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Van Til, Linda; Fikretoglu, Deniz; Pranger, Tina; Patten, Scott; Wang, JianLi; Wong, May; Zamorski, Mark; Loisel, Patrick; Corbiére, Marc; Shields, Norman; Thompson, Jim; Pedlar, David
doi: 10.2522/ptj.20120156
Goffar, Stephen L.; Reber, Rett J.; Christiansen, Bryan C.; Miller, Robert B.; Naylor, Jacob A.; Rodriguez, Brittany M.; Walker, Michael J.; Teyhen, Deydre S.
doi: 10.2522/ptj.20120103pmid: 23580629
BackgroundLower extremity overuse injuries are detrimental to military readiness. Extremes of arch height and heavy loads carried by military personnel are associated with increased risk for overuse injury. Little is known regarding the impact of load carriage on plantar pressure distributions during gait.ObjectiveThe objective of this study was to determine how load carriage affects plantar pressure distributions during gait in individuals with varying arch types.DesignA cross-sectional, repeated-measures design was used for the study.MethodsThe study was performed at a research laboratory at Fort Sam Houston, Texas. Service members who were healthy and weighing ≥70 kg were enrolled in the study. The participants (97 men, 18 women; mean age=31.3 years, SD=5.6; mean weight=86.0 kg, SD=11.0) were categorized as having high-, normal-, or low-arched feet on the basis of published cutoff values for the arch height index. Plantar pressure measurements were obtained with the use of an in-shoe pressure measurement system while participants wore combat boots and walked on a treadmill under 3 loaded conditions (uniform, 20-kg load, and 40-kg load). Maximal force (MaxF) and force-time integral (FTI) were assessed with the use of a 9-sector mask to represent regions of the foot. A 3 × 3 repeated-measures analysis of variance was used for analysis across the levels of load and arch type.ResultsA significant interaction existed between arch type and load for MaxF and FTI in the medial midfoot, with greater force in low-arched feet. In the medial forefoot, MaxF and FTI were greatest in high-arched feet across all load conditions. In the great toe region, low-arched and normally arched feet had greater MaxF and FTI. The relative distribution of FTI increased proportionately in all regions of the foot regardless of arch type for all load conditions.LimitationsThe influence of fatigue, greater loads, and different walking speeds was not assessed.ConclusionsRegardless of arch type, increases in load did not alter the relative distribution of force over the plantar foot during gait. Participants with high-arched feet had greater force in the medial forefoot region, whereas those with normally arched or low-arched feet had greater force in the great toe region, regardless of load. These differences in force distribution may demonstrate different strategies to generate a rigid lever during toe-off.
Scherer, Matthew R.; Claro, Pedro J.; Heaton, Kristin J.
doi: 10.2522/ptj.20120144pmid: 23162043
BackgroundThe risk of traumatic brain injury (TBI) and comorbid posttraumatic dizziness is elevated in military operational environments. Sleep deprivation is known to affect a service member's performance while deployed, although little is known about its effects on vestibular function. Recent findings suggest that moderate acceleration step rotational stimuli may elicit a heightened angular vestibulo-ocular reflex (aVOR) response relative to low-frequency sinusoidal stimuli after 26 hours of sleep deprivation. There is concern that a sleep deprivation–mediated elevation in aVOR function could confound detection of comorbid vestibular pathology in service members with TBI. The term “dynamic visual acuity” (DVA) refers to an individual's ability to see clearly during head movement and is a behavioral measure of aVOR function. The Dynamic Visual Acuity Test (DVAT) assesses gaze instability by measuring the difference between head-stationary and head-moving visual acuity.ObjectiveThe purpose of this study was to investigate the effects of 26 hours of sleep deprivation on DVA as a surrogate for aVOR function.DesignThis observational study utilized a repeated-measures design.MethodsTwenty soldiers with no history of vestibular insult or head trauma were assessed by means of the DVAT at angular head velocities of 120 to 180°/s. Active and passive yaw and pitch impulses were obtained before and after sleep deprivation.ResultsYaw DVA remained unchanged as the result of sleep deprivation. Active pitch DVA diminished by −0.005 LogMAR (down) and −0.055 LogMAR (up); passive pitch DVA was degraded by −0.06 LogMAR (down) and −0.045 LogMAR (up).LimitationsSample homogeneity largely confounded accurate assessment of test-retest reliability in this study, resulting in intraclass correlation coefficients lower than those previously reported.ConclusionsDynamic visual acuity testing in soldiers who are healthy revealed no change in gaze stability after rapid yaw impulses and subclinical changes in pitch DVA after sleep deprivation. Findings suggest that DVA is not affected by short-term sleep deprivation under clinical conditions.
Resnik, Linda J.; Borgia, Matthew L.
doi: 10.2522/ptj.20120415pmid: 23641029
BackgroundThe Department of Veterans Affairs (VA) and the Department of Defense published evidence-based guidelines to standardize and improve rehabilitation of veterans with lower limb amputations; however, no studies have examined the guidelines' impact.ObjectivesThe purposes of this study were: (1) to describe the utilization of rehabilitative services in the acute care setting by people who underwent major lower limb amputation in the VA from 2005 to 2010, (2) to identify factors associated with receipt of rehabilitation services, and (3) to examine the impact of the guidelines on service receipt.DesignA cross-sectional study of 12,599 patients, who underwent major surgical amputation of the lower limb at a VA medical center from January 1, 2005, to December 31, 2010, was conducted. Data were obtained from main and surgical inpatient datasets and the inpatient encounters files of the Veterans Health Administration databases.MethodsRehabilitation services were categorized as physical therapy, occupational therapy, and either (any therapy), before or after amputation. Separate multivariate logistic regressions examined the impact of guideline implementation and identified factors associated with service receipt.ResultsPatients were 1.45 and 1.73 times more likely to receive preoperative physical therapy and occupational therapy and 1.68 and 1.79 times more likely to receive postoperative physical therapy and occupational therapy after guideline implementation. Patients in the Northeast had the lowest likelihood of receiving preoperative and postoperative rehabilitation services, whereas patients in the West had the highest likelihood. Other patient characteristics associated with service receipt were identified.LimitationsThe sample included only veterans who had surgeries at VA Medical Centers and cannot be generalized to veterans with surgeries outside the VA or to nonveteran patients and settings.ConclusionsFurther quality improvement efforts are needed to standardize delivery of rehabilitation services for veterans with amputations in the acute care setting.
Teyhen, Deydre S.; Childs, John D.; Dugan, Jessica L.; Wright, Alison C.; Sorge, Joshua A.; Mello, Jeremy L.; Marmolejo, Michael G.; Taylor, Adam Y.; Wu, Samuel S.; George, Steven Z.
doi: 10.2522/ptj.20120152pmid: 23064733
Showing 1 to 10 of 19 Articles
BackgroundSome veterans, and especially those with mental disorders, have difficulty reintegrating into the civilian workforce.PurposeThe objectives of this study were to describe the scope of the existing literature on mental disorders and unemployment and to identify factors potentially associated with reintegration of workers with mental disorders into the workforce.Data SourcesThe following databases were searched from their respective inception dates: MEDLINE, EMBASE, Cumulative Index Nursing Allied Health (CINAHL), and PsycINFO.Study SelectionIn-scope studies had quantitative measures of employment and study populations with well-described mental disorders (eg, anxiety, depression, posttraumatic stress disorder, substance-use disorders).Data ExtractionA systematic and comprehensive search of the relevant published literature up to July 2009 was conducted that identified a total of 5,195 articles. From that list, 81 in-scope studies were identified. An update to July 2012 identified 1,267 new articles, resulting in an additional 16 in-scope articles.Data SynthesisThree major categories emerged from the in-scope articles: return to work, supported employment, and reintegration. The literature on return to work and supported employment is well summarized by existing reviews. The reintegration literature included 32 in-scope articles; only 10 of these were conducted in populations of veterans.LimitationsStudies of reintegration to work were not similar enough to synthesize, and it was inappropriate to pool results for this category of literature.ConclusionsComprehensive literature review found limited knowledge about how to integrate people with mental disorders into a new workplace after a prolonged absence (>1 year). Even more limited knowledge was found for veterans. The results informed the next steps for our research team to enhance successful reintegration of veterans with mental disorders into the civilian workplace.
BackgroundLimited evidence exists on how strength and endurance exercises commonly used to prevent low back pain affect muscle morphometry and endurance.ObjectiveThe purpose of this study was to analyze the effects of 2 exercise regimens on the morphometry and endurance of key trunk musculature in a healthy population.DesignThe study was designed as a randomized controlled trial.SettingThe study was conducted in a military training setting.ParticipantsA random subsample (n=340; 72% men, 28% women; mean [±SD] age=21.9±4.2 years; mean [±SD] body mass index=24.8±2.8 kg/m2) from the larger Prevention of Low Back Pain in the Military trial (N=4,325) was included.InterventionThe core stabilization exercise program (CSEP) included low-load/low-repetition motor control exercises, whereas the traditional exercise program (TEP) included exercises conducted at a fast pace, with the use of high-load, high-repetition trunk strengthening exercises.MeasurementsBaseline and follow-up examinations included ultrasound imaging of the trunk muscles and endurance tests. Linear mixed models were fitted to study the group and time effect and their interactions, accounting for the clustering effect.ResultsSymmetry generally improved in the rest and contracted states, but there were no differences suggestive of muscle hypertrophy or improved ability to contract the trunk muscles between soldiers receiving the CSEP or the TEP. Total trunk endurance time decreased over the 12-week period, but endurance performance favored soldiers in the CSEP group. Endurance time was not associated with future episodes of low back pain.LimitationsThe lack of morphological changes may not be detectable in an already-active cohort, or a more intensive dose was needed.ConclusionsAlthough improved symmetry was noted, neither the CSEP nor the TEP resulted in muscle hypertrophy. Longer endurance times were noted in individuals who completed the CSEP but were not strongly predictive of future low back pain episodes.