Pressure Injury on Poststroke Admission Assessment to Skilled Nursing Facilities: Risk Factors, Management, and Impact on Rehabilitation.

OBJECTIVE: To describe pressure injury (PrI) prevalence, comorbidities, and rehabilitation utilization among older adults with stroke at skilled nursing facilities' (SNFs') admission assessment. DESIGN: Retrospective cohort. SETTING AND PARTICIPANTS: Older Medicare beneficiaries (>65 years old) with stroke admitted to SNFs. METHODS: We extracted data between 2013 and 2014 using the Master Beneficiary Summary, Medicare Provider Analysis and Review, and Minimum Data Set 3.0. PI data were assessed during admission assessment. RESULTS: Of the 65,330 older adults poststroke admitted to SNFs, 11% had at least 1 PrI present on admission assessment. Individuals who were non-Hispanic Black, with a longer hospital stay, from lower socioeconomic status, with higher proportions of comorbidities (eg, underweight, urinary and bowel incontinence, diabetes, congestive heart failure, arrhythmias, and infections), and higher functional impairments were likely to present with a PrI at SNF admission assessment. Compared with individuals with superficial PrI, individuals with deep PrI were more likely to be young-old (<75 years), non-Hispanic Black, from lower socioeconomic status, present with a shorter hospital stay, an intensive care unit stay, with higher functional impairments, skin integrity issues, system failure, and infections. Compared to those without PrI or superficial PrI, individuals with any-stage PrI or deep PrI were more likely to be cotreated by physical and occupational therapist and less likely to receive individual therapy. Those with PrI poststroke had low documented turning and repositioning rates than those without PrI. CONCLUSIONS AND IMPLICATIONS: Identifying modifiable risk factors to prevent PrIs poststroke in SNFs will facilitate targeted preventative interventions and improve wound care efficacy and rehabilitation utilization for optimized patient outcomes. Identifying residents with a higher risk of PrI during acute care discharge and providing early preventive care during post-acute care would possibly decrease costs and improve outcome quality.

Effects of upper and lower body wearable resistance on spatio-temporal and kinetic parameters during running.

Wearable resistance training involves added load attached directly to the body during sporting movements. The effects of load position during running are not yet fully established. Therefore, the purpose of this research was to determine spatio-temporal and kinetic characteristics during submaximal running using upper, lower and whole-body wearable resistance (1-10% body mass (BM)). Twelve trained male runners completed eight 2-min treadmill running bouts at 3.9 m/s with and without wearable resistance. The first and last bouts were unloaded, while the middle 6 were randomised wearable resistance conditions: upper body (UB) 5% BM, lower body (LB) 1%, 3%, 5% BM and whole body (WB) 5%, 10% BM. Wearable resistance of 1-10% BM resulted in a significant increase in heart rate (5.40-8.84%), but minimal impact on spatio-temporal variables. Loads of 5% BM and greater caused changes in vertical stiffness, vertical and horizontal force, and impulse. Functional and effective propulsive force (2.95%, 2.88%) and impulse (3.40%, 3.38%) were significantly (p < 0.05) greater with LB5% than UB5%. Wearable resistance may be used to increase muscular kinetics during running without negatively impacting spatio-temporal variables. The application of these findings will vary depending on athlete goals. Future longitudinal studies are required to validate training contentions.

Acute kinematic and kinetic adaptations to wearable resistance during vertical jumping.

One variation of vertical jump (VJ) training is resisted or weighted jump training, where wearable resistance (WR) enables jumping to be overloaded in a movement specific manner. A two-way analysis of variance with Bonferroni post hoc contrasts was used to determine the acute changes in VJ performance with differing load magnitudes and load placements. Kinematic and kinetic data were quantified using a force plate and contact mat. Twenty sport active subjects (age: 27.8 ± 3.8 years; body mass (BM): 70.2 ± 12.2 kg; height: 1.74 ± 0.78 m) volunteered to participate in the study. Subjects performed the counter movement jump (CMJ), drop jump (DJ) and pogo jump (PJ) wearing no resistance, 3% or 6% BM affixed to the upper or lower body. The main finding in terms of the landing phase was that the effect of WR was non-significant (P > .05) on peak ground reaction force. With regard to the propulsive phase the main findings were that for both the CMJ and DJ, WR resulted in a significant (P < .05) decrease in jump height (CMJ: -12% to -17%, DJ: -10% to -14%); relative peak power (CMJ: -8% to -17%, DJ: -7% to -10%); and peak velocity (CMJ: -4% to -7%, DJ: -3% to -8%); while PJ reactive strength index was significantly reduced (-15% to -21%) with all WR conditions. Consideration should be given to the inclusion of WR in sports where VJ's are important components as it may provide a novel movement specific training stimulus. Highlights WR of 3 or 6 % BM provided a means to overload the subjects in this study resulting in decreased propulsive power and velocity that lead to a reduced jump height and landing force. Specific strength exercises that closely mimic sporting performance are more likely to optimise transference, therefore WR with light loads of 3-6% body mass (BM)appear a suitable tool for movement specific overload training and maximising transference to sporting performance. Practitioners can safely load their athletes with upper or lower body WR of 3-6% BM without fear of overloading the athletesover and above the landing forces they are typically accustomed too. As a training stimulus it would seem the WR loading provides adequate overload and athletes should focus on velocity of movement to improve power output and jump height i.e. take-off velocity.

The Effect of Foam Rolling Duration on Hamstring Range of Motion.

UNLABELLED: Musculoskeletal health benefits from flexibility training and maintaining a functional, or sport specific, range of motion is important to one's overall fitness. Commercial foam rollers are commonly used in gyms, therapy clinics and homes, yet data are lacking on the optimal rolling duration and effect on range of motion. PURPOSE: The purpose of this study was to examine the effect of varied durations of a commercial foam roller treatment on hamstring range of motion. METHODS: The knee extension range of motion of 33 college aged men and women (age= 20±1.5y, mass= 72.2±10.8 kg) was assessed after a short (2 sets of 10s) and long (4 sets of 30s) duration of hamstring self-administered myofascial release using a commercial foam roller. A one way ANOVA was performed to compare the mean knee extension angle for each condition to baseline measures. RESULTS: Results indicated that neither the short duration (67.30 ± 10.60 deg) nor long duration (67.41 ± 10.81 deg) rolling condition produced significant increases in knee extension compared to baseline (67.70 ± 9.90 deg). CONCLUSION: Self-administered foam rolling for a total duration of up to 2 minutes is not adequate to induce improvements in knee joint flexibility. Contributing factors may include the amount of pressure imparted by the commercial roller as well as duration of treatment.