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.     

Structural and functional foot and ankle characteristics associated with falls in older people

BackgroundFalls affect approximately one in three older people, and foot problems are amongst the modifiable potential risk factors.Research questionwhat are the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults?MethodOne hundred eighty-seven community-dwelling older adults (106 females) aged 62–90 years (mean 70.5 ± 5.2) from Isfahan, Iran were recruited. Foot and ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured. Fall history was documented in the preceding year. Univariate analyses compared fallers and non-fallers on all variables to determine significant differences and logistic regression analysis identified variables independently associated with falls.ResultsSeventy-four participants (39.9 %) had experienced a fall in the previous year. Logistic regression analysis revealed that less first metatarsophalangeal joint extension (odds ratio 0.82, 95 % CI 0.73−0.91), less plantarflexor muscle strength (odds ratio 0.29, 95 % CI 0.15−0.55), greater pressure-time integral in the medial forefoot (odds ratio 2.65, 95 %CI 1.10–6.38), greater center of pressure velocity in the forefoot (odds ratio 1.27, 95 % CI 1.07–1.49) and greater foot pain (odds ratio 1.09, 95 % CI 1.02–1.16) were significantly and independently associated with falls after accounting for physiological falls risk factors.SignificanceWe have identified several structural and functional foot and ankle characteristics associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.     

社区55岁及以上人群轻度认知功能障碍与跌倒风险的关联研究

  目的   探讨轻度认知功能障碍(mild cognitive impairment, MCI)与社区人群跌倒风险的关联, 为预防老年人跌倒提供参考。   方法   2015年9月, 对宁夏吴忠市参加基本公共卫生体检的826名55岁及以上社区人群进行认知功能测评, 2016年3月期间(6个月后)通过电话随访调查跌倒发生情况并比较不同人群跌倒发生率; 采用非条件Logistic回归分析模型分析跌倒与轻度认知功能障碍的相关性。   结果   共有521人完成了随访, 其中MCI组127人。2015年9月~2016年3月期间, 共有32人报告发生跌倒, 发生率为6.1%(32/521), 其中女性跌倒发生率(8.85%, 23/260)高于男性(3.45%, 9/261), 两组差异有统计学意义(RR=2.56, P=0.010)。MCI组发生率(9.45%, 12/127)是非MCI组的1.86倍, 差异具有统计学意义(RR=1.86, P=0.073);多因素分析控制了性别、年龄和文化程度等人口学变量后, MCI与跌倒发生风险无明显性关联(OR=1.41, P=0.382)。   结论   社区老年人群跌倒发生率较高, 且女性高于男性; 尚未观察到MCI与人群跌倒发生风险明显相关, 需要今后大样本人群研究进一步验证。     

Does a single control mechanism exist for both forward and backward walking?

It has been proposed that the highly reproducible forward walking (FW) locomotor pattern is generated by a central neuronal program or central pattern generator (CPG) which provides the underlying mechanism which produces the coordinated walking movement. The purpose of this study was to quantify the differences in the muscular activation patterns during FW and backward walking (BW) at a constant step frequency and to determine if common features exist across both locomotor conditions. The hypothesis was that FW and BW are both mediated by the same CPG; therefore, only small modifications in the CPG are required in order to produce the different characteristics of each walking mode. The results noted kinematically reversed patterns at the hip and ankle joints between FW and BW. The knee joint movement pattern was similar between conditions, however, a phase shift of 14.3% of the gait cycle occurred. An approximately 25% phase shift in the muscle activation patterns existed between FW and BW in four of the six muscles studied. Additionally, a pattern recognition technique was applied to the combined EMG signals to determine the minimum number of features required to generate the measured muscular output. Only two main features were necessary to produce the EMG patterns for both the FW and BW condition. The main features in FW were more consistent than noted in BW. The results support the notion that a single spinal mechanism such as a CPG with two main features appears to be in control during both FW and BW.