Early Interventions to Address Functional Limitations and Comorbidities to Volumetric Muscle Loss
Abstract
Objectives and Rationale: Battlefield casualty and trauma often results in major injury to the extremities, one example of this is volumetric muscle loss (VML) injuries. While advances in prolonged field care have saved many Service members’ lives, those with VML injures are left with long-term functional complications. Unlike more simple muscle injuries, VML injuries are not capable of undergoing significant self-repair. One factor limiting muscle function recovery is a lack of current treatments and rehabilitation techniques and lack of understanding of the secondary effects due to VML such as physical inactivity. We are investigating how early rehabilitation may improve muscle function following VML injury. We will test two specific aims: (1) to determine if early rehabilitation approaches are sufficient to improve the function and quality of the remaining tissue after VML injury and (2) to understand if injury-induced physical inactivity significantly impairs the quality of remaining tissue after VML injury and the responsiveness to rehabilitation. Research Applicability: By studying and understanding early rehabilitation following injury, we hope to improve healing of the muscle and effective rehabilitation. Additionally, we hope to elevate the wounded Service members’ long-term quality of life. The proposed work directly addresses the Neuromusculoskeletal Injuries Rehabilitation Research Award Focus Area: “Limited understanding of the management of patient rehabilitation strategies throughout the rehabilitation process following neuromusculoskeletal injury.” Primarily this proposal addresses the “innovative rehabilitation techniques for Service members with neuromusculoskeletal injuries.” Additionally, this proposal will secondarily address “optimal dose, timing, frequency, duration, and setting of rehabilitation techniques.” Clinical and Patient Alignment and Timelines: This proposal will examine and advise future clinical guidelines for rehabilitation following extremity trauma. Advances in military medicine have made extremity wounds the most common survivable injury in modern military conflicts. Approximately 14,500 Service members were evacuated from war between 2001 and 2013, and about 77% had some musculoskeletal injuries. Of injuries that limit Service members from returning to duty, ~83% are orthopaedic and many have a component of VML. Extremity combat casualties cost the Department of Defense $42.4 billion in initial costs and contribute to the $108.8 billion in lifetime disability benefit cost to injured Service members and require the longest hospitalization and rehabilitation times. Using the Army Physical Evaluation Board, it has been shown that disability ratings following VML-related injuries do not improve over time, even with additional recovery time. This proposal will investigate early rehabilitation to understand how to improve muscle function and how these injuries relate to long-term health of the Service member. We hope that the research outcomes can be used to test these rehabilitation plans in large animal models of VML injury. If successful, we plan to collaborate with our clinical colleagues to test these rehabilitation approaches in the clinic and ultimately inform clinical cage guidelines. Service Member Benefit: This proposal is expected to benefit injured Service members. This work addresses the most significant extremity injury among Service members evacuated from the battlefield. Understanding of limitations on rehabilitation and how VML injury results in secondary inactivity is expected to further our understanding significantly. The long-term functional limitations of VML injury extensively impacts long-term health. While the burden of VML injury is directly on the Service member, it is likely that an extended burden is also felt by the Service member’s family and team of caregivers. With this, any increase in the functional capacity of those wound
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1810710
Entities
People
- Jarrod A. Call
Organizations
- United States Army
- University of Georgia