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This paper seeks to describe how novel technologies such as the computer-assisted research environment (CAREN) may improve physical and cognitive rehabilitation for wounded warfighters.The CAREN system is a dynamic platform which may assist service members who have sustained improvised explosive device injuries during Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn. The complex nature of warfighter injuries present unique rehabilitation challenges that demand new tools for quick return to active duty or the civilian community.Virtual reality-based gait training programs may directly influence physiological and biomechanical performance for those who have endured combat injuries. The CAREN system provides a safe, interactive environment for the user while capturing kinematic and kinetic data capture to improve rehabilitation regimens.This paper provides an overview of the CAREN system and describes how this dynamic rehabilitation aid may be a translational tool for collecting biomechanical and physiological data during prosthetic training. The CAREN platform allows users to be fully immersed in a virtual environment while healthcare providers use these simulations to improve gait and stability, obstacle avoidance, or improved weight shifting. As such, rehabilitation regimens may be patient specific.

Exposure to explosive armaments during Operation Iraqi Freedom and Operation Enduring Freedom contributed to approximately 14% of the 352 612 traumatic brain injury (TBI) diagnoses in the US military between 2000 and 2016. The US Department of Defense issued guidelines in 2009 to (1) standardize TBI diagnostic criteria; (2) classify TBI according to mechanism and severity; (3) categorize TBI symptoms as somatic, psychological, or cognitive; and (4) systematize types of care given during the acute and rehabilitation stages of TBI treatment. Polytrauma and associated psychological and neurologic conditions may create barriers to optimal rehabilitation from TBI. Given the completion of recent combat operations and the transition of TBI patients into long-term care within the US Department of Veterans Affairs system, a review of the literature concerning TBI is timely. Long-term follow-up care for patients who have sustained TBI will remain a critical issue for the US military.

Nickel−nitrilotriacetic acid-functionalized single-walled carbon nanotubes have been synthesized for the directed, reversible self-assembly of polyhistidine-tagged macromolecules onto the nanotube surface. Carbon nanotubes were first covalently functionalized with 4-carboxybenzene diazonium salt, which rendered them water-soluble. The acid moieties on the carbon nanotube were covalently reacted with Nα,Nα-bis(carboxymethyl)-l-lysine hydrate, forming amide bonds to the nanotube complex. The nitrilotriacetic acid (NTA) moiety of the Nα,Nα-bis(carboxymethyl)-l-lysine was complexed with Ni2+ and used to specifically bind a polyhistidine-tagged photosynthetic reaction center (RC) from Rhodobacter sphaeroides as a model system. We demonstrate that the histidine-tagged RC protein (RC-His) specifically binds to SWNT-NTA-Ni in a reversible manner. The free RC-His in solution can be removed through histidine binding to Ni-NTA-agarose resin and purified by filtration. This approach allows for both positional and ori...

Brad M Isaacson,1,2 Thomas M Swanson,1,2,4 Benjamin K Potter,4 Paul F Pasquina2,3 1The Henry M Jackson Foundation for the Advancement of Military Medicine, 2The Center for Rehabilitation Sciences Research, Department of Physical Medicine and Rehabilitation, Uniformed Services University of Health Sciences, 3Department of Rehabilitation, Walter Reed National Military Medical Center, 4Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland, USA Abstract: Tourniquet use during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) has contributed to the high survival rate of combat-injured service members. While preservation of a life – even at the potential expense of a limb – should always take precedence, delayed perfusion in traumatized residual limbs may alter the proliferation, differentiation, and function of endothelial and osteoprogenitor cells. Given the synergistic relationship between angiogenesis and osteogenesis, and the influence of environmental conditions on bone formation, hypoxic conditions from tourniquets may in part explain the higher frequency of heterotopic ossification (HO) present during OIF/OEF. Determining a correlation between tourniquet usage/duration on subsequent HO formation remains challenging. Long-term retrospective investigations have been limited, since the United States Army's Institute of Surgical Research did not standardized tourniquet issuance until July 2004. Thus, associating tourniquet-induced HO in previous military conflicts is not feasible, since poor medical documentation and inadequate application of these medical devices prevent large-scale meta-analyses. Therefore, this article focuses on the basics of bone biology and how tourniquet usage following combat trauma may impact osteogenesis, and subsequently, ectopic bone formation. Keywords: heterotopic ossification, osteogenesis, combat, trauma, ectopic bone, osteoprogenitor cells, Operation Iraqi Freedom, Operation Enduring Freedom