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

中心总结/摘要 肢体丧失和活动中心（CLiMB）的使命是保护、恢复和增强功能 活动性、独立性和参与下肢丧失或其他肌肉骨骼损伤的退伍军人。 CLiMB为因医疗合并症或服务后创伤而导致行动不便的退伍军人提供服务， 以及那些在现役期间受伤的人，包括人数不多但很重要的妇女群体， 少数民族代表不足。CLiMB通过创新和严谨的方式完成这一使命 研究;向退伍军人患者和提供者，VA领导和其他利益相关者传播发现; 并将知识和设备转化为临床护理。CLiMB是国内和国际公认的 主要研究者是一个由临床科学家、工程师、生物力学家和 流行病学家该中心的科学方法和研究重点领域涵盖基础科学， 工程设计和开发，应用临床研究。CLiMB的研究重点领域植根于 研究的平行重要性（1）预防损伤的发生和进展，（2）创新的流动性 器械开发，（3）循证治疗和康复干预，以及（4）个性化 手术和修复/矫正治疗干预。重点领域项目是通过一个协同的 与患者、临床医生、临床科学家和中心内外的科学家合作， 识别和定义退伍军人患者未满足的临床需求。项目的成功是通过CLiMB的 临床转化途径，其中项目通常开始于发现或创新阶段，并在 临床翻译因此，该中心非常重视确保其研究 和创新具有已证明的临床需求和转化途径，以确保退伍军人受益 直接从他的工作。CLiMB翻译可以采取不同的形式（知识和设备），包括证据 支持临床实践指南、医生决策支持工具、患者决策辅助工具， 护理点，并与行业合作，将退伍军人可用的设备商业化。 CLiMB的成功和成就是独特的实验室和智力资源的结果， 我们的重点领域。这些核心资源加速和促进了国际社会的合作， 著名的临床医生和科学家，在康复科学，工程和 临床护理这些资源是我们中心多年来培养的，随着这次更新，我们进一步 正式确定其结构，领导和目的，包括以下七个核心：（1）生物力学和 基础科学，（2）成像和运动分析，（3）计算建模，（4）快速原型，（5）临床 研究设计，流行病学和生物统计学，（6）新技术和应用，以及（7）管理和 保护人类受试者。CLiMB未来的工作将在中期基础上向前迈出重要一步 工程发现的演变，独特的CLiMB资源，并出现验证创新 决策支持工具。2021年，该中心有十名PI致力于寻找新的治疗方法 退伍军人与下肢损失或其他肌肉骨骼损伤，并翻译这些发现的点， 退伍军人护理其计划中的创新研究将利用新技术和应用，包括： 3D打印、肌肉骨骼仿真和假肢仿真的独特方面， 个性化的假肢/矫形器处方方法;最先进的成像和运动分析 了解和治疗骨科疾病的技术;截肢水平共享的决策支持工具 最大化功能结果的决策;以及优化愈合的尖端康复策略 减轻疼痛CLiMB将完成这一使命，同时继续致力于培训下一个 一代调查员。

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.