Plasma flow distal to tourniquet placement provides a physiological mechanism for tissue salvage.

Military literature has demonstrated the utility and safety of tourniquets in preventing mortality for some time, paving the way for increased use of tourniquets in civilian settings, including perioperatively to provide a bloodless surgical field. However, tourniquet use is not without risk and the subsequent effects of tissue ischemia can impede downstream rehabilitative efforts to regenerate and salvage nerve, muscle, tissue and bone in the limb. Limb ischemia studies in both the mouse and pig models have indicated not only that there is residual flow past the tourniquet by means of microcirculation, but also that recovery from tissue ischemia is dependent upon this microcirculation. Here we expand upon these previous studies using portable Near-Infrared Imaging to quantify residual plasma flow distal to the tourniquet in mice, pigs, and humans and leverage this flow to show that plasma can be supersaturated with oxygen to reduce intracellular hypoxia and promote tissue salvage following tourniquet placement. Our findings provide a mechanism of delivery for the application of oxygen, tissue preservation solutions, and anti-microbial agents prior to tourniquet release to improve postoperative recovery. In the current environment of increased tourniquet use, techniques which promote distal tissue preservation and limb salvage rates are crucial.

THE EFFECT OF ELECTRICAL STIMULATION VERSUS SHAM CUEING ON SCAPULAR POSITION DURING EXERCISE IN PATIENTS WITH SCAPULAR DYSKINESIS.

BACKGROUND: Conventional therapeutic exercise programs are commonly used to treat patients with scapular dyskinesis. There are no studies that have examined traditional therapeutic exercise programs with the addition of remote triggered electrical stimulation (ES) to affect the position of the scapula (using spine to scapular border distance as a reference point) during the performance of exercises that have lower upper trapezius (UT) to lower trapezius (LT) ratio exercises. PURPOSE: The purpose of this pilot study was to compare scapular position after performance of three low UT/LT ratio therapeutic exercises in two conditions, electrical stimulation (ESTherex) and sham electrical stimulation (ShamTherex) in asymptomatic persons who were positive for scapular dyskinesis. STUDY DESIGN: Randomized trial, single-blinded. METHODS: Eleven asymptomatic university students representing 15 scapulae with a positive Scapular Dyskinesis Test were recruited as subjects. Participants were randomized into exercise and electrical stimulation (ESTherex) or exercise and sham electrical stimulation (ShamTherex). Subjects performed side-lying shoulder external rotation and flexion, and prone horizontal abduction with external rotation in both conditions. Scapular position was assessed during active abduction at four angles before and after performance of these exercises. RESULTS: There were no significant differences in scapula to spine distance between ESTherex and ShamTherex groups at 0, 45, 90 and 120 degrees of shoulder abduction. A between group difference (ESTherex and ShamTherex) approached significance at 45 degrees (p = 0.089, CI=-.152 to 1.88 cm) with the post mean measurement of the ShamTherex group (6.44 cm) greater than the post mean measurement of the ESTherex group (5.57 cm). The ESTherex showed a significant pre-to-post mean within group improvement in spine to scapula distance at 120 degrees (mean 2.76 cm, t=4.89, p=.003). CONCLUSIONS: Electrical stimulation with exercises for scapular dyskinesis showed improvements in spine to scapula distance at 120 degrees of shoulder abduction. LEVEL OF EVIDENCE: Therapy, level 1b.

Retrospective analysis of language-related cultural disparity trends in acute rehabilitation: Implications for health communication / Análisis retrospectivo de las tendencias en las desigualdades relacionadas con el idioma y la cultura en la rehabilitación aguda: Implicaciones para la comunicación en salud

Objective: The purpose of this study was to examine retrospective data to determine if disparities existed in physical therapy outcomes for acute rehabilitation patients. Materials and Methods: Patients from different ethnic/language groups were compared and disparities were measured by comparing Functional Independent Measures® (FIM) scores. Results: Records of three thousand one hundred and ninety-seven patients admitted to a large acute rehabilitation center in the United States over a six year period were analyzed. Of the 23 language groups represented, the largest three language groups, English, Spanish, and South East (SE) Asian (Hmong, Khmer, Laotian, and Cambodian) languages were analyzed with a total of2,253 subjects. It was found that the three groups were not significantly different, in terms of their length of stay in the rehabilitation setting (F=2.30, p=.101), age (F=2.52, p=.081), or number of comorbidities (F=2.93, p=.054). However, admission FIM® (F=54.94, p<.001), projected FIM® goal (F=56.67, p<.001) and discharge FIM® (F=44.81, p<.001) were all significantly different, with the non-English speakers scoring lower at all three rating points by therapists. Conclusions: The results of this study demonstrate the importance of the effect of cultural and linguistic barriers on health communication interactions. In addition, this study provides insights to international health professionals on the issues of cross-cultural variations in the presentation of language barriers and their impact on potential research outcomes.

Objetivo: El propósito de este estudio fué el examinar retrospectivamente los datos para determinar si las disparidades existen en los resultados de la Fisioterapia para pacientes en rehabilitación aguda. Materiales y Métodos: Se hizo una comparación entre los pacientes de diferentes grupos étnicos o lingüisticos y las disparidades se midieron a través de un test conocido como Functional Independent Measures® (FIM). Resultados: En este estudio fueron analizados los registros de tres mil ciento noventa y siete pacientes admitidos a un centro de rehabilitación en los Estados Unidos en un periodo de seis años. De los veintitres grupos lingüisticos representados, los grupos más grandes y que se tomaron para el analisis fueron el Inglés, el Español y las lenguas del Sureste Asiatico (Hmong, Khemer, Laotian, y Cambodian) con un total de 2.253 sujetos. Se encontró que los tres grupos no tenian diferencias estadisticas significativas en términos de la duración de su estadia en el centro de rehabilitación (F=2.30, p=.101), edad (F=2.52, p=.081), o número de co-enfermedades (F=2.93, p=.054). Sinembargo el test FIM® de admisión (F=54.94, p<.001), el FIM® proyectado (F=56.67, p<.001) y el test FIM® de salida (F=44.81, p<.001) reportaron diferencias significativas, siendo los de habla Inglesa los que tuvieron puntajes más bajos en los tres puntos de medición de los terapistas. Conclusiones: Los resultados de este estudio demuestran la importancia de las barreras culturales y lingüisticas que afectan las interacciones de la communicación en salud. Además, este estudio provee áreas de reflexión para los profesionales en salud internacional sobre las variaciones interculturales en las barreras lingüisticas y su efecto en los resultados de los estudios.