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Reg Richard,
Mary Jo Baryza,
Judith A Carr,
William S Dewey,
Mary E Dougherty,
Lisa Forbes-Duchart,
Beth J Franzen,
Tanja Healey, Mark E Lester,
S K F Li,
Merilyn Moore,
Dana Nakamura,
Bernadette Nedelec,
Jonathan Niszczak,
Ingrid S Parry,
Charles D Quick,
Michael Serghiou,
R Scott Ward,
Linda Ware,
Alan Young
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ABSTRACT: Burn rehabilitation is an essential component of successful patient care. In May 2008, a group of burn rehabilitation clinicians met to discuss the status and future needs of burn rehabilitation. Fifteen topic areas pertinent to clinical burn rehabilitation were addressed. Consensus positions and suggested future research directions regarding the physical aspects of burn rehabilitation are shared.
Journal of burn care & research: official publication of the American Burn Association 07/2009; 30(4):543-73. · 1.37 Impact Factor
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ABSTRACT: The development of burn scar contractures is due in part to the replacement of naturally pliable skin with an inadequate quantity and quality of extensible scar tissue. Predilected skin surface areas associated with limb range of motion (ROM) have a tendency to develop burn scar contractures that prevent full joint ROM leading to deformity, impairment, and disability. Previous study has documented forearm skin movement associated with wrist extension. The purpose of this study was to expand the identification of skin movement associated with ROM to all joint surface areas that have a tendency to develop burn scar contractures. Twenty male subjects without burns had anthropometric measurements recorded and skin marks placed on their torsos and dominant extremities. Each subject performed ranges of motion of nine common burn scar contracture sites with the markers photographed at the beginning and end of motion. The area of skin movement associated with joint ROM was recorded, normalized, and quantified as a percentage of total area. On average, subjects recruited 83% of available skin from a prescribed area to complete movement across all joints of interest (range, 18-100%). Recruitment of skin during wrist flexion demonstrated the greatest amount of variability between subjects, whereas recruitment of skin during knee extension demonstrated the most consistency. No association of skin movement was found related to percent body fat or body mass index. Skin recruitment was positively correlated with joint ROM. Fields of skin associated with normal ROM were identified and subsequently labeled as cutaneous functional units. The amount of skin involved in joint movement extended far beyond the immediate proximity of the joint skin creases themselves. This information may impact the design of rehabilitation programs for patients with severe burns.
Journal of burn care & research: official publication of the American Burn Association 07/2009; 30(4):625-31. · 1.37 Impact Factor
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ABSTRACT: Popular running magazines and running shoe companies suggest that imprints of the bottom of the feet (plantar shape) can be used as an indication of the height of the medial longitudinal foot arch and that this can be used to select individually appropriate types of running shoes. This study examined whether or not this selection technique influenced injury risk during United States Army Basic Combat Training (BCT). After foot examinations, BCT recruits in an experimental group (E: n = 1,079 men and 451 women) selected motion control, stability, or cushioned shoes for plantar shapes judged to represent low, medium, or high foot arches, respectively. A control group (C: n = 1,068 men and 464 women) received a stability shoe regardless of plantar shape. Injuries during BCT were determined from outpatient medical records. Other previously known injury risk factors (e.g., age, fitness, and smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference in injury risk between the E and C groups among men (risk ratio (E/C) = 1.01; 95% confidence interval = 0.88-1.16; p = 0.87) or women (risk ratio (E/C) = 1.07; 95% confidence interval = 0.91-1.25; p = 0.44). In practical application, this prospective study demonstrated that selecting shoes based on plantar shape had little influence on injury risk in BCT. Thus, if the goal is injury prevention, this selection technique is not necessary in BCT.
The Journal of Strength and Conditioning Research 05/2009; 23(3):685-97. · 1.83 Impact Factor
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ABSTRACT: Stress fracture susceptibility results from accelerated bone remodeling after onset of novel exercise and may be reflected in bone turnover changes. It is unknown if the bone turnover response to exercise is different between sexes.
To assess disparity between sexes in bone metabolism markers during military recruit training and to evaluate relationships between bone turnover markers and factors that may affect bone metabolism.
Volunteers were age-matched men (n = 58) and women (n = 199), 19 yr old, entering gender-integrated combat training. Blood was collected at 0, 2, and 4 months and anthropometric and fitness measures at 0 and 4 months. Serum was analyzed for biomarkers reflecting bone formation (bone alkaline phosphatase and procollagen I N-terminal peptide), bone resorption (C-telopeptide cross-links of type I collagen and tartrate-resistant acid phosphatase), endocrine regulation (parathyroid hormone, calcium, and 25(OH)D), and inflammation (interleukin 1B, interleukin 6, and tumor necrosis factor alpha). Data were analyzed using ANOVA, correlation, and regression analyses.
Bone turnover markers were higher in men (P < 0.01) and increased similarly for both sexes from 0 to 2 months (P < 0.01). Independent of gender, VO2max (R = 0.477) and serum calcium (R = 0.252) predicted bone formation activity (bone alkaline phosphatase) at baseline (P < 0.01). Serum calcium and parathyroid hormone decreased (2.0 and 6.4%, respectively) from 0 to 2 months (P < 0.001), returning to baseline at 4 months for both sexes. Men exhibited a decrease in 25(OH)D from 0 to 4 months (P = 0.007). Changes in endocrine regulators were significantly correlated with changes in bone turnover markers. Inflammatory markers did not differ between sexes and did not increase.
Military training increased bone formation and resorption markers in 2 months, suggesting rapid onset of strenuous exercise accelerates bone turnover similarly in men and women. Although bone turnover markers were higher in men than women, bone formation status may be related to aerobic fitness and serum calcium independent of gender and may be affected by small changes in endocrine regulators related to nutrition.
Medicine and science in sports and exercise 10/2008; 40(11 Suppl):S660-70. · 3.71 Impact Factor
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ABSTRACT: To examine change in physical fitness and body composition after a military deployment to Afghanistan.
One hundred and ten infantry soldiers were measured before and after a 9-month deployment to Afghanistan for Operation Enduring Freedom. Measurements included treadmill peak oxygen uptake (peak VO2), lifting strength, medicine ball put, vertical jump, and body composition estimated via dual-energy x-ray absorptiometry (percent body fat, absolute body fat, fat-free mass, bone mineral content, and bone mineral density).
There were significant decreases (P < 0.01) in peak VO2 (-4.5%), medicine ball put (-4.9%), body mass (-1.9%), and fat-free mass (-3.5%), whereas percent body fat increased from 17.7% to 19.6%. Lifting strength and vertical jump performance did not change predeployment to postdeployment.
Nine months deployment to Afghanistan negatively affected aerobic capacity, upper body power, and body composition. The predeployment to postdeployment changes were not large and unlikely to present a major health or fitness concern. If deployments continue to be extended and time between deployments decreased, the effects may be magnified and further study warranted.
Medicine and science in sports and exercise 08/2008; 40(9):1687-92. · 3.71 Impact Factor
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ABSTRACT: In Basic Combat Training (BCT) running shoes are prescribed based on plantar foot shape (reflecting longitudinal arch height). In response to a request from the Military Training Task Force of the Defense Safety Oversight Council this study examined whether or not this prescription technique influenced injury risk. After foot examinations BCT recruits in an experimental group (E, n=1,079 men, 456 women) were prescribed motion control stability or cushioned shoes for foot shapes judged to represent low medium or high arches respectively. A control group (C, n=1,068 men, 464 women) received a stability shoe regardless of plantar foot shape. Injuries during BCT were determined from outpatient visits provided by the Army Medical Surveillance Activity. Other previously known injury risk factors (e.g. age fitness smoking) were obtained from a questionnaire and existing databases. Multivariate Cox regression controlling for other injury risk factors showed little difference between the E and C groups among men (risk ratio (CIE) = 1.1195% confidence interval = 0.91- 1.34) or women (risk ratio (CIE)=1.14 95% confidence interval = 0.91-1.44). This prospective study demonstrated that prescribing shoes on the basis of the shape of the plantar foot surface had little influence on injury risk even after control of known injury risk factors.
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