Improving Mobility and Function Following Transfemoral Amputation: A Novel Approach to Reverse Volumetric Muscle Loss
Abstract
Lower limb amputations (LLA) are twice as common as upper-extremity amputations. After LLA, the long-term consequences are daunting, with most individuals with LLA experiencing severe joint pain in their back, hips, and knee(s). The existing pain can make it difficult for individuals with LLA to remain active and return to work, which can lead to a multitude of concerns. Lack of activity and community engagement is associated with psychological distress (e.g., depression) and worsened health (e.g., higher blood pressure). These health risks are present for individuals with LLA who have the most advanced prosthesis, suggesting that prosthetic design, fit, and use are not the only important factors in outcomes following LLA. The goal of this study is to use an easy and safe treatment, ischemic preconditioning (IC), to improve function in individuals with LLA so that these individuals can lead longer, healthier lives. IC is a treatment that includes the use of an inflated blood pressure cuff on the leg to stop blood flow to the lower extremity (down through the toes) for five minutes followed by five minutes of normal blood flow while the cuff is deflated. This cycle is repeated five times for a total of 50 minutes. In our pilot study of three individuals with LLA, we found that seven sessions of IC improved strength, muscle volumes, and walking ability. Therefore, this study aligns with the FY22 PRORP Clinical Translational Research Award focus area of Tissue Regeneration Therapeutics because it specifically targets volumetric muscle loss after LLA. This study also aligns with the FY22 PRORP CTRA goal of Retention Strategies, specifically Return to Duty. Improving function after LLA could potentially increase return-to-duty rates and quality of life for Service Members and Veterans with LLA. The goal of the proposed clinical trial is to improve care and quality of life for individuals with LLA, which would help Service Members, Veterans, and other civilians with LLA. In the current standard-of-care model outlined by the Department of Defense/Department of Veterans Affairs, the only opportunity to focus on the intact limb is to increase range of motion following amputation of other leg. We are proposing an innovative shift to the clinical care model after LLA to focus on strengthening the intact limb to improve overall function. Greater strength, muscle volume, and blood flow in the intact limb would lead to better functional performance and activities of daily living, which are the next two progressions of clinical care after rehabilitation intervention. This would potentially impact everyone involved in the clinical care of individuals with LLA. In order to better understand how this intervention could fit into the rehabilitation model, we are proposing an aim to measure perceptions and feedback of IC from physiatrists and patients. Understanding how these critical groups view the barriers and benefits of IC will provide more information about translating this clinical trial to larger clinical care.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Jan 04, 2024
- Source ID
- HT94252310474
Entities
People
- Lindsay Slater
Organizations
- United States Army
- University of Illinois at Chicago