Military Medicine International Journal of amsus raising the bar: extremity trauma care guest editors
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7 years; however, controls had the advantage of familiarity and routine training on the OC facility. This familiarity con- trols had with the OC may account for some of the difference in performance; however, large performance differences between amputees and nonamputees are observed in multiple other reports. 13,30 In 1995, approximately 2% of soldiers with major limb amputation returned to duty. With regard to OEF/OIF, there was an eight-fold increase (16%) of soldiers with amputation returning to duty. 6,31
One means for a soldier with amputa- tion to demonstrate function beyond basic ambulation may be completing a military equivalent OC with performance comparable to nonamputees. For military applications, OCs are used to simulate impediments to tactical soldier move- ment that might be found in urban or rural settings. 25,32 OC
fitness components such as upper and lower body aerobic and anaerobic power, muscu- lar strength and endurance, and less quanti fiable skill attri- butes such as agility and technique. 23,25
In military training, OCs have many intended functions including improving fit- ness, agility, con fidence, and camaraderie. 23,25
Utilization of timed OCs for military performance assessment is important as multiple physiologic attributes contribute to overall per- formance in these tests and a tactical unit can only move as fast as it is slowest member. 17,21,25,32 Therefore, removing the rope climb obstacle was a salient point in this study. SWAT operators ’ safety decision to eliminate the obstacle raised concern over the ability of TTAs, as a group, to com- plete the course. During training and accommodation, a small number of the TTA group were able to complete the task largely as an exclusively upper limb activity. This was not advised by the trainers because many of the remaining obstacles require vigorous, reliable use of the upper limbs or a combination of upper and lower limbs. Therefore, com- pleting the rope climb exclusively with the upper limbs cre- ated notable fatigue and compromised performance during the remainder of the course while participants were training and practicing. Hence, use of the feet to assist with the rope climb was advised. Unfortunately, TTAs were unable to oppose their prosthetic feet and ankles to create suf ficient
friction to enable the lower extremities to assist the upper limbs in lifting during the climb. This presented an obvious limitation of existing feet and ankle systems for TTAs in this task. It also prevented the TTAs, as a group to be able to complete the course as originally designed. This, in addition to the 31% to 35% difference in overall performance, further highlights some of the impairment created by TTA. How- ever, a few individuals in the TTA group were able to com- plete the course as designed. Although group analyses were necessary in order to meet study objectives, individual anal- yses may reveal considerable differences between TTAs. This observation that some individuals could complete the course, supports individual assessment for making return to duty determinations following injury related to combat or other facets of military service. The mean number of additional arti ficial limbs used by subjects in this study was lower than that reported else- where. 33
1 additional recreational prosthesis, thus having 2 prostheses in service, whereas others have reported an average of 3 prostheses. Although these two studies disagree over one additional prosthesis, the present study demonstrates an TABLE I. Time to Completion Data Obstacle Variflex
Elite Blade Re-Flex Rotate Control Mean
SD Mean
SD Mean
SD Mean
SD Jacob
’s Ladder 32.9
12.8 31.8
15.6 29.6
10.2 22.0*
8.2 Balance Beam 11.6 3.7
11.3 3.3
10.9 2.7
8.4* 1.7
A-Frame 39.6
14.4 37.0
11.6 36.6
13.9 23.4*
5.7 Culverts
14.0 3.8
14.4 † 3.9 14.4 † 3.3 12.0 1.8
Fence 14.0
‡ 4.9
12.4 4.6
13.2 4.0
8.6* 2.6
Rope Bridge 29.7
11.3 26.9
8.0 27.6
7.9 19.5*
5.2 Cargo Net 57.1 20.0
62.4 27.1
57.9 23.7
37.1* 6.9
High Step 13.9
5.5 12.4
2.9 12.1
2.4 9.8*
1.6 Angle Wall 11.7 4.8
11.1 3.5
14.9 17.0
7.0* 2.4
Slalom 14.2
3.5 13.6
3.0 14.5
3.2 13.8
1.6 Pete
’s Dragon 58.7
28.3 56.1
17.5 69.9
73.2 38.5*
7.6 Monkey Bars 20.7 8.4
20.9 7.2
21.7 8.4
14.5* 4.7
Over/Under Walls 20.9
11.4 19.5
6.6 19.4
8.3 14.3*
3.1 Angle Tube 17.1 9.9
16.6 7.4
21.3 † 23.5 11.5 3.2
Rope Traverse 36.8
15.0 41.4
22.0 44.5
26.6 26.3*
9.6 SWAT Ladder 25.9 12.7
25.1 9.4
29.0 20.5
15.5* 4.7
Sprint Finish 5.9
1.1 5.9
1.4 6.6
ठ1.7
5.1 0.8
Total Time 424.7
143.9 418.9
130.2 443.9
219.9 287.2*
58.4 Time data are in seconds. Effect sizes (Cohen ’s d) was large (d ≥ 0.80) for all statistically significant comparisons between prosthetic feet conditions and controls; small (d = 0.34) for signi ficant comparisons between Variflex and Elite Blade; and medium (d = 0.53) for significant comparisons of Elite Blade with Re-Flex Rotate. *p ≤ 0.05 compared to all prosthetic feet conditions. †p ≤ 0.05 compared to controls. ‡p ≤ 0.05 compared to Elite Blade. §p ≤ 0.05 compared to Vari flex. MILITARY MEDICINE, Vol. 181, November/December Supplement 2016 51 Energy-Storing and Shock-Adapting Prosthetic Feet in Transtibial Amputees Yüklə 1,64 Mb. Dostları ilə paylaş:
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