Rafael f. escamilla, PT, PhD, CSCS, FACSM1 • Clare lewis, PT, PsyD, MPH, MTC, FAAOMPT2 • DunCan Bell, MPT3 Gwen BramBlet, MPT3 • Jason Daffron, MPT3 • steve lamBert, MPT3 • amanDa PeCson, MPT3 roDney imamura, PhD 4 • lonnie Paulos, MD 5 • James r. anDrews, MD 6 Core Muscle Activation During Swiss Ball and Traditional Abdominal Exercises t he "core" has been used to refer to the lumbopelvic-hip complex, which involves deeper muscles, such as the internal oblique, transversus abdominis, transversospinalis (multifidus, rotatores, semispinalis), quadratus lumborum, and psoas major and minor, and superficial muscles, such as the rectus abdominis, external oblique, erector spinae (iliocostalis, spinalis, longissimus), t ConClusions: The roll-out and pike were the most effective exercises in activating upper and lower rectus abdominis, external and internal obliques, and latissimus dorsi muscles, while minimizing lumbar paraspinals and rectus femoris activity .

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BackgroundGlobally the older population is increasing rapidly. As a result there is an increase in frail older persons living within the community, with increased risks of a hospital admission and higher mortality and morbidity rates. Due to complexity of care, health care professionals face challenges in providing effective case management and avoiding unplanned admissions to hospital. A community virtual ward (CVW) model was developed to assist health care professionals to support older persons at home during periods of illness and/or functional decline.MethodsA quantitative observational study was conducted to examine if a CVW model of care reduced unplanned hospital admissions and emergency department (ED) presentations in 54 patients over a 12-month period. The sign-rank test examined matched data on bed days, ED presentations, and unplanned hospital admissions pre- and post-CVW implementation. Other risk factors for admission to hospital were examined using the Mann–Whitney test pre-and post-CVW admission, including falls, living alone, and cognition. Correlations between hospital admission avoidances and unplanned hospital admissions and ED presentations were tested using Spearman’s ρ test.ResultsThere was a reduction in ED presentations post-CVW admission (P<0.001), and median unscheduled admissions were reduced (P=0.001). Those living alone had a lower number of ED presentations (median 0.5, interquartile range 0–1) prior to admission in comparison to those living with a caregiver, with no differences observed during admission to CVW. For those who experienced a fall during CVW admission, the odds ratio (OR) of requiring long-term care doubled for each extra fall (OR =2.24, 95% CI 1.11 to 4.52, P=0.025). Reduced cognition was associated with an increased risk of ED presentations (ρ=0.292, P<0.05) but not associated with increased risks of unplanned hospital admissions (ρ=0.09, P=0.546). There were no significant correlations seen between admission avoidance and the number of unplanned hospital admissions or ED presentations.ConclusionThrough an integrated approach to care, a CVW model in the care of older persons can reduce ED presentations and unplanned hospital admissions.

In laparoscopic abdominoperineal resection of the rectum (LAP-AP) an abdominal incision is completely avoided as the tumor is delivered through the perineal incision. It is our belief that the view provided in the pelvis by laparoscopy is significantly better than at laparotomy and allows excellent anatomical definition and meticulous dissection. In this study we compared the adequacy of excision of the first 12 patients undergoing LAP-AP to the last 16 patients undergoing open abdominoperineal resection (OP-AP). In all patients the procedure was carried with curative intent for adenocarcinoma and the Dukes staging and Jass score's were similar in both groups. [table: see text] The data demonstrate similar nodal harvest in both groups as well as extent of radial excision. However, two patients in the open group had microscopic radial margin involvement despite being microscopically clear at surgery. We conclude that although long-term follow-up is required to address the issue of local cancer recurrence, laparoscopic rectal dissection appears as good as open surgery and may allow a more precise assessment of excision margins.

Background:Prone, supine, and side position exercises are employed to enhance core stability.Hypothesis:Overall core muscle activity would be greater in prone position exercises compared with supine and side position exercises.Study Design:Controlled laboratory study.Methods:Eighteen men and women between 23 and 45 years of age served as subjects. Surface electrodes were positioned over the upper and lower rectus abdominis, external and internal obliques, rectus femoris, latissimus dorsi, and lumbar paraspinals. Electromyography data were collected during 5 repetitions of 10 exercises, then normalized by maximum voluntary isometric contractions (MVIC). Differences in muscle activity were assessed using 1-way repeated-measures analysis of variance, while t tests with a Bonferroni correction were employed to assess pairwise comparisons.Results:Upper and lower rectus abdominis activity was generally significantly greater in the crunch, bent-knee sit-up, and prone position exercises compared with side position exercises. External oblique activity was significantly greater in the prone on ball with right hip extension, side crunch on ball, and side bridge (plank) on toes compared with the prone and side bridge (plank) on knees, the crunch, or the bent-knee sit-up positions. Internal oblique activity was significantly greater in the prone bridge (plank) on ball and prone on ball with left and right hip extension compared with the side crunch on ball and prone and side bridge (plank) on knees positions. Lumbar paraspinal activity was significantly greater in the 3 side position exercises compared with all remaining exercises. Latissimus dorsi activity was significantly greater in the prone on ball with left and right hip extension and prone bridge (plank) on ball and on toes compared with the crunch, bent-knee sit-up, and prone and side bridge (plank) on knees positions. Rectus femoris activity was significantly greater in the prone on ball with left hip extension, bent-knee sit-up, or prone bridge (plank) on toes compared with the remaining exercises.Conclusion:Prone position exercises are good alternatives to supine position exercises for recruiting core musculature. Side position exercises are better for oblique and lumbar paraspinal recruitment.Clinical Relevance:Because high core muscle activity is associated with high spinal compressive loading, muscle activation patterns should be considered when prescribing trunk exercises to those in which high spinal compressive loading may be deleterious.