The Impact of Moderate and High Intensity Cardiovascular Exertion on Sub-Elite Soccer Referee's Cognitive Performance: A Lab-Based Study.

Soccer referees represent a specialized population who are required to perform decisional or perceptual tasks during physical exertion. Recent studies have demonstrated that submaximal acute exercise has a positive impact on cognitive performance. However, less is known about the impact of more strenuous exertion on cognitive performance. This study assessed the effect of moderate and maximal intensity exercise exertion on a cognitive performance in sub-elite soccer referees. Twelve experienced soccer referees (4 female, 8 male) were recruited. Data were collected on 2 separate days. Baseline fitness level was assessed by a standardized aerobic capacity test (VO2max Test) on Day 1, along with practice trials of the Stroop Color Word Test (Stroop Test) for evaluating cognitive performance. On Day 2, cognitive performance was assessed before, during, and after an incremental intensity exercise protocol based on the Fédération International de Football Association (FIFA) referee fitness test. Relative to results obtained at rest performance on the Stroop Test improved at moderate exertion and at maximal exertion during the modified FIFA fitness test (F = 18.97, p = .005). Mean time to completion (in seconds) of the interference Stroop task significantly improved (p < .05) between rest and moderate exertion [-3.0 ± 3.0 seconds] and between rest and maximal exertion [-4.8 ± 2.6 seconds]. In summary, we observed that cognitive performance was found to improve when sub-elite soccer referees performed moderate and maximal exercise relative to results obtained at rest. It is possible that referees focus their attention to improve goal-oriented processing in the brain during physical exertion.

Conservative management of posterior ankle impingement: a case report.

OBJECTIVE: To describe the pain and functional improvements of a patient with posterior ankle impingement following a treatment plan incorporating soft tissue therapy, chiropractic adjustment and a progressive rehabilitation program. CLINICAL FEATURES: A 37-year- old male presented with posterolateral ankle pain exacerbated by plantar flexion two weeks after sustaining an inversion ankle sprain. Oedema was present and the patient was describing a sensation of instability while walking. The initial diagnosis of lateral ankle sprain was found to be complicated by a posterior ankle impingement caused by a tenosynovitis of the flexor hallucis longus sheath suspected during the physical examination and confirmed by MRI. INTERVENTION AND OUTCOME: The patient was treated over a 14-week period. Soft tissue therapy, a rehabilitation program and cortisone injection were used to treat this condition. A precise description of the rehabilitation program that contains open kinetic chain, closed kinetic chain, proprioception, and conditioning exercises prescribed to the patient is given. After the treatment plan, the patient returned to play pain free and had no daily living restrictions. SUMMARY: A protocol including rest, soft tissue therapy, open and closed kinetic chain exercises, sport-specific exercises and cortisone injection appeared to facilitate complete recovery of this patient's posterior ankle impingement.

OBJECTIF: Présenter l'histoire de cas, notamment la progression de la douleur et le retour aux activités fonctionnelles, chez un patient présentant un accrochage postérieur de la cheville. L'article présente ces données en lien avec un plan de traitement incorporant le traitement des tissus mous, l'ajustement chiropratique et un programme de réadaptation progressive. CARACTÉRISTIQUES CLINIQUES: Un homme âgé de 37 ans présentant une douleur à la cheville postéro-latérale exacerbée par une flexion plantaire deux semaines après avoir subi une entorse de la cheville en inversion. Le patient souffrait d'un œdème et se plaignait d'une sensation d'instabilité lorsqu'il marchait. Le diagnostic initial d'une entorse de la cheville en inversion a été modifié suite à l'examen physique. L'entorse est compliquée par un accrochage postérieur de la cheville relié à une ténosynovite de la gaine du muscle long fléchisseur de l'hallux. Cette trouvaille mise en évidence à l'examen physique fut confirmée par une IRM. INTERVENTION ET RÉSULTATS: Le patient a été traité pendant une période de 14 semaines. Le traitement des tissus mous, un programme de réadaptation et l'injection de cortisone ont été utilisés pour traiter cette condition. Une description précise du programme de réadaptation (exercices cinétiques en chaîne ouverte et fermée, exercices proprioceptifs ainsi que de conditionnement physique), est présentée. Après le traitement, le patient est retourné au jeu sans douleur et sans aucune contrainte dans ses activités quotidiennes. RÉSUMÉ: Un protocole comprenant du repos, le traitement des tissus mous, des exercices cinétiques en chaîne ouverte et fermée, des exercices particuliers pour la discipline sportive et l'injection de cortisone semble avoir facilité une guérison complète de l'accrochage postérieur de la cheville de ce patient.

Perceptions of family and staff on the role of the environment in long-term care homes for people with dementia.

BACKGROUND: Disruptive behaviors are frequent and often the first predictor of institutionalization. The goal of this multi-center study was to explore the perceptions of family and staff members on the potential contribution of environmental factors that influence disruptive behaviors and quality of life of residents with dementia living in long-term care homes. METHODS: Data were collected using 15 nominal focus groups with 45 family and 59 staff members from eight care units. Groups discussed and created lists of factors that could either reduce disruptive behaviors and facilitate quality of life or encourage disruptive behaviors and impede the quality of life of residents. Then each participant individually selected the nine most important facilitators and obstacles. Themes were identified from the lists of data and operational categories and definitions were developed for independent coding by four researchers. RESULTS: Participants from both family and staff nominal focus groups highlighted facility, staffing, and resident factors to consider when creating optimal environments. Human environments were perceived to be more important than physical environments and flexibility was judged to be essential. Noise was identified as one of the most important factors influencing behavior and quality of life of residents. CONCLUSION: Specialized physical design features can be useful for maintaining quality of life and reducing disruptive behaviors, but they are not sufficient. Although they can ease some of the anxieties and set the stage for social interactions, individuals who make up the human environment are just as important in promoting well-being among residents.

Evaluation of a thromboprophylaxis quality improvement project in a palliative care unit.

CONTEXT: The benefits of anticoagulation treatment for primary prophylaxis in patients with advanced progressive diseases are unclear. Moreover, there are no empirically based guidelines on thromboprophylaxis for palliative care patients. OBJECTIVES: To prospectively evaluate a quality improvement protocol on the use of thromboprophylaxis on a 36-bed palliative care unit (PCU). METHODS: A protocol was developed to guide and standardize practice related to venous thromboembolic events (VTE) and anticoagulation medication use on the PCU in patients with a life expectancy of less than six months. Through a prospective audit, data were collected for consecutively admitted patients over a period of four months. RESULTS: Of the 127 patients admitted to the PCU, 41 (32.3%) were on thromboprophylaxis on admission. All but one of these patients had come from an acute care hospital. Thromboprophylaxis was discontinued in 36 (87.8%) of these patients; one patient went on to develop a VTE. Of the 71 patients admitted without thromboprophylaxis, none of the patients were started on thromboprophylaxis and six went on to develop a VTE. CONCLUSION: In this quality improvement study of patients admitted to a PCU largely for end-of-life care, thromboprophylaxis was discontinued in most patients without a significant increase in the incidence of symptomatic VTE. The validity of recommendations extrapolated from the general hospitalized cancer population supporting routine thromboprophylaxis and applied to these patients can be challenged. A policy that requires thromboprophylaxis in all hospitalized cancer patients may run the risk of indiscriminately including patients who are in the terminal phase of their lives.