A novel assessment for Readiness Evaluation during Simulated Dismounted Operations: A reliability study

Testing an adjustable prosthetic socket in a simulated military environment

Introduction: The purpose of this study was to test the performance of an adjustable socket for transtibial prosthesis users during military relevant tasks. Methods: Investigational sockets with motor-driven adjustable panels were fabricated for each participant. Sensors to detect liner-to-socket distance were embedded in the socket wall during fabrication, and collected data were used to calculate a socket fit metric (SFM). Participants completed two military readiness assessments, the Readiness Evaluation during simulated Dismounted Operations and the Common Military Tasks, in each of three socket volume adjustment modes: static (non-adjustable), user-adjusted (using a phone app), and auto (adjusted by a controller). Socket and participant performance and self-reported outcome metrics were collected. Results: In 11 Service members or Veterans, the SFM distribution was significantly lower for the auto mode compared with the user-adjusted and static modes (P = 0.023, 0.010, respectively). The socket volume was adjusted more often (P = 0.003) and underwent a greater range of adjustment (P = 0.001) for auto versus user-adjusted. The change in pre- and post-activity socket comfort score (SCS) was not significantly different between modes. Conclusions: The results highlight the errors in socket fit in static and user-adjusted sockets and demonstrate how an automatically adjusting socket can minimize error without impeding task performance.

Development of a multidimensional military readiness assessment

There is a need to be able to accurately evaluate whether an injured service member is able to return to duty. An effective assessment would challenge and measures physical and cognitive performance in a military-relevant context. Current assessments are lacking in one or more of these aspects. The simulation and data capture abilities of virtual reality systems are promising for use as the basis of multidimensional assessments. The team has previously developed a military-specific assessment in the Computer Assisted Rehabilitation Environment (CAREN) called the Readiness Evaluation During simulated Dismounted Operations (REDOp). Due to notable limitations in the original assessment, we have developed the next iteration, REDOp2. The assessment is able to challenge and measure a broader range of physical and cognitive performance domains in a more streamlined fashion. While limited to facilities with a CAREN, REDOp2 has the potential to provide an effective tool for highly trained and experienced wounded service members that require thorough assessment prior to returning to duty to ensure the safety of the team and mission. This methods paper describes the specific limitations in REDOp, how they were addressed in REDOp2, and suggested next steps to prepare the assessment for implementation.

Inclusion of a Military-specific, Virtual Reality-based Rehabilitation Intervention Improved Measured Function, but Not Perceived Function, in Individuals with Lower Limb Trauma

INTRODUCTION

Lower extremity injury is common in the military and can lead to instability, pain, and decreased function. Military service also places high physical demands on service members (SMs). Standard treatment interventions often fail to align with these unique demands. Thus, the goal of the study was to evaluate the effectiveness of a military-specific virtual reality-based rehabilitation (VR) intervention supplemental to standard care (SC) in improving military performance in SMs with lower extremity injuries.

MATERIALS AND METHODS

As part of an institutional review board-approved randomized control trial, SMs receiving care at an advanced rehabilitation center were randomized to receive either SC or VR in addition to SC (VR+SC). Participants were evaluated before treatment and ∼3 weeks later using a previously developed and validated military-specific assessment. Perceived improvement in physical function was measured using a Global Rating of Change (GROC) questionnaire. A repeated measures ANOVA was used to evaluate the effects of adding VR on the military-specific assessment measures. Linear regression was used to determine the relationship between perceived improvement, measured improvement, and VR volume.

RESULTS

The VR+SC group was able to traverse a greater distance in the assessment following the VR intervention. There was no significant difference in GROC between groups. For the VR+SC group, change in distance completed was not correlated with GROC, but GROC was correlated with VR volume.

CONCLUSION

VR improved the distance that participants were able to traverse in the assessment. However, the VR+SC group demonstrated a disconnect between their perceived functional improvement as measured by the GROC and functional improvement as measured by the change in the distance completed. Rather, the perceived improvement appears to be more correlated with the volume of VR received. The way in which the treatment progression is structured and communicated may influence how patients perceive their change in physical function.