The broad goals of the Advanced Rehabilitation Science focus area target validating current methods and developing novel rehabilitation strategies that address life-style, mechanical and biological factors associated with achieving optimal function following extremity trauma or amputation. It is particularly important to address functional rehabilitation areas specific to the active duty Service members who, following combat related extremity trauma and/or amputation, desire to remain on active duty and/or deploy and those Veterans who wish to maintain a highly active lifestyle. In each of the ARCs, this research focus area is supported by a variety of state of the art facilities and equipment including:

Motion Analysis Technology tracks human movement during a range of important functional activities such as walking, running and stair climbing. Ultimately, whether collected as an adjunct to clinical care or for research, the knowledge gained is used to help improve function and quality of life for patients.

Computer Assisted Rehabilitation Environment (CAREN) provides immersive virtual reality environments allowing patients to experience challenging scenarios in a safe, controlled manner. The CAREN is an ideal tool for training patients with extremity trauma or amputation on how to safely negotiate varied terrains and minimize fall risk. It also incorporates demanding military-relevant scenarios to prepare Service members who wish to return to active duty.

The medical/surgical intervention focus area, the newest effort within the EACE research program, is focused on the evaluation of next generation regenerative medicine therapeutics and approaches for the restoration of tissue structure and function following traumatic injury. Led by the EACE team at WRNMMC/Uniformed Services University of the Health Sciences (USUHS), current efforts are focused on building operational capacity. Numerous efforts are currently in development and once fully operational, the EACE team is well positioned to be engaged in a myriad of cutting edge, clinically relevant research projects with the potential to significantly advance the standard of care. 

For example, the EACE supports the DOD Osseointegration Program at WRNMMC/ USUHS. Osseointegration (OI) is the use of a surgical implant to achieve direct skeletal attachment of a prosthetic limb to the residual limb of a person with an amputation. Over the next several years, the DOD OI Program, supported by EACE team members at WRNMMC, will be conducting several research studies for both upper and lower limb OI to evaluate its effectiveness at improving functional outcomes and quality of life for Service members and Veterans with limb loss. 

EACE supports well-established and ongoing research in the area of advanced prosthetics and orthotics at each of the DOD ARCs and in the VA. New advancements in technology have led patients to have higher functional and performance expectations than ever before and EACE researchers are working to not only meet, but exceed these expectations. Numerous research efforts are underway to develop and test new designs, improve prescription criteria and advance the functional capabilities of the end user.

EACE partners with the Naval Health Research Center (NHRC) to study the DOD/VA extremity trauma and amputation population. This research focus area seeks to comprehensively describe characteristics of the limb loss and extremity trauma population as well as the greater population of Wounded Warriors with permanent extremity functional loss from recent conflicts. The EACE epidemiology team is working to define this population, develop and validate a corresponding medical code algorithm and identify prospective data on health outcomes for this group. There is great value in longitudinally tracking long-term health outcomes and the impact of interventions that in turn support evidence based clinical decision making. The EACE/NHRC epidemiologic research program uses existing data to conduct population-level research with the goals of decreasing morbidity and mortality while maximizing health and quality of life outcomes for patients with limb loss.

Current epidemiology projects within these populations include:

• Incidence of and risk of long-term adverse health outcomes:  Studies aim to identify independent risk and protective factors for various secondary health effect outcomes.
• Factors associated with early return to duty:  Developing models that identify independent contribution of various characteristics (individual and rehabilitative) associated with successful return to duty after amputation.
• Military outpatient and inpatient healthcare costs:  Epidemiological and economic analyses to quantify and estimate direct and indirect costs of inpatient and outpatient amputee care.