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Study Design: Pretest/posttest case series design., Introduction: Rates of prosthetic device abandonment are highest among persons with upper extremity (UE) amputation. Modified Constraint-Induced Movement Therapy (mCIMT), which has been extensively studied in patients with chronic, subacute, and acute stroke, is an under-utilized approach to treat persons with UE amputation., Purpose of the Study: To present an mCIMT intervention for prosthetic device training after a unilateral UE amputation., Methods: The two cases from an advanced rehabilitation center herein described followed a standard UE amputation rehabilitation program used in conjunction with a home training program using mCIMT 3 hours a day, 5 days a week, for 3 weeks. Progress was evaluated weekly using the Activities Measure for Upper Limb Amputees (AM-ULA); Disabilities of the Arm, Shoulder, and Hand; Trinity Amputation and Prosthesis Experience Scales-Revised., Results: Both the cases exhibited an increase in observable and objective functional use with a UE prosthetic device, as indicated by the AM-ULA., Conclusions: To our knowledge, this is the first description of mCIMT as part of a unilateral UE amputee rehabilitation program. The AM-ULA results show meaningful change, whereas Disabilities of the Arm, Shoulder, and Hand and Trinity Amputation and Prosthesis Experience Scales-Revised show mixed results., (Copyright © 2018 Hanley & Belfus. All rights reserved.)

Introduction: Polytrauma, to include major limb amputation, in a military population presents unique rehabilitation challenges with the overarching goal of restoring function leading to the primary question, "Is this Service Member (SM) capable of returning to duty following rehabilitation?" The US military has a vested interest in maximizing injured SMs occupational performance to allow for return to duty. The purpose of this report is to describe marksmanship (shot grouping and weapon qualification) and return to duty outcomes following a course of VRE-based firearm training in a polytrauma patient population., Methods: The medical records, stored in the Armed Forces Health Longitudinal Technology Application (AHLTA), of all patients who received rehabilitative care at the Center for the Intrepid (CFI) to include VRE-based firearms training between 01OCT2015 and 01AUG2016 were manually reviewed for inclusion. Subjects included all adult (18 years and older) SMs (active duty at time of admission) with a diagnosis of polytrauma who had been referred to and treated (received additional services such as physical and or occupational therapy) at the CFI. Approval for this research was received from the Brooke Army Medical Center Department of Clinical Investigation Office of the Institutional Review Board., Results: Medical records of 30 SMs with a polytrauma diagnosis met the inclusion criteria. Mean shot group sizes for the M9 and M4 weapon decreased between initial and post training time points for the M9 zero (p = 0.009) and M4 zero (p = 0.020). There was no significant difference between initial and post training time points at the other shooting distances with either weapon. There was an 89% qualification rate for both the M9 (n = 18) and M4 (n = 19) weapons for those who attempted qualification; 43% of the population (n = 13) did not attempt qualification with either weapon., Conclusion: SMs with polytrauma demonstrated a high rate of weapon qualification (accuracy) following VRE-based firearm training. Shot group size (precision) at short distances with a M9 pistol and M4 rifle also improved with training. While overall marksmanship appeared to improve, high return to duty rates were not directly related to firearm training or marksmanship. Future efforts need to focus on consistent clinical documentation of firearm training procedure and the establishment of psychometric properties for marksmanship outcome measures., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2019.)

Study Design: Prospective, repeated-measures study., Introduction: Understanding individual hand function can assist therapists with the process of determining relevant treatment approaches and realistic therapeutic outcomes. At this point in time, a composite test that assesses both unilateral and bimanual hand function in relation to a functional activity is not available., Purpose of the Study: To establish the reliability and validity of the suitcase packing activity (SPA)., Methods: An expert panel established face and content validity. Eighty healthy, English-speaking volunteers aged between 18 and 45 years were randomly assigned to either 1 or 2 sessions (test-retest reliability). Relative agreement between 2 examiners using an intraclass correlation coefficient (ICC) 3,1 determined interrater reliability. Test-retest reliability was determined by using a repeated-measures analysis of variance and an ICC 3,2 . Concurrent validity was evaluated against 2 well-established hand evaluations using separate tests of correlational coefficients., Results: Face and content validity were established across 4 focus groups. Our results demonstrate good to excellent interrater reliability (ICC 3,1 ≥ 0.93) and good to excellent test-retest reliability (ICC 3,2 ≥ 0.83). SPA scores were moderately correlated with the 2-hand evaluations., Discussion: Through evaluating hand function during participation in a goal-directed activity (eg, packing a suitcase), the SPA exhibits promise in usefulness as a future viable outcome measure that can be used to assess functional abilities following a hand injury., Conclusion: The SPA is a valid and reliable tool for assessing bimanual and unilateral hand function in healthy subjects., Levels of Evidence: Diagnostic level II., (Published by Elsevier Inc.)

Crossed dominance (CD) is defined as an individual's dominant hand and dominant eye being on opposite sides of the body. CD negatively impacts an individual's ability to accurately aim and fire long-barreled guns. The authors developed and evaluated a hand dominance transfer (HDT) intervention to improve the M16 rifle shooting accuracy, efficiency, and skill transfer. Twenty-four U.S. Army soldiers with CD were taught how to handle and fire an M16 rifle using the nondominant hand. Training was conducted at a military, indoor laser-equipped weapons simulator. Accuracy for shooting 40 rounds at baseline with the nondominant eye and dominant hand (NDE/DH) was 22.12 compared to shooting 30.46 with the dominant eye and nondominant hand (DE/NDH). This difference was statistically significant with p = .000. The transfer of shooting accuracy skill (retention) following the HDT intervention was 33.42 with a comparative p value of .100. Efficiency of shooting 10 rounds at baseline with the NDE/DH was 6.3 compared to shooting 7.3 with the DE/NDH. This difference was not statistically significant (p = .107). The transfer of shooting efficiency skill (retention) was 7.96 with a comparative p value of .349. This study supports shooting with the DE/NDH. HDT could be further developed to address the soldiering skill of shooting an M16.

A functional capacity evaluation (FCE) evaluates the ability of an individual to perform activities related to employment. There is no FCE specific to the military population; therefore, a FCE for the military population (FCE-M) was developed to evaluate an injured service member's (SM) ability to return to duty. The FCE-M is herein described along with descriptions of three active duty SMs who completed the evaluation. The three SMs completed all categories of the FCE-M with the first two cases achieving a work-level classification of Heavy-Very Heavy and the third a classification of Medium-Heavy. The FCE-M provides a systematic assessment of performance of highly specified military tasks and may provide value in assessing readiness for returning to duty., (Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.)