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Background: Ankle-foot orthoses (AFOs) are commonly used to overcome mobility limitations related to lower limb musculoskeletal injury. Despite a multitude of AFOs to choose from, there is scant evidence to guide AFO prescription and limited opportunities for AFO users to provide experiential input during the process. To address these limitations in the current prescription process, this study evaluates a novel, user-centered and personalized 'test-drive' strategy using a robotic exoskeleton ('AFO emulator') to emulate commercial AFO mechanical properties (i.e., stiffness). The study will determine if brief, in-lab trials (with emulated or actual AFOs) can predict longer term preference, satisfaction, and mobility outcomes after community trials (with the actual AFOs). Secondarily, it will compare the in-lab experience of walking between actual vs. emulated AFOs. Methods and analysis: In this participant-blinded, randomized crossover study we will recruit up to fifty-eight individuals with lower limb musculoskeletal injuries who currently use an AFO. Participants will walk on a treadmill with three actual AFOs and corresponding emulated AFOs for the "in-lab" assessments. For the community trial assessment, participants will wear each of the actual AFOs for a two-week period during activities of daily living. Performance-based and user-reported measures of preference and mobility will be compared between short- and long-term trials (i.e., in-lab vs. two-week community trials), and between in-lab trials (emulated vs. actual AFOs). Trial registration: The study was prospectively registered at www.clininicaltrials.gov (Clinical Trials Study ID: NCT06113159). Date: November 1st 2023. https://classic.clinicaltrials.gov/ct2/show/NCT06113159. [ABSTRACT FROM AUTHOR]

To determine gender disparities and potential factors that modify prosthesis prescription practices in veteran patients who have undergone their first major unilateral amputation due to diabetes or peripheral arterial disease. A retrospective cohort study using the VA Corporate Data Warehouse to compare prosthesis prescription rates and time to prescription between men and women veterans. The primary exposure was gender. The primary outcome was a qualifying prosthesis prescription within 12 months of the incident amputation. The secondary outcome was time to prosthesis prescription. Multiple logistic and linear regression was used to control for potential confounders and identify potential effect modification. 2,862 individuals met study criteria, with 1690 (60%) prescribed a qualifying prosthesis. Men were more likely to receive a prosthesis prescription than women (59% versus 45%, respectively; p = 0.03). This difference was observed primarily among those with a diagnosis of major depressive disorder. In this subgroup, the odds of men receiving a prosthesis over women was over 3 times (adjusted odds ratio = 3.3; 95% Confidence Interval, 1.5, 7.4). Men had a mean shorter time to prescription compared to women (112 ± 72 versus 136 ± 79 days, respectively, p = 0.08). Depression in women negatively impacts their prosthesis prescription rates and time to prescription compared to men. This disparity may have significant impacts on future function and quality of life. This study found that men more commonly received a prosthesis prescription and received it earlier than women. This disparity was most extreme among women who had been diagnosed with major depressive disorder. Providers should identify at risk patients early and consider targeted interventions to address depression during the preoperative and immediate postoperative phases. Future research should continue to work to identify gender-specific needs that exacerbate disparity. [ABSTRACT FROM AUTHOR]

Background: Selection of a foot is an important aspect of prosthetic prescription and vital to maximizing mobility and functional goals after lower limb amputation. Development of a standardized approach to soliciting user experiential preferences is needed to improve evaluation and comparison of prosthetic feet. Objective: To develop rating scales to assess prosthetic foot preference and to evaluate use of these scales in people with transtibial amputation after trialing different prosthetic feet. Design: Participant‐blinded, repeated measures crossover trial. Setting: Veterans Affairs and Department of Defense Medical Centers, laboratory setting. Participants: Seventy‐two male prosthesis users with unilateral transtibial amputation started, and 68 participants completed this study. Interventions: Participants trialed three mobility‐level appropriate commercial prosthetic feet briefly in the laboratory. Main Outcome Measures: "Activity‐specific" rating scales were developed to assess participants' ability with a given prosthetic foot to perform typical mobility activities (eg, walking at different speeds, on inclines, and stairs) and "global" scales to rate overall perceived energy required to walk, satisfaction, and willingness to regularly use the prosthetic foot. Foot preference was determined by comparing the rating scale scores, after laboratory testing. Results: The greatest within‐participant differences in scores among feet were observed in the "incline" activity, where 57% ± 6% of participants reported 2+ point differences. There was a significant association (p <.05) between all "activity‐specific" rating scores (except standing) and each "global" rating score. Conclusions: The standardized rating scales developed in this study could be used to assess prosthetic foot preference in both the research and clinical settings to guide prosthetic foot prescription for people with lower limb amputation capable of a range of mobility levels. [ABSTRACT FROM AUTHOR]

Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally. [ABSTRACT FROM AUTHOR]

Objective: To assess the effects of different prosthetic feet on energy costs associated with walking and running in people with transtibial amputation. Literature Survey: The Pubmed, CINAHL, and Web-of-Science bibliographic databases were searched for original research published through June 30, 2018. References from identified articles were also reviewed. Methodology: Two reviewers screened titles, abstracts, and articles for pertinent studies. Details were extracted with a standardized template. Risk of bias was assessed using domain-based methods. Prosthetic feet were grouped into categories and compared according to energy costs associated with walking or running over various terrain conditions. Meta-analyses were conducted when data quantity and homogeneity permitted. Evidence statements were formed when results were consistent or undisputed. Synthesis: Fifteen studies were included. Participants (n = 141) were predominantly male (87.9%), had unilateral amputation (95.7%) from non-dysvascular causes (87.9%), and were classified as unlimited community ambulators or active adults (56.0%). Participants were often young but varied in age (mean age 24.8-66.6 years). Available evidence indicates that feet with powered dorsiflexion reduce energy costs relative to dynamic response feet in unlimited community ambulators or active adults when walking on level or declined surfaces. Dynamic response feet do not significantly reduce energy costs compared to energy storing, flexible keel, or solid ankle feet when walking on level terrain. Running feet do not reduce energy costs relative to dynamic response in active adults when running. Select feet may reduce energy costs under specific conditions, but additional research is needed to confirm preliminary results. Conclusions: The overall body of evidence is based on small samples, comprised mostly of participants who may not well represent the population of prosthesis users and test conditions that may not well reflect how prostheses are used in daily life. However, evidence suggests energy costs are affected by prosthetic foot type only under select conditions. [ABSTRACT FROM AUTHOR]

The shortage of physician-scientists in physical medicine and rehabilitation remains a critical problem. The Rehabilitation Medicine Scientist Training Program was developed in 1995 to provide structured career development training for aspiring rehabilitation medicine researchers. Initially funded by a 5-yr K12 grant from the National Institutes of Health National Center for Medical Rehabilitation Research, the structure was revised in 2001, continued in a stable format through three additional funding cycles (2001-2006, 2006-2012, and 2012-2016), and was again revised to a research education program (National Institutes of Health R25) model in 2019. With this change in format of the Rehabilitation Medicine Scientist Training Program, we now report the productivity of funded trainees and discuss future directions informed by the Rehabilitation Medicine Scientist Training Program's current R25 structure. [ABSTRACT FROM AUTHOR]

Abstract Background Myoelectric control of upper extremity powered prostheses has been used clinically for many years, however this approach has not been fully developed for lower extremity prosthetic devices. With the advent of powered lower extremity prosthetic components, the potential role of myoelectric control systems is of increasing importance. An understanding of muscle activation patterns and their relationship to functional ambulation is a vital step in the future development of myoelectric control. Unusual knee muscle co-contractions have been reported in both limbs of trans-tibial amputees. It is currently unknown what differences exist in co-contraction between trans-tibial amputees and controls. This study compares the activation and co-contraction patterns of the ankle and knee musculature of trans-tibial amputees (intact and residual limbs), and able-bodied control subjects during three speeds of gait. It was hypothesized that residual limbs would have greater ankle muscle co-contraction than intact and able-bodied control limbs and that knee muscle co-contraction would be different among all limbs. Lastly it was hypothesized that the extent of muscle co-contraction would increase with walking speed. Methods Nine unilateral traumatic trans-tibial amputees and five matched controls participated. Surface electromyography recorded activation from the Tibialis Anterior, Medial Gastrocnemius, Vastus Lateralis and Biceps Femoris of the residual, intact and control limbs. A series of filters were applied to the signal to obtain a linear envelope of the activation patterns. A co-contraction area (ratio of the integrated agonist and antagonist activity) was calculated during specific phases of gait. Results Co-contraction of the ankle muscles was greater in the residual limb than in the intact and control limbs during all phases of gait. Knee muscle co-contraction was greater in the residual limb than in the control limb during all phases of gait. Conclusion Co-contractions may represent a limb stiffening strategy to enhance stability during phases of initial foot-contact and single limb support. These strategies may be functionally necessary for amputee gait; however, the presence of co-contractions could confound future development of myoelectric controls and should thus be accounted for.

Purpose: Amputation results in reduced mobility and contributes to reduced quality of life. The increased metabolic cost of ambulation has been suggested as an important contributor to reduced mobility in this population. Current research on the metabolic energy expenditure of ambulation will be critically reviewed from the perspectives of ecological validity of the research methods and the relative contribution to functional improvement in amputees. Recommendations will be made regarding possible future directions for research and their potential clinical utility.Methods: Narrative review.Results: The methods used to quantify metabolic energy expenditure of amputee ambulation do not emulate typical mobility conditions that amputees experience. Amputee mobility is characterized by short bouts of activity with starting, stopping and changes of direction. This is opposed to the typical metabolic testing protocol that requires at least 5 min of steady state linear walking on a treadmill. These studies, therefore, have limitations in ecological validity and therefore limitations in the extent to which they accurately reflect the effect of amputation level, amputation etiology and prosthetic components on energy consumption during walking. Further, the broader perspective on outcomes after dysvascular amputation and sports participation limitations, raises questions about the relative importance of improving metabolic costs and its potential effect on improving mobility in amputees.Conclusion: The greatest potential clinical impact of future research requires methods with improved ecological validity, and the ability to translate metabolic energy expenditure outcomes into functional terms that are meaningful to both clinicians and patients.Implications for RehabilitationThe search for objective measurements to define the effects of amputation on outcome and the consequences of prosthetic components on mobility has focused in part on the use of study designs incorporating metabolic measurement.However, there are important limitations to the ecological validity of these measures and their relative importance as an outcome measure in dysvascular amputees as well as in sports/leisure participation.Novel research approaches are required to quantify the functional impact of increased metabolic energy expenditure and to better understand the psychophysical limitations that result. [ABSTRACT FROM PUBLISHER]