Aging and the Use of Pedestrian Facilities in Winter-the Need for Improved Design and Better Technology.

Aging and the Use of Pedestrian Facilities in Winter-The Need for Improved Design and Better Technology.

Filed under: Rehab Centers

J Urban Health. 2012 Nov 28;
Li Y, Hsu JA, Fernie G

Walking outdoors is often difficult or impossible for many seniors and people with disabilities during winter. We present a novel approach for conducting winter accessibility evaluations of commonly used pedestrian facilities, including sidewalks, street crossings, curb ramps (curb cuts and dropped curbs), outdoor stairs and ramps, building and transit entrances, bus stops, and driveways. A total of 183 individuals, aged 18-85 completed our survey. The results show that cold weather itself had little impact on the frequency of outdoor excursions among middle-aged and older adults while the presence of snow and/or ice on the ground noticeably kept people, especially older adults at home. The survey found that the key elements decreasing winter accessibility were icy sidewalks and puddles at street crossings and curb ramps. While communities have recognized the need to improve snow and ice removal, little attention has been paid to curb ramp design which is especially ineffective in winter when the bottom of the ramps pool with rain, snow, and ice, making it hazardous and inaccessible to nearly all users. We conclude that investigations of alternative designs of curb ramp are needed.
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Partial restoration of knee kinematics in severe valgus deformity using the medial-pivot total knee arthroplasty.

Filed under: Rehab Centers

Knee Surg Sports Traumatol Arthrosc. 2012 Nov 29;
Kitagawa A, Ishida K, Chin T, Tsumura N, Iguchi T

PURPOSE: The objectives of the study were to examine knee kinematics in knees with severe valgus deformities and to compare pre- and post-operative knee kinematics for the same subjects implanted with medial-pivot total knee arthroplasty (TKA). METHODS: Seven subjects with severe valgus deformities due to osteoarthritis (OA) or rheumatoid arthritis (RA) were enrolled in the prospective study. Prior to TKA, three-dimensional (3D) kinematics were assessed by 3D to 2D registration technique using the image matching software ‘Knee Motion’, under in vivo, weight-bearing conditions. Postoperatively, each subject again performed the same motion under fluoroscopic surveillance. RESULTS: Preoperative kinematics demonstrated external rotation of tibias from extension to flexion, and small posterior femoral translations dominated in the medial condyle associated with anterior slides during partial range of motion. Postoperatively, these non-physiological tibial rotations were restored, and most subjects exhibited small internal rotations of tibias. On average, preoperative tibial internal rotation was -4.7° ± 7.6° from full extension to maximum flexion, and the angle was 4.8° ± 3.1° postoperatively (p = 0.01). In addition, small amounts of posterior translation of the lateral condyle and anterior translation of the medial condyle were confirmed in most subjects postoperatively. CONCLUSIONS: The study showed that the preoperative kinematic pattern established in severe valgus deformity was different from the physiological knee pattern. In addition, post-operative results suggest that the non-physiological kinematics were partially restored after TKA by using the prosthesis design even in the absence of the posterior cruciate ligament (PCL) and the cam-post mechanism. LEVEL OF EVIDENCE: II.
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Predictors of transfer from rehabilitation to acute care in burn injuries.

Filed under: Rehab Centers

J Trauma Acute Care Surg. 2012 Dec; 73(6): 1594-1599
Schneider JC, Gerrard P, Goldstein R, Divita MA, Niewczyk P, Ryan CM, Tan WH, Kowalske K, Zafonte R

BACKGROUND: Transfer to acute care from rehabilitation represents an interruption in a patient’s recovery and a potential deficiency in quality of care. The objective of this study was to examine predictors of transfer to acute care in the inpatient burn rehabilitation population. METHODS: Data are obtained from Uniform Data System for Medical Rehabilitation from 2002 to 2010 for patients with a primary diagnosis of burn injury. Predictor variables include demographic, medical, and facility data. Descriptive statistics are calculated for acute and nonacute transfer patients. Logistic regression analysis is used to determine significant predictors of acute transfer within the first 3 days. A scoring system is developed to determine the risk of acute transfer. RESULTS: There were 78 acute transfers in the first 3 days of a total of 4,572 burn admissions. Functional level at admission, age, and admission classification are significant predictors of transfer to acute care (p < 0.05). Total body surface area burned and medical comorbidities were not significantly associated with acute transfer risk. A 12-point acute transfer risk scoring system was developed, which demonstrates validity. CONCLUSION: Efforts to reduce readmissions to acute care should include greater scrutiny of older, lower-functioning patients with burn injury who are evaluated for admission to inpatient rehabilitation. This acute transfer scoring system may be useful to clinicians, health care institutions, and policymakers to help predict those patients at highest risk for early transfer to the acute hospital from rehabilitation. LEVEL OF EVIDENCE: Prognostic/diagnostic study, level II. HubMed – rehab


Are Patients Meeting the Updated Physical Activity Guidelines? Physical Activity Participation, Recommendation, and Preferences Among Inner-City Adults With Rheumatic Diseases.

Filed under: Rehab Centers

J Clin Rheumatol. 2012 Nov 26;
Manning VL, Hurley MV, Scott DL, Bearne LM

BACKGROUND: Physical activity (PA) improves the health of people with rheumatic diseases. Revised guidelines (published in the United States in 2008 and in the United Kingdom in 2011) recommend that adults complete 150 or more minutes of moderate-intensity PA or 75 or more minutes of vigorous-intensity PA (or equivalent) in bouts of 10 or minutes per week, yet whether people with rheumatic diseases meet these guidelines is unknown. OBJECTIVES: This study evaluates the PA levels of adults with rheumatic diseases attending an inner-city hospital against the updated PA guidelines. It assesses respondents’ PA preferences and the proportion who report ever receiving PA advice from a healthcare professional (HCP). METHODS: Five hundred and eight patients (46% response rate) attending the general rheumatology clinics of an inner-city UK hospital completed the self-report International Physical Activity Questionnaire and 3 additional questions: “Has a doctor or other HCP ever suggested PA or exercise to help your arthritis or joint symptoms?” “Would you like help from your doctor or health service to become more physically active?” and “Which physical activities do you enjoy?” RESULTS: Overall, 61% of respondents met the updated PA guidelines, and 39% did not meet the guidelines. Forty-three percent of respondents reported ever receiving PA advice from an HCP, and 50% reported that they would “like help” to become more physically active. Walking was the most preferred PA (65%). CONCLUSIONS: Almost two-thirds of our respondents met the updated PA guidelines; however, many were entirely inactive. Recommending regular PA should be integral to rheumatic disease management, and walking offers a potentially accessible, inexpensive, and acceptable PA intervention.
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