Neuromusculoskeletal Injury Rehabilitation

What & Why

Advanced prosthetic arm

Neuromusculoskeletal (NMS) injuries are a leading problem for military service members. The Neuromusculoskeletal Injuries Rehabilitation portfolio includes Department of Defense (DoD) efforts in rehabilitation and reintegration in the general areas of amputation/prosthetics, limb trauma/orthotics, spinal cord injury, and other service-related neuromusculoskeletal injury, including applied and translational research and clinical implementation. The overall goal is to maximize rehabilitation after service-related neuromusculoskeletal injuries.

Research findings demonstrate the need to prioritize medical research in this area:

  • According to the Army Office of the Surgeon General, since 2001 there have been more than 1650 amputations in OIF, OEF, and unaffiliated conflicts–half of these injuries were caused by IEDs
  • Extremity injuries were noted in up to 54% of casualties from OEF/OIF (Belmont et al., 2012; Owens et al. 2008)
  • According to the Army Health of the Force Report, musculoskeletal injuries account for 76% of the medical non-deployable population
  • Spine injuries increased from 1% of all injuries in Korea and Vietnam to 7.4% in OIF/OEF
  • Of the more than 250,000 Americans with serious spinal cord injuries and disorders, about 42,000 are Veterans (VA, 2009)

Top Priorities

Mechanical arm

The NMS Scientific Working Group identifies and prioritizes current and future research needs. Capability gaps were developed and analyzed to determine the needs of the military with regard to neuromusculoskeletal injury rehabilitation. Results helped the CRMRP to establish program direction, priorities, and funding strategies.

In the area of NMS Injury Rehabilitation, specific capabilities in need of supporting research include:

  • Lack of short and long term evidence for existing support and reintegration strategies, and a need for new evidence-based support and reintegration strategies.
  • Limited current technologies, including prosthetics and orthotics, for the rehabilitation or replacement of function that optimize patient interaction, usability, and durability.
    • Limited proprioceptive and other sensory inputs inhibits functional use and safety
    • Limited intuitive user intent control for functional use of assistive technologies.
    • Limited device interoperability between available and future components that limits functional potential of multi joint systems
    • Limited human – device interface to address health, comfort, and function
  • After primary neuromusculoskeletal injury there is limited ability to predict, prevent, and mitigate development of secondary health deficits.
    • Inability to determine factors that predict development and successful treatment of osteoarthritis, low back pain, or other musculoskeletal conditions
    • Limited strategies to predict, prevent, or mitigate early onset co-morbidities or chronic complications such as obesity, cardiovascular disease, and diabetes
  • Limited understanding of the management throughout the rehabilitation process following neuromusculoskeletal injury.
    • Limited ability to accurately diagnose and clinically classify degree of injury in an austere environment to optimize rehabilitation of neuromusculoskeletal injuries.
    • Inadequate evidence to determine the optimal dose, timing, frequency, duration, setting and use of innovative rehabilitative techniques to minimize impairments, maximize function and performance, and/or achieve optimal quality of life.
    • Limited understanding of potential confounds to optimal rehabilitation factors that may adversely affect rehabilitation outcomes (sleep, stress, nutrition, hydration, smoking, patient compliance)
  • Lack of validated metrics that effectively assess initial presentation, rehabilitation, and reintegration following neuromusculoskeletal injury.
Example or prosthetic leg
Example of new socket

Work In Progress

Examples of research efforts in the Neuromusculoskeletal Injury Rehabilitation portfolio include:

  • Using advanced prosthetics to enhance community reintegration
  • Training simulators for patients with upper limb amputation to optimize function
  • Improved residual limb health through new sockets, monitoring, and diagnostics
  • Strategies to optimize residual limb interface in osseointegration
  • Development and evaluation of new rehabilitation strategies to optimize outcomes
  • Exoskeleton based rehabilitation strategies for patients with Spinal Cord Injury
Soldier doing leg press
Physical therapy