Providence VA Medical Center, Rhode Island
Focus Area 3
Restoring Limb Function
Linda Resnik, PT, PhD, FAPTA
Susan D’Andrea, PhD
|Investigators in Focus Area 3 conduct research on rehabilitation in upper limb amputation and neuro-rehabilitation methods to address limb function post stroke. CfNN supported research on restoring limb function provides new hope to Veterans and other persons with amputation and mobility.
Linda Resnik, leader of FA3 continues to lead the Merit Review Renewal of the VA Home Study of an Advanced Upper Limb Prosthesis (VA RR&D A9226-R). The overall objective of the study is to examine the feasibility, acceptance and benefits of home use of an advanced upper limb prosthetic device as well as the logistical support requirements utilized during three months of home usage. The renewal study aims to compare the outcomes of users of EMG pattern recognition (PR) to the outsomes of users without. This effort builds upon the successful Home studs. Data from that study, including prescription and training recommendations, repairs data, and guidelines for best practices are being broadly disseminated to programmatic partners to facilitate the clinical implementation of the DEKA Arm, which received FDA approval in 2014, in part due to data provided by the VA Optimization study¹, and is now being called the LUKE Arm.
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In the News
Linda Resnik has been chosen as the 2017 recipient of the Paul B. Magnuson Award for Outstanding Achievement in Rehabilittion Research and Development.
Through the VA studies of the DEKA Arm and Home study (Resnik and her team have collected screening data on well over 120 upper limb amputees; enabling comparision of dexterity and activity performance by amputation level for conventional prosthesis users and providing critically needed data on the reliability and validity of commonly used measures. 2-4 Screening and testing data enabled the team to advance the field of outcome assessment in upper limb amputation leading the development of several new outcome measures for upper limb amputation including the: Activities Measure for Upper Limb Amputees (AM-ULA), the Timed Based Measure of Activity Measure for Upper LImb Amputees (BAM-ULA).5
Dr. Resnik has led several systematic reviews of measures of upper limb amputation, 8,9 contributed to the development of evidence based clinical guidelines for the rehabilitation of persons with upper limb amputation, 10 and guiding the selection of outcome measures for a joint VA-DoD effort to develop a toolbox of measures for persons with limb trauma and amputation.
Dr. Resnik also is the Principal Investigator of a national study of Veterans and service members with upper limb amputations. This study is a collaborative effort involving partners from the University of Massachusetts Medical School, four VA Medical Centers, and a DoD site. The primary aims of this work are to: describe patterns of prosthesis use; identify the impact of amputation and prosthesis use on function, activities and participation; and identify unmet prosthetic needs. Findings will also be compared for male and female amputees. The study includes one year longitudinal follow-up survey to examine changes in satisfaction with care and prosthetic services, physical performance, self-reported quality of life and physical function to assess the implementation of new clinical guidelines. The study also includes an in person assessment which aims to quantify physical function using a battery of performance based tests.
FA3 investigator, Susan D'Andrea, PhD, is leading a new collaborative effort, partnering with the Stroke Recovery Research Program at the Medical University of South Carolina (MUSC) and Mark Bowden of the Ralph H. Johnson VA Medical Center in Charlestown, SC to test the hypothesis that the effects of virtual reality treadmill training and tDCS may be synergistic and further improvement observed than with the application of either therapy alone.
In the CfNN Gait and Motion Analysis lab, we are focused on rehabilitation of lower limb amputees. Dr. Susan D’Andrea is the PI of an RR&D SPiRE grant “Virtual Reality for Individuals with Lower Limb Amputation” and the co-investigator/site PI for five additional amputee or lower-limb gait related projects. She is collaborating with Dr. Maikos at VANYHHS and other military medical centers to perform validation across different Gait Labs to ensure accurate results across sites and support quality collaborations
1. Resnik L. Research update: VA study to optimize DEKA arm. J rehabil Res Dev. 2010;47(3):ix-x.
2. Resnik L, Baxter K, Borgia M, Mathewson K. Is the UNB test reliable and valid for use with adults with upper limb amputation? J Hand Ther. 2013;26(4):353-359; quiz 359.
3. Resnik L, Borgia M, Latlief G, Sasson N, Smurr-Walters L. Self-reportrd and performance-based
4. Resnik L, Borgia M. Reliability, Validity and Responsiveness of the QuickDASH in Patients with Upper Limb Amputation. Arch Phys Med Rehabil. 2015.
5. Resnik L, Adams L, Borgia M, et al. Development and Evaluation of the Activities Measure for Upper Limb Amputees. Arch Phys Med Rehabil. 2012.
6. Renik L, Borgia M, Acluche F. Timed Activity Performance in Persons with Upper Limb Amputation: A Preliminary Study. Journal of Hand Therapy, In Press. 2017.
7. Resnik L, Borgia M, Acluche F. Brief activity perfromance measure for upper limb amputees: BAM-ULA. Prosthet Orthot Int. 2017:309364616684196.
8. Resnik L, Borgia M Silver B. Measuring Community Integration in Persons with Limb Trauma and Amputation: A Systematic Review. Arch Phys Med Rehabil. 2017;98(3):561-580 e568.
9. Resnik L, Borgia M, Silver B, Cancio J. Systematic Review of Measures of Impairment and Activity Limitation for Person with Upper Limb Trauma and Amputation. Arch Phys Med Rehabil. 2017.
10. Managemnt of Upper Extremity Amputation Rehabilitation Working Group. VA/DoD Clinical Proctice Guideline for the Management of Upper Extremity Amputation Rehabilitation. Department of Veterans Affairs, Department of Defense; 2014.