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Joint Dislocation and Reduction Simulator for Training



OBJECTIVE: Develop and demonstrate a simulation-based system to provide psychomotor skills training for medical practitioners for the task of identifying and treating shoulder, elbow, and finger joint dislocations. 

DESCRIPTION: Joint dislocation, sometimes referred to as luxation, occurs when there is an abnormal separation in the joint, where two or more bones meet. Joint dislocations occur when a sudden, great force is applied to the joint, such as a hard fall during parachuting or heavy blow during a vehicular crash. The highest incidence of dislocations occurs in the shoulder, elbow, knee, and finger joints. Currently, the military experiences a significantly higher rate of joint dislocations than the general public. With each dislocation, the ligaments keeping the bones fixed in the correct position can be damaged or loosened, making it easier for the joint to be dislocated in the future. This results in a large number of patients with repeated dislocation injuries. Fortunately, joint dislocations have readily apparent indications and a straightforward treatment path. Physicians perform a joint reduction, whereby the dislocation is restored to correct alignment through a manual manipulation. Unfortunately, there are no simulation devices currently available which simulate joint dislocations or train the psychomotor skills needed for a joint reduction. This means the first time a practitioner performs a joint reduction, it is on an actual patient. Military medical training locations, including the Defense Medical Training Research Institute and Uniformed Services University of Health Sciences, conduct courses for a variety of medical providers and are required to teach skills associated with joint reduction, but must do so without a suitable training simulator. Additionally, joint reduction has been identified as a core competency for orthopedic surgeons deploying as part of a trauma team. To alleviate this gap in training capability, this announcement seeks a simulator capable of simulating joint dislocation and treatment, thereby allowing risk-free, repeatable practice of the procedure. The proposed training device should: - Support established training objectives - Support practice of both cognitive and psychomotor skills - Include palpable anatomical landmarks to determine proper joint alignment - Demonstrate the signs and symptoms of joint dislocation - Replicate appropriate range of motion for dislocated and properly reduced joints - Be capable of simulating the most common upper extremity joint dislocations, including: anterior shoulder dislocation (primary interest), interphalangeal (IP) joint dislocation, metacarpophalangeal (MCP) joint dislocation, and elbow dislocation - Allow for fast reset - Ability to train multiple providers 

PHASE I: Design/develop an innovative concept for a simulation-based training system to perform a joint reduction procedure. The effort should clearly analyze the scientific, technical, and commercial merit, as well as feasibility of using a low-cost medical simulator for training advanced medical providers of all levels in Military Medical Training Programs. Proposed work should include research into feasibility of developing the capability and describing the overall concept. The effort should seek innovative and novel ideas to provide a hands-on, low-cost, and realistic simulation solution. The offeror shall identify innovative technologies being considered; technical risks of the approach selected; and costs, benefits, and schedule associated with development and demonstration of the prototype. 

PHASE II: Develop and demonstrate a prototype system from the recommended solution in Phase I that provides realistic and meaningful interaction for hands-on treatment. At the culmination of Phase II, the offeror shall demonstrate a prototype training device with all capabilities fully implemented. The offeror shall perform mechanical testing to determine that joint motion characteristics, such as range of motion or the amount of force required to perform a reduction, are consistent with the live human joint characteristics. The offeror shall consider projection of costs to manufacture, maintain and resupply, as well as the equipment lifecycle. The evaluation of the proposed system by the user community at a military installation is required. The offeror shall conduct usability evaluations to assess the system in terms of: benefit to training, ease of use, anatomical accuracy, physiological accuracy, realism, and motivation to use. Data from these studies shall be provided, analyzed, and presented in a final report. 

PHASE III: Follow-on activities are expected to be pursued by the offeror to demonstrate the application of this system to civilian hospitals, residency training programs, and other military medical facilities. Various medical providers, such as orthopedic surgeons, sports medicine physicians, nurse practitioners, and physician’s assistants, perform joint reduction. The associated training facilities for these providers, including military training hospitals, civilian universities, etc., would all be potential end users. The offeror shall focus on transitioning the technology from research to operational capability and shall demonstrate that this system could be used in a broad range of military and civilian medical training environments. The offeror shall pursue transition of the device as a standalone training unit and as a component of a mannequin system. As such, the offeror shall pursue transitioning of the capability into larger mannequin platforms, including currently commercially available medical mannequins and emerging research platforms, such as the modular mannequin program. 


1: Belmont Jr, P. J., Goodman, G. P., Waterman, B., DeZee, K., Burks, R., & Owens, B. D. (2010). Disease and nonbattle injuries sustained by a US Army brigade combat team during Operation Iraqi Freedom. WILLIAM BEAUMONT ARMY MEDICAL CENTER EL PASO TX.

2:  Hsiao, Mark, et al. "Incidence of acute traumatic patellar dislocation among active-duty United States military service members." The American journal of sports medicine 38.10 (2010): 1997-2004.


KEYWORDS: Medical Simulation; Orthopedic Simulation; Joint; Reduction; Dislocation; Simulator; Training Device 

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