JOINT BASE SAN ANTONIO-FORT SAM HOUSTON, Texas - Researchers from the U.S. Army Medical Center of Excellence, or MEDCoE, and Brook Army Medical Center, or BAMC, were awarded a medical research grant to improve training on ankle ultrasound imaging by physical therapists.

The research titled "Development and Feasibility of a Diagnostic Ultrasound Training Program for PTs to Evaluate Acute Ankle Sprain," was awarded to a collaborative team of four Army physical therapists: Col. Theodore Croy, Program Director, Army-Baylor Doctoral Program in Physical Therapy, or DPT, assigned to MEDCoE; Maj. Jon Umlauf, Army-Baylor Faculty assigned to BAMC; Maj. Bryan Pickens, Fellowship Director assigned to BAMC; and recently retired Maj. Christopher Allen, former Program Director, Army-Baylor Doctoral Fellowship in Orthopaedic Manual Physical Therapy and current Associate Professor, College of Allied Health Sciences, University of Cincinnati.

The $244,500 award is allocated through the Army Medical Department Advanced Medical Technology Initiative, or AAMTI, by the U.S. Army Medical Research and Development Command, or USAMRDC. The AAMTI grant was specifically awarded using USAMRDC's Extended Innovation Fund for the identification, exploration, and demonstration of key technologies and enabling biomedical principles required to overcome technological barriers that are medically and militarily unique.

The funding initiative provides Army Medicine leaders with the resources to conduct advanced technology development, demonstration and validation of important new technologies for projects up to 18 months in duration.

Through the grant, that was announced on October 2, the research team plans to develop a comprehensive diagnostic pathway for acute ankle sprains that integrates a clinical and sonographic evaluation. The group, who are all current or recent cadre with the Army-Baylor DPT program, also expects to develop an ultrasound training program for physical therapists as part of the research.

The DPT program trains 26 students annually, awarding qualified candidates a doctoral degree in physical therapy after a challenging 30 months of instruction. The Army-Baylor DPT program is currently ranked eighth in the nation according to U.S. News & World Report.

Croy, who has been with MEDCoE since 2011 and has served as the DPT Program Director since 2017, said, "This grant builds upon skills and knowledge that we have been incorporating and studying for years in the lumbar spine, shoulder, and ankle."

He believes the area of research will have a significant impact on physical therapist practices across the Military Health System. "Accessible, portable and capable diagnostic imaging can aid in decision making for injured service members; this grant increases our ability to create a ready medical force," related Croy.


Umlauf is the DPT program's Clinical Internship Director and trains physical therapy students during phase two, hospital based training, at BAMC. He has been awarded four AAMTI grants since 2018, to include another study scheduled for 2020 with Pickens on the subject of telehealth for lower back pain.

He describes this project as a feasibility study to determine if military physical therapists can train to integrate diagnostic ultrasound into their standard clinical examination for acute ankle sprains.

Umlauf explained, "We will develop a simulation-based training program using a refined clinical and sonographic evaluation pathway specific for acute ankle sprains."

This simulation training will be augmented with classroom training to create an eight-hour blended learning approach to train physical therapists in the DPT program with instruction at MEDCoE and BAMC. Following the program, subjects will be given a mastery examination to determine the training's effectiveness.


"Military physical therapists, when adequately trained to perform diagnostic ultrasound of acute ankle sprains, will provide a means of advanced imaging at a lower cost closer to the point of injury," said Umlauf.

He acknowledged, however, that creating separate, lengthy training programs for military physical therapists is very challenging. "Leveraging technology such as simulation-based training and integrating it into already established training courses will provide a cost-effective means to add this skillset and allow rapid expansion of medical capabilities to deployed settings."

According to the Defense Health Agency, there have been nearly 1.2 million ankle sprains among military members since 2005, making these injuries the eighth most common reason for accessing healthcare among military members.

"Improving our ability to evaluate and manage these common injuries directly impacts medical readiness and lost duty days," said Umlauf. "Our team believes that integration of point of care ultrasound evaluation will provide an opportunity to more accurately diagnose and will provide insight to the management and prognosis of this common and debilitating injury, thus improving readiness."

The research will take place at both BAMC and MEDCoE and is scheduled to begin July 2020 and end in July 2021. The joint MEDCoE and BAMC research team plans to present their findings during several professional forums and through articles in technical or peer-reviewed journals by the end of 2021.

Croy maintains that the study will improve diagnostic care which could lead to improvement in clinical treatment of injuries. He said, "Researching a common injury helps physical therapists build new skills, new knowledge and new opportunities for care."

He believes that the team's most important role during the study is to rigorously investigate musculoskeletal ultrasound and develop the expertise which may inform clinical management of an acute ankle sprain in the near future. "We already know the utility in the assessment of ligament injuries; what we want to know is how we may best train physical therapists to practice well," concluded Croy.

For more information on the Army Medical Department Advanced Medical Technology Initiative visit https://www.tatrc.org/www/labs-and-programs/aamti.