (AFO) use. A secondary aim was to compare these results with those from individuals with unilateral transtibial amputation (TTA) and able-bodied controls. DESIGN: Cross-sectional study. SETTING: Two clinical research centers. PARTICIPANTS: Thirteen individuals (N=13) with lower limb injury who used a passive-dynamic AFO underwent metabolic analysis at 3 standardized speeds with and without their AFO. Results were compared with individuals with unilateral TTA who used a passive prosthetic foot and able-bodied controls with no musculoskeletal, neurologic, or cardiovascular deficits. MAIN OUTCOME MEASURES: Oxygen consumption, heart rate, and rating of perceived exertion. RESULTS: The use of the passive-dynamic AFO did not significantly change energetic demand (oxygen consumption, heart rate, perceived exertion) in participants with a lower limb [LL] injury. Heart rate (P<.037) was significantly greater than able-bodied controls, but perceived exertion was significantly lower (P≤.031). There were no significant differences between participants with an LL injury (with or without the AFO) and individuals with TTA. CONCLUSIONS: Many individuals with LL injuries may expect to use passive-dynamic AFOs with little to no metabolic consequence. The stabilizing and assistive benefits of the AFO likely balance with its well-known range of motion limitations and power reductions. Passive-dynamic AFO use can sometimes be an alternative for individuals considering TTA. These results support that AFO users may be able to achieve similar energetic demands as those with amputation.