Gianluca Del Rossi

Spine-board Transfer Techniques and the Unstable Cervical Spine

Study Design. A repeated-measures design using a cadaveric model was used in this preliminary investigation on the effectiveness of spine-board transfer techniques. Objectives. To compare the amount of angulation (flexion–extension) motion that results at the cervical spine during the execution of the log-roll maneuver and the lift-and-slide technique; and to examine how changes to the integrity of the cervical spine impacts the amount of motion generated during the transfer process. Summary of Background Data. Very little research has been performed to establish the efficacy of spine-board transfer techniques. Early studies have indicated that the log-roll maneuver may not be appropriate for transferring victims with thoracolumbar injuries. Also, there has not been a single study that has reported the impact of transfer techniques on the unstable cervical spine. This lack of data necessitated the present study. Methods. Four groups (with six participants each) were asked to execute the log-roll maneuver and the lift-and-slide technique on five cadavers. An electromagnetic motion analysis device was used to assess the amount of angulation motion generated at the C5–C6 segment during the execution of these transfer techniques. To examine how changes to the integrity of the cervical spine impacts the amount of motion that is produced during the transfer process, flexion–extension motion was assessed under various conditions: across a stable C5–C6 segment, after the creation of a posterior ligamentous injury, and after a complete segmental injury. Results. No significant differences in angulation motion were noted between transfer techniques. However, significant differences were noted between all three injury conditions. That is, as the severity of the injury increased, the average amount of angulation motion produced at the site of the lesion also increased, regardless of technique. Conclusion. The participants of this study were able to restrict flexion–extension motion equally well with thelog-roll maneuver as with the lift-and-slide technique. However, more research is needed to fully ascertain the effectiveness of spine-board transfer techniques.

The 6-Plus-Person Lift Transfer Technique Compared With Other Methods of Spine Boarding

CONTEXT To achieve full spinal immobilization during on-the-field management of an actual or potential spinal injury, rescuers transfer and secure patients to a long spine board. Several techniques can be used to facilitate this patient transfer. OBJECTIVE To compare spinal segment motion of cadavers during the execution of the 6-plus-person (6+) lift, lift-and-slide (LS), and logroll (LR) spine-board transfer techniques. DESIGN Crossover study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Eight medical professionals (1 woman, 7 men) with 5 to 32 years of experience were enlisted to help carry out the transfer techniques. In addition, test conditions were performed on 5 fresh cadavers (3 males, 2 females) with a mean age of 86.2 +/- 11.4 years. MAIN OUTCOMES MEASURE(S) Three-dimensional angular and linear motions initially were recorded during execution of transfer techniques, initially using cadavers with intact spines and then after C5-C6 spinal segment destabilization. The mean maximal linear displacement and angular motion obtained and calculated from the 3 trials for each test condition were included in the statistical analysis. RESULTS Flexion-extension angular motion, as well as anteroposterior and distraction-compression linear motion, did not vary between the LR and either the 6+ lift or LS. Compared with the execution of the 6+ lift and LS, the execution of the LR generated significantly more axial rotation (P = .008 and .001, respectively), more lateral flexion (P = .005 and .003, respectively), and more medial-lateral translation (P = .003 and .004, respectively). CONCLUSIONS A small amount of spinal motion is inevitable when executing spine-board transfer techniques; however, the execution of the 6+ lift or LS appears to minimize the extent of motion generated across a globally unstable spinal segment.

Cervical spine motion in manual versus Jackson table turning methods in a cadaveric global instability model.

Study Design A study of spine biomechanics in a cadaver model. Objective To quantify motion in multiple axes created by transfer methods from stretcher to operating table in the prone position in a cervical global instability model. Summary of the Background Data Patients with an unstable cervical spine remain at high risk for further secondary injury until their spine is adequately surgically stabilized. Previous studies have revealed that collars have significant, but limited benefit in preventing cervical motion when manually transferring patients. The literature proposes multiple methods of patient transfer, although no one method has been universally adopted. To date, no study has effectively evaluated the relationship between spine motion and various patient transfer methods to an operating room table for prone positioning. Methods A global instability was surgically created at C5-6 in 4 fresh cadavers with no history of spine pathology. All cadavers were tested both with and without a rigid cervical collar in the intact and unstable state. Three headrest permutations were evaluated Mayfield (SM USA Inc), Prone View (Dupaco, Oceanside, CA), and Foam Pillow (OSI, Union City, CA). A trained group of medical staff performed each of 2 transfer methods: the “manual” and the “Jackson table” transfer. The manual technique entailed performing a standard rotation of the supine patient on a stretcher to the prone position on the operating room table with in-line manual cervical stabilization. The “Jackson” technique involved sliding the supine patient to the Jackson table (OSI, Union City, CA) with manual in-line cervical stabilization, securing them to the table, then initiating the tables lock and turn mechanism and rotating them into a prone position. An electromagnetic tracking device captured angular motion between the C5 and C6 vertebral segments. Repeated measures statistical analysis was performed to evaluate the following conditions: collar use (2 levels), headrest (3 levels), and turning technique (2 levels). Results For all measures, there was significantly more cervical spine motion during manual prone positioning compared with using the Jackson table. The use of a collar provided a slight reduction in motion in all the planes of movement; however, this was only significantly different from the no collar condition in axial rotation. Differences in gross motion between the headrest type were observed in lateral bending (Foam Pillow<Prone View, P=0.045), medial lateral translation (Foam Pillow<Mayfield, P=0.032), and anterior posterior translation (Prone View<Mayfield, P=0.030). Conclusions The data suggest that the manual transfer technique produces 2 to 3 times more cervical spine angular motion than the Jackson table method of transfer. The use of a collar provides significant benefit in limiting spine motion that is only observed in axial rotation. Choice of headrest does have a significant effect on the amount of motion allowed during turning, with the Foam Pillow and Prone View generally providing more effective stabilization compared with the Mayfield.

Supplemental Substances Derived from Foods as Adjunctive Therapeutic Agents for Treatment of Neurodegenerative Diseases and Disorders

Neurodegenerative disorders and diseases (NDDs) that are either chronically acquired or triggered by a singular detrimental event are a rapidly growing cause of disability and/or death. In recent times, there have been major advancements in our understanding of various neurodegenerative disease states that have revealed common pathologic features or mechanisms. The many mechanistic parallels discovered between various neurodegenerative diseases suggest that a single therapeutic approach may be used to treat multiple disease conditions. Of late, natural compounds and supplemental substances have become an increasingly attractive option to treat NDDs because there is growing evidence that these nutritional constituents have potential adjunctive therapeutic effects (be it protective or restorative) on various neurodegenerative diseases. Here we review relevant experimental and clinical data on supplemental substances (i.e., curcuminoids, rosmarinic acid, resveratrol, acetyl-L-carnitine, and ω-3 (n-3) polyunsaturated fatty acids) that have demonstrated encouraging therapeutic effects on chronic diseases, such as Alzheimers disease and neurodegeneration resulting from acute adverse events, such as traumatic brain injury.

Transferring patients with thoracolumbar spinal instability: are there alternatives to the log roll maneuver?

Study Design. Using a cadaveric model, the amount of spinal motion generated during the execution of various prehospital transfer techniques was evaluated using a crossover study design. Objective. To assess the quantity of segmental motion generated across a globally unstable thoracolumbar spine during the execution of the log roll (LR), lift-and-slide, and 6-plus-person (6+) lift. Summary of Background Data. The LR has been reported to be inappropriate for transferring patients with thoracolumbar injuries. Although potentially safer methods have been identified for use with cervical spine injuries, alternatives to the LR have not been recognized in the case of thoracolumbar injuries. Methods. Three-dimensional angular motion was recorded across the T12–L2 vertebrae during execution of 3 transfer techniques using cadavers with intact spines and then repeated following an L1 corpectomy. Using a three-dimensional electromagnetic tracking device, the maximum angular motion was measured 3 times for each technique, and the mean value from the 3 trials was included in the statistical analysis. Results. Statistical tests revealed that there was a significant difference in axial rotation between the LR and lift-and-slide (P = 0.008) but only when these were executed in the presence of a destabilized T12–L1 segment. In addition, analysis of lateral flexion data identified a main effect for technique with the LR generating greater motion than either lifting technique. Finally, no significant difference was noted for flexion-extension among techniques. Conclusion. The execution of the LR maneuver tends to generate more motion than either of the lifting methods examined in this investigation. More research is needed to identify the safest possible method for transferring or moving patients with thoracolumbar instability.

Motion generated in the unstable spine during hospital bed transfers.

BACKGROUND The purpose of this study was to compare the motion generated when executing the bed transfer procedure in cadavers with unstable lower cervical spines. METHODS Five cadavers received a global instability at the C5-6 level. Each cadaver was moved with and without a rigid cervical collar. The amount of translation resulting from the bed transfer was measured. RESULTS Statistical analysis revealed no difference in spinal movement between treatments (with or without a collar). Anterior/posterior (AP) and medial/lateral motions were similar in magnitude and much higher than longitudinal motion. CONCLUSIONS There was very little resistance to motion in the AP and lateral directions. Thus, it may not be surprising that no difference in the amount of motion was noted between transfers conducted by skilled hands with or without a collar. Current hospital transfer techniques have the potential to inflict an unacceptably large displacement on an unstable spine.

Fabricating a better mouthguard. Part II: The effect of color on adaptation and fit

The thermoforming process involves the heating of plastic sheets to a critical temperature followed by the shaping of the heated material into a three-dimensional structure. Given that custom-fabricated mouthguards are produced using the thermoforming process, the adaptation of plastic sheets to a stone model of the dentition is likely to be affected by the ability of the mouthguard material to be heated. The purpose of this study was to establish if material color affected the adaptation and fit of custom-made mouthguards. Twelve stone models were used in this investigation. Five mouthguards were produced using each model. These mouthguards were made using clear-, white-, black-, blue- and green-colored ethyl vinyl acetate. The force required to remove the various colored mouthguards from the corresponding stone models was determined using a strain gauge housed within a specially designed apparatus. Each of the mouthguards were tested three times at two different angles of pull -45 degrees and 90 degrees . Statistical tests performed using the average amount of force required for mouthguard removal revealed an angle by color interaction. Post hoc analyses revealed that the mean force required to remove the clear-colored mouthguards from their respective stone models was significantly less than the force required to pull away blue-, black- and green-colored mouthguards. This difference between clear- and dark-colored mouthguards was observed at both angles tested with the exception of the black mouthguard which differed from the clear-colored mouthguard only when removed at an angle of 90 degrees . The results of the present study indicate that by using dark-colored mouthguard material, one can achieve superior adaptation and thus produce a more firmly fitting mouthguard.

Are scoop stretchers suitable for use on spine-injured patients?

INTRODUCTION In the prehospital setting, spine-injured patients must be transferred to a spine board to immobilize the spine. This can be accomplished using both manual techniques and mechanical devices. OBJECTIVES The study aimed to evaluate the effectiveness of the scoop stretcher to limit cervical spine motion as compared to 2 commonly used manual transfer techniques. METHODS Three-dimensional angular motion generated across the C5-C6 spinal segment during execution of 2 manual transfer techniques and the application of a scoop stretcher was recorded first on cadavers with intact spines and then repeated after C5-C6 destabilization. A 3-dimensional electromagnetic tracking device was used to measure the maximum angular and linear motion produced during all test sessions. RESULTS Although not statistically significant, the execution of the log roll maneuver created more motion in all directions than either the lift-and-slide technique or with scoop stretcher application. The scoop stretcher and lift-and-slide techniques were able to restrict motion to a comparable degree. CONCLUSION The effectiveness of the scoop stretcher to limit spinal motion in the destabilized spine is comparable or better than manual techniques currently being used by primary responders.

Comparison of Thoracolumbar Motion Produced by Manual and Jackson-table-turning Methods: Study of a Cadaveric Instability Model

BACKGROUND Patients who have sustained a spinal cord injury remain at risk for further neurologic deterioration until the spine is adequately stabilized. To our knowledge, no study has previously addressed the effects of different bed-to-operating room table transfer techniques on thoracolumbar spinal motion in an instability model. We hypothesized that the conventional logroll technique used to transfer patients from a supine position to a prone position on the operating room table has the potential to confer significantly more motion to the unstable thoracolumbar spine than the Jackson technique. METHODS Three-column instability was surgically created at the L1 level in seven cadavers. Two protocols were tested. The manual technique entailed performing a standard logroll of a supine cadaver to a prone position on an operating room Jackson table. The Jackson technique involved sliding the supine cadaver to the Jackson table, securing it to the table, and then rotating it into a prone position. An electromagnetic tracking device measured motion--i.e., angular motion (flexion-extension, lateral bending, and axial rotation) and linear translation (axial, medial-lateral, and anterior-posterior) between T12 and L2. RESULTS The logroll technique created significantly more motion than the Jackson technique as measured with all six parameters. Manual logroll transfers produced an average of 13.8 degrees to 18.1 degrees of maximum angular displacement and 16.6 to 28.3 mm of maximum linear translation. The Jackson technique resulted in an average of 3.1 degrees to 5.8 degrees of maximum angular displacement (p < 0.001) and 4.0 to 10.0 mm of maximum linear translation (p < 0.05). CONCLUSIONS Compared with the logroll, the Jackson-table transfer method provides superior immobilization of an unstable thoracolumbar spine during transfer of supine cadavers to a prone position on the operating room table. CLINICAL RELEVANCE This study addresses in-hospital patient safety. Performing the Jackson turn requires approximately half as many people as required for a manual logroll. This study suggests that the Jackson technique should be considered for supine-to-prone transfer of patients with known or suspected instability of the thoracolumbar spine.

Simple equations to predict concentric lower-body muscle power in older adults using the 30-second chair-rise test: a pilot study.

Although muscle power is an important factor affecting independence in older adults, there is no inexpensive or convenient test to quantify power in this population. Therefore, this pilot study examined whether regression equations for evaluating muscle power in older adults could be derived from a simple chair-rise test. We collected data from a 30-second chair-rise test performed by fourteen older adults (76 ± 7.19 years). Average (AP) and peak (PP) power values were computed using data from force-platform and high-speed motion analyses. Using each participant’s body mass and the number of chair rises performed during the first 20 seconds of the 30-second trial, we developed multivariate linear regression equations to predict AP and PP. The values computed using these equations showed a significant linear correlation with the values derived from our force-platform and high-speed motion analyses (AP: R = 0.89; PP: R = 0.90; P < 0.01). Our results indicate that lower-body muscle power in fit older adults can be accurately evaluated using the data from the initial 20 seconds of a simple 30-second chair-rise test, which requires no special equipment, preparation, or setting.