Page 63 - Journal of Special Operations Medicine - Spring 2015

Table 5 Change in Average Power (%) The patient had an initial bilateral Biodex test performed;
Extension Flexion Extension Flexion however, the ability to compare strength to the contralat­
Case Speed 1 Speed 1 Speed 2 Speed 2 eral limb was limited because of trauma sustained to his
1 14.2 70.1 –11.9 47.4 lower left extremity 2 years earlier. He had a 43% deficit
in peak torque (Table 1), 56% deficit in average power
2 42.2 19 33.5 90.9 (Table 2), and 58% deficit in total work (Table 3), all with
3 7.6 26.2 44.5 29.4 knee extension at 90º/sec. He demonstrated deficiency
4 12.8 24.8 29.2 47.1 at 300º/sec only in total work (Table 3). After 2 weeks
5 33.2 35 29.4 18.3 of training on the right lower extremity, the patient’s im­
provements were greatest in extension at 90º/sec with
6 76.4 102.5 108.4 212.1 peak torque increasing 63% (Table 4), average power 8%
7 75.3 63.6 79.7 86.1 (Table 5), and total work 77% (Table 6, Figure 1).
Notes: All measurements are affected extremity comparing power (W)
after 2 weeks of BFR training to baseline measurement before BFR Figure 1 Average percent total work difference of the
training started, expressed as percentage. Speed 1 is 90º/sec. Speed 2 affected to the nonaffected extremity. Speed 1 is 90º/sec.
is 300º/sec. Speed 2 is 300º/sec.
Table 6 Change in Total Work (%)
Extension Flexion Extension Flexion
Case Speed 1 Speed 1 Speed 2 Speed 2
1 7 69.6 –13.6 49.5
2 27.3 3.9 22.8 ­20.1
3 77.6 17.1 34.9 26.3
4 26.1 6.4 54.1 20.8
5 24.8 25.2 26.9 17.9
6 40.8 64.8 77.3 159.4
7 62.7 61.9 63.4 78.7
Notes: All measurements are affected extremity comparing work (J)
after 2 weeks of BFR training to baseline measurement before BFR Case Presentation 4
training started, expressed as percentage. Speed 1 is 90º/sec. Speed 2
is 300º/sec. The patient is a 26­year­old man who in 2009 sustained
a gunshot wound to the right femur. He underwent
total knee replacement surgery; however, he first needed open reduction and internal fixation, but subsequently
to increase his quadriceps strength and function. He was developed osteomyelitis. After a prolonged course of
referred for BFR training 4 years after his last surgery.
treatment—including removal of all hardware, multiple
debridements, and both local and systemic antibiotics—
Initial Biodex testing demonstrated a more significant def­ his fracture healed following revision fixation in 2011.
icit in knee extension, with a 52% deficit in peak torque To treat an acquired quadriceps contracture, he had a
(Table 1), 61% deficit in average power (Table 2), and soft­tissue release approximately 1 year later. He was
57% deficit in knee extension total work in the left lower referred for BFR training 1 year after his last surgery.
extremity compared with the contralateral side (Table 3),
with the largest deficits shown in extension at 90º/sec. His knee extension weakness was substantial, with a def­
After 2 weeks of BFR therapy, he had a 42% increase in icit in peak torque of 67% and 54% compared with the
power (Table 5) and a 27% increase in both peak torque contralateral limb at 90º/sec and 300º/sec, respectively
(Table 4) and total work (Table 6) at 90º/sec.
(Table 1). Average power showed 76% and 73% defi­
cits in knee extension (Table 2), and total work showed
Case Presentation 3 74% and 73% deficits in knee extension (Table 3). After
2 weeks of BFR training, his peak torque improved 13%
The patient is a 24­year­old man who sustained major and 36% (Table 4), average power improved 13% and
left lower extremity trauma in 2011 resulting in tibia 29% (Table 5), and total work improved 26% and 54%
plafond, fibula, and calcaneus fractures. He subse­ at 90º/sec and 300º/sec, respectively (Table 6).
quently underwent multiple surgical interventions for
management of his injuries and most recently had a Case Presentation 5
right knee arthroscopy to include microfracture. He was
referred for BFR training for his right lower extremity 6 The patient is a 29­year­old man who in 2010 sustained
months after his most recent surgery. left open tibia and fibula fractures from an improvised

Blood Flow Restriction Rehabilitation for Extremity Weakness 53