ORLANDO, Fla. — Military service members must undergo rehabilitation after amputation to help them return to service or retire and live life as normally as possible. However, there is no one specific way for physical therapists to know if amputees are done with rehabilitation.
“By Medicare standards, in the civilian population if you can walk 150 feet you are good to go home, but that wasn’t the goal. It was to return to duty or combat or to the life they led before [their amputation],” Robert S. Gailey, Jr., PhD, PT, professor of the department of physical therapy at the Miller School of Medicine, said at the O&P World Congress, here. “So we looked at creating a device or system that could measure current functional capabilities, and address the systems that needed to be focused on in rehab.”
Gailey and colleagues’ research was divided into two phases. First, researchers determined what the norms were in active duty US service members by testing 97 soldiers at Fort Bragg in Fayetteville, N.C. In the second phase, researchers included 118 service members with limb loss from Brooke Army Medical Center, Walter Reed Army Medical Center and Fort Bragg and matched them with 97 non-military soldiers.
Study participants underwent the Comprehensive High-level Activity Mobility Prediction (CHAMP) assessment, which included single limb stance, Edgren side step test, T-test and Illinois Agility test, at two separate times to test for test-retest reliability. The best CHAMP scores were then added together to produce a composite CHAMP score. Participants received a point depending on their score per activity with 40 as the maximum number of points and one as the minimum.
“The key things we wanted to focus on was balance, postural stability, which is key even in dynamic situations, coordination at the basic and complex level, power, speed and agility,” Gailey said.
In the single limb balance test, participants stood on each limb for a maximum of 30 seconds and researchers combined best stance times for both limbs. Researchers found three transtibial amputees who were able to balance for 30 seconds with their hip at 90° for the entire 30 seconds. Although none of the unilateral transfemoral amputees could perform the Edgren Side Step test in the non-amputee range, study results showed 53% of unilateral transtibial amputees and 12% of bilateral amputees could. Similarly, 55% of unilateral transtibial amputees and 8% of bilateral amputees could perform the T-test in the non-amputee range and 62% of unilateral transtibial amputees and 4% of bilateral amputees performed the Illinois Agility test in the non-amputee range. None of the unilateral transfemoral amputees could perform either of these tasks in the non-amputee range.
According to Pearson correlation analysis, researchers found a strong relationship between CHAMP performance and 6-minute walk test distance.
“Interestingly, when you look at the individual’s ability to perform all four events, where we had about 50% of transtibials [able to perform], it drops to only 5%,” Gailey said. “So the take-home is being able to control a prosthetic foot or knee in a very intricate pattern and there are different systems that need to be addressed in rehab. Just passing one test doesn’t do it. It must be a combination of tests to determine if the person is ready to go back into service.”
To help bring the CHAMP assessment into practice, the researchers began developing the CHAMP app for physical therapists to use on their phone when assessing patients. Although the current equipment is not capable of measuring intervals for the modified T-test and Illinois Agility test, it does streamline data collection and measurement intervals. So far, the app has been used among able-bodied patients.
“[The CHAMP test] is a gift in an unfortunate situation, for this test seems to be very appropriate,” Gailey said. “The idea is we have the tests for individuals to measure high levels of mobility. There really is no ceiling affect because nobody reached the highest point [in our studies], but it also gives us the ability to now address the military service members who are in military treatment facilities as technical athletes. They rehab to a point, they heal their wounds and then they can determine what they want to be able to do with the rest of their life, whether it’s return to service or combat, or back to sport and the life they enjoyed before.” — by Casey Tingle
Disclosure: Gailey has no relevant financial disclosures.