Functional outcomes and associated factors of individuals with unilateral traumatic lower limb amputation in Sri Lanka: An observational study.

BACKGROUND: Rehabilitation is important after an amputation surgery. This study was conducted to find the level of functional outcomes of individuals with unilateral traumatic lower limb amputation and the impact of sociodemographic, amputation, and rehabilitation characteristics on functional outcomes. METHODS: An observational cross-sectional study was conducted with 48 participants (aged 20-60 years) who visited the Center for Handicapped from across the country. Functional outcomes were measured using the Locomotor Capabilities Index, Amputee Mobility Predictor with Prosthesis, 6-minute walk distance, and spirometry test and sociodemographic, amputation, and rehabilitation characteristics using a self-constructed questionnaire. RESULTS: Amputee Mobility Predictor with Prosthesis K levels showed 65% had the ability to ambulate in the community and could master environmental barriers. Locomotor Capabilities Index scores showed 96% could independently perform basic daily activities with or without using assistive devices and 83% could perform advanced daily activities. None of the individuals had achieved their predicted 6-minute walk distance, but 52% had "good and above" level of maximum oxygen consumption; restrictive respiratory pattern was indicated among 31%. Amputee Mobility Predictor with Prosthesis and Locomotor Capabilities Index scores were significantly ( p < 0.005) affected by mobility hours/day, amputation level, prosthesis usage, and satisfaction. Six-minute walk distance was significantly ( p < 0.005) related to income, time since amputation, duration of rehabilitation, mobility hours/day, sex, job engagement, previous job, amputation level, K levels, and satisfaction with prosthesis. CONCLUSION: Rehabilitation in Sri Lanka mainly focuses on basic walking training, not on long-term survival, distance walking, and cardiorespiratory endurance, which can lead to future comorbidities. Raising awareness in the society about rehabilitation services and more effective rehabilitation programs are recommended.

Core stability training effects on lower limb rehabilitation of judokas / Efeitos do treino de estabilidade do core na reabilitação em membros inferiores de judocas / Efectos del entrenamiento de la estabilidad del core en la rehabilitación de los miembros inferiores de judokas

ABSTRACT Introduction Judo is a sport that presents a high incidence of sports injuries. Judo athletes want to master their skills to the maximum. Good physical conditioning is necessary to decrease the incidence of surgeries and achieve better results. Core stability exercises can discretely reduce the likelihood of lower limb injuries in judo athletes. Objective This paper examines the rehabilitation of core stability training effects on lower limb injuries in judokas by case studies. Methods A Chinese judo team member with a lower limb injury underwent core stability training. Isokinetic strength tests, body composition tests, and functional checks explored the athlete's physical recovery after training. Results The athletes' lower limbs progressed with good recovery (P<0.05). Additionally, a recovery in fitness level was also noted (P<0.05). Conclusion Core stability training positively affects recovery from lower limb injuries in judokas. Evidence level II; Therapeutic Studies - Investigating the results.

RESUMO Introdução O judô é um esporte com alta incidência de lesões esportivas. Atletas de judô querem dominar o máximo de suas habilidades. Para diminuir a incidência de cirurgias e alcançar melhores resultados é necessário um bom condicionamento físico. Os exercícios de estabilidade do core podem reduzir discretamente a probabilidade de lesões nos membros inferiores em judocas. Objetivo Este artigo analisa o efeito da reabilitação com treino de estabilidade do core em lesões de membros inferiores de judocas por meio de estudos de caso. Métodos Um membro da equipe chinesa de judô com lesão de membro inferior realizou treinamento de estabilidade do core. Foram utilizados testes de força isocinética, testes de composição corporal e verificações funcionais para explorar a recuperação física do atleta após o treino. Resultados Os membros inferiores dos atletas evoluíram com boa recuperação (P<0,05). Adicionalmente, notou-se também uma recuperação no nível de aptidão física (P<0,05). Conclusão O treinamento de estabilidade do core afeta positivamente a recuperação de lesões de membros inferiores em judocas. Nível de evidência II; Estudos terapêuticos - Investigação de resultados.

RESUMEN Introducción El judo es un deporte con alta incidencia de lesiones deportivas. Los atletas de judo quieren dominar el máximo de sus capacidades. Para reducir la incidencia de las cirugías y lograr mejores resultados, es necesario un buen acondicionamiento físico. Los ejercicios de estabilidad del core pueden reducir discretamente la probabilidad de lesiones de las extremidades inferiores en los judokas. Objetivo Este artículo examina el efecto de la rehabilitación con el entrenamiento de la estabilidad del core en las lesiones de las extremidades inferiores en los judokas mediante el estudio de casos. Métodos Un miembro del equipo de judo chino con una lesión en las extremidades inferiores se sometió a un entrenamiento de estabilidad del core. Se utilizaron pruebas de fuerza isocinética, pruebas de composición corporal y controles funcionales para explorar la recuperación física del atleta después del entrenamiento. Resultados Los miembros inferiores de los atletas evolucionaron con una buena recuperación (P<0,05). Además, también se observó una recuperación del nivel de aptitud física (P<0,05). Conclusión El entrenamiento de la estabilidad del core afecta positivamente a la recuperación de las lesiones de las extremidades inferiores en los judokas. Nivel de evidencia II; Estudios terapéuticos - Investigación de resultados.

Hamstring Strain Injury Rehabilitation.

Hamstring strain injuries are common among athletes and often require rehabilitation to prepare players for a timely return to sport performance while also minimizing reinjury risk. Return to sport is typically achieved within weeks of the injury; however, subsequent athlete performance may be impaired, and reinjury rates are high. Improving these outcomes requires rehabilitation practitioners (eg, athletic trainers and physical therapists) to understand the causes and mechanisms of hamstring strain injury, know how to perform a thorough clinical examination, and progress loading to the site of injury safely and effectively. This narrative review discusses current clinical concepts related to these aspects of rehabilitation for hamstring strain injury, with the aim of helping practitioners improve athletes' outcomes. Collectively, this knowledge will inform the implementation of evidence-based rehabilitation interventions.

Elevated Kinesiophobia Is Associated With Reduced Recovery From Lower Extremity Musculoskeletal Injuries in Military and Civilian Cohorts.

OBJECTIVE: The purpose of this study was to examine associations between level of kinesiophobia and improvement in physical function during recovery from lower extremity injury. METHODS: A total 430 adults (mean [SD]: age = 27.3 [6.4] years; sex = 70.5% men; body mass index = 27.6 [5.2] kg/m2) were included in the analyses. Using the Patient-Reported Outcomes Measurement Information System, physical function was evaluated in parallel with treatment from a physical therapist at the initial visit and every 3 weeks until final visit or up to 6 months. A Tampa Scale of Kinesiophobia (TSK-17) score of >41 indicated elevated TSK. Four TSK groups were identified: (1) TSK score improved from >41 at initial visit to <41 by final visit (TSK_I), (2) TSK score was <41 at initial and final visits (TSK-), (3) TSK score was >41 at initial and final visits (TSK+), and (4) TSK score worsened from <41 at initial visit to ≥41 by final visit (TSK_W). Linear mixed effects models were used to examine differences between groups in improved physical function over time, with adjustment for depression and self-efficacy. RESULTS: Groups with elevated kinesiophobia at the final visit had smaller positive improvements in physical function (mean change [95% CI]: TSK+ = 7.1 [4.8-9.4]; TSK_W: 6.0 [2.6-9.4]) compared with groups without elevated kinesiophobia at the final visit (TSK_I = 9.8 [6.4-13.3]; TSK- = 9.7 [8.1-11.3]) by 12 weeks. CONCLUSIONS: Elevated kinesiophobia that persists or develops over the course of care is associated with less improvement in physical function within military and civilian cohorts. IMPACT: The findings of this prospective longitudinal study support the need to assess for elevated kinesiophobia throughout the course of care because of its association with decreased improvement in physical function. LAY SUMMARY: To help improve your physical function, your physical therapist can monitor the interaction between fear of movement and your clinical outcomes over the course of treatment.

Muscle damaging eccentric exercise attenuates disuse-induced declines in daily myofibrillar protein synthesis and transiently prevents muscle atrophy in healthy men.

Short-term disuse leads to muscle loss driven by lowered daily myofibrillar protein synthesis (MyoPS). However, disuse commonly results from muscle damage, and its influence on muscle deconditioning during disuse is unknown. Twenty-one males [20 ± 1 yr, BMI = 24 ± 1 kg·m-2 (± SE)] underwent 7 days of unilateral leg immobilization immediately preceded by 300 bilateral, maximal, muscle-damaging eccentric quadriceps contractions (DAM; subjects n = 10) or no exercise (CON; subjects n = 11). Participants ingested deuterated water and underwent temporal bilateral thigh MRI scans and vastus lateralis muscle biopsies of immobilized (IMM) and nonimmobilized (N-IMM) legs. N-IMM quadriceps muscle volume remained unchanged throughout both groups. IMM quadriceps muscle volume declined after 2 days by 1.7 ± 0.5% in CON (P = 0.031; and by 1.3 ± 0.6% when corrected to N-IMM; P = 0.06) but did not change in DAM, and declined equivalently in CON [by 6.4 ± 1.1% (5.0 ± 1.6% when corrected to N-IMM)] and DAM [by 2.6 ± 1.8% (4.0 ± 1.9% when corrected to N-IMM)] after 7 days. Immobilization began to decrease MyoPS compared with N-IMM in both groups after 2 days (P = 0.109), albeit with higher MyoPS rates in DAM compared with CON (P = 0.035). Frank suppression of MyoPS was observed between days 2 and 7 in CON (IMM = 1.04 ± 0.12, N-IMM = 1.86 ± 0.10%·day-1; P = 0.002) but not DAM (IMM = 1.49 ± 0.29, N-IMM = 1.90 ± 0.30%·day-1; P > 0.05). Declines in MyoPS and quadriceps volume after 7 days correlated positively in CON (r2 = 0.403; P = 0.035) but negatively in DAM (r2 = 0.483; P = 0.037). Quadriceps strength declined following immobilization in both groups, but to a greater extent in DAM. Prior muscle-damaging eccentric exercise increases MyoPS and prevents loss of quadriceps muscle volume after 2 (but not 7) days of disuse.NEW & NOTEWORTHY We investigated the impact of prior muscle-damaging eccentric exercise on disuse-induced muscle deconditioning. Two and 7 days of muscle disuse per se lowered quadriceps muscle volume in association with lowered daily myofibrillar protein synthesis (MyoPS). Prior eccentric exercise prevented the decline in muscle volume after 2 days and attenuated the decline in MyoPS after 2 and 7 days. These data indicate eccentric exercise increases MyoPS and transiently prevents quadriceps muscle atrophy during muscle disuse.

Military Service Members with Major Lower Extremity Fractures Return to Running with a Passive-dynamic Ankle-foot Orthosis: Comparison with a Normative Population.

BACKGROUND: Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. QUESTIONS/PURPOSES: Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. METHODS: We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. RESULTS: For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. CONCLUSION: The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. LEVEL OF EVIDENCE: Level III, therapeutic study.

The Influence of Injury History on Countermovement Jump Performance and Movement Strategy in Professional Soccer Players: Implications for Profiling and Rehabilitation Foci.

CONTEXT: Professional soccer players who have sustained a lower limb injury are up to 3× more likely to suffer a reinjury, often of increased severity. Previous injury has been shown to induce compensatory strategies during neuromuscular screening tests, which might mask deficits and lead to misinterpretation of readiness to play based on task outcome measures. OBJECTIVE: To investigate the influence of previous injury in professional soccer players on countermovement jump (CMJ) performance and movement strategy. DESIGN: Cross-sectional. SETTING: Professional soccer club competing in the English Championship (tier 2). Patients (or Other Participants): Outfield players with a minimum of 6 years as a professional. INTERVENTION(S): Players were categorized as previously injured (n = 10) or not injured (n = 10). All players completed double- and single-leg CMJ trials. MAIN OUTCOME MEASURES: CMJ performance was quantified as jump height and flight time:contraction time ratio. CMJ movement strategy was quantified as force-time history, differentiating eccentric and concentric phases and CMJ depth. RESULTS: Double-leg CMJ was not sensitive to previous injury in performance or movement strategy. In contrast, single-leg CMJ performance was impaired in players with previous injury, who generated significantly lower eccentric and concentric peak force and rate of force development, and a deeper countermovement. Impaired single-leg CMJ performance was also evident in the nonaffected limb of previously injured players, suggesting cross-contamination. Hierarchical ordering revealed that the eccentric phase of the CMJ contributed little to performance in previously injured players. In noninjured players, the eccentric rate of force development and concentric peak force were able to account for up to 89% of the variation in CMJ performance. CONCLUSIONS: Single-leg CMJ is advocated for player profiling, being more sensitive to previous injury, and negating the opportunity for interlimb compensation strategies. Movement strategy deficits in previously injured players suggest rehabilitation foci specific to eccentric force development.

Using Normative Data and Unilateral Hopping Tests to Reduce Ambiguity in Return-to-Play Decisions.

CONTEXT: After a lower extremity injury, patients often return to sport (RTS) when the injured limb's performance on unilateral hopping tests is similar to that of the uninjured limb. However, the exact target symmetry value patients must reach before the RTS is unclear. OBJECTIVE: To identify variables that predict limb symmetry index (LSI) values on 6 unilateral hopping tests in healthy, physically active adults. DESIGN: Cross-sectional study. SETTING: Research laboratory. PATIENTS OR OTHER PARTICIPANTS: In total, 275 healthy, physically active adults, consisting of recreational athletes (n = 198), National Collegiate Athletic Association Division I student-athletes (n = 56), and Army Reserve Officer Training Corps cadets (n = 21), volunteered to participate (143 men, 132 women, age = 20.16 ± 2.19 years, height = 172.66 ± 10.22 cm, weight = 72.64 ± 14.29 kg). INTERVENTION(S): Each participant completed 3 speed (6-m crossover-hop, side-hop, figure-8 hop) and 3 distance (triple-crossover-hop, lateral-hop, medial-hop) functional performance tests on both limbs. MAIN OUTCOME MEASURE(S): Mean performance of the dominant and nondominant limbs and LSI values. Two multiple regression models were used to find variables that might help to predict a participant's LSI for each functional performance test. RESULTS: The models helped to predict limb symmetry for 10 of the 12 multiple regressions. Unilateral limb performance was the best predictor of LSI values, as it was statistically significant in 11 of the 12 regression models. Sex and body mass index were significant predictor variables for the side hop and figure-8 hop, respectively. CONCLUSIONS: We found significant predictor variables that clinicians can use in the absence of baseline testing to determine patient-specific LSI values. Individualizing RTS decisions in this way may help to minimize subjectivity in the decision-making process and ensure a safe and timely return to competition.

Management of Lower Extremity Fractures in the Elderly: A Focus on Post-Operative Rehabilitation.

Fractures in the elderly population are increasing in incidence and represent a rising burden of disease. It is difficult for the elderly population to adhere to restricted weight bearing, and immobility poses significant risks and increased morbidity. Therefore, a primary goal of fracture management in the elderly population is early post-operative weight bearing. This review examines published literature regarding lower extremity fracture management in the elderly, with a focus on post-operative rehabilitation. While extensive literature supports early weight bearing after hip fractures in the elderly, further research is warranted to provide guidelines for management of other lower extremity fractures in this population.

Spinal manual therapy and exercises for chronic hamstring injuries in a sprinter: A case report.

INTRODUCTION: Hamstring injuries tend to be chronic in nature and thus require considerable recovery time in athletes. Although some rehabilitation protocols have been previously advocated, there is no consensus in terms of the treatment protocol for chronic hamstring injuries. METHODS: We present the case of a 15-year-old male sprinter who was successfully treated with a combination of manual therapy targeting the lumbosacral region and hamstring-specific exercises. The patient presented with hamstring pain which persisted for 7 weeks. RESULTS: Manual therapy immediately reduced pain and increased muscle strength. The patient was able to run satisfactorily without pain 30 days after the initial intervention. CONCLUSIONS: This case report suggests that the use of manual therapy targeting the lumbosacral region, along with hamstring exercises, may be beneficial in chronic hamstring pain management.

Heterotrophic Ossification in Patient With Prosthetic Leg.

Heterotrophic ossification (HO) is a well-described phenomenon in patients with spinal cord injury, head injury, burns, hip replacement, and general trauma. However, it has also been described through a relative paucity of case reports that repeated microtrauma from the use of weight-bearing leg prostheses is an additional possible cause of HO. In our case, we examine a patient who developed an extreme case of HO after he began an exercise regimen with assistance from a running limb. This abnormal formation was actually advantageous because it created a more snug fit of the prosthetic device and improved the patient's ability to run.

Efectividad de la Wii Fit Balance frente a otras intervenciones para la recuperación del equilibrio en pacientes postictus. Revisión sistemática y metaanálisis / Effectiveness of Wii Fit Balance board in comparison with other interventions for post-stroke balance rehabilitation. Systematic review and meta-analysis

Introducción: La realidad virtual es una herramienta terapéutica en auge dentro del campo de la neurorrehabilitación. Entre los sistemas de realidad virtual no inmersiva más empleados destaca la videoconsola Wii Fit Balance. Objetivo: Revisar la literatura científica publicada en los últimos años acerca de la efectividad de la herramienta Wii Fit Balance para el entrenamiento del equilibrio en pacientes que han sufrido un ictus en comparación con las terapias convencionales y analizar dicha información desde un punto de vista cuantitativo y cualitativo. Sujetos y métodos: Se ha llevado a cabo una búsqueda en las bases de datos PubMed, Lilacs, PEDro, Scopus, Web of Science y Cochrane Library. Los descriptores de búsqueda utilizados fueron «Wii Fit Balance», «Wii», «stroke», «ictus» y «balance». Se analiza la calidad metodológica de los estudios incluidos a través de la escala PEDro. Para las variables que fue posible, se llevó a cabo un metaanálisis. Resultados: Se seleccionaron 16 ensayos clínicos aleatorizados para la revisión sistemática, y seis de ellos se incluyeron en el metaanálisis. Dentro del análisis descriptivo se observó heterogeneidad de resultados. Esta misma situación se confirmó a través de los resultados del metaanálisis, ya que tanto para las variables de equilibrio estático como dinámico analizadas se observaron mejoras intragrupo, pero sin que existieran diferencias significativas entre grupos postintervención. Conclusiones: La plataforma de realidad virtual Wii Fit Balance es una herramienta terapéutica válida que ha demostrado ser al menos igual de efectiva que el entrenamiento convencional del equilibrio en pacientes postictus

Introduction: Virtual reality is a booming therapeutic tool within the eurorehabilitation field. Among the different non-inmersive virtual reality systems, the most outstanding is the platform, Wii Fit Balance. Aim: To review the scientific literature published in recent years about the effectiveness of Wii Fit Balance tool. The use of this platform for balance training in patients who have suffered a stroke compared to conventional therapies is going to be analyzed from a quantitative and qualitative point of view. Subjects and methods: A search of the databases has been carried out: PubMed, Lilacs, PEDro, Scopus, Web of Science and Cochrane Library. Descriptors employed were «Wii Fit Balance», «Wii», «stroke», «ictus» and «balance». Studies were analyzed methodologically by PEDro Scale. For those possible variables a meta-analysis was elaborated. Results: Sixteen randomized clinical trials were selected for the systematic review and six of them were included in the meta-analysis. Results for the descriptive analysis were heterogeneous. This situation is confirmed through the meta-analysis results, because the analyzed variables for static and dynamic balance show intra-group improvement and no significant differences between groups post-intervention. Conclusion: Wii Fit Balance, virtual reality platform, is an available therapeutic tool which has been shown at least as effective as conventional balance training in post-stroke patients

Hamstring rehabilitation in elite track and field athletes: applying the British Athletics Muscle Injury Classification in clinical practice.

RATIONALE: Hamstring injuries are common in elite sports. Muscle injury classification systems aim to provide a framework for diagnosis. The British Athletics Muscle Injury Classification (BAMIC) describes an MRI classification system with clearly defined, anatomically focused classes based on the site of injury: (a) myofascial, (b) muscle-tendon junction or (c) intratendinous; and the extent of the injury, graded from 0 to 4. However, there are no clinical guidelines that link the specific diagnosis (as above) with a focused rehabilitation plan. OBJECTIVE: We present an overview of the general principles of, and rationale for, exercise-based hamstring injury rehabilitation in British Athletics. We describe how British Athletics clinicians use the BAMIC to help manage elite track and field athletes with hamstring injury. Within each class of injury, we discuss four topics: clinical presentation, healing physiology, how we prescribe and progress rehabilitation and how we make the shared decision to return to full training. We recommend a structured and targeted diagnostic and rehabilitation approach to improve outcomes after hamstring injury.

Multipurpose Virtual Reality Environment for Biomedical and Health Applications.

Virtual reality is a trending, widely accessible, and contemporary technology of increasing utility to biomedical and health applications. However, most implementations of virtual reality environments are tailored to specific applications. We describe the complete development of a novel, open-source virtual reality environment that is suitable for multipurpose biomedical and healthcare applications. This environment can be interfaced with different hardware and data sources, ranging from gyroscopes to fMRI scanners. The developed environment simulates an immersive (first-person perspective) run in the countryside, in a virtual landscape with various salient features. The utility of the developed VR environment has been validated via two test applications: an application in the context of motor rehabilitation following injury of the lower limbs and an application in the context of real-time functional magnetic resonance imaging neurofeedback, to regulate brain function in specific brain regions of interest. Both applications were tested by pilot subjects that unanimously provided very positive feedback, suggesting that appropriately designed VR environments can indeed be robustly and efficiently used for multiple biomedical purposes. We attribute the versatility of our approach on three principles implicit in the design: selectivity, immersiveness, and adaptability. The software, including both applications, is publicly available free of charge, via a GitHub repository, in support of the Open Science Initiative. Although using this software requires specialized hardware and engineering know-how, we anticipate our contribution to catalyze further progress, interdisciplinary collaborations and replicability, with regards to the usage of virtual reality in biomedical and health applications.

Biomechanical improvements following foot strike biofeedback training for a patient using a passive dynamic ankle-foot orthosis during running.

BACKGROUND AND PURPOSE: Passive dynamic ankle-foot orthoses have potential to facilitate return to running after a lower limb trauma. However, transitioning patients to new movement patterns that enhance passive dynamic ankle-foot orthoses benefits can pose a challenge. The purpose of this case study was to report biomechanical and functional outcomes for a patient utilizing a passive dynamic ankle-foot orthoses following completion of a session-based, midfoot strike run training program. CASE DESCRIPTION AND METHODS: A patient using a passive dynamic ankle-foot orthoses to run due to surgically reconstructed tibia\fibula fracture underwent eight treadmill running sessions over 2 weeks while viewing continuous visual feedback on measured foot strike. FINDINGS AND OUTCOMES: After treatment, foot strike was changed from rearfoot to midfoot on the affected limb along with an 18% increase in mechanical work ratio of the ankle-foot-brace complex. Similar improvements were retained at one and five months following treatment. CONCLUSION: This report provides preliminary evidence that biofeedback-based foot strike training can enhance ankle-foot mechanical performance of patients using a passive dynamic ankle-foot orthoses to run. CLINICAL RELEVANCE: For patients using a passive dynamic ankle-foot orthoses to run following lower limb trauma, supplementing standard rehabilitation programs with biofeedback-based footstrike training may improve biomechanical performance and running capability.

The Relationship Among 3 Generic Patient-Reported Outcome Instruments in Patients With Lower Extremity Health Conditions.

CONTEXT: Generic patient-reported outcome (PRO) instruments are designed to capture health-related quality-of-life outcomes and to determine treatment effectiveness from the patient's perspective. Multiple generic PROs are used in clinical practice, and an investigation of the psychometric properties of these instruments in a high-functioning, physically active population is important for the future use of these instruments. OBJECTIVE: To determine the relationship among 3 generic PROs: the modified Disablement in the Physically Active (mDPA) Scale, the Patient-Reported Outcome Measurement Information System Physical Function (PROMIS-PF), and the Short Form 12 (SF-12) in physically active patients seeking treatment for a lower extremity health condition. DESIGN: Cross-sectional study. SETTING: Athletic training clinical facility, physical therapy clinic. PATIENTS OR OTHER PARTICIPANTS: One hundred patients seeking rehabilitation services for a lower extremity health condition. MAIN OUTCOME MEASURE(S): All patients completed a demographic questionnaire and the 3 generic PROs at 1 time point during their rehabilitation: the mDPA-Total, mDPA-physical summary component (mDPA-PSC), mDPA-mental summary component (mDPA-MSC), the PROMIS-PF, and SF-12 mental component summary (SF-MCS) and physical component summary (SF-PCS). Separate Spearman rank (r) correlations were performed to assess the strength of the relationship among PRO instruments. The floor and ceiling effects were also examined. RESULTS: A strong relationship was present between the SF-12 PCS and the mDPA-Total (r = -0.65), the mDPA-PSC (r = -0.64), and the PROMIS-PF (r = 0.65). Significant moderate relationships were identified between the mDPA-MSC and the SF-12 PCS (r = -0.43) and MCS (r = -0.53). Weak relationships were noted between the mDPA-Total and SF-12 MCS (r = -0.21) and the SF-12 MCS and mDPA-PSC (r = -0.10) and PROMIS-PF (r = 0.20). CONCLUSIONS: The PROMIS-PF and mDPA had good convergent and divergent validity. Clinicians treating physically active patients should consider these instruments for use in clinical practice. Future researchers should examine additional psychometric properties of these instruments in physically active patients.

High-Level Performance After the Return to Run Clinical Pathway in Patients Using the Intrepid Dynamic Exoskeletal Orthosis.

BACKGROUND: Severe ankle and foot injuries in the US military can result in high-level functional limitation, lost duty days, and medical discharge. OBJECTIVE: To assess the effectiveness of the Return to Run Clinical Pathway (RTR) in returning patients with lower extremity fractures who utilized the Intrepid Dynamic Exoskeletal Orthosis (IDEO) to high-level mobility. METHODS: Thirty servicemembers with lower extremity fractures who utilized the IDEO unilaterally and completed the RTR at Naval Medical Center San Diego were included in this retrospective operational review. The Comprehensive High-level Activity Mobility Predictor (CHAMP) and all subtests were completed prior to and after completion of the RTR as part of routine clinical care. An analysis of covariance (ANCOVA) was used to compare CHAMP scores before and after the RTR. RESULTS: Significant improvements were found in the T test (mean change, faster by 5.3 seconds; 95% confidence interval: 3.6, 7.1 seconds; P = .03) and total CHAMP score (mean change, 4.2 points; 95% confidence interval: 3.0, 5.3 points; P<.05). No significant changes were noted in the single-legged stance subtest, the Edgren sidestep test, or the Illinois agility test. CONCLUSION: The RTR led to improvements in high-level, multidirectional mobility in IDEO users with a history of fractures. Applicability of the intervention used in this study requires further validation before widespread use. LEVEL OF EVIDENCE: Therapy, level 4. J Orthop Sports Phys Ther 2019;49(7):529-535. Epub 13 Feb 2019. doi:10.2519/jospt.2019.8763.

Mobility, prosthesis use and health-related quality of life of bilateral lower limb amputees from the 2008 Sichuan earthquake.

BACKGROUND:: The 2008 Sichuan Earthquake resulted in many amputees, yet due to the rare incidence, few studies have explored the rehabilitation outcomes and quality of life of bilateral lower limb amputees after major natural disasters. OBJECTIVES:: To evaluate rehabilitation outcomes of 17 young and adult bilateral lower limb amputees under the StandTall rehabilitation programme and to identify factors associated with successful functional recovery of bilateral amputees after large-scale disasters. STUDY DESIGN:: Cross-sectional study. METHODS:: Mobility (amputee mobility predictor), prosthesis use (Houghton Scale) and health-related quality of life (Trinity Amputation and Prosthesis Experience Scale, Short Form 12) were evaluated through questionnaires and performance-based assessments. Means of scores were compared using T-tests. RESULTS:: Subjects with bilateral through-knee or transtibial amputations had less activity restriction ( p < 0.01) and higher mobility ( p = 0.03). Subjects using prostheses more than 50% waking time had better general adjustment ( p = 0.02) and less functional restriction ( p = 0.01). Exercise and education were associated with higher mobility ( p = 0.06) and mental quality of life, respectively ( p = 0.09). CONCLUSIONS:: Amputation level and knee joint salvage, prosthesis use, exercise and education were associated with better rehabilitation outcomes including ambulation, adjustment and quality of life in bilateral lower limb amputees from the 2008 Sichuan Earthquake. CLINICAL RELEVANCE: The study examined a unique group of traumatic bilateral lower limb amputees who were young and healthy before having traumatic amputations from a single episode of natural disaster. The factors associated with better functional recovery after the earthquake were investigated and may support future development of post-disaster rehabilitation strategies for bilateral lower limb amputees.

Validity of an On-Field Readaptation Program Following a Hamstring Injury in Professional Soccer.

CONTEXT: Despite the presence of various injury prevention programs, the rate of hamstring injuries and reinjuries is increasing in soccer, warranting the need for a soccer-specific rehabilitation program. OBJECTIVE: To develop and validate a new, functional on-field program for the rehabilitation and readaptation of soccer players after a hamstring strain injury through a panel of experts; and determine the usefulness of the program through its application in professional soccer players. DESIGN: A 13-item program was developed, which was validated by a panel of experts and later applied to professional soccer players. SETTING: Soccer training ground. PARTICIPANTS: Fifteen strength and conditioning and rehabilitation fitness coaches with a professional experience of 15.40 (1.57) years in elite clubs and national teams in Europe validated the program. The program was later applied to 19 professional soccer players of the Spanish First Division (La Liga). INTERVENTIONS: Once a player sustained a clinically diagnosed injury, the player would first be subject to mobilization and strengthening exercises in the gym after undergoing treatment by percutaneous needle electrolysis. The player would then complete an on-field readaptation program consisting of 13 drills arranged in a progressive manner in terms of complexity. The drills integrated various aspects of repeated sprint abilities, retraining and reeducation of biomechanical patterns, and neuromuscular control of the core and lower limbs. MAIN OUTCOME MEASURES: Aiken's V for each item of the program and number of days taken by the players to return to play. RESULTS: The experts evaluated all items of the program very highly, as seen from Aiken's V values between 0.78 and 0.98 (0.63-0.99) for all drills, while the return to play was in 22.42 (2.32) days. CONCLUSION: This program has the potential to help a player suffering from a hamstring strain injury to adapt to real-match conditions in the readaptation phase through the application of sports-specific drills that were very similar to the different injury mechanisms.

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

INTRODUCTION: Individuals with delayed below-knee amputation have previously reported superior clinical outcomes compared with lower limb reconstruction. The UK military have since introduced a passive-dynamic ankle-foot orthosis (PDAFO) into its rehabilitation care pathway to improve limb salvage outcomes. The aims were to determine if wearing a PDAFO improves medium-term clinical outcomes and what influence does multidisciplinary team (MDT) rehabilitation have after PDAFO fitting? Also, what longitudinal changes in clinical outcomes occur with MDT rehabilitation and how do these results compare with patients with previous lower extremity trauma discharged prior to PDAFO availability? METHODS: We retrospectively evaluated levels of mobility, activities of daily living, anxiety, depression and pain in a heterogeneous group of 23 injured UK servicemen 34±11 months after PDAFO provision. We also retrospectively analysed 16 patients across four time points (pre-PDAFO provision, first, second and final inpatient admissions post-PDAFO provision) using identical outcome measures, plus the 6 min walk test. RESULTS: Outcomes were compared with previous below-knee limb salvage and amputees. Before PDAFO, 74% were able to walk and 4% were able to run independently. At follow-up, this increased to 91% and 57%, respectively. Mean depression and anxiety scores remained stable over time (p>0.05). After 3 weeks, all patients could walk independently (pre-PDAFO=31%). Mean 6 min walk distance significantly increased from 440±75 m (pre-PDAFO) to 533±68 m at last admission (p=0.003). The ability to run increased from 6% to 44% after one admission. CONCLUSIONS: All functional and most psychosocial outcomes in PDAFO users were superior to previous limb salvage and comparable to previous below-knee amputees. The PDAFO facilitated favourable short-term and medium-term changes in all clinical outcome measurements.