I am physical therapist working in a rehab center where we often see traumatic leg and arm injuries from car and work-related accidents. We are trying to develop a way to measure and document muscle loss from the time of the injury through discharge from treatment. What are other trauma centers using?

Missing muscle and soft tissue mass referred to as volumetric muscle loss (VML) is a big problem for soldiers and civilians alike following traumatic injuries. Efforts are being made to document the effect these injuries have so that better treatment outcomes can be developed.

With the increased number of combat-casualties from Operation Iraqi Freedom, military teams have worked hard to put together a standardized protocol that would accurately assess and clearly describe injuries of this type.

A standard assessment protocol should include photographs, video analysis, and tests and measures for motion, strength, and function. Any and all of these tools can be used to document before, during, and after injury effects and progress.

The military rehab team recommends the following for evaluating volumetric muscle loss and its effects:

  • Divide injuries by upper extremity (arms and lower extremity (legs).
  • Divide limb injuries above and below the joint (above/below elbow for the arm, above/below knee for the leg).
  • Take photos and videos to document appearance, movement, strength, and function. Wound size, location, and severity can be shown this way. Loss of skin, soft tissue mass, and atrophy (wasting) of muscles can be documented this way as well.
  • Analyze videos of movement and gait (walking pattern) to aid in developing the plan-of-care.

    Gathering all of this information is important when the team selects the best management option for each patient. These guidelines are subject to change as rehab specialists such as yourself along with other members of your team (e.g., surgeons, occupational therapists, orthotists, and prosthetists) continue to develop this idea.