Bacterial contamination of bath-water from spinal cord lesioned patients with pressure ulcers exercising in the water

Bacteriology of pressure ulcers in individuals with spinal cord injury: What we know and what we should know

Individuals with spinal cord injury (SCI) are at increased risk for the development of pressure ulcers. These chronic wounds are debilitating and contribute to prolonged hospitalization and worse medical outcome. However, the species of bacteria and the role that specific species may play in delaying the healing of chronic pressure ulcers in the SCI population has not been well characterized. This study will review the literature regarding what is known currently about the bacteriology of pressure ulcers in individuals with SCI. An electronic literature search of MEDLINE (1966 to February 2014) was performed. Eleven studies detailing bacterial cultures of pressure ulcers in the SCI population met inclusion criteria and were selected for review. Among these studies, bacterial cultures were often polymicrobial with both aerobic and anaerobic bacteria identified with culture techniques that varied significantly. The most common organisms identified in pressure ulcers were Staphylococcus aureus, Proteus mirabilis, Pseudomonas aeruginosa, and Enterococcus faecalis. In general, wounds were poorly characterized with minimal to no physical description and/or location provided. Our present understanding of factors that may alter the microbiome of pressure ulcers in individuals with SCI is quite rudimentary, at best. Well-designed studies are needed to assess appropriate wound culture technique, the impact of bacterial composition on wound healing, development of infection, and the optimum medical and surgical approaches to wound care.

Ambulation in simulated fractional gravity using lower body positive pressure: cardiovascular safety and gait analyses

The purpose of this study is to assess cardiovascular responses to lower body positive pressure (LBPP) and to examine the effects of LBPP unloading on gait mechanics during treadmill ambulation. We hypothesized that LBPP allows comfortable unloading of the body with minimal impact on the cardiovascular system and gait parameters. Fifteen healthy male and female subjects (22–55 yr) volunteered for the study. Nine underwent noninvasive cardiovascular studies while standing and ambulating upright in LBPP, and six completed a gait analysis protocol. During stance, heart rate decreased significantly from 83 ± 3 beats/min in ambient pressure to 73 ± 3 beats/min at 50 mmHg LBPP ( P < 0.05). During ambulation in LBPP at 3 mph (1.34 m/s), heart rate decreased significantly from 99 ± 4 beats/min in ambient pressure to 84 ± 2 beats/min at 50 mmHg LBPP ( P < 0.009). Blood pressure, brain oxygenation, blood flow velocity through the middle cerebral artery, and head skin microvascular blood flow did not change significantly with LBPP. As allowed by LBPP, ambulating at 60 and 20% body weight decreased ground reaction force ( P < 0.05), whereas knee and ankle sagittal ranges of motion remained unaffected. In conclusion, ambulating in LBPP has no adverse impact on the systemic and head cardiovascular parameters while producing significant unweighting and minimal alterations in gait kinematics. Therefore, ambulating within LBPP is potentially a new and safe rehabilitation tool for patients to reduce loads on lower body musculoskeletal structures while preserving gait mechanics.

Lower body positive-pressure exercise after knee surgery

Lower body positive pressure allows unloading of the lower extremities during exercise in a pressurized treadmill chamber. This study assessed the preliminary feasibility of lower body positive pressure exercise as a rehabilitation technique by examining its effects on gait mechanics and pain, postoperatively. Fifteen patients who had arthroscopic meniscectomy or anterior cruciate ligament reconstruction participated in this study. Patients exercised for 5 minutes at 2.0 mph under three body weight conditions (normal body weight, 60% body weight, and 20% body weight) in random order. Bilateral ground reaction force, electromyographs, and dynamic knee range of motion were collected, and pain was assessed using a visual analog scale. Ground reaction forces for surgically treated and contralateral extremities were reduced 42% and 79% from normal body weight conditions when ambulating at 60% and 20% body weight, respectively. After meniscectomy, ambulatory knee range of motion decreased only at 20% body weight (37 degrees), compared with normal body weight conditions (49 degrees). Peak electromyographic activity of the biceps was maintained at all body weight conditions, whereas that of the vastus medialis was reduced at 20% body weight. Pain relief was significant with lower body positive pressure ambulation after anterior cruciate ligament reconstruction. This study showed that lower body positive pressure exercise is effective at reducing ground reaction forces, while safely facilitating gait postoperatively.