Understanding longer-term musculoskeletal complications secondary to extremity trauma and limb loss

Laboratory

The Extremity Trauma & Amputation Center of Excellence (EACE) is a one-of-a-kind organization within the Department of Defense and Department of Veterans Affairs consisting of teams of researchers embedded at the point of care within multiple Military Treatment Facilities (MTFs) across the nation. In line with the congressionally directed mission of the EACE, the research efforts undertaken focus on the mitigation, treatment, and rehabilitation of traumatic extremity injuries and amputations with a specific focus on translating their findings into clinical practice to improve the care of Servicemembers and Veterans. The proposed work will be conducted by the EACE-Bethesda team at Walter Reed National Military Medical Center (WRNMMC), the nation’s largest and most renowned military medical center. This world class institution offers a full suite of infrastructure and facilities which are ideally suited for a wide variety of research activities (i.e., bench to bedside). Importantly, the EACE-Bethesda multidisciplinary team is comprised of basic and translational scientists of varying educational backgrounds, and clinicians from across the medical spectrum, which when taken together, provides a privileged perspective of the injury conditions that challenge wounded Servicemembers. The Biomechanics and Virtual Reality Laboratories primarily focus on aspects of rehabilitation after extremity trauma or limb loss. In particular, we use optical motion capture and force platforms to measure kinematic and kinetic data during human movement; integrated measurements of muscle (EMG) and/or brain (EEG) activity can supplement such evaluations. Additionally, the CAREN system – composed of a 6 degree-of-freedom motion platform, instrumented treadmill, and a 180-degree curved screen – allows patients to interact with virtual environments, for the purposes of evaluating and/or training gait, posture, and other aspects of human movement.

Project Description

An overarching objective of our research program is to better understand longer-term musculoskeletal complications secondary to extremity trauma and limb loss (e.g., low back pain and osteoarthritis), conditions that are reported at rates much higher than the general population, and likely influenced, in part, by the human-device interaction and resulting influences on movement characteristics, among other factors. These secondary musculoskeletal complications are especially concerning for service members with extremity trauma and limb loss, as they are typically injured at a young age and therefore will live with a pronounced and progressively increasing risk for many years. In 2020, projects/topics available to prospective BESIP interns include investigations that will enable the student to:

1. Assist in the design, development, and execution of clinical research.
2. Gain exposure to various technologies and approaches for evaluating human movement and other functional outcomes.
3. Gain experience with novel prosthetic and orthotic technologies, and understand their influences on the human-device interaction.

Essential to all of these are a basic understanding of mechanics and experience with computer programming (e.g., MATLAB). In addition to learning human movement science and biomechanical research, the intern will also be exposed to other aspects of physical medicine and rehabilitation, including physical/occupational therapy, prosthetics/orthotics, and other related sub-disciplines, as relevant.