Center for Limb Loss and MoBility
Joseph Czerniecki, M.D.
Associate Director, VA Center for Limb Loss and MoBility, Seattle, WA
Professor, Department of Rehabilitation Medicine, University of Washington, Seattle, WA
Rehabilitation Care Service (117)
VA Puget Sound Health Care System
I have a long history of research related to amputations and prosthetics. My research career interests have spanned the evaluation of biomechanical componentry on functional mobility, the relationship between biomechanical variables and metabolic energy costs, to the evaluation of pain, pain related disability and treatment of post amputation pain syndromes. More recently I have been involved with research that aims to understand the dynamics of factors that influence amputee outcome. This background has provided me with a broad scientific and clinical understanding of post amputation disability. The goal of this project is to understand and quantify the modifiable risk factors that contribute to poor outcome for four years post lower extremity amputation in veterans with peripheral vascular disease and diabetes. These patients have a high mortality and a high likelihood of incurring additional co-morbidities that adversely affect function. Although traditionally factors such as mortality and contralateral amputation have been viewed as health care factors that are dependent on the “medical care” provided, recent conceptualization of these processes in a chronic disease model reveal the importance of psychosocial variables that strongly interact to affect ulceration rates as well as other complications in individuals with diabetes. The results of this study therefore will likely be the first to prospectively quantify the longitudinal outcome of individuals who have undergone lower extremity amputation, but it will also enable us to quantify the relative importance of modifiable biological, psychological and social factors that contribute to that outcome. Ultimately this will lead to restructured health care practices that will not only enhance outcome from both a medical and a functional perspective but will lead to an enhanced quality of life. The research team of rehabilitation physicians, rehabilitation psychologists, epidemiologists, and statisticians, all with a long history of research related to amputations and experience with conducting multicenter trials is in an ideal position to conduct this important work.
Sangeorzan BJ, Harrington RM, Wyss LR, Czerniecki JM, Matsen FA; Circulatory and Mechanical Response of Skin to Loading. Journal of Orthopedic Research, 7(4):1-7, 1989.
Czerniecki JM, Gitter A; The Effects of Prosthetic Foot Design on Stance Phase Joint Moments and Muscle Power Output Characteristics in Running: Journal of Biomechanics, 24(1):63-75, 1991.
Gitter A., Czerniecki JM, DeGroot DM; Biomechanical Analysis of the Influence of Prosthetic Feet on Below Knee Amputee Walking. American Journal of Physical Medicine and Rehabilitation, 70(3):142-148, 1991.
Czerniecki JM, Gitter A; Insights into Amputee Running: A Muscle Work Analysis. American Journal of Physical Medicine and Rehabilitation, 71(4):209-218, 1992.
Beck JC, Czerniecki JM; A method for optimization of above-knee prosthetic shank-foot inertial characteristics. Gait and Posture, 2:75-84, 1994.
Czerniecki JM, Gitter AJ, Weaver K; The effect of alterations in prosthetic shank mass on the metabolic costs of ambulation in above-knee amputees. American Journal of Physical Medicine and Rehabilitation, 73:348-352, 1994.
Czerniecki JM, Gitter AJ, Beck JC; Energy transfer mechanisms as a compensatory strategy in below-knee amputee runners. Journal of Biomechanics, 29:717-722, 1996.
Gitter AJ, Czerniecki JM, Weaver K; A reassessment of center of mass dynamics as a determinant of the metabolic inefficiency of above-knee amputee ambulation. American Journal of Physical Medicine and Rehabilitation, 74:332- 338, 1995.
Czerniecki JM, Gitter AJ; Gait analysis in the amputee: has it helped the amputee or contributed to the development of improved prosthetic components? Gait and Posture. 4:258-268, 1996. Requested Review Article
Seroussi RE, Gitter AJ, Czerniecki JM; The mechanical work adaptations of above-knee amputee ambulation. Archives of Physical Medicine and Rehabilitation, 77:1209-1214, 1996.
Gitter AJ, Czerniecki JM, Meinders M; The effect of prosthetic mass on swing phase work during above-knee amputee ambulation. American Journal of Physical Medicine and Rehabilitation, 76:114-121, 1997.
Meinders M, Gitter AJ, Czerniecki JM; The function of ankle plantarflexor activity during push-off. Scandinavian Journal of Rehabilitation Medicine, 30:39-46, 1998.
Ehde, D, Czerniecki JM, Smith DG, Campbell KM, Edwards WT, Jensen MP, Robinson LR; Chronic Phantom Sensation, Phantom Pain, Residual Limb Pain, and other Regional Pain following Lower Limb. Archives of Physical Medicine and Rehabilitation, 81:1039-44, 2000.
Ehde, DM, Smith DG, Czerniecki JM, Campbell KM, Malchow DM, Robinson LR; Back pain as a secondary disability in persons with lower limb amputations. Archives of Physical Medicine and Rehabilitation , 82(6):731-4, 2001.
Hafner, B, Sanders, J, Czerniecki JM, Fergason, J; Transtibial energy-storage-and-return prosthetic devices: A review of energy concepts and a proposed nomenclature. Department of Veterans Affairs Journal of Rehabilitation Research and Development, 39(1):1-11, 2002.
Legro, MW, Reiber, GE, Czerniecki, JM, Sangeorzan, BJ; Recreational activities of lower limb amputees with prostheses. Department of Veterans Affairs Journal of Rehabilitation Research and Development, 38:319-325, 2001.
Roy Choudury, S, Reiber GE, Pecarero, JA, Czerniecki, JM, Smith DG, Sangeorzan, BJ; Post-operative management of transtibial amputations in VA hospitals. Department of Veterans Affairs Journal of Rehabilitation Research and Development, 38:293-298, 2001.
Klute GK, Kallfelz C, Czerniecki, JM; Mechanical properties of prosthetic limbs: Adapting to the patient. Department of Veterans Affairs Journal of Rehabilitation Research and Development, 38:299-307, 2001.
Weaver K, Price R, Czerniecki JM, Sangeorzan BJ; Design and Validation of an Instrument Package Designed to Increase the Reliability of Ankle Range of Motion Measurements. VA Journal of Rehabilitation Research & Development, 38(5):471-475, 2001.
Coleman KL, Boone DA, Smith DG, Czerniecki JM; Effect of trans-tibial pylon flexibility on ground reaction forces during gait. Prosthetics Orthotics International, 25:195-201, 2001.
Czerniecki JM; Gait Analysis in Lower Extremity Amputation. Physical Medicine and Rehabilitation: State of the Art Reviews. 16(2): 323-337, 2002.
Hafner, B, Sanders, J, Czerniecki JM, Fergason, J; Energy Storage and Return Prostheses: Does Patient Perception Correlate With Biomechanical Analysis? Clinical Biomechanics. 17(5): 325-44, 2002.
Klute GK, Czerniecki, JM, and Hannaford B;Artificial Muscles: Actuators for Biorobotic Systems,” International Journal of Robotics Research, 21(4): 295-309, 2002.
Assal M, Shofer JB, Rohr E, Price R, Czerniecki JM, Sangeorzan B; Assessment of an electronic goniometer designed to measure equinus contracture. VA Journal of Rehabilitation Research and Development 40 (3): 235-240, 2003.
Robinson LR, Czerniecki JM, Ehde DM, Edwards WT, Judish DA, Goldberg ML, Campbell KM, Smith DG, Jensen MP; Trial of Amitryptiline for relief of pain in amputees: results of a randomized controlled trial. Archives of Physical Medicine and Rehabilitation, 85:1-6, 2004.
Berge JS, Klute GK, Czerniecki, JM; Mechanical Properties of Shock Absorbing Pylons Used In Transtibial Prostheses. Journal of Biomechanical Engineering, 126 (1): 120-122, 2004.
Norvell DC, Czerniecki JM, Reiber GE, Maynard C, Pecoraro JA, Weiss NS; The Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis Among Veteran Traumatic Amputees and Nonamputees. Archives of Physical Medicine and Rehabilitation. 86: 487-493, 2004.
Williams RM, Ehde DM, Smith DG, Czerniecki JM, Hoffman AJ, Robinson LR; A two-year longitudinal study of social support following amputation. Disability Rehabilitation 26 (14-15): 862-874, 2004.
Ferris D, Czerniecki JM, Hannaford B; An Ankle Foot Orthosis Powered by Artificial Muscles. Journal of Applied Biomechanics. 21(2):189-97.
Berge JS, Klute GK, Czerniecki JM; Efficacy of a shock-absorbing pylon based on laboratory, field and outcome metrics. Journal of Rehabilitation Research and Development. 42(6):795-808, 2005.
Orendurff MS, Segal AD, McDowell ML, Klute GK, Pecoraro, JA, Czerniecki JM; Gait efficiency using the C-leg. VA Journal of Rehabilitation Research and Development, 43(2):239-46, 2006.
Czerniecki JM; Research and Clinical Selection of Foot-Ankle Systems. Journal of Prosthetics and Orthotics. 17(4):S35-S37, 2005.
Orendurff MS, Rohr ES, Sangeorzan BJ, Czerniecki JM; An equinus deformity of the ankle accounts for only a small amount of the increased forefoot plantar pressure in patients with diabetes. J Bone Joint Surg Br., 88(1): 65-68, 2006.
Klute, GK, Orendurff MS, Berge JS, Williams RM, Czerniecki, JM., Prosthetic Intervention Effects on Activity of Lower Extremity Amputees. Archives of Physical Medicine and Rehabilitation. 87(5): 717-722, 2006.
Williams RM, Turner AP, Orendurff M, Segal AD, Klute GK, Pecoraro J, Czerniecki, JM; Does Having a Computerized Prosthetic Knee Influence Cognitive Performance During Amputee Walking? Archives of Physical Medicine and Rehabilitation 87(7):989-94, 2006.
Segal AD, Orendurff MS, McDowell, ML, Klute GK, Pecoraro JA, Czerniecki JM; The gait biomechanics of transfemoral amputees using the C-leg compared to a conventional prosthesis. VA Journal of Rehabilitation Research and Development, 43 (7): 857-870, 2006.
Robinson LR, Edwards WT, Smith DG, Ehde DM, Czerniecki J M, Patterson DR, Campbell KM, Goldberg M, Jensen MP; Effect of perioperative epidural anesthesia on phantom limb and residual limb pain. Pain Medicine. In Press.
Segal A, Orendurff M, Czerniecki JM, Klute GK; Local Dynamic Stability in Turning and Straight-Line Gait. Journal of Biomechanics. 41(7)1486-93, 2008.