Comparative Effect of Commercially Available Custom Dynamic Orthoses (CDOs)
Abstract
Service members and civilians who suffer severe, traumatic lower leg injuries have persistent pain, stiffness, weakness, and functional limitations that last for the rest of their lives. These injuries are common and have significant impact on the ability to return to Service or work, lead to high long-term disability costs, and result in high rates of depression. This proposal for the "Orthotics and Prosthetics Outcomes Research Award" addresses the need for significant advances in lower limb orthoses to return active Service members, Veterans, and civilians who suffer severe lower leg trauma to an active and productive life. Conflicts associated with the Global War on Terror have resulted in many limb injuries. Over half of evacuated service members have limb injuries and two-thirds of injured soldiers who did not return to duty had extremity trauma. The long term disability costs may approach $2 billion. Individuals who experience traumatic injuries often have many surgeries, including fusion of the ankle, or in the foot, and even amputation. Arthritis, which often occurs after traumatic joint fractures, can result in disability that can be worse than heart or kidney failure. One-fifth of these individuals demonstrate symptoms of severe depression and nearly half are unemployed. Landmark civilian and military outcomes studies show individuals who sustain limb-threatening trauma have poor outcomes years after the injury. Traditional rehabilitative techniques used to restore function and quality of life after injury are often unable to overcome the limitations that result from scarring, deformity, and damage from traumatic injury. Significant advances are needed to improve the long term function of these young and active Service members. Over the last decade, custom fit carbon fiber braces, referred to as custom dynamic orthoses (CDOs), have been shown to dramatically improve function after lower leg trauma in active Service members. The devices consists of a cuff at or below the knee that is connected to a carbon fiber strut in the back that flexes with loading and then springs back to provide power to the individual as they walk or run. A rigid foot plate acts to protect and support the foot, limiting motion at painful, arthritic joints. Various design characteristics of CDOs are known to have significant impacts on the ability of the device to improve function. Despite a recent increase in interest and information regarding these devices, little is known about how commercially available CDOs impact function. Within this project we will complete the following activities: (1) We will use measures of function and mobility to directly compare two commercially available CDO designs in individuals that have limited function due to a traumatic lower leg injury. (2) In the same individuals, we will compare function and mobility with the devices to their function without a device, and to their function with the device they received as part of their standard medical care (if any). (3) We will also work to understand why individuals prefer one device over another. Over 70 individuals who have limited function due to traumatic lower leg injury are expected to participate in the study. They will be fit with two robust custom fitted and commercially available CDO designs. The participants will have 3 months to use and become familiar with each CDO device. We will use questionnaires, tests of physical mobility and agility, and computerized motion analysis techniques to assess device and individual performance. There are sufficient differences between the two designs to expect differences in preference and functional improvement. We also expect to see differences between function with the device and when the individual completes the tests without a device, and with the device they received as part of their medical care (if any). We expect the data from this study will immediately inform clinical care decisions in bot
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Oct 29, 2018
- Source ID
- W81XWH1820073
Entities
People
- Jason M. Wilken
Organizations
- United States Army
- University of Iowa