The Impact of Introducing a Physical Medicine and Rehabilitation Trauma Consultation Service to an Academic Level 1 Trauma Center.

OBJECTIVE: Previous retrospective studies suggest that early physical medicine and rehabilitation (PM&R) consultation for trauma patients improves outcome and reduces acute care length of stay (LOS). There have not been controlled studies to evaluate this impact. This study assesses the impact of PM&R consultations on acute trauma patients. DESIGN: This study compared measured outcomes before and after the introduction of a PM&R consultation service to the trauma program at a large academic hospital. The primary outcome measure was acute care LOS. RESULTS: The 274 historical controls and 76 patients who received a PM&R consultation were not different in injury severity score, age, or sex. Length of stay was not different between the two groups. However, when early (≤8 days after injury) versus late (>8 days) consults were compared, the early group had a markedly lower LOS (12 vs. 30 days, P < 0.001). When adjusted for injury severity score, an early consult was associated with an 11.8-day lower LOS (P < 0.001). The early consult group also had fewer complications and less usage of benzodiazepines and antipsychotics. CONCLUSIONS: An acute care PM&R consultation of 8 days or less after admission is associated with a shorter acute care LOS, fewer complications, and less use of benzodiazepines and antipsychotics.

The feasibility of measuring the activation of the trunk muscles in healthy older adults during trunk stability exercises.

BACKGROUND: As the older adult population increases, the potential functional and clinical burden of trunk muscle dysfunction may be significant. An evaluation of risk factors including the impact of the trunk muscles in terms of their temporal firing patterns, amplitudes of activation, and contribution to spinal stability is required. Therefore, the specific purpose of this study was to assess the feasibility of measuring the activation of trunk muscles in healthy older adults during specific leg exercises with trunk stabilization. METHODS: 12 asymptomatic adults 65 to 75 years of age were included in the study. Participants performed a series of trunk stability exercises, while bilateral activation of abdominal and back extensor muscles was recorded by 24 pairs of Meditrace surface electrodes. Maximal voluntary isometric contractions (MVIC) were performed for electromyographic (EMG) normalization purposes. EMG waveforms were generated and amplitude measures as a percentage of MVIC were calculated along with ensemble average profiles. 3D kinematics data were also recorded, using an electromagnetic sensor placed at the left lateral iliac crest. Furthermore, a qualitative assessment was conducted to establish the participant's ability to complete all experimental tasks. RESULTS: Excellent quality abdominal muscle activation data were recorded during the tasks. Participants performed the trunk stability exercises with an unsteady, intermittent motion, but were able to keep pelvic motion to less than 10 degrees . The EMG amplitudes showed that during these exercises, on average, the older adults recruited their abdominal muscles from 15-34% of MVIC and back extensors to less than 10% of MVIC. There were similarities among the abdominal muscle profiles. No participants reported pain during the testing session, although 3 (25%) of the participants reported delayed onset muscle soreness during follow up that was not functionally limiting. CONCLUSION: Older adults were able to successfully complete the trunk stability protocol that was developed for younger adults with some minor modifications. The collected EMG amplitudes were higher than those reported in the literature for young healthy adults. The temporal waveforms for the abdominal muscles showed a degree of synchrony among muscles, except for the early activation from the internal oblique prior to lifting the leg off the table.

A comparison of trunk muscle activation amplitudes during gait in older adults with and without chronic low back pain.

OBJECTIVE: To investigate abdominal and low back muscle activation amplitudes of older adults (at least 50 years of age) experiencing nonspecific chronic low back pain (LBP) and of adults without LBP while they walked on a level surface at a self-selected speed. DESIGN: Cross-sectional. SETTING: Dynamics of human motion laboratory. PARTICIPANTS: Nine asymptomatic control participants (mean ± standard deviation: 64.9 ± 8.8 years) and 9 participants experiencing LBP (61.4 ± 9.8 years) were selected for this study. METHODS: Surface electromyography (EMG) was recorded over the bilateral lower rectus abdomini, internal obliques, lateral erector spinae longissimus, and lumbar multifidus muscle sites while participants walked across a pressure-sensor mat at a self-selected speed. To normalize EMG amplitudes during gait, the participants performed a series of maximal voluntary isometric contractions. EMG signals were full-wave rectified and low-pass filtered to yield a linear envelop waveform. For the gait trials, a window was identified from right heel strike to the second left heel strike and 4 subphases, including right and left loading response and mid stance, were identified. EMG amplitudes were calculated for each subphase. MAIN OUTCOME MEASUREMENTS: Two sample t-tests compared demographic information and spatiotemporal gait parameters between groups. EMG activation amplitude differences between groups and among subphases of gait were analyzed for each muscle with use of general linear models, followed by Tukey honestly significant difference post hoc comparisons. RESULTS: No differences were found between the groups for demographic or gait parameters. The control group participants activated their lower rectus abdomini muscles (P < .05) and right internal oblique muscles significantly more than did the LBP group (P < .05), whereas the LBP group activated their left lateral erector spinae and both lumbar multifidi sites significantly more than did the control group (P < .05). CONCLUSIONS: The activation amplitudes of the anterior muscle sites were lower for participants with LBP, whereas the posterior sites were activated to higher amplitudes than in the control group. Although most muscles responded to the subphases indicating muscle synergies, the group by muscle interactions for the right internal oblique and lateral erector spinae show that the differences between groups were not systematic. These results describe neuromuscular alterations in persons between 50-80 years with LBP that can be used for developing subject-specific management related to maintaining spinal stability.

Differences in abdominal muscle activation patterns of younger and older adults performing an asymmetric leg-loading task.

OBJECTIVES: To determine whether differences exist between younger (20-50 years) and older adults (>65 years) in abdominal muscle amplitudes, temporal patterns, and three-dimensional (3D) pelvic motion, while performing an asymmetric leg-loading task. DESIGN: Cross-sectional. SETTING: Neuromuscular function laboratory. PARTICIPANTS: Ten healthy younger (33.3 +/- 7.7 years) and 10 healthy gender- and body mass index-matched older adults (69.0 +/- 6.6 years). INTERVENTION: Surface electromyograms from 6 abdominal muscle sites bilaterally and pelvic motions were simultaneously recorded. MAIN OUTCOME MEASURE(S): Root mean square (RMS) amplitude during the leg extension phase was calculated for each muscle. Ensemble average waveforms for the total exercise were analyzed using principal component (PC) analysis. Total angular displacement of the pelvis was calculated. Student t tests were performed on demographic and angular displacement data. Three-factor mixed model analysis of variances (group, muscle, side) tested main effects and interactions (P < .05) for the RMS amplitude and PC scores from the temporal waveforms. Bonferroni post-hoc analyses tested pair-wise differences. RESULTS: There were no between-group differences for the pelvic motions. Three PC patterns captured 85% of the variance in the waveforms. The external oblique (EO) RMS amplitudes were significantly (P < .05) higher than those of the other 3 muscle sites, similar for the PC1 scores which captured overall amplitude. The PC2 score for the internal oblique (IO) was significantly higher (P < .05) than that of all other muscles, illustrating a higher initial amplitude compared with later in the movement. There was a significant group by muscle interaction for PC3 scores, demonstrating group differences in temporal patterns. CONCLUSIONS: Both groups were able to minimize lumbopelvic motion and recruited their abdominal muscles to similar overall amplitudes, with the IO muscle activated to higher amplitudes early in the movement task. The older adult group demonstrated a distinctive drop in abdominal activity during the leg-lowering phase of the exercise and less symmetry among muscle sites.