One Plus One Equals Three (Or More …): Combining the Assessment of Movement Behavior and Subjective States in Everyday Life.

One plus one equals three (or more …): combining the assessment of movement behavior and subjective states in everyday life.

Front Psychol. 2013; 4: 216
Bussmann JB

HubMed – rehab


Dynamic pressure testing for chronic exertional compartment syndrome in the UK military population.

J R Army Med Corps. 2013 Jun; 159(2): 114-118
Dharm-Datta S, Minden DF, Rosell PA, Hill PF, Mistlin A, Etherington J

OBJECTIVES: Chronic exertional compartment syndrome is one of the main causes of exertional leg pain. Diagnosis is based on the history and intracompartmental muscle pressure testing during exercise prior to consideration of fasciotomy for treatment. We present the data gathered at Defence Medical Rehabilitation Centre Headley Court during the first year of a revised protocol on dynamic pressure testing from May 2007. METHODS: The exercise protocol involved exercising patients using a representative military task: the Combat Fitness Test with a 15 kg Bergen on a treadmill, set at 6.5 km/h with zero incline up to 15 min and if completed, a further 5 min at 7.5 km/h. Subjects informed us when the exertional leg pain was 7/10 on a visual analogue scale and were instructed to carry on till failure (pain 10/10) or till the test finished. Mean pressure during this time period (7/10 to 10/10) was calculated by computer. RESULTS: Over 1 year, we performed 151 intracompartmental pressure studies in 76 patients. 120 were successful in 68 patients, with 31 technical failures. All studies were performed in the anterior or deep posterior muscle compartments as these were the symptomatic compartments; no patients had symptoms in the lateral or superficial posterior compartments and these were not tested. There was only one complication with a posterior tibial artery puncture. In 119 compartment studies, the mean pressure was 97.8 mm Hg (SD 31.7). These data are normally distributed (Shapiro Wilk test, W=0.98 p=0.125). CONCLUSIONS: Our data based on this exercise protocol are comparable with the few studies that record dynamic pressure during running-based exercise. There is no accepted diagnostic pressure or exercise protocol. Due to the uncertainty of diagnostic criteria, it is necessary to perform a study measuring dynamic pressures in normal asymptomatic subjects. HubMed – rehab


Medical lessons learnt from the US and Canadian experience of treating combat casualties from Afghanistan and Iraq.

J R Army Med Corps. 2013 Jun; 159(2): 102-109
Dharm-Datta S, McLenaghan J

The Winston Churchill Memorial Trust, established in 1965, funds Travelling Fellowships and both authors visited hospitals in Germany, Canada and the USA regarded as centres of excellence with expertise in the early care, reconstruction and rehabilitation of the combat casualties of our NATO Allies, as recipients of these Fellowships. This article presents some of the lessons learnt in the field of musculoskeletal trauma and rehabilitation from the Canadian and US military medical systems. In trauma, there were significant differences in wound debridement policy, use of external fixators for fractures, primary use of circular frames for open tibial fractures and a far more liberal use of bone morphogenetic protein in fracture treatment. Differences in soft tissue reconstruction policy regarding flaps for soft tissue cover over exposed bone, near-universal usage of topical negative pressure dressings and use of Allgöwer-Donati suture pattern to close all wounds were noted. Ertl amputation osteoplasty, a modified form of transtibial amputation, had also been reintroduced. In rehabilitation, the management of heterotopic ossification, in particular with imaging techniques and excision surgery, was identified. For the upper limb, we observed the patient training required to use a myoelectric hand and the future possibility of targeted muscle re-innervation to make controlling these myoelectric prostheses more natural using innate motor patterns. For the lower limb, we found we used identical above knee prostheses. For patients who have had limb reconstruction and have poor function, an energy-storing orthosis was demonstrated to compensate for the loss of range of motion and muscle power. HubMed – rehab


A comparison of two 3-week resistance training programmes commonly used in short-term military rehabilitation.

J R Army Med Corps. 2013 Mar; 159(1): 35-39
Kristensen J, Burgess S

INTRODUCTION: Resistance training is an important component of rehabilitation due to its ability to increase muscular strength and enhance functional ability. The aim of this study was to assess the effects of two different resistance-training programmes currently used in military rehabilitation. METHOD: 27 male rehabilitation patients, serving with the Armed Forces and suffering from a range of lower limb musculoskeletal injuries were divided into two matched groups. Group 1 (n=14) performed the Daily Adjusted Progressive Resistance Exercise (DAPRE), whereas Group 2 (n=13) performed the Functional Strength Training (FST). An 8 repetition maximum (8RM) deadlift and countermovement vertical jump (CMVJ) test were used as Functional Assessment Tests (FATs) and as measures of changes in strength and power, respectively. Both were conducted on admission and at discharge. RESULTS: Lower limb strength and power increased significantly in both the DAPRE (p?0.001/p?0.001) and the FST (p?0.001/0.001) groups. There was no significant difference between groups for either strength (p?0.05) or power (p?0.05). CONCLUSIONS: Short-term resistance training during rehabilitation can lead to gains in strength and power despite differences in programme design. However we conclude that three weeks of resistance training is insufficient duration to see significant differences between different training protocols. HubMed – rehab