Millitary servants with the consequences of combat injury engaged in adaptive volleyball: indicators of psycho-physical and social society

In the article, we present data on the place of adaptive volleyball in the structure of physical culture and sports rehabilitation of servicemen with the consequences of a combat injury, characterize competitions for the military, which include adaptive volleyball (Invictus Game’s, Warriors Game’s); the specifics of their conduct, the rules of the competition, taking into account the individual characteristics of injured servicemen, have been determined; The paper presents data on the impact on individual health indicators (physical, mental and social) of combatants, characterizes the influence of sports games, and adaptive volleyball in particular on social changes, which are promoted by adaptive volleyball (uniting by common interests and physical activity of family members; opportunity communicate and train with brothers-in-arms, like-minded people; acquisition of individual skills of interaction with others, which can be effectively transferred to other types of activities of military personnel with the consequences of combat trauma – joint decision-making, analysis of the results of the work carried out, etc.); provided the results of psycho-physical and social adaptation of ATO/OOS participants who were engaged in the sections of physical culture and sports rehabilitation using adaptive volleyball and took part in specialized competitions for military personnel; the need to use individual innovative fitness technologies (TRX and Black-Roll) in comprehensive programs for restoring health and correcting dysfunctions that arose as a result of combat trauma in men of I-II mature age – veterans of the Russian-Ukrainian war was confirmed; it was shown that as a result of systematic sports games in the sections of physical culture and sports rehabilitation – adaptive volleyball, the level of manifestation of PTSD, aggressiveness, anxiety for no apparent reason, depressive states decreases, the quality of life of servicemen changes with the consequences of combat trauma (especially with relatives, friends, colleagues work), the level of stress resistance and social adaptation to the changed conditions of everyday household and professional activity increases, the lost communication skills are restored, the disposition to work in a team, making joint, deliberate decisions is manifested.

A Comparative Study Between Two Combat Injury Severity Scores

ABSTRACT Introduction In recent years, specific trauma scoring systems have been developed for military casualties. The objective of this study was to examine the discrepancies in severity scores of combat casualties between the Abbreviated Injury Scale 2005-Military (mAIS) and the Military Combat Injury Scale (MCIS) and a review of the current literature on the application of trauma scoring systems in the military setting. Methods A cross-sectional, descriptive, and retrospective study was conducted between May 1, 2005, and December 31, 2014. The study population consisted of all combat casualties attended in the Spanish Role 2 deployed in Herat (Afghanistan). We used the New Injury Severity Score (NISS) as reference score. Severity of each injury was calculated according to mAIS and MCIS, respectively. The severity of each casualty was calculated according to the NISS based on the mAIS (Military New Injury Severity Score—mNISS) and MCIS (Military Combat Injury Scale-New Injury Severity Score—MCIS-NISS). Casualty severity were grouped by severity levels (mild—scores: 1-8, moderate—scores: 9-15, severe—scores: 16-24, and critical—scores: 25-75). Results Nine hundred and eleven casualties were analyzed. Most were male (96.37%) with a median age of 27 years. Afghan patients comprised 71.13%. Air medevac was the main casualty transportation method (80.13). Explosion (64.76%) and gunshot wound (34.68%) mechanisms predominated. Overall mortality was 3.51%. Median mNISS and MCIS-NISS were similar in nonsurvivors (36 [IQR, 25-49] vs. [IQR, 25-48], respectively) but different in survivors, 9 (IQR, 4-17) vs. 5 (IQR, 2-13), respectively (P < .0001). The mNISS and MCIS-NISS were discordant in 34.35% (n = 313). Among cases with discordant severity scores, the median difference between mNISS and MCIS-NISS was 9 (IQR, 4-16); range, 1 to 57. Conclusion Our study findings suggest that discrepancies in injury severity levels may be observed in one in three of the casualties when using mNISS and MCIS-NISS.

Gunshot Injuries of the Maxillofacial Region

The current principles and pillars in the management of gunshot maxillofacial injuries have largely been the result of an exhaustive experimental approach spanning centuries of warfare. However, while medical professionals endlessly strive to revolutionize healthcare in combat injury, there are simultaneous efforts directed towards creation of new and ever more lethal arms and ammunition. Consequently, these doctrines continue to undergo significant transformations with a contemporary understanding of war injuries as well as the advent of new surgical materials and modern instrumentation. Previously accepted principles like external pin fixations without adequate exposure of bony fragments, fracture stabilization using intra-osseous wiring and inter-maxillary fixation, minimal attention to primary soft tissue closure and delay in definitive management have been sidelined for most of the part. On the other hand, new principles have evolved that including adequate exposure of fracture fragments and precise anatomic rigid fixation, immediate bone grafting, definitive soft tissue management and early definitive repair allowing for better return of patients to their pre-traumatic appearance.

Massage for Combat Injuries in Veteran with Undisclosed PTSD: a Retrospective Case Report

Introduction: Massage has shown promise in reducing symptoms related to dissociation and anxiety that can exacerbate chronic pain and suffering. The combat wounded, veteran population is increasing and requires a multidisciplinary approach for comprehensive treatment. This case study examines massage therapy use to improve veteran combat injury rehabilitation and recovery experience through purposive, retrospective, and comprehensive SOAP note review. Methods: A 31-year-old White male received seven, 60-min, full body massages for combat related shoulder injury complications incurred approximately six years before presentation. The right shoulder sustained a broken humeral head and complete dislocation during a defensive maneuver in a life-threatening attack. This case study utilized data from three different assessments: goniometric measurements for shoulder range of motion, observation and documentation for environmental comfort behaviors, and client self-report for treatment goal attainment. Six weekly, full body, 60-min massages were completed sequentially. A follow-up 60-min treatment was completed at Week 8. Treatment to the injured area included focused trigger point therapy, myofascial release, and proprioceptive neuromuscular facilitation to the neck, shoulder, and chest. Results: Total percent change for active flexion, extension, abduction, adduction, internal rotation, and external rotation were 12.5, 150, 40, 167, 14.3, and 0%, respectively. Total percent change for passive flexion, extension, abduction, adduction, internal rotation, and external rotation were 63.6, 350, 66.7, 450, 133, and 77.8%, respectively. Environmental comfort behaviors were reduced. Client treatment goals were attained. Conclusions: Massage therapy provided meaningful benefit to a combat injury for a veteran with PTSD.

Outpatient Pharmacy Prescriptions During the First Year Following Serious Combat Injury: A Retrospective Analysis

Introduction Limited research has analyzed the full range of outpatient medication prescription activity following serious combat injury. The objectives of this study were to describe (1) outpatient medication prescriptions and refills during the first 12 months after serious combat injury, (2) longitudinal changes in medication prescriptions during the first-year postinjury, and (3) patient characteristics associated with outpatient prescriptions. Materials and methods This was a retrospective analysis of existing health and pharmacy data for a random sample of U.S. service members who sustained serious combat injuries in the Iraq and Afghanistan conflicts, 2010–2013 (n = 381). Serious injury was defined by an Injury Severity Score (ISS) of 9 or greater. These patients typically participate in military rehabilitation programs (eg, amputation care) where prescription medications are essential. Data sources were the Expeditionary Medical Encounter Database for injury-specific data, the Pharmacy Data Transaction Service for outpatient medication prescriptions and refills, and the Military Health System Data Repository for diagnostic codes of pain and psychological disorders. Military trauma nurses reviewed casualty records to identify types of injuries. Using the American Hospital Formulary Service Pharmacologic-Therapeutic Classification system, clinicians identified 13 categories of prescription medications (eg, opioid, psychotherapeutic, immunologic) for analysis. Multivariable negative binomial and logistic regression analyses evaluated significant associations between independent variables (eg, blast injury, traumatic brain injury [TBI], ISS, limb amputation, diagnoses of chronic pain, or psychological disorders) and prescription measures (ie, number or category of medication prescriptions). We also describe longitudinal changes in prescription activity postinjury across consecutive quarterly intervals (91 days) during the first-year postinjury. Results During the first-year postinjury, patients averaged 61 outpatient prescriptions, including all initial prescriptions and refills. They averaged eight different categories of medications, primarily opioid, immunologic, gastrointestinal/genitourinary, central nervous system (CNS), nonopioid analgesic, and psychotherapeutic medications (representing 82% of prescriptions) during the first year. Prescription activity generally declined across quarters. There was still substantial prescription activity during the fourth quarter, as 79% of patients had at least one prescription. From 39 to 49% of patients had fourth-quarter prescriptions for opioid, CNS, or psychotherapeutic medications. Longitudinally, we found that 24–34% of patients had an opioid, CNS, or psychotherapeutic prescription during each of the final three quarters. In multivariable analysis, ISS, limb amputation (particularly bilateral amputation), and diagnoses of chronic pain and post-traumatic stress disorder (PTSD) were associated with significantly higher counts of individual and multiple medication prescriptions. TBI was associated with significantly lower numbers of prescriptions for certain medications. Conclusions This is one of the first studies to provide a systematic analysis of outpatient medication prescriptions following serious combat injury. The results indicate substantial prescription activity from multiple medication categories throughout the first-year postinjury. Diagnoses of chronic pain, PTSD, and limb amputation and ISS were associated with significantly higher counts of prescriptions overall and more prescription medication categories. This study provides initial evidence to better understand medication prescription activity following serious combat injury. The results inform future research on medication prescription practices and planning for rehabilitation.