JRRD, Volume 47, Number 4, 2010
are surviving but with multiple-limb injuries, which may involve challenges for mobility [3,29]. Other studies in noncombat-associated lower-limb loss have found pain, poor prosthetic fit, poor prosthetic performance, comorbid- ities, change in cardiovascular fitness and activity level, change in prosthetic use, lack of consideration of the user’s needs in the prescription process to increase the likelihood of wheelchair use [30–35].
One of the main focuses of the multidisciplinary team is to educate the individual on the possibility of suc- cess or failure in using prosthetic devices, based on their medical status, the severity of injury, the availability of resources, and the state of technology at the time. Collabo- rative efforts of the medical care team and the injured ser- vicemember or veteran need to match the person’s expectations and preferences within the environment of use, device function, and type of mobility AT [36–37]. Multiple types of mobility AT may also be useful, because of the number of issues associated with relying on one form of mobility AT. Increased forces sustained by the nonamputated limb (for example, in the case of someone with unilateral transfemoral limb loss using a prosthetic device for primary mobility) may lead to early onset arthritis. Similarly, an individual who only uses a wheelchair for mobility may be at a higher risk of devel- oping a degenerative rotator cuff injury to the shoulder joint. Our study finds that many survey participants use more than one type of mobility AT, including prosthetic devices, supplementary use of wheelchairs, and various assistive devices such as canes, crutches, and walkers. A combined approach concerning mobility AT may help decrease the possible detrimental effects of the prolonged use of a sole form of mobility AT. Having an option of which mobility AT to use for different activities and fatigue levels could increase satisfaction and functional mobility, but this needs further study.
Our study of combat-associated limb loss responds to the call for AT outcomes research . Although our population may be distinguished by the cause of the limb loss, studies of mobility ATs in other populations of lower-limb loss (spinal cord injury, stroke, or vascular disease) also report 43 to 50 percent use of mobility AT devices, mostly wheelchairs [39–41]. More research is needed to further understand why these mobility ATs are abandoned, who is best served by specific types of devices, and how to train all people with lower-limb loss to best use these valuable tools.
This information will be useful for developing improved guidelines for mobility AT prescription,
addressing correctable issues leading to abandonment, and documenting for policy makers the importance and role of wheelchairs and other ATs to increase mobility in veterans and servicemembers with lower-limb loss.
The majority of the individuals from the Vietnam war and OIF/OEF conflicts with lower-limb loss choose to use a combination of mobility ATs for their means of mobility. Individuals sustaining multiple-limb loss, espe- cially at proximal levels, tend to either abandon all pros- theses in favor of a wheelchair for their primary means of mobility or choose to use both prostheses and a wheel- chair. The availability of a variety of types of mobility ATs enhances physical functioning for veterans and ser- vicemembers with lower-limb loss.
Until the OIF/OEF group reaches the same age and has similar life experiences as the Vietnam group, the influence of the recent DOD/Department of Veterans Affairs (VA) rehabilitation policies on prosthetic device and AT use may not be fully realized. However, the expe- riences of the Vietnam group may help predict future trends of prosthetic and assistive device use for these younger servicemembers as they age.
Author Contributions: Study concept and design: L. V. McFarland, G. E. Reiber. Acquisition of data: L. V. McFarland, G. E. Reiber.
Analysis and interpretation of data: J. Z. Laferrier, L. V. McFarland, G. E. Reiber.
Drafting of manuscript: J. Z. Laferrier, L. V. McFarland, M. L. Bon- inger, R. A. Cooper, G. E. Reiber.
Critical revision of manuscript for important intellectual content: J. Z. Laferrier, L. V. McFarland, M. L. Boninger, R. A. Cooper, G. E. Reiber.
Obtained funding: L. V. McFarland, G. E. Reiber.
Administrative, technical, or material support: J. Z. Laferrier, L. V. McFarland, M. L. Boninger, R. A. Cooper, G. E. Reiber.
Study supervision: L. V. McFarland, G. E. Reiber.
Financial Disclosures: The authors have declared that no competing interests exist.
Funding/Support: This material was based on work supported by the VA, Health Services Research and Development Service, grant IIR 05- 244, and a Career Scientist Award to Dr. Reiber, grant RCS 98-353. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the VA or the DOD.