Quantitative Ambulatory Assessment and Prognosis of the Impact of Severe Upper Limb Injuries on Real-World Behavior
Abstract
Background: Military personnel are at particularly high risk for severe upper limb injuries (SULIs)—often involving damage to the peripheral nerves—that adversely impact quality of life, limit occupational and recreational participation, and present major economic and readiness burdens on the military system. The majority of these patients develop chronic neuropathic pain. Though rarely fatal, these injuries are associated with a 23% increased risk of attrition from duty. Due to their injuries, SULI patients are forced to adopt unnatural, one-handed patterns of limb use during acute phase of recovery. If such “one-handedness” becomes chronic, they will be at very high risk of long-term pain and disability. Successful functional recovery and reintegration depends on resuming more normal bimanual patterns of movement during everyday activities. Assessing limb function in the real world has, however, been beyond reach until now. Overarching Hypothesis: We predict that individuals with SULIs are at increased risk of developing chronic one-handedness during real-world activities through learned disuse of the injured limb. We have developed an innovative technique that uses small wireless sensors to unobtrusively gather high-resolution data on upper limb movement during everyday life. We use this approach to evaluate our overarching hypothesis and to address the following specific aims. Specific Aims: Aim 1. Establish how patterns of real-world limb use by SULI patients evolve as they transition from the subacute to chronic stage of recovery. Aim 2. Identify factors that predict success in reestablishing more normal, bimanual patterns during real-world limb use and develop a model that can guide evidence-based decisions on SULI care and treatment. Aim 3. Evaluate whether traditional tests of limb function used in the clinic or laboratory capture real-world limb use in SULI patients. Aim 4. Use advanced statistical techniques to understand the complex relationship between perceived versus remembered pain and use of the affected limb. Study Design: Our interdisciplinary team of leading clinicians and scientists is optimally suited to achieving these aims, and we have abundant preliminary data demonstrating the efficacy of our approach. Over 3 years, this longitudinal design follows 60 individuals who have undergone surgical repairs of one or more of the major forearm nerves as they move from acute to chronic stages of recovery. Each year, we acquire 7 continuous days of data on everyday limb use using wireless sensors worn on the wrists and biceps, as well pain severity throughout the day using text messages delivered with a novel phone app. Participants also complete annual standardized assessments of limb function and validated surveys and questionnaires selected to provide insights into their quality of life and participation in occupational, recreational, and social activities. Military Relevance: This project will provide clinicians and researchers with a new and powerful technique for measuring real-world limb function and pain in SULI patients that can be deployed in any environment. This approach will revolutionize their ability to assess and monitor progress in SULI patients. Data acquired in this longitudinal project will yield unprecedented insights into the evolution of SULI recovery and the influence of pain and other factors on patients’ functional outcomes. The model generated from this data will serve as a basis for making individualized evidence-based decisions with regard to optimal SULI care and rehabilitation.
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110173
Entities
People
- Scott Frey
Organizations
- Curators of the University of Missouri
- United States Army