Department of Veterans Affairs Rehabilitation Research & Development Center for Limb Loss and MoBility (CLiMB)

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CENTER SUMMARY/ABSTRACT The mission of the Center for Limb Loss and MoBility (CLiMB) is to preserve, restore, and enhance functional mobility, independence, and participation in Veterans with lower limb loss or other musculoskeletal impairments. CLiMB serves Veterans with mobility disabilities arising from medical comorbidities or post-service trauma, as well as those with injuries sustained while on active duty, including small but important cohorts of women and other under-represented minorities. CLiMB accomplishes this mission by conducting innovative and rigorous research; disseminating discoveries to Veteran patients and providers, VA leadership, and other stakeholders; and translating knowledge and devices into clinical care. CLiMB’s nationally and internationally recognized Principal Investigators are a multidisciplinary group of clinician-scientists, engineers, biomechanists, and epidemiologists. The Center’s scientific approaches and research Focus Areas span basic science, through engineering design and development, to applied clinical research. CLiMB’s research Focus Areas are rooted in the parallel importance of studying (1) Prevention of impairment onset and progression, (2) Innovative mobility device development, (3) Evidence-based treatment and rehabilitation interventions, and (4) Personalized surgical and prosthetic/orthotic treatment interventions. Focus Area projects are conceived through a synergistic collaboration with patients, clinicians, clinician-scientists, and scientists both within and outside the Center who identify and define unmet clinical needs in our Veteran patients. Project success is achieved through CLiMB’s clinical translational pathway where projects often begin in a Discovery or Innovation phase and culminate in clinical Translation. Consequently, the Center has placed a significant emphasis on ensuring that its research and innovations have a demonstrated clinical need and a pathway to translation to ensure that Veterans benefit directly from its work. CLiMB Translation can take on different forms (knowledge and devices) including evidence to support clinical practice guidelines, physician decision support tools, patient decision aids available at the point of care, and collaborations with industry to commercialize devices that are made available to Veterans. CLiMB’s success and achievements are the result of unique laboratory and intellectual resources that cut across our Focus Areas. These Core resources accelerate and facilitate the collaborative work of internationally renowned clinicians and scientists with complementary expertise in rehabilitation science, engineering, and clinical care. These resources have been cultivated by our Center for years, and with this renewal we are further formalizing their structure, leadership, and purpose to include the following seven Cores: (1) Biomechanics & Basic Science, (2) Imaging & Motion Analysis, (3) Computational Modeling, (4) Rapid Prototyping, (5) Clinical Study Design, Epidemiology, & Biostatistics, (6) Novel Technologies & Applications, and (7) Administration & Protection of Human Subjects. CLiMB’s future work will take a major step forward based upon the interim evolution of engineering discoveries, unique to CLiMB resources, and the emergence of validated innovation and decision support tools. In 2021, the Center has ten PIs who are committed to finding new ways of treating Veterans with lower limb loss or other musculoskeletal impairments and translating these findings to the point of Veteran care. Its planned innovative studies will harness novel technologies and applications including: the unique aspects of 3D printing, musculoskeletal simulation, and prosthetic emulation to develop novel and personalized approaches to prosthetic/orthotic prescription; state-of-the-art imaging and motion analysis techniques to understand and treat orthopedic maladies; decision support tools for amputation-level shared decision making to maximize functional outcomes; and cutting edge rehabilitation strategies to optimize healing and reduce pain. CLiMB will accomplish this mission while continuing its commitment to the training of the next generation of investigators.