Uninjured People Research Articles

Prolonged Time to Brake Following Lower Extremity Injuries.

No guidelines exist for recommending return to driving. This study will examine time to brake (TTB) after lower extremity injuries versus in uninjured people. The potential effect of various types of lower extremity injuries on TTB will be measured. Patients with injuries to the pelvis, hip, femur, knee, tibia, ankle, and foot underwent testing using a driving simulator to assess TTB. Comparison was with a control group of uninjured people. Two-hundred thirty-two patients with lower extremity injuries participated. The majority were in the tibia and ankle regions (47%). Mean TTB for control subjects was 0.74 seconds, compared with 0.83 for injured patients, noting a 0.09-second difference (P = 0.017). Left-sided injuries averaged TTB of 0.80 seconds, right-sided injuries averaged TTB of 0.86 seconds, and bilateral injuries averaged TTB of 0.83 seconds, all prolonged versus control subjects. The longest TTB was exhibited after ankle and foot injuries (0.89 seconds) while the shortest was after tibial shaft fractures (0.76 seconds). Any lower extremity injury caused a prolonged TTB compared with control patients. Left, right, and bilateral injuries all had longer TTB. Ankle and foot injuries experienced the longest TTB. Additional investigation is warranted to develop safe guidelines for return to driving.

Inter and intra-examiner reliability of musculoskeletal ultrasound scanning of Anterior Talofibular Ligament and ankle muscles.

Although the function of subjects with chronic ankle instability (CAI) has been examined, structural analysis by ultrasound scanning of the structures surrounding the ankle is limited. Before such structural comparisons between injured and uninjured people can be made it is important to investigate a reliable measurement protocol of structures possibly related to CAI. The aim of this study was to investigate the inter-intra examiner reliability of ultrasonic characteristics of selected structures in healthy subjects. Eleven healthy participants were assessed by an experienced sonographer and inexperienced certificated examiner. Ultrasound images were collected of the ATFL length and ankle muscles of gastrocnemius medialis (GM), tibialis anterior (TA) and peroneals. Thickness was measured for the muscles, whilst cross-sectional area (CSA) was measured for the peroneals. Inexperienced examiner repeated the measurements a week later. Inter-examiner reliability was excellent for all structures (ICC3,1 = 0.91-0.98). Intra-examiner reliability shows excellent agreement for all structures (ICC3,1 = 0.92-0.98) except GM (good agreement) (ICC3,1 = 0.82). LoA, relative to structure size, ranged from 1.38 to 6.88% for inter-reliability and from 0.07 to 5.79% for intra-reliability. This study shows a high level of inter-intra examiner reliability in measuring the structures possibly related to CAI. Future research has been planned to investigate the structural analysis in CAI by using applied MSUS protocol.

Brain Neuroplasticity Effects on the Occurrence of Anterior Cruciate Ligament Injury and the Effect of this Injury on Brain Function and Structure: A Systematic Review

Objective: The present study aimed to investigate the effect of brain neuroplasticity on the incidence of anterior cruciate ligament (ACL) injury and on brain function and structure before and after ligament reconstruction and after a period of rehabilitation exercises. Materials & Methods: In this review study, a search was conducted in PubMed, Scopus, Web of Science, Google Scholar, ScienceDirect, MedLine, Pedro, CINAHL, SPORTDiscus, and Cochrane Databases as well as national databases on related studies published from 1970 to 2021 using keywords in Persian and English related to the research topic. Results: The initial search yielded 65 articles. Based on the inclusion and exclusion criteria, 24 articles were selected for review of which 5 articles prospectively examined the effect of brain neuroplasticity on the incidence of ACL injury. Their results showed that the brains of people with ACL injury was different from the uninjured people, especially in the motor-sensory part of the cerebral cortex and cerebellum, which caused errors during movement planning of these persons. Ten articles examined the effect of ACL injury before reconstruction on brain function and structure and reported that changes occur in the level of motor-sensory cortex of the brain at least two weeks after the injury; after one year, these structural and functional changes were widely increased in injured people compared to healthy people. These studies also showed that the ligament dysfunction and the damage to mechanical receptors cause the reorganization of the central nervous system. In injured people, the control activity of motor-visual areas and their need for visual feedback have increased. Seven articles examined these changes after ligament reconstruction and showed that the brain neuroplasticity or functional and structural changes resulting from the injury not only did not return to normal conditions, but also increased after a while despite the reconstruction. Two articles examined these changes after a period of rehabilitation exercises and showed that functional and Conclusion: The changes in the brain after ACL injury not only persist after ligament reconstruction, but also increase after reconstruction. The common rehabilitation exercises whose main focus is not on eliminating these functional and structural changes in the brain cannot overdrive this negative neuroplasticity after injury which is one of the important causes of secondary injury and subsequent complications. In developing exercises to prevent ACL injury and for rehabilitation, it is better to use the new principles of motor learning and exercises related to visual feedback along with conventional exercises to overdrive negative neuroplasticity created in the brain and create positive neuroplasticity to support ACL.

Factors influencing casualty risk in the 14th November 2016 MW7.8 Kaikōura, New Zealand earthquake

The November 14, 2016 MW7.8 Kaikōura Earthquake was one of the largest earthquakes to occur in New Zealand in the past 100 years and resulted in two deaths and 618 injuries. Understanding the context and cause of casualties from earthquakes is important for informing risk reduction activities such as building codes, education of protective actions, and casualty modelling. Data on casualties (deaths and injuries) from the Kaikōura earthquake were sourced from New Zealand's publicly funded accidental injury insurance scheme. Casualties were compared to a control group of uninjured people using a case-control design. Odds ratios were calculated through multivariate logistic regression to quantify the influence of individual, seismological and contextual factors on casualty risk. Females were twice as likely to be injured than males, and injury risk increased 30% with every 10 year increase in age. People were 2.9 times more likely to be injured if they were in non-residential buildings, and injury risk increased 2.2 times for every unit increase in MMI shaking intensity. Thirty-seven percent of casualties were from falls, 44% were from actions of people during shaking and 8% were due to being hit by contents. Nine percent of people were injured after shaking stopped during evacuations, or clean-up. The results indicate that in regions with a well-regulated building industry with modern building codes such as New Zealand, casualties are dominated by non-fatal injuries, and the number of these injuries are determined by the behaviour of individuals during and immediately following earthquake shaking.

An Australian study of long-term hospital admissions and costs comparing patients with unintentional burns and uninjured people

BackgroundThe objective of this study was to describe and quantify the long-term hospital service use (HSU) after burn injury and associated costs in a population-based cohort of patients with unintentional burns and compare with uninjured people. MethodsThis retrospective population-based cohort study analysed de-identified linked health administrative data of all unintentional burns patients (n = 10,460) between 2000 and 2012 in Western Australia and a matched uninjured comparison cohort (n = 42,856). HSU after burn injury (annual admission counts and cumulative length of stay) was examined. HSU costs were based on the Australian Refined Diagnosis Related Groups (AR-DRGs) code on each record. Generalised linear models were used to examine and quantify associations between burn injury and long-term HSU and associated costs. ResultsThere were 48,728 hospitalisations after burn occurring within the study period in the burn cohort; in the uninjured comparison cohort, there were 53,244 post-study index hospitalisations. Of those in the burn cohort, 63.9% (n = 6828) had a further hospitalisation after burn injury; this compared with 40.4% (n = 17,297) in the uninjured cohort. After adjustment for socio-demographic and pre-existing health conditions the burn cohort had 2.48 times the hospitalisation rate compared to the uninjured cohort (95% CI: 2.33–2.65). The cost of post-index hospitalisations in the burn cohort totalled to $AUS248.3 million vs $AUS240.8 million in the uninjured cohort. After adjustment, the burn cohort had hospital costs 2.77 times higher than the uninjured controls (95% CI: 2.58–2.98). ConclusionsAfter adjustment for covariates, burn patients experienced greater hospital use for a prolonged period after the initial injury compared with uninjured people. The mean cost per episode of care was generally higher for members of the burn cohort compared to the uninjured cohort indicating either more complicated admissions or admissions for more expensive conditions.

Burn induced nervous system morbidity among burn and non-burn trauma patients compared with non-injured people

ObjectiveBurns cause acute damage to the peripheral nervous system with published reports identifying that neurological changes after injury remain for a prolonged period. To shed some light on potential mechanisms, we assessed injury etiology and patterns of nervous system morbidity after injury by comparing long-term hospital admissions data of burns patients and other non-burn trauma patients with uninjured people. MethodsLinked hospital and death data of a burn patient cohort (n=30,997) in Western Australia during the period 1980–2012 were analysed along with two age and gender frequency matched comparison cohorts: non-burn trauma patients (n=28,647) and; non-injured people (n=123,399). The number of annual NS disease admissions and length of stay (LOS) were used as outcome measures. Multivariable negative binomial regression modelling was used to derive adjusted incidence rate ratios and 95% confidence intervals (IRR, 95% CI) and adjusted Cox regression models and hazard ratios (HR) were used to examine time to first nervous system admission after burn and incident admission rates. ResultsThe most common peripheral nervous system condition identified in each cohort (burn, non-burn trauma, uninjured) were episodic and paroxysmal disorders followed by nerve root and plexus disorders and polyneuropathies/peripheral NS conditions. Significantly elevated admission rates for NS conditions (IRR, 95% CI) were found for the burn (2.20, 1.86–2.61) and non-burn trauma (1.85, 1.51–2.27), compared to uninjured. Peripheral nervous system admission rates after injury (IRR, 95% CI) were significantly higher regardless of age at time of injury for the burn (<15years: 1.97, 1.49–2.61; 15–45: 2.70, 2.016–3.55; ≥45year: 1.62, 1.33–1.97) and non-burn trauma cohorts (<15years: 1.91, 1.55–2.35; 15–45: 1.94, 1.51–2.49; ≥45year: 1.42, 1.18–1.72), when compared to the uninjured. Significantly higher rates of incident NS hospitalisations were found for the burn cohort vs. uninjured cohort for a period of 15-years after discharge (0–5 years: HR, 95% CI: 1.97, 1.75–2.22; 5–15 years; HR, 95% CI: 1.44, 1.28–1.63). The non-burn trauma cohort had significantly higher incident nervous system admissions for 10 years after discharge (0–30 days: HR, 95% CI: 4.75, 2.44–9.23; 30days to 1-year HR, 95% CI: 2.95, 2.34–3.74; 1–5 years; HR, 95% CI: 1.47, 1.26–1.70; 5–10 years; HR, 95% CI: 1.34, 1.13–1.58). ConclusionsResults suggest that injury patients are at increased risk of peripheral nervous system morbidity after discharge for a prolonged period of time. The time patterns associated with incident nervous system conditions suggest possible differences in underlying pathology and long-term patient care needs. Further research is needed to elucidate the underlying neuropathology.

Contemporary perspectives of core stability training for dynamic athletic performance: a survey of athletes, coaches, sports science and sports medicine practitioners

BackgroundCore stability training has grown in popularity over 25 years, initially for back pain prevention or therapy. Subsequently, it developed as a mode of exercise training for health, fitness and sport. The scientific basis for traditional core stability exercise has recently been questioned and challenged, especially in relation to dynamic athletic performance. Reviews have called for clarity on what constitutes anatomy and function of the core, especially in healthy and uninjured people. Clinical research suggests that traditional core stability training is inappropriate for development of fitness for heath and sports performance. However, commonly used methods of measuring core stability in research do not reflect functional nature of core stability in uninjured, healthy and athletic populations. Recent reviews have proposed a more dynamic, whole body approach to training core stabilization, and research has begun to measure and report efficacy of these modes training. The purpose of this study was to assess extent to which these developments have informed people currently working and participating in sport.MethodsAn online survey questionnaire was developed around common themes on core stability training as defined in the current scientific literature and circulated to a sample population of people working and participating in sport. Survey results were assessed against key elements of the current scientific debate.ResultsPerceptions on anatomy and function of the core were gathered from a representative cohort of athletes, coaches, sports science and sports medicine practitioners (n = 241), along with their views on effectiveness of various current and traditional exercise training modes. Most popular method of testing and measuring core function was subjective assessment through observation (43%), while a quarter (22%) believed there was no effective method of measurement. Perceptions of people in sport reflect the scientific debate, and practitioners have adopted a more functional approach to core stability training. There was strong support for loaded, compound exercises performed upright, compared to moderate support for traditional core stability exercises. Half of the participants (50%) in the survey, however, still support a traditional isolation core stability training.ConclusionPerceptions in applied practice on core stability training for dynamic athletic performance are aligned to a large extent to the scientific literature.

A retrospective cohort study to compare post-injury admissions for infectious diseases in burn patients, non-burn\xa0trauma patients and uninjured people

BackgroundInjury triggers a range of systemic effects including inflammation and immune responses. This study aimed to compare infectious disease admissions after burn and other types of injury using linked hospital admissions data.MethodsA retrospective longitudinal study using linked health data of all patients admitted with burns in Western Australia (n = 30,997), 1980–2012, and age and gender frequency matched cohorts of people with non-burn trauma (n = 28,647) and no injury admissions (n = 123,399). Analyses included direct standardisation, negative binomial regression and Cox proportional hazards regression.ResultsAnnual age-standardised infectious disease admission rates were highest for the burn cohort, followed by the non-burn trauma and uninjured cohorts. Age-standardised admission rates by decade showed different patterns across major categories of infectious diseases, with the lower respiratory and skin and soft tissue infections the most common for those with burns and other open trauma. Compared with the uninjured, those with burns had twice the admission rate for infectious disease after discharge (incident rate ratio (IRR), 95% confidence interval (CI): 2.04, 1.98–2.11) while non-burn trauma experienced 1.74 times higher rates (95%CI: 1.68–1.81). The burn cohort experienced 10% higher rates of first-time admissions after discharge when compared with the non-burn trauma (hazard ratio (HR), 95%CI: 1.10, 1.05–1.15). Compared with the uninjured cohort, incident admissions were highest during the first 30 days after discharge for burns (HR, 95%CI: 5.18, 4.15–6.48) and non-burn trauma (HR, 95%CI: 5.06, 4.03–6.34). While incident rates remained high over the study period, the magnitude decreased with increasing time from discharge: burn vs uninjured: HR, 95%CI: 30 days to 1 year: 1.69, 1.53–1.87; 1 to 10 years: 1.40, 1.33–1.47; 10 years to end of study period: 1.16, 1.08–1.24; non-burn trauma vs uninjured: HR, 95%CI: 30 days to 1 year: 1.71, 1.55–1.90; 1 to 10 years: 1.30, 1.24–1.37; 10 years to end of study period: 1.09, 1.03–1.17).ConclusionsBurns and non-burn trauma patients had higher admission rates for infectious diseases compared with age and gender matched uninjured people. The pattern of annual admission rates for major categories of infectious diseases varied across injury groups. Overall, the burn cohort experienced the highest rates for digestive, lower respiratory and skin and soft tissue infections. These results suggest long-term vulnerability to infectious disease after injury, possibly related to long-term immune dysfunction.

A population-based retrospective cohort study to assess the mental health of patients after a non-intentional burn compared with uninjured people

BackgroundThe objective of this study was to describe and quantify mental health (MH) admissions experienced by patients with unintentional burns subsequent to their injury. MethodsA retrospective population-based cohort study that used de-identified linked hospital, death and mental health in-patient case registry data of all burn patients hospitalised for unintentional burns (n=10,460) between 2000 and 2012 in Western Australia and an age and gender matched uninjured comparison cohort (n=42,856). Cohorts had a median age at study index of 26 years with males comprising 66% of each cohort. MH admissions for 5 years before and after the injury were examined. Negative binomial and Cox proportional hazards regressions were adjusted for socio-demographic and pre-existing health conditions and used to quantify associations between burns and MH hospitalisations. ResultsIn the burn cohort during the 5-year post-burn period, 4% had a MH admission, 2% were admitted for self-harm, and 3% were admitted for a behavioural disorder caused by drugs/alcohol. Significantly elevated adjusted admission rates for MH conditions were observed for the burn cohort compared with the uninjured cohort (IRR, 95% CI: 4.89, 3.52–6.79). Increased MH admission rates were found for all age groups but were most pronounced in those younger than 18 years of age at time of burn (IRR, 95% CI: 6.28, 3.00–13.14), followed by those aged 18–60 (5.14, 3.59–7.35) and those over 60 years (IRR, 95% CI: 2.97, 1.38–6.39) compared to the uninjured cohort. Gender-specific analyses showed significant differences for male (IRR, 95% CI: 4.48, 3.05–6.59) and female burn patients (IRR, 95% CI: 6.00, 3.62–9.92), compared to uninjured. The burn cohort had higher adjusted first time admissions for MH conditions (HR, 95% CI: 3.55, 2.72–4.64), mood and anxiety disorders (HR, 95% CI: 3.77, 2.81–5.08), psychotic disorders (HR, 95% CI: 3.55, 1.99–6.15) and behavioural disorders related to alcohol/drugs (HR, 95% CI: 4.75, 3.09–7.28) for five years after the initial burn. ConclusionsPatients hospitalised for unintentional burns had significantly higher MH admission rates after discharge than that observed for an uninjured cohort. Ongoing mental health support is clearly indicated for many burns patients for a prolonged period after discharge.

Re: A Primer on Pigmentation.

Dr. Greenhalgh has added a significant body of information for the burn world to review regarding pigmentation in last month's edition: A Primer on Pigmentation.1 There are some additional findings from the literature involving sun-related skin cancers that should be brought to light with regard to Greenhalgh's statements in the section: REPIGMENTATION BURN INJURY. “Questions arise as to whether burn patients are at increased risk for sun-related skin cancers than uninjured people? This question has not really been investigated, but currently, there is no evidence of increased risk for skin cancer from sun exposure. The risk for developing Marjolin's ulcers is related to chronic nonhealing wounds, not sun exposure.” We agree with these contentions, but would also like to add that both Mellemkjaer et al2 and Lindelöf et al3 reported in two large >2 decade longitudinal studies on burn patients that the risk of squamous cell and malignant melanoma did not occur more often than expected. Mellemkjaer reported a slightly decreased risk for all types of skin cancer explained by a reduced risk of BCC and MM. Also, Lindelöf in a subgroup of 12,783 patients who were followed for 20–39 years detected no increased risk of skin cancer. It was construed that this might have been related to reduced exposure to the sun of the patients after the burn injury.

Increases in human motoneuron excitability after cervical spinal cord injury depend on the level of injury.

Unitary F waves were common in paralyzed thenar muscles of people who had a chronic spinal cord injury (SCI) at the C4 level compared with uninjured people, but F waves did not occur in people that had SCI at the C5 or C6 level. These results highlight that intrinsic motoneuron excitability depends, in part, on how close the motoneurons are to the site of the spinal injury, which could alter the generation and strength of voluntary and involuntary muscle contractions.

Visual observation of scapulohumeral rhythm: Let’s take a look

As physiotherapists we are taught to use our senses to help examine people for dysfunction found throughout the body. This includes vision, touch, sound, smell and hopefully not taste. Two of the most common traits we assess with observation are gait in patients with lower limb injury and scapulohumeral rhythm in patients with shoulder dysfunction. This clinical commentary aims to shed some light on evidence surrounding the use of visual observation for scapulohumeral rhythm for patients seeking treatment for shoulder dysfunction. Abnormal scapular movement is commonly referred to as scapular dyskinesis and has traditionally been linked to various types of shoulder dysfunction. Research indicates that between 64–100% of patients seeking treatment for shoulder instability and impingement respectively have abnormal scapular movements or dyskinesis [1]. Motions of the scapula, relative to the thorax, include upward/downward rotation about an anterior/posterior axis, internal and external rotation about a superior/inferior axis, and anterior/posterior tilt about a medial/lateral axis [2]. Generally, the scapula should progressively upwardly rotate and posteriorly tilt during humeral elevation [3]. Movement into internal or external rotation is more variable depending on plane and angle of humeral elevation [3]. Biomechanically, many studies have attempted to link abnormal scapular movements with specific shoulder dysfunctions, most commonly subacromial impingement syndrome. A recent systematic review looked at nine studies in an attempt to determine if patients with subacromial impingement syndrome exhibited alterations in scapular movements compared to unimpaired people [4]. When all studies were compiled, it was noted that patients with impingement demonstrated decreased upward rotation and decreased external rotation during humeral elevation compared to uninjured people [4]. Clinically, decreased upward rotation would present as decreased movement of the inferior angle superolaterally and decreased external rotation would appear as prominence of the medial scapular border (commonly referred to as winging). These alterations were most noticeable during elevation in the scapular plane [4]. These biomechanical studies allow a thorough understanding of changes found in patients but often lack translation to the clinical setting. There are several options, from a research perspective, available to guide clinicians on the appropriateness of any clinical measure, namely, reliability and diagnostic accuracy. Reliability coefficients provide insight into the agreement between multiple clinicians or agreement when one clinician performs the same task on multiple occasions. Reliability coefficients vary in calculation but generally output a value between 0 and 1 which is sometimes represented as 0–100. Measurements are recommended to have reliability coefficients greater than 0.90 or 90 to be considered sufficient for clinical

Early Predictors of Outcomes Following Non-Operative Management of ACL Injury

Objectives:Identification of patient characteristics early after injury that influences long-term outcomes is needed to guide appropriate decision-making with regard to surgical management. The purpose of this study was to determine factors early after ACL injury which predict outcomes following non-operative management of ACL injury.Methods:59 (52.5% F; mean age 31.3±10.7 yrs) athletes completed rehabilitation to resolve knee joint range of motion, effusion, pain and gait impairments (quiet knee) after ACL injury. Patients then completed 10 additional rehabilitation sessions over 5 weeks consisting of progressive strengthening and neuromuscular training. Quadriceps strength testing, 4 single-legged hop tests, the Knee Outcome Survey Activities of Daily Living Scale (KOS), Global Rating Scale for Perceived Function (GR), and International Knee Documentation Committee 2000 form (IKDC) were completed following these 10 sessions. Two years after non-operative rehabilitation patients again completed the IKDC. “Normal” knee function was defined as an IKDC score in the top 85% of scores reported by uninjured people of the same age and sex, with “below normal” knee function equal to scores in the bottom 15% of normative data. Fisher's exact tests and Mann-Whitney U tests were used to test differences in baseline and clinical measures after non-operative rehabilitation between those with “normal” and “below normal” knee function at 2 years. A logistic regression model was used to identify factors predictive of 2 year knee function. A prior significance level was set at p≤.05.Results:11 patients (18.6%) reported knee function <15% on the IKDC at 2 years (Normal: 93.8±4.5%, 95% CI: 92.3-95.1; Below Normal: 72.1±12.7%, 95% CI: 63.6-80.6). No group differences existed for age (p=0.613) or sex (p=0.320) between those who scored in the normal range and those who scored <15%. Patients with self-reported IKDC knee function <15% had significantly lower IKDC scores at baseline (p=0.010; Normal: 83.0±10.0%, 95% CI: 80.1-85.9; Below Normal: 72.7±10.8%, 95% CI: 64.9-80.4) and required a greater number of days to achieve a quiet knee after injury (p=0.005; Normal: 58.5±21.9 days, 95% CI: 52.1-64.8; Below Normal: 77.6±17.7 days, 95% CI: 65.7-89.5). A trend toward significance was present for quadriceps strength (p=0.076; Normal: 93.5±9.1%, 95% CI: 90.8-96.1; Below Normal: 88.4±7.4%, 95% CI: 83.4-93.4) but no group differences were present for hop scores (single: p=0.684; crossover: p=0.630; triple: p=0.724; 6-meter timed: p=0.341), KOS (p=0.119), or GR (p=0.136). A logistic regression model including IKDC, days to achieve a quiet knee, and quadriceps strength was statistically significant with IKDC and days to achieve a quiet knee being significant predictors of knee function at 2 years (p=0.001; R2=0.433; IKDC: p=0.040, OR=0.909; days to achieve a quiet knee: p=0.014, OR=1.054; quad strength: p=0.220, OR=0.941).Conclusion:Only 18% of active individuals managed non-operatively after ACL injury had IKDC scores <15% of norms 2 years after injury and rehabilitation. Lower baseline subjective knee function was predictive of poorer self-reported non-operative outcomes despite similar hop scores to those reporting normal knee function at 2 years. Longer time from injury to resolution of initial knee impairments also predicted poorer self-reported knee function, highlighting the importance of early rehabilitation with aggressive intervention to resolve impairments.

Retrospective Study on Search and Rescue Operations in Two Prealps Areas of Italy

The rising number of people involved in outdoor recreation and tourism in mountain forest and wilderness areas close to urban areas has led to an increase of rescue efforts in the last decades. The study analyzes rescue operations in 2 mountain areas of the Veneto Prealps in Italy. A retrospective review of search and rescue incident reports for a 20-year period was performed. The study also takes into consideration any differences between accidents in the 2 areas in relation to the morphology and mountain activities involved. There has been an increase in accidents, and the greater participation in mountain activities does not seem to be accompanied by an improvement in knowledge of the specific risks in this kind of environment. Inexperience is reflected in many reasons for callouts and is related to the remarkable rise in the number of rescued but uninjured people; the trend of fatalities and injuries is otherwise stable. Comparison of the 2 areas reveals differences in accidents mainly attributable to diversities in mountain activities involved that led to different health consequences. Search and rescue missions in mountain areas are dangerous for rescuers and made difficult by the severe environment. The knowledge of accident characteristics is therefore very important and is necessary to reduce risks for tourists and healthcare costs. To tackle the problem of safety there is also a need for more information in the form of preventive education and publicity about the typical hazards.

Time to Re-think the Zurich Guidelines?

Time to Re-think the Zurich Guidelines?

Desempenho dos membros inferiores após reconstrução do ligamento cruzado anterior

O desempenho dos membros inferiores em tarefas dinâmicas pode auxiliar no entendimento do controle motor em indivíduos submetidos à reconstrução do LCA. Os objetivos do presente estudo foram investigar o déficit bilateral e a simetria entre os membros inferiores de sujeitos submetidos à reconstrução do LCA e comparar com sujeitos não lesionados. Vinte adultos jovens foram divididos em dois grupos (LCA e controle). A tarefa consistiu na execução do exercício Leg Press (unilateral direita e esquerda e bilateral). O número de repetições máximas (RM) foi quantificado e então o déficit bilateral e o índice de assimetria foram calculados. Os resultados mostraram assimetria no número de RM realizada entre membros no grupo LCA (p=0,005) e apenas o grupo controle apresentou déficit bilateral (p=0,004). Conclui-se que indivíduos que realizaram a reconstrução do LCA apresentaram assimetrias entre membros, sem a presença de déficit bilateral.

Nuclear/radiological terrorism: Emergency department management of radiation casualties

Recent world events have increased concern that hospitals must be prepared for radiological emergencies. Emergency departments (EDs) must be ready to treat patients suffering from injuries in combination with radiation exposure or contamination with radioactive material. Every hospital should have a Radiological Emergency Medical Response Plan, tested through periodic drills, which will allow effective handling of contaminated and injured patients. Treatment of life-threatening or severe traumatic injuries must take priority over radiation-related issues. The risk to ED staff from radioactive contamination is minimal if universal precautions are used. The likelihood of significant radiation exposure to staff under most circumstances is small. Educating medical staff on the magnitude of the radiological hazards allows them to promptly and confidently provide the necessary patient care. Measures must be taken to prevent the “worried well” and uninjured people with radioactive contamination from overwhelming the ED.

Effects of Mild Traumatic Brain Injury: Comparison of Direct and Indirect Injury Groups

AbstractThe aims were to investigate the general and specific effects of mild traumatic brain injury (mTBI), and if people with orthopaedic injuries who had sustained their injuries through exposure to acceleration/deceleration force could have sustained a brain injury. The Rapid Screen of Concussion and Digit Symbol Substitution Test were given to patients with mTBI (89 male, 23 female), and patients with orthopaedic injuries that did (27 male, 5 female) or did not (27 male, 15 female) involve deceleration forces within 24 hours of injury. A group of uninjured people (31 male, 12 female) were also tested. Compared to all other groups, patients with mTBI recalled fewer words and correctly answered fewer orientation questions. Patients with either mTBI or deceleration orthopaedic injuries showed slower speed of information processing than patients with nondeceleration orthopaedic injuries or participants without injury. Nondeceleration patients and uninjured participants did not differ. These results suggest that there are both general injury effects and specific mTBI effects on efficiency of cognitive functioning. The results also highlight the probability that patients with a diagnosis of orthopaedic injury who were exposed to acceleration/deceleration forces may have suffered a mild brain injury as well.

Specificity of muscle action after anterior cruciate ligament injury

Neuromuscular control is believed to be a critical factor in dynamic knee stability. The purpose of this study was to evaluate voluntary muscle control in anterior cruciate ligament deficient (ACL-D) and uninjured people. Twenty athletes of similar age participated in this study. Subjects performed a target-matching protocol that required them to produce isometric moments about the knee with fine control in flexion, extension, varus, and valgus (i.e., loads were generated in the plane perpendicular to the long axis of the shank). Electromyographic data were collected from 10 muscles that span the knee. A specificity index was calculated for each muscle to describe how fine-tuned (specific) its muscle activity pattern was with respect to its principal direction of action in the load plane. Diminished specificity of muscle action was observed in 8 of 10 muscles in the ACL-D subjects’ involved knees when compared with the activity patterns from their uninvolved knees and those from the uninjured subjects’ knees. The vastus lateralis muscle was especially affected. Increased and more global co-contraction was also observed in the ACL-D limbs. The alterations in muscle firing patterns observed in this study are consistent with diminished neuromuscular control.

Snow sports injuries in Scotland: a case-control study

Objectives: To examine the incidence and patterns of snow sports injuries at the three largest commercial ski areas in Scotland and to identify factors associated with injury risk. Methods: A...