Gait analysis of patients with distal radius fracture by using a novel laser Timed Up-and-Go system

BackgroundPostmenopausal women are at risk of fall and fracture with the physical decline. Distal radius fracture (DRF) is considered as the primary fragility fracture, and women with this fracture showed poor results in the usual Timed Up-and-Go (TUG) test, indicating a decline in balance and physical ability. The detailed physical characteristics of female DRF patients have not been extensively examined.Research questionIs the novel laser TUG system able to detect and analyze the detailed gait characteristics in patients with DRF whose physical ability has tended to decline?MethodsIn this cross-sectional case control study, the gait characteristics of 32 female patients with DRF who had undergone surgery were evaluated at 2 weeks postoperatively with a laser TUG system to analyze the detailed leg motion during normal TUG test. Forty-three age- and sex-matched non-fractured women were evaluated by the laser TUG system as controls. Lifestyle and present illness were corrected at the time of TUG measurement. Detailed data during laser TUG in both groups were compared statistically, and odds ratio and thread shod of the fracture was elucidated through a logistic regression analysis.ResultsDRF patients showed slower speed and had to do more steps to complete the TUG test. Furthermore, asymmetric trajectory and significantly further distance from the marker were observed. Thirteen steps to complete the TUG test was the thread shod of DRF.SignificanceDetailed gait characteristics of patients with DRF were detected by the laser TUG system. The gait decline and abnormality could be one of the reasons of consecutive fragility fracture. To prevent secondary fragility fractures, this system can be useful for screening.     

Accelerations relevant to blunt trauma: theory and data

Maximum acceleration and the Head Injury Criterion (HIC) are both used as indicators of likely head injury severity. A dataset has previously been published of impacts of an instrumented missile on four ground surfaces having a layer of between 0 and 16 cm of sand. The dataset is compared with recently-developed theory that predicts power-function dependence of maximum acceleration and HIC on drop height. That prediction was supported by the data. The surfaces differed in respect of the exponents estimated.     

Blobbing injury patterns

Introduction“Blobbing” is a modern outdoor activity where a participant sits on the end of a partially inflated air bag (“blobber”) and is launched into the water when another participant jumps onto the air bag from a platform on the opposite side (“jumper”). This is the first study to evaluate the injury patterns associated with blobbing.Patients and methodsA retrospective data analysis was conducted based on 86 patients who sustained blobbing injuries between January 2011 and December 2016.The date of birth, gender, day of injury, diagnosis, body region of trauma, and treatment were recorded for the patients. Treatment was subclassified into conservative or surgical treatment. The position of the participant was recorded as either a jumper or a blobber.ResultsOne-third of the patients sustained a spine injury, which was the most common body part injured. The most frequent type of injury was cervical spine distortion. All shoulder (n = 9), elbow (n = 3), hand (n = 2), knee (n = 3), and foot (n = 12) injuries occurred in jumpers, whereas all ear (n = 6) and lung (n = 5) injuries occurred in blobbers. Head (n = 5) and spine (n = 33) injuries were distributed in jumpers and blobbers. Sixty-nine patients were treated with conservative treatment. Three ankle fractures and two spine fractures were treated with immediate surgical treatment. Twelve patients were treated with conservative treatment but were referred for potential surgery at their hospital at home.ConclusionBoth jumpers and blobbers were prone to injuries. More severe injuries with the potential for surgical treatment occurred in jumpers, presumably because of bad landings. This analysis of the injury patterns in blobbers might lead to the introduction of protective gear and changes in the behavior of participants in order to reduce the risk of injury.     

Do No Harm: A Multifactorial Approach to Preventing Emergency Department Falls—A Quality Improvement Project

IntroductionPatient falls in the emergency department are a unique patient safety issue because of the often challenging nature of the environment. As there are a variety of potential causative factors for patient falls in the emergency department, this project employed a multifactorial approach to prevent patient falls in a Level 1 trauma center emergency department (adult only) in an urban tertiary care teaching hospital.MethodsThis project was a single-unit quality improvement intervention that compared postintervention monthly unit-level data to historic monthly rates on the same unit. The intervention was multifaceted with patient-level, nurse-level, and unit-level interventions employed. A task force was convened to review and identify specific departmental gaps related to fall prevention, complete a retrospective review of departmental patient falls to determine causative factors, and implement interventions to reduce ED falls. A comprehensive program consisting of an ED-specific fall risk assessment tool, remote video monitoring (RVM), stretcher alarms, and a robust patient safety culture, among other interventions, was implemented. Patient falls and falls with injuries were tracked as an outcome measure.ResultsAfter data driven analysis of causation, selection of key interventions, staff education, and sustained focus for 2 years, the department experienced a 27% decrease in falls and a 66% decrease in falls with injuries.DiscussionA multifactorial approach was an effective strategy to decrease patient falls in the emergency department.     

综合护理干预对住院老年精神障碍患者跌倒的影响

目的探讨综合护理干预对住院老年精神障碍患者跌倒发生率的影响。方法将2012年10月-2014年11月我院收治的772例65岁以上精神科老年患者按入院时间先后分为两组,将2012年10月-2013年10月住院的367例老年患者作为对照组,给予老年精神科常规护理;将2013年11月-2014年11月住院的405例老年患者作为观察组,在常规护理基础上,实施综合护理干预措施,比较两组患者住院期间跌倒发生情况。结果对照组患者跌倒发生率为1.63%,观察组患者跌倒发生率为0.49%,明显低于对照组(P0.01)。结论综合护理干预对降低住院了老年精神障碍患者的跌倒具有积极的作用。     

服刑病犯应激性/心因性精神障碍状况分析与心理干预

目的：探讨服刑期间病区病犯应激性／心因性精神障碍的发病因素及相应对策。方法选取我院服刑人员病区病犯106例，采用症状自评量表（SCL‐90）进行心理测试，与国内常模进行比较分析。应用（SCL‐90）对服刑病犯人员进行心理干预前后效果比较。结果服刑病犯10个心理症状情况因子测试结果均高于国内常模为心理健康状态障碍，P＜0．01。心理干预后，取得了较好的疗效（ P＜0．05或 P＜0．01）。结论服刑期间病犯存在应激性／心因性精神障碍因素，应根据病犯的四大心理特点给予相应的矫治对策，重塑健全人格。     

Sleep quality is associated with walking under dual-task,but not single-task performance

ObjectivesThe objective of this study was to assess the relationship between sleep behavior and gait performance under single-task (ST) and dual-task (DT) walking conditions in community- dwelling older adults.MethodsWalking under ST and DT conditions was evaluated in 34 community-dwelling older adults, 64.7% women, mean age 71.5 (SD ± 5.8). Gait-speed and gait-variability data were collected using the OPAL wearable sensors of the Mobility Lab. Sleep behavior (sleep efficiency [SE] and sleep latency [SL]) was assessed using actigraphy, over 5 consecutive nights.ResultsLower SE was associated with decreased gait speed and increased stride-length variability during DT (rs = 0.35; p = 0.04; rs = −0.36; p = 0.03, respectively), whereas longer SL was associated with increased stride-length variability during DT (rs = 0.38; p = .03). After controlling for age and cognition, SE accounted for 24% and 33% of the variability in stride length and stride time. No associations were found between sleep and gait measures under ST walking.ConclusionsLower SE is associated with decreased gait speed and increased gait variability under DT conditions that are indicative of an increased risk for falls in older adults. Our findings support clinical recommendations to incorporate the evaluation of sleep quality in the context of risk assessment for falls.     

Motor dual-tasking deficits predict falls in Parkinson's disease: A prospective study

IntroductionFalls severely affect lives of Parkinson's disease (PD) patients. Cognitive impairment including dual-tasking deficits contribute to fall risk in PD. However, types of dual-tasking deficits preceding falls in PD are still unclear.MethodsWalking velocities during box-checking and subtracting serial 7s were assessed twice a year in 40 PD patients over 2.8 ± 1.0 years. Fourteen patients reported a fall within this period (4 excluded fallers already reported falls at baseline). Their dual-task costs (DTC; mean ± standard deviation) 4.2 ± 2.2 months before the first fall were compared with 22 patients never reporting falls. ROC analyses and logistic regressions accounting for DTC, UPDRS-III and disease duration were used for faller classification and prediction.ResultsOnly walking/box-checking predicted fallers. Fallers showed higher DTC for walking while box-checking, p = 0.029, but not for box-checking while walking, p = 0.178 (combined motor DTC, p = 0.022), than non-fallers. Combined motor DTC classified fallers and non-fallers (area under curve: 0.75; 95% confidence interval, CI: 0.60–0.91) with 71.4% sensitivity (95%CI: 41.9%–91.6%) and 77.3% specificity (54.6%–92.2%), and significantly predicted future fallers (p = 0.023). Here, 20.4%-points higher combined motor DTC (i.e. the mean difference between fallers and non-fallers) was associated with a 2.6 (1.1–6.0) times higher odds to be a future faller.ConclusionMotor dual-tasking is a potentially valuable predictor of falls in PD, suggesting that avoiding dual task situations as well as specific motor dual-task training might help to prevent falls in PD. These findings and their therapeutic relevance need to be further validated in PD patients without fall history, in early PD stages, and with various motor-motor dual-task challenges.     

Individual analysis of dynamic stability for twenty-four Tai Chi forms among persons with knee osteoarthritis: A pilot study

BackgroundTai Chi (TC) training has been increasingly used to prevent falls. However, the underlying biomechanical mechanisms of TC training which influence fall risk remain unknown. As a result, the selection of TC forms differs among studies, leading to inconsistent results.Research questionIs dynamic stability different between the simplified 24 Yang-style TC forms among adults with knee osteoarthritis?MethodsTen participants with mild to moderate knee osteoarthritis were recruited. Under one-on-one instruction by an experienced TC master, each participant learned how to correctly perform the 24-form TC movements. Participants’ full-body kinematic and kinetic data was collected during walking trials and performance of the respective TC forms. Their dynamic stability was calculated in both sagittal and frontal planes and compared between each TC form and regular walking.ResultsThe results indicate that dynamic stability in both planes significantly varies among forms. Moreover, some forms pose a greater challenge to dynamic stability in comparison to others. The most challenging TC forms are Form 8 for stability in the sagittal plane and Form 10 in the frontal plane. Among all forms, Form 1 appears to be the least challenging.SignificanceOur findings could provide foundational information to identify the best TC forms for optimizing the effectiveness of TC-based fall prevention interventions.