Identifying more economical approaches to medical imaging for the rehabilitation of traumatic military injuries

The cost of National Health Service care for the 265 amputee casualties of British Operations in Afghanistan between 2003 and 2014 is projected to be £288 million (Edwards et al., 2015, Clinical Orthopaedics and Related Research). This cost is due to the development of secondary comorbidities such as osteoporosis, type 2 diabetes, obesity, and cardiovascular disease. An independent and physically active lifestyle can benefit health and prevent such diseases. Physical activity is restricted following lower limb amputation due to a significant loss of muscle and strength. There is also an increased risk of developing musculoskeletal injuries such as osteoarthritis, which is a further barrier to physical activity. In addition, the energy cost of performing activities of daily living is increased, limiting what an individual can do independently. This research aimed to identify economical approaches for using medical images to measure muscle size and support practitioners in tailoring rehabilitation for achieving independently active lifestyles following severe military injuries. The term ‘economical’ was considered with respect to time demand and safety. Imaging modalities considered were Magnetic Resonance Imaging (MRI) and Brightness-mode (B-mode) ultrasound. A large reduction in the time demand of analysing MRI images was achieved by increasing the distance between analysed images. The resulting time demand of 24 hours for the entire lower limb was considered too long for clinical use. B-mode ultrasound was identified as an alternate approach and is valuable for the assessment of those with metallic foreign objects such as shrapnel. A limitation of B-mode ultrasound is the inability to measure individual muscle size although it can measure muscle group size and is useful for physiotherapists and injury rehabilitators. The two methods identified in this research can be used to measure muscle size and monitor changes throughout rehabilitation so that appropriate and timely modifications can be made.