[OCULAR DISEASES, FALLS AND HIP FRACTURES].

BACKGROUND: Falls occur among old people and sometimes cause fractures in the hip. There are many reasons for falls. OBJECTIVES: To examine which ocular diseases are frequent among old people who fell and had hip fractures; to verify whether the use of glasses can prevent fall events. METHODS: A survey was conducted on a sample of 100 patients, 63 women and 37 men, who fell and broke their hip between the years 2008 - 2012, were operated on and hospitalized for rehabilitation. Their mean age was 78+8.4 years old and mean weight, 69+14.4 kg. All these patients were examined by an ophthalmologist to detect ocular diseases. RESULTS: Only 67% of them suffered from ophthalmic disease. Among them, 49.3% suffered from problems in the anterior compartment of at least one eye, 32.8% in the posterior compartment and 17.9% in both compartments. The cataract was the most frequent disease (42%), and the second, was the retinopathy. We must mention that 77.6% of the patients who needed glasses were not using them at the time of the fall. The mean age of the patients who had no ocular disease was 4 years younger than the age of those who suffered from it (Independent t-test, p=0.0115 1-side). CONCLUSIONS: Treatment for optic diseases and the use of glasses are important factors in falls prevention among the elderly. DISCUSSION: Elderly people are more prone to fall and break their hip than younger people. Even though it was not statistically proved, disorders in visual acuity and in the visual field, can cause falls among old people.

[ABOUT ZONDA, PENROSE, STENT AND HEBREW AS A BONDWOMAN: SHOULD WE SEASON OUR LANGUAGE OR RATHER IMMERSE INTO IT?]

INTRODUCTION: The Israeli everyday medical slang includes foreign names. Some of these terms had already been translated to Hebrew, but are rarely in use. Terms such as "staung, schpadel, penrose, pinzette, tourniquet, gauze pad, PEG or retractor" are most frequently in use in foreign languages, as well as nouns like pasteurization, mesmerizing (hypnotizing) which originated from their historical developer. The authors believe that we will also continue to use these original foreign terms and eponyms in the future.

[ON THE BED AND BESIDE IT].

INTRODUCTION: Hospital beds are essential equipment for any hospital and clinical work. Various types of beds are in regular use in different medical branches. We survey historical points regarding the development of different types of beds, and medical eponyms, which connected to hospital beds. We must pay attention to the complications of prolonged confinement to bed.

Paraparesis after Spinal Anesthesia During Delivery.

Traumatic injury to the spinal cord during spinal or epidural anesthesia is usually secondary to either direct needle penetration or intra-neural injection of local anesthetics. Two women were admitted to a rehabilitation department with paraparesis and hypoesthesia after delivery. One had undergone a lower segment cesarean section under spinal anesthesia and the other, a spontaneous delivery under epidural anesthesia. After discharge from the rehabilitation treatment, they both experienced some weakness in the lower limbs. The patho-physiological basis of this complication seems to be either direct damage to the spinal cord by intra-neural injection of local anesthetics, or local ischemia.

Comparison of the Functional Outcomes of Lower Limb Amputees with or without End-Stage Renal Disease.

BACKGROUND: The potential for full rehabilitation following amputation among end-stage renal disease patients is poor. OBJECTIVES: To evaluate the functional outcomes and survival among amputees treated with hemodialysis at the end of the rehabilitation procedure. METHODS: We recruited 46 patients after lower limb amputation. Of these individuals, 19 (41.3%) were treated with dialysis and 27 (58.7%) were non-dialysis-dependent patients (NDDP). Both groups were divided into three sub-groups according to their independence with regard to activities of daily living (ADL) and their ability to walk with prostheses. RESULTS: The survival of lower limb amputees treated with dialysis was shorter compared to NDDP. Survival after amputation among the NDDP who were fully or partially independent in ADL and with regard to mobility, was longer compared to the non-mobile amputees as with the patients treated with dialysis. CONCLUSIONS: Survival was significantly longer in lower limb amputees NDDP and shorter in patients who did not achieve a certain level of functioning.

Easy Technique for Radiographic Evaluation of Stump-socket Fit in Below-knee Amputees.

BACKGROUND: The alignment of a prosthesis affects the way load is transferred to the stump through the socket; this is critically important for its comfort and function. The aim of the study was to assess the value of radiopaque materials in evaluation of stump-socket fit in people with below-knee amputation. MATERIAL AND METHODS: Thirty-two amputees (skin breakdown group) had cutaneous lesions in the stump, and another 26 amputees (control group) had no lesion in the stump after training with their prosthesis. Metallic markers were attached to weight-bearing points in the internal socket. X-rays were taken in the antero-posterior and lateral projections. RESULTS: In the antero-posterior view, the weight-bearing points of the stump did not correspond to the metallic markers placed over the patellar tendon and the tibial tuberosity points in the socket in 78.1% of the 32 amputees in the skin breakdown group. This malalignment was present in 42.3% of the 26 amputees in the control group (Pearson Chi-Square, p<0.007). In the lateral view, in 65.6% of the 32, the weight-bearing points of the stump did not correspond to the metallic markers placed over the patellar tendon and the tibial tuberosity points in the socket. This malalignment was noted in 23.1% of the 26 patients in the other group (Pearson Chi-Square, p<0.002). CONCLUSIONS: 1. The conflict between the prosthesis and residual limb is the cause of skin disruption at different sites of the stump and can be successfully treated by prosthetic socket modification. 2. Efforts should be made to systematically identify any discrepancies between the stump and the soc-ket. 3. Correct adaptation of the prosthesis to the weight-bearing points of the stump will offer clinicians the possibility of quantification and visualization of this interaction using simple radiographic techniques.

[HAMSTRING STRAIN INJURIES IN SPORTSMEN].

INTRODUCTION: Acute hamstring strain injuries are common in sports that involve sprinting, kicking, jumping or high-speed skilled movements. Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. It is generally believed that they happen during the terminal swing phase of the gait cycle. Most hamstring injuries occur along the proximal musculo-tendon junction, where the muscle fibrils intersect with the tendon, but may occur anywhere between the origin and the insertion. A number of potential risk factors have been proposed for hamstring strain, among them fatigue, lack of flexibility, imbalance of muscular strength with a low hamstring to quadriceps ratio, and insufficient warm-up. Certain types of hamstring injuries are more likely to require prolonged rehabilitation and delayed return to play. An emphasis on neuro-muscular control and eccentric strengthening of the involved muscles is suggested for the successful return to sport after injury.

[EXTRINSIC AND INTRINSIC FACTORS FOR FALLS THAT CAUSED HIP FRACTURE].

INTRODUCTION: Among the reasons described as possibly causing falls in older and elderly people are extrinsic factors such as bumping into objects, slipping on a wet floor, etc., and intrinsic factors - those that occur suddenly without warning. OBJECTIVES: To investigate the connection between the reasons for falls, extrinsic or intrinsic and different medical and nonmedical factors. METHODS: The survey included 82 people, 53 women and 29 men, who fell and broke their hip, underwent surgery, and were treated at the Rehabilitation Department. Data showed that 39 people fell due to extrinsic factors and 43 due to intrinsic reasons. We examined the correlation with several factors, both medical and non-medical, that may have influenced the scenario of each group. RESULTS: Falls due to extrinsic reasons took place at all hours of the day and night, mainly in people who were alone and who wore shoes or sandals at the time of the fall and who either suffered from slight or no disturbances in attention and concentration. Falls due to intrinsic reasons occurred mainly during rest or sleep hours, in people who walked barefoot or with socks or slippers and who suffered moderate or severe disturbances in attention and concentration. CONCLUSIONS: Although the differences in the extrinsic vs. intrinsic reasons for falls that led to broken hips were fairly clear, it would be difficult to recommend new tools for prevention of this phenomenon. Trying to predict an infrequent future event such as a traumatic fall is inherently difficult.

Clinical profile of fallers with femoral neck fractures.

OBJECTIVE: To describe the most common characteristics of elderly people who fell and fractured their femoral neck and who were admitted to our rehabilitation setting after surgery by an orthopedic surgeon. SETTING: A rehabilitation department in a general regional hospital. PARTICIPANTS: A cohort of 100 patients, 37 men and 63 women, hospitalized for rehabilitation after surgery for a fracture in the femoral neck. METHODS: All the patients were interviewed by a physician from the rehabilitation department about the circumstances of their fall injuries, examined by an ophthalmologist for ocular problems, and evaluated by an occupational therapist for cognitive function. Data about background diseases were retrieved from the patients' medical records. MAIN OUTCOME MEASUREMENTS: Age of the patients, place and time of the fall, the circumstances of the fall event, the footwear used at the time of the fall, ophthalmic problems, cognitive disorders, eyeglasses use, walking aids use, medication used that may affect the central nervous system, and the presence of diseases that may influence patients' equilibrium. RESULTS: The mean age of the patients was 78 years, with a mean weight of 69 kg. Seventy-eight percent had 1-5 diseases that could influence their balance during weight bearing; 67% had an ophthalmic disease. For 70% of the patients, the cause of the fall appeared to be intrinsic (personal). Seventy-two percent wore socks or slippers, or were barefoot at the time of the fall. Sixty-four percent of the patients who used a walking aid did not use it during the fall event. Seventy-one percent of falls occurred indoors and 29% outdoors. Fifty-five percent of the patients were with another person when they fell. Fifty-one percent were taking tranquilizers or medications for sleep disorders. Sixty-eight percent fell during the daylight hours, between 6 AM and 6 PM. Of the patients who wore eyeglasses, 77.6% were not wearing them when they fell. Seventy percent had a short-term memory disorder, 57% had a concentration disorder, and 49% had an orientation disorder. CONCLUSIONS: Characteristics common to patients who fell and fractured their femoral neck included age older than 78 years, cognitive impairment, nonuse of eyeglasses that were prescribed, and inappropriate footwear.

[The importance and composition of pre-season examination in sportsmen].

Every competitive athlete in Israel is required by law to undergo a periodical pre-participation physical examination (PPE), before the competitive season. The PPE is intended to discover medical problems which might affect the health of the athletes, and rarely, may even pose a risk to their lives. It includes a sports-oriented medical questionnaire, a thorough physical examination, and a resting electrocardiogram (ECG). From a certain age onwards, it also includes a graded exercise test (GXT). Numerous studies and standpoints of several professional committees and sports medicine organizations in Europe have emphasized the importance of the first 3 parts of the PPE, namely the questionnaire, physical examination, and resting ECG. Currently, the role of the GXT in the PPE remains debatable. In this review, we will discuss the latest available scientific information in favor of including a resting ECG and, sometimes, a GXT in the PPE of competitive athletes, as mandated by the Israeli Sports Law.

[Injured players candidates for professional volleyball team: sign them up or not?].

Competitive volleyball teams master six basic skills: serve, pass, set, attack, block and dig. Each of these skills comprises a number of specific techniques, considered standard practice in high-level volleyball. Five professional volleyball players were candidates to join a first division team in Israel. Their medical dossier presented previous injuries that occurred during their sport's activity. Two of the players had a suprascapular nerve injury, one had a lesion in the hamstrings, another one had an operated ankle sprain and the fifth one had an operated anterior cruciate ligament (ACL) tear in both knees and a mallet fifth finger. The team physician had to make the decision as to whether they are able to continue playing volleyball at a high level, taking into consideration the different skills necessary in this sport. Players having suprascapular nerve injury might have difficulties to hit the serve, to hit and to block the ball. Those with unstable knee or ankle take a risk white landing. Lesions in the hamstrings cause local pain during jumping to attack or to block the ball and a mallet finger will disturb the player when attempting to set the ball, to handle it in attack or to block.

Falls in stroke patients: risk factors and risk management.

BACKGROUND: Falls are common events among hospital inpatients and constitute a major health problem in the rehabilitation setting. Many risk factors for falls have been identified for stroke patients, such as muscle weakness, medication side effects, hypoglycemia, hypotension, etc. OBJECTIVES: To assess the risk factors for falls among patients hospitalized for rehabilitation following acute stroke. METHODS: In a retrospective study of 56 falls over a period of 5 years in 41 stroke patients hospitalized for rehabilitation we surveyed the nurses' safety risk assessment of the fall. Thirty patients fell once, 9 patients twice and 2 patients four times. The data were obtained from the medical and nursing records. Safety precautions were taken by the nurses for the entire group of patients. RESULTS: Most of the falls occurred among male patients who had reduced muscular tone (70%), paralysis (54%) and/ or hypoesthesia in the involved side of the body. Patients who suffered from hemiplegia fell more often than those with hemiparesis (Wilcoxon rank sum test, P = 0.04, one-sided). Forty-eight percent of the falls occurred during the first month after the last stroke, 70% during the morning or the afternoon, and 62% occurred close to the patient's bed. In 89% of falls the patients used hypoglycemic, antihypertensive, tranquilizing or neuroleptic drugs. Communication disorders (29%), hemianopia or blindness (21%) and visuospatial agnosia (18%) were incremental risk factors for falls. Fifty percent of the falls were caused by either an intrinsic or extrinsic mechanism. CONCLUSIONS: These data suggest that the group of stroke patients at risk for falls in a rehabilitation department can be identified by a variety of impairment and functional assessments. The information may be potentially useful for designing interventions directed at reducing fall frequency among stroke survivors.

[Utilization of prosthesis in patients who underwent below-knee amputation].

BACKGROUND: Thirty-two patients, among them 25 men (78.1%) and 7 women (21.9%), underwent surgery for below-knee amputation at the Western Galilee hospital, Nahariya, received a prosthesis and began rehabilitation treatment at the same hospital. Of these, 27 patients--21 men (77.8%) and 6 women (22.8%) responded to the authors request to complete the questionnaire. Four of these underwent bilateral below-knee amputation. The authors had no previous information about routine use of prosthesis after the termination of the rehabilitation process. METHODS: All patients who underwent a below-knee amputation between the years 2000 and 2004 and received a prosthesis thereafter, were surveyed. Each one was asked to complete a detailed questionnaire. The patients were asked about the use of prosthesis during daily activities, their mobility inside and outside the home, the possibility of returning to work, the influence on their social activity, the various complications caused by the prosthesis, the use of a walking aid, their ability to drive a car or to use public transport, and their ability to accomplish some physical tasks. The questionnaire included information about the patient's age, sex, level of education, civil status and familial support, in order to evaluate their influence on the use of the prosthesis. RESULTS AND CONCLUSIONS: The statistically significant results were all dependent upon the amputee's age. With an increase in age, the patient wears the prosthesis fewer hours per day inside and outside the home, has difficulty in walking quickly, tires earlier while walking and has a reduced quality of life.

Axillary nerve conduction changes in hemiplegia.

AIM: To prove the possibility of axillary nerve conduction changes following shoulder subluxation due to hemiplegia, in order to investigate the usefulness of screening nerve conduction studies in patients with hemiplegia for finding peripheral neuropathy. METHODS: Forty-four shoulders of twenty-two patients with a first-time stroke having flaccid hemiplegia were tested, 43 +/- 12 days after stroke onset. Wasting and weakness of the deltoid were present in the involved side. Motor nerve conduction latency and compound muscle action potential (CMAP) amplitude were measured along the axillary nerve, comparing the paralyzed to the sound shoulder. The stimulation was done at the Erb's point whilst the recording needle electrode was inserted into the deltoid muscle 4 cm directly beneath the lateral border of the acromion. Wilcoxon signed rank test was used to compare the motor conduction between the sound and the paralytic shoulder. Mann-Whitney test was used to compare between plegic and sound shoulder in each side. RESULTS: Mean motor nerve conduction latency time to the deltoid muscle was 8.49, SD 4.36 ms in the paralyzed shoulder and 5.17, SD 1.35 ms in the sound shoulder (p < 0.001). Mean compound muscle action potential (CMAP) amplitude was 2.83, SD 2.50 mV in the paralyzed shoulder and was 7.44, SD 5.47 mV in the sound shoulder (p < 0.001). Patients with right paralyzed shoulder compared to patients with right sound shoulder (p < 0.001, 1-sided for latency; p = 0.003, 1-sided for amplitude), and patients with left paralyzed shoulder compared to patients with left sound shoulder (p = 0.011, 1-sided for latency, p = 0.001, 1-sided for amplitude), support the same outcomes. The electro-physiological changes in the axillary nerve may appear during the first six weeks after stroke breakout. CONCLUSION: Continuous traction of the axillary nerve, as in hypotonic shoulder, may affect the electro-physiological properties of the nerve. It most probably results from subluxation of the head of the humerus, causing demyelinization and even axonopathy. Slowing of the conduction velocities of the axillary nerve in the paralyzed shoulders may be related also to the lowering of the skin temperature and muscular atrophy in the same limb. The usefulness of routine screening nerve conduction studies in the shoulder of hemiplegic patients seems to be advocated.