PRINCIPAL INVESTIGATOR

Stretching His Interests

Physiatrist David C. Morgenroth, MD, is a physician-scientist and educator focused on improving the function and quality of life of people with limb loss

O&P Almanac introduces individuals who have undertaken O&P-focused research projects. Here, you will get to know colleagues and healthcare professionals who have carried out studies and gathered quantitative and/ or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

GROWING UP AS A 5-foot-7-inch basketball player in New York City, David C. Morgenroth, MD, spent a lot of time training to jump higher—“a vital skill to earn respect in the New York City playgrounds,” he explains. So it came naturally that he decided to study gait biomechanics during his undergraduate years at University of California at Berkeley. While there, he worked for two years in a biomechanics lab studying the stiffness properties of the human ankle related to walking, running, and jumping.

After earning his bachelor’s degree in human biodynamics in 1996, Morgenroth moved back to New York City to teach middle school math and science at a public school. It was this experience as a teacher—coupled with his research studies as an undergraduate—that seeded his interest in academic medicine and led him to earn his doctor of medicine from the State University of New York at Brooklyn College of Medicine in 2003.

Fast forward 17 years, and Morgenroth now puts all of his interests to good use in academic, clinical, and research roles. “I am a physiatrist—a physical medicine and rehabilitation (PM&R) physician—with a background in gait biomechanics,” he explains. At the University of Washington (UW), he is an associate professor and vice chair for research in the Department of Rehabilitation Medicine. He also serves in several positions at the Department of Veterans Affairs Puget Sound Health Care System’s Seattle campus: as a staff physician; an investigator for the VA’s Rehabilitation Research and Development Center for Limb Loss and Mobility (CLiMB); and an associate program director for the Amputee Rehabilitation Fellowship.

“As an academic physician, my professional roles include clinical care, research, teaching, administrative leadership, and service,” he explains. “My goal as a physician-scientist is to ground my research in key questions most relevant to the patients I am caring for in the clinical setting, and subsequently to inform my clinical practice with high-quality research findings.”

Embracing O&P

Morgenroth discovered PM&R during medical school—a field he deemed “a great match for my interests in neuromusculoskeletal physiology and in helping restore function to individuals with disabling conditions.” During his residency training, he decided to focus on limb loss rehabilitation: “Not only did I enjoy working with this patient

population in the clinical setting, but I realized the opportunity to use my gait biomechanics background as a researcher focused on improving mobility in people with limb loss,” he says. He also enjoys the multidisciplinary nature of this field, “which affords me the rewarding opportunity to work closely with prosthetists and other rehabilitation professionals.”

Morgenroth seeks to elevate the lives of amputees through his many research endeavors. His most recent studies focus on improving the process and outcomes related to prosthetic foot prescription. “There is limited evidence to guide clinicians in the current prosthetic foot prescription process, which instead is based primarily on provider experience,” he explains. Although prescription success often is defined primarily by user satisfaction, “typically there aren’t opportunities for people with limb loss to try out different feet prior to prescription in order to provide experiential input to the process.”

In two concurrent projects, both funded by the Department of Defense Orthotics and Prosthetics Outcomes Research Program, Morgenroth’s research team is studying a patientcentered “test-drive” strategy to improve prosthetic foot prescription using either commercial prosthetic feet, or a customizable, robotic prosthetic foot that mimics the mechanical properties of commercially available prosthetic feet through software control. This prosthetic foot emulator (the Humotech Caplex system) can provide individuals with limb loss the opportunity to test several prosthetic foot designs within a single test session. By allowing patients a chance to offer experiential feedback during the prescription process, “this study has the potential to provide meaningful benefit to clinicians, as well as to the patients that they care for,” he explains. Although these studies are ongoing, the research team has noted a satisfying and unexpected preliminary result: Numerous study participants have, in an unsolicited manner, requested unblinding at the conclusion of the study because they greatly favored one of the prosthetic feet trialed more than their prescribed prosthetic foot, says Morgenroth, and “they have subsequently asked their clinical team to prescribe that particular study foot.”

In other investigations, Morgenroth is studying the prevention and treatment of secondary disabling musculoskeletal conditions, such as intact limb knee osteoarthritis and low back pain, which are more prevalent in those with lowerlimb loss than in the general population and can cause further mobility limitations. “My research has focused on understanding the underlying mechanical knee loading conditions of the intact limb in this population, as well as understanding the effect of prosthetic foot characteristics on intact limb knee loading during walking,” he explains. His team revealed in vivo evidence that knee joint loading rate may be as important as knee joint loading magnitude in association with degenerative tibiofemoral osteoarthritis, he says. “We also demonstrated that increased prosthetic ankle-foot push-off is associated with decreased intact limb knee loading in persons with transtibial amputations.” These findings have important implications for prosthetic ankle-foot design, according to Morgenroth.

In addition, Morgenroth is focused on developing a better understanding of the underlying etiology of low back pain and pain-related interference in persons with lower-limb amputation. He has been studying “whether commonly described clinical correlates were, in fact, associated with low back pain,” he says. “We demonstrated that low back pain was associated with increased transverse plane rotation during walking, and that excessive lumbar lordosis angle and relatively small leg-length discrepancies were not associated with low back pain in persons with transfemoral amputation.” He believes these findings have implications for the clinical care of veterans with transfemoral amputation. “For instance, we typically no longer attempt to correct relatively small leg-length discrepancies in the clinical setting,” minimizing the likelihood of falls due to catching the prosthetic foot on the ground during the swing phase of walking.

Morgenroth is involved in other projects that focus on novel strategies for reducing phantom limb pain, as well as novel prosthetic solutions for women with limb loss, and for people with partial foot amputations.

Patient-Focused

In his role as a clinician, Morgenroth cares for individuals with all types of amputations. “I find great satisfaction in caring for a spectrum of patients, ranging from high-functioning athletes with goals such as climbing mountains and running marathons, to older individuals with multiple comorbid conditions with more basic goals such as being able to transfer from a wheelchair to bed to allow independent living,” he says.

“The goal of my research program is to move projects along the continuum— from discovery and innovation through validation and, ultimately, implementation into clinical practice to help improve the lives of people with limb loss,” he says. His current prosthetic foot prescription research projects are in the innovation and validation phases, and he hopes “to continue this line of research with future projects moving into the

translation phase.” This will include projects that continue to focus on a test-driven strategy for prosthetic foot prescription as well as parallel strategies, including developing predictive models that can aid clinicians in best-matching patient-level factors with characteristics of different prosthetic feet.

“I view prosthetic limbs as only one of multiple important aspects of improving the lives of people with limb loss,” says Morgenroth. “As a clinical community and as a research community, we need to focus as much on the biopsychosocial factors and interventions as we do on prosthetic factors and interventions in order to best serve our patients.”

Staying Active and Giving Back

While Morgenroth never pursued basketball professionally, he continues to enjoy sports and recreational activities in his free time. Married with two young boys, he says that “family and professional life fill most of each day,” but he seeks balance with sports and hobbies.

“After growing up as a basketball player, in my late 20s I was introduced to the sport of ultimate Frisbee and ended up playing competitively during my internal medicine Intern year at Brown University,” he says. He met his wife while playing on a coed team in Seattle, and the couple traveled to the Middle East two consecutive summers with the organization Ultimate Peace to help run ultimate Frisbee camps, bringing together youth from different backgrounds who have been divided by ongoing conflict in the area.

“These days, I play sports with my kids and love hiking in the beautiful Pacific Northwest,” Morgenroth says. He also plays music and is an avid cyclist— having completed a 3,000-mile bike ride from his college apartment in Berkeley, California, to his parents’ apartment in New York City in 1996, following his graduation. “We carried everything we needed on our bikes, including camping equipment, clothes, bike tools, water, and food,” he recalls. “We rode almost every day for nine weeks, camping along our route, and receiving the generosity of strangers we met on the trip who occasionally housed us for the night and cooked us dinner. It was an incredible way to get to know the people and landscape throughout the United States, and a trip that I hope to take again when my kids are old enough.”

Given his wide variety of interests— both professional and personal—it’s clear that Morgenroth will be relentless in all of his pursuits, including his investigations into the O&P patient population to ultimately improve quality of life for lower-limb prosthesis users.

Morgenroth hikes with his son, Louis.

He notes, for example, that the best possible prosthetic limb may not be helpful in cases where the person with limb loss has chronic residual limb pain, post-traumatic stress disorder, and poor social support. “It is vital that we focus the lens of our research and clinical care on the patient who may be using a prosthesis, rather than overly focusing on the prosthesis itself,” he says. “Along these lines, while we have made great strides in prosthetic technologies, it is vital that technological advances are married to true clinical need.”

NOTABLE WORKS

David C. Morgenroth, MD, a physiatrist affiliated with the University of Washington’s Department of Rehabilitation Medicine and the Department of Veterans Affairs Puget Sound Health Care System, is the author or co-author of dozens of peer-reviewed articles and conference presentations. Some of his most impactful contributions include the following: • Morgenroth, D.C., Medverd, J.R., Seyedali, M., Czerniecki, J.M. “The

Relationship Between Knee Joint Loading Rate During Walking and

Degenerative Changes on Magnetic Resonance Imaging.” Clinical

Biomechanics, 2014 Jun; 29(6):664-70. PMID: 24820134; PMCID 4111971 • Morgenroth, D.C., Orendurff, M.S., Shakir, A., Segal, A., Shofer, J., Czerniecki,

J.M. “The Relationship Between Lumbar Spine Kinematics During Gait and

Low-Back Pain in Transfemoral Amputees.” American Journal of Physical

Medicine and Rehabilitation, 2010 Aug; 89(8):635-43. PMID: 20647781 • Morgenroth, D.C., Roland, M., Pruziner, A.L., Czerniecki, J.M.

“Transfemoral Amputee Intact Limb Loading and Compensatory

Gait Mechanics During Down Slope Ambulation and the Effect of Microprocessor-Controlled and Power Knee Mechanisms.”

Clinical Biomechanics, 2018, Jun 12; 55:65-72. PMID 29698851 • Morgenroth, D.C., Segal, A.D., Zelik, K.E., Czerniecki, J.M., Klute, G.K.,

Adamczyk, P.G., Orendurff, M.S., Hahn, M.E., Collins, S.H., Kuo, A.D. “The

Effect of Prosthetic Foot Push-Off on Mechanical Loading Associated

With Knee Osteoarthritis in Lower Extremity Amputees.” Gait and

Posture, 2011 Oct; 34(4):502-7. PMID: 21803584; PMCID: 3189331