A digital exercise and augmented reality training system improved mobility among stroke patients: A randomized control trial.

BACKGROUND: The Selfit system was developed to improve the mobility and gait-related functions of stroke patients by providing digital exercises and augmented reality training system. OBJECTIVE: To evaluate the effects of a digital exercise and augmented reality training system on mobility, gait-related functions and self-efficacy outcomes in stroke patients. METHODS: A randomized control trial was conducted on 25 men and women diagnosed with an early sub-acute stroke. Patients were randomly assigned to either the intervention (N= 11) or the control groups (N= 14). Patients in the intervention group received a digital exercise and augmented reality training using the Selfit system in addition to the standard physical therapy treatment. Patients in the control group were treated with a conventional physical therapy program. Timed Up and Go (TUG) test, 10-meter walk test, the Dynamic Gait Index (DGI), and the Activity-specific Balance Confidence (ABC) scale were completed before and after the intervention. Feasibility and satisfaction among patients and therapists were also assessed after the completion of the study. RESULTS: The intervention group practiced proportionally more time per session than the control group with a mean change of 19.7% following 6 sessions (p= 0.002). The intervention group showed better improvement in post-TUG score compared to the control group (p= 0.04). ABC, DGI, and the 10-meter walk test scores were not significantly different between the groups. Both therapists and participants demonstrated high satisfaction with the Selfit system. CONCLUSION: The findings suggest that Selfit holds promise as an effective intervention for improving mobility and gait-related functions among patients with an early sub-acute stroke as compared to conventional physical therapy treatments.

The Landing Error Scoring System Real-Time test as a predictive tool for knee injuries: A historical cohort study.

PURPOSE: To assess the value of the Landing error score system - real time test as a predictive tool for knee injuries among combat soldiers in the Israeli defense forces. METHODS: All 2474 Israeli defense forces' combat soldiers enrolled at the Israeli defense forces Injury Prevention and Rehabilitation Center were included. A retrospective cohort study was conducted. The predictive variable assessed was the landing error score system - real time score. The three main outcome variables were the incidence of overuse knee injuries, the meniscal injury, and the anterior cruciate ligament injury. Receiver operator characteristic analysis was performed to evaluate the test's potential as a predictive tool and in order to establish optimal cutoff scores. RESULTS: The area under the curve of the receiver operation curves demonstrated no predictive value of the landing error score system - real time test for all three outcome variables (knee injuries: area under the curve 0.526, 95% confidence interval 0.498, 0.554, anterior cruciate ligament injuries: area under the curve 0.496, 95% confidence interval 0.337, 0.656, meniscus injuries: area under the curve 0.515, 95% confidence interval 0.454, 0.576). INTERPRETATION: Based on the results of this study, the landing error score system - real time test has no predictive value for knee overuse injuries, meniscal injuries, and anterior cruciate ligament injuries. However, due to the small number of cases of anterior cruciate ligament injuries, the predictive value for anterior cruciate ligament injuries of this test should be further investigated.

The Association Between History of an Ankle Sprain and Traumatic Meniscal Injury Among Infantry Combat Soldiers in the Israeli Defense Forces: A Historical Cohort Study.

INTRODUCTION: The high frequency and number of ankle inversion injuries and meniscal injuries in military populations is an area of concern due to the debilitating effects and cumulative consequences of these particular injuries on the soldiers sustaining injury and the consequences on the operational effectiveness of the Israeli Defense Force (IDF). This study examines the possible relationship between ankle inversion injury and potential for subsequent meniscal injury in infantry soldiers in the IDF. MATERIAL AND METHODS: All 89,069 infantry combat soldiers (including special units), recruited to the IDF between 2007 and 2017 were included in this study. A historical cohort study was conducted. The cohort was divided into two groups: The exposure group included all participants that had suffered at least one ankle sprain in the past and the unexposed group that included all participants who did not suffer an ankle sprain in the past. A Cox proportional-hazards model (COX) model was used in order to obtain the adjusted to confounders association between exposure and outcome expressed in hazard ratio (HR). RESULTS: The crude association between ankle sprain in the past and the development of meniscal injury in this study was 0.87 (Relative risk = 0.87, P = 0.007). After adjusting for unit type, Body Mass Index (BMI), previous fracture of the lower limb, and the use of eyeglasses, using a COX model, the adjusted association between ankle sprain in the past and the development of meniscal injury was 0.8 (HR = 0.8, P = 0.001, confidence interval (95%) 0.74, 0.88). CONCLUSION: The results of this study indicate ankle sprains to be a protective factor for meniscal injury. Our main conclusion from the results of this study is that the assumption that those with previous leg injuries are at a greater risk for further leg injuries is questionable and cannot be generalized. Hence, the association between different types of injuries should be investigated separately.

Medical Attrition from Commanders Training in the Israeli Defense Forces (IDF): A Cross-sectional Study on 23,841 Soldiers.

INTRODUCTION: Attrition from training is associated with substantial financial and personnel loss. There is a plethora of medical literature and research of attrition rates related to initial/phase 1 training (basic combat training); however, the analysis of second phase training (commanders training, consisting of schools that qualify junior commanders and officers for infantry and non-infantry combat units) is limited. The purpose of this study is to perform a comprehensive survey regarding to medical attrition from commanders training in the IDF (Israeli Defense Forces) in order to present the commanders of the IDF a detailed situation report that will serve as an evidence-based platform for future policy planning and implementation. METHODS: A cross-sectional study including all soldiers (23,841) who participated in commanders training in the IDF in the period of 2012-2015 was performed. Soldiers for whom the attrition reason (medical or not medical) was missing were excluded from this study. Data were collected from the adjutancy-computerized system as well as the IDF's computerized medical consultation records package (CPR). Descriptive statistics were performed using mean, standard deviation, and median in order to express results. For the determination of statistical significance, chi-square test, Student's t-test, and Poisson regression models were used. RESULTS: Out of 23,841 soldiers that participated in this study, 75% (17,802) were males and 25% (6,039) were females. The overall attrition rate was 0.7% (164). The attrition rate for males was 0.86% (148 out of 17,082 males) and 0.26% (16 out of 6,039 females) for females. After adjusting for training unit, age, and BMI, the risk for attrition was 1.6 (160%) times higher for males as compared with females, and this result was statistically significant (IRR = 1.6, p = 0.01, CI 1.1, 2.2). The re-injury rate was 41% (68 out of 164 soldiers). The three most frequent diagnoses for attrition were orthopedics (66%), general surgery diagnoses (12%), and diagnoses related to internal medicine (11%). Out of 107 soldiers that attired due to orthopedic reasons, 36 (34%) suffered from calf and ankle injuries, 22 (21%) attired due to diagnoses related to the lower back, and 22 (21%) attired due to diagnoses related to the knee region. The highest attrition rate was encountered in the school for infantry junior command (2.2%) and the lowest rate was encountered in the officer training school for non-infantry units (0.11%). After adjusting for age and BMI, the risk for ankle injury was 2.55 (255%) times higher for soldiers in the school for infantry junior command as compared with soldiers in the officer school for infantry units (IRR = 2.55 p = 0.017, CI 1.18, 5.47). CONCLUSION: The attrition rate from commanders training in the IDF is low, and at this point, however, due to lack of uniform criteria for attrition, it cannot serve as an objective measure. We suggest measuring and discussing overuse injury rates (which is the most frequent cause of attrition), instead. Based on our results, we recommend an implementation of a better medical screening policy in order to reduce the re-injury rates during commanders training.

Overuse Injuries Among Female Combat Warriors in the Israeli Defense Forces: A Cross-sectional Study.

Introduction: Integration of females in combat units poses a unique challenge for army commanders around the world. The purpose of this study is to provide a detailed up-to-date situation report regarding overuse injuries among combat female warriors in the IDF (Israeli Defense Forces) in order to enable evidence-based decision-making, prevention policy, and further research of this highly significant military public health issue. Methods: A cross-sectional descriptive study was conducted including 2,519 females recruited to combat duties during the year of 2013. The main data source was the IDF's computerized medical consultation records package (CPR). Descriptive statistics was performed and some results were compared with males using data from other reports and studies of the IDF. Results: The overall injury rate was 28.3%. Of all injuries, 86% were in the ankle and calf (41%), the lower back (23%), and the knee (22%) regions. The average lost training days was 11 d for females as compared with 8 d for males. The overall rates of stress fractures and the rates of femur and femoral neck stress fractures were significantly higher among females as compared with males (11.2% vs. 2.5%, p = 0.0032, and 7.8% vs. 1.6% p = 0.00001, respectively). Conclusions: The overuse injury rates among females in the IDF are high and may be considered a significant military public health problem. In order to reduce the numbers of overuse injuries, which is expected to significantly increase after the IDF's policy change regarding to combat duties open for females, we recommend planning and implementation of policies and intervention programs and further research regarding to overuse injuries among female combat warriors with special focus on the calf and ankle, lower back, and knee regions and femoral stress fractures.

Overuse Injuries in the IDF's Combat Training Units: Rates, Types, and Mechanisms of Injury.

Introduction: Overuse injuries are responsible for most lost training days and attrition from combat training in the Israeli Defense Forces (IDF) as in armies around the world. The purpose of this study is to understand the rates, types, and mechanism of occurrence of overuse injuries in the IDF in order to provide the IDF's commanders a detailed updated situation report in order to enable commanders decision-making, prevention policy, and further research of this highly significant military public health issue. Methods: A cross-sectional study including 20,000 soldiers recruited to combat units during the year of 2013 was performed. Most of the data were collected from the IDF's computerized medical consultation records package. Descriptive statistics (percent, mean, standard deviation, and median) were used in order to express results. The study was approved by the IDF's institutional review board. Results: The overall injury rate was 24.5%. The total number of injuries was 6,393 with an average of 1.32 ± 0.22 injuries per injured soldier. The injury rate was 18.4% in the infantry units and 36.1% in non-infantry units. Of all injuries, 87% occurred in the lower back and lower limb regions. The most frequent injury sites were the calf and ankle (34%), the knee region (22%), and the lower back (19%). Of all injuries, 74% occurred during running (45%) or long-distance walking (29%). The average lost training days due to injuries was 9 d per soldier and 6.5 d per injury. The total number of stress fractures was 494-2.5% of all soldiers (four fractures per 100 person years). The calf and ankle region was the most frequent site of stress fractures and accounted for 84% of all stress fractures, the vast majority of them (95%) were fractures of the distal tibia. The average number of lost training days due to stress fractures was 16 ± 6.1 per fracture. Conclusions: As in other armies around the world, overuse injuries in the IDF are a major public health problem and poses a significant challenge to the IDF's commanders and the medical corps policy leaders. Further studies should be performed in order to identify the risk factors for these injuries especially in the lower back and the lower limb regions as part of the effort to try and reduce the rates of these injuries as much as possible. This study emphasizes the need for a continuous surveillance and monitoring system for overuse injuries as a significant and integral component of any intervention plan in the domain of overuse injuries.

Pre-hospital intra-osseous freeze dried plasma transfusion: a case report.

BACKGROUND: Hemorrhage and coagulopathy are among the leading causes of death in combat and are considered the leading causes of preventable deaths. Plasma, in the form of Fresh Frozen Plasma (FFP) is considered a key component in the Damage Control Resuscitation performed within hospitals. Freeze-Dried Plasma (FDP) can be stored at room temperature and therefore is potentially useful in pre-hospital conditions. Our case report join to few cases where FDP was administered at the point of injury. It is also unique as it describes an intra- osseous administration given to pediatric patient. CASE REPORT: M.S. otherwise healthy 13 year old girl was injured due to gunshots and grenade blast. On the first triage by the IDF medical teams she suffered from: Severe hemorrhagic shock, (Blood pressure could not be measured, Heart rate 163), superficial wounds to her face, (forehead and Rt. Eye), gunshot wounds with active bleeding from her Lt. Arm and her RT. Knee (Mangled Extremity Severity Score (MESS) 8) and open fractures of left elbow and right thigh. A peripheral intravenous catheter was established and 1 g tranexamic acid in 500 ml of Hartman fluid were administered. Due to difficulties in establishing a functioning intra-venous line, an intra-osseous catheter was established and one unit of FDP (250 ml) was given in the field. She was transferred by a military medical team to a regional civilian hospital for further treatment. Upon arrival to the hospital her blood pressure and heart rate were significantly improved. After three weeks of hospitalization M.S. was discharged and she was returned to her homeland. CONCLUSION: We have described the successful use of FDP for pre hospital resuscitation of a 13 year old girl suffering from severe hemorrhagic shock as a result of gunshots and grenade blast. This case report demonstrates that intra-osseous FDP administration for as part pre hospital resuscitation of children has a favorable outcome.

Attrition due to orthopedic reasons during combat training: rates, types of injuries, and comparison between infantry and noninfantry units.

PURPOSE: The purpose of this study is to identify the prevalence and types of orthopedic injuries in infantry and noninfantry units responsible for attrition from combat training. METHODS: 18,651 soldiers consecutively recruited to combat units (5 infantry and 4 noninfantry units) were included in this study. All recruited soldiers underwent and successfully passed a meticulous medical selection process. In all units, the soldiers participated in a suited fitness program that included marching, running, and strength training. Data were collected directly from attrite soldiers' files and detailed lists provided by the units' medical clinics. RESULTS: Out of 18,651 recruits, 641 (3.44%) attrite because of medical reasons. The leading cause of attrition was orthopedic diagnoses, and their overall rate was 43% (274 out of 641). Overuse injuries accounted for 90% of all orthopedic injuries. Low-back and lower extremity injuries accounted for 71.5% of all orthopedic injuries. There was high similarity in orthopedic injuries types and rates between infantry and noninfantry units. CONCLUSION: On the basis of our results, we recommend a multidisciplinary intense effort including physicians, physical training officers, physiotherapists, and commanders to significantly reduce overuse injuries, especially in the low-back and lower extremity regions.

Crossing chronic total occlusions with a new 0.014'' CiTop guidewire: proof of concept.

OBJECTIVE: To evaluate the feasibility of a new 0.014'' CiTop guidewire to cross total occlusions within normal and diseased blood vessels; proof of concept. BACKGROUND: Despite recent advances, chronic arterial occlusions remain the main obstacle of coronary and peripheral interventions. METHODS: The OVALUM CiTop 0.014'' guidewire is an over-the-wire catheter designed to penetrate through chronic total occlusions (CTO) and allow for further PCI interventions. The CiTop guidewire was tested in normal peripheral and coronary arteries of swine (n = 7) and in totally occluded arterial lesions within human amputations (n = 10). RESULTS: The CiTop 0.014'' guidewire was operated successfully in seven peripheral blood vessels and 12 coronary arteries without angiographic or histological evidence of damage to the arterial wall. The CiTop crossed 9 of the 10 occluded segments within the human amputation with no angiographic or histological evidence of arterial damage (90% success rate). Average time to cross the occlusion was 4.6 +/- 5.6 min. In one artery (10%), angiographic evidence of perforation was noted and there was histological evidence for arterial wall damage. CONCLUSION: Our data show that the new 0.014'' CiTop guidewire can be well operated within normal peripheral and coronary arteries of swine, and with minimal complications within totally occluded blood vessels from human amputations while effectively penetrating and crossing total arterial occlusions.