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Evidence-based Prosthetics is Focus of New Workshops
Robert Gailey, PhD, PT, is happy to
see his research career going "backwards."
A physical therapist and investigator
at the Miami VA Medical Center and
University of Miami, Gailey has been
funded by VA to study the best ways to
identify the functional deficits of amputees.
He hopes to enroll 90 veterans, most
with amputations resulting from diabetes-related
vascular disease.
"This is one of the first times we've
done something 'in reverse,' explains
Gailey. "My career has been based on
working with Paralympic athletes and
high-functioning amputees, developing
training programs for them, and then
introducing those exercises to the elderly.
We've had tremendous success and raised
the bar of expectation for the dysvascular
amputee. Now, what we're doing
is just the reverse: We're learning from
the dysvascular amputee how to identify
what needs to be done, and the next step
is to translate that for the traumatic and
younger amputee."
Gailey's research is one of the driving
forces behind a new series of workshops
his team is holding for prosthetists and
physical therapists throughout VA. With
support from the prosthetics manufacturer
Ossur, the first event was held in Miami
from Jan. 16 – 18. Others will follow, in different
regions. The goals are to acquaint VA
clinicians with the latest bionic technology,
guide them in developing training programs
for amputees who use the equipment, and
promote a seamless transition between Department
of Defense and VA rehabilitation
programs.
"We want to bring VA practitioners up to
speed on the latest technology that soldiers
are receiving in the military rehabilitation
facilities," says Gailey.
VA 'paving the way' with clinical
trials
Another phase of research by Gailey's
group and others within VA is studying
the differences among the new prosthetic
limbs, and determining how to best match
them with veterans' needs. For example,
the Rheo Knee from Ossur and C-Leg from
Otto Bock both feature high-end microprocessors.
But the Rheo, with a faster microprocessor,
offers more "swing control" to
enable users to walk faster, while the C-Leg
is known for having more "stance control"
and may be better for someone with poor
balance who needs more stability.
'Almost every socket design
and component can trace its
foundation to VA research.'
Clinical trials comparing prosthetic
limbs have been difficult because of a lack
of well-established outcomes measures,
says Gailey. But studies such as his new
one, aimed at better identifying amputees'
functional needs, are part of a larger effort
within VA to generate hard evidence to
guide care and prosthetics fitting.
"This is where VA is paving the way,"
he notes. "Our study, 'Evidence-Based
Amputee Rehabilitation,' is among the first
where a functional measure is being used in
the clinic to look at balance, power, strength
and other outcomes. We then will try to
elevate the patient's function–not by 'shotgunning'
treatment, but by targeting specific
elements or functional limitations and then
giving appropriate therapy."
While his new project will include
mainly diabetic amputees, most of whom
are older and less active, he expects the
research to also benefit returning OIF/OEF
veterans.
"We wanted to focus on the majority, not
the minority. We're trying to take care of the
largest amputee population within the VA.
But the principles of using a clinical assessment
tool and then putting together an individualized
program based on the results is
something we can translate to the younger,
traumatic amputee population. In fact, we
now have a different set of items, of higher
difficulty, for this group." He hopes to
work with DoD colleagues in the future to
develop a standardized measurement instrument
targeted to younger, stronger, more
active amputees.
Strong partnership between
VA and Department of Defense
Gailey says collaboration between VA
and DoD in prosthetics is robust. Paul
Pasquina, MD, medical director of amputee
care at Walter Reed Army Medical Center,
was on the faculty at the Miami VA workshop–one
of many recent examples of
clinicians from the two agencies participating
in workshops together. And VA physical
therapists and prosthetists will have
residencies at the Center for the Intrepid,
the Army's brand new $50 million facility at
Ft. Sam, Texas, for the care of servicemen
and women with wounds such as limb loss
and burns.
While DoD may be on the front lines of
clinical care for returning veterans, at least
in their early stages of rehabilitation, Gailey
says VA is playing a critical leadership role
in prosthetics education and research.
"Many of the prosthetic developments
since World War II have come from the
VA," he says. "If you look at it historically,
almost every socket design and almost
every component can trace its foundation
back to VA research. We're recapturing
that leadership role once again, because it's
necessary."
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