Physical Medicine & Rehabilitation

Constraint-induced Movement Therapy for improving motor function of the paretic lower extremity after stroke: a case report A 56-year-old woman with chronic stroke and gait dysfunction was recruited for this study. A Lower-Extremity Constraint-Induced Movement Therapy (LE-CIMT) protocol was given consisting of 3.5 hours/day of supervised intervention activities on 10 consecutive weekdays. Motor training was intensive and involved shaping. In addition, a group of behavior management strategies was employed to induce further unsupervised practice and transference of motor skills from the laboratory to real world situations. Changes in functional mobility, walking speed, balance, level of assistance, perceived quality of movement and level of confidence while performing daily activities were assessed five times in both the baseline and intervention phases. The outcomes observed after the intervention were determined by calculating the difference between the average scores obtained in both phases. Changes in perceived quality of movement, level of confidence, level of assistance, and balance were observed. Correspondence: Sarah dos Anjos, University of Alabama at Birmingham, 1720 2nd Avenue South, SHPB360. Birmingham, AL, USA. 35.294-0001. Disclosures: The authors have no conflict of interest. No funding was received. Clinicaltrials.gov: NCT03114046 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Effects of Whole Body Vibration on Motor Impairments in Patients with Neurological Disorders: A Systematic Review Objective This systematic review was conducted to examine the effects of whole body vibration (WBV) training on motor impairments among patients with neurological disorders, and to investigate which the whole body vibration training parameters induced improvement in motor impairments. Design PubMed, SCOPUS, PEDro, REHABDATA, and web of science were searched for randomized controlled trials and Pseudo- randomized controlled trials investigated the effect of WBV on motor impairments in patients with neurological disorders. The methodological quality was rated using the Cochrane Collaboration's tool Results Twenty studies were included in this systematic review. Four studies included patients with multiple sclerosis, cerebral palsy (n=2), stroke (n=9), Parkinson's disease (n=3), spinal cord injuries (n=1), and spino-cerebellar ataxia (n=1). The results showed different evidence of benefits and non-benefits for WBV training in motor impairments outcomes. Conclusion There is weak evidence for a positive effect of short-term WBV training on spasticity of lower extremities, mobility, balance and postural control. Besides, positive effect of the long-term effect of WBV training on mobility in patients with neurological disorders. The optimal WBV training parameters in treating patients with neurological disorders remain unclear. Anas Alashram, MSc, Doctorate Student in Neurology Department, Faculty of Medicine and Surgery, University of Rome "Tor Vergata", Italy, anasalashram@gmail.com Elvira Padua, PhD, Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Roma Open University, Rome, Italy. elvira.padua@unisanraffaele.gov.it Giuseppe Annino, PhD, Department of Medicine System, University of Rome "Tor Vergata", Italy, g_annino@hotmail.com Correspond author: Anas R. Alashram, Deperatment of Neurology University of Rome Tor Vergata, Rome, Italy E-mail: anasalashram@gmail.com Sources of funding/acknowledgements: The authors have no source of funding or any potential conflicts of interest to disclose. Funding or grants or equipment provided for the project from any source: None. Financial benefits to the authors: None. Details of any previous presentation of the research, manuscript, or abstract in any form: None. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ultrasound Imaging for Lateral Elbow Pain: Pinpointing the Epicondylosis No abstract available

Creation and initial validation of a picture-based version of the limitations of activity domain of the SF-36 Those with limited language comprehension or literacy face problems completing written questionnaires evaluating their health or physical status on which treatment plans are based. This brief report describes how a picture-based version of the 10 items in the limitations of activities (LoA) section of the SF-36 was developed iteratively and then piloted. Study participants: 101 community-living volunteers (58 female 43 male aged 18-93 years) educated to post-secondary level (52) high school grades 10-12 (44) and grade 9 or less (5). They first completed the picture-based SF-36LoA and described verbally and in writing what they understood each picture to mean, and then completed the English text version of the SF-36LoA domain for comparison assessment. Additional feedback suggested where pictures could be altered to increase information capture. Subjects rated their health as 26.7% excellent, 25.7% very good, 29.8% good, 10.9% fair and 6.9% poor. Analysis showed strong correlation between text-based SF-36LoA questions and the picture-based visual score – VSF-36LoA - (ICC=0.98) with question 10 correlating highest (ICC=0.90) and question 2 lowest (ICC=0.82). The VSF-36LoA is the first picture-based version of the SF-36; good correlation with the text-based version and global need warrants further development to aid those with limited literacy or language comprehension. Corresponding author: Macnab, Andrew John MD (London), Department of Pediatrics, University of British Columbia, Room C234, BC Children's Hospital, 4500 Oak Street, Vancouver, BC Canada V6H 3N1, phone: 604 875 2850, fax: 604 875 2530, ajmacnab@gmail.com Submitted to: American Journal of Physical Medicine and Rehabilitation Funding: none received Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Usefulness of Basic Movement Scale in Hip Fracture Patients – Construct Validity from a Cross-Sectional Study Objective To investigate the validity of using total score and to examine the constitution and characteristics of the Basic Movement Scale (BMS) in post-surgery patients with hip fracture. Design The dimensionality and the threshold difficulty intervals between each score and item difficulty hierarchy of the BMS were examined using factor analysis and Rasch analysis in 37 patients admitted to our hospital between April and November 2015. Results For factor analysis, the contribution ratio of the first factor was 78.9%, that of the second factor was 6.5%, and there were no items that fit the Rasch analysis. The threshold was reversed at six of the 48 locations. The difficulty of the 12 BMS items was distributed roughly evenly among all 9 lots, with some deviation. There was one very easy item, and there were some items almost overlapping in difficulty. Conclusions The results showed a unidimensional association between the items and evaluation index. The difficulty threshold of each score was approximated to the interval scale. Therefore, the BMS has evident construct validity and enables quantitative evaluation of physical ability, assessment of the effects of daily training, and general predictions of the feasibility of patients' clinical goals. (190words) All correspondence and requests for reprints should be addressed to: Tai Takahashi, MD, PhD, Department of Social Services and Healthcare Management, School of Health and Welfare, International University of Health and Welfare, Akasaka 4-1-26, Minato-ku, Tokyo, Japan Phone: 03-5574-3900 FAX: 03-5574-3961 e-mail: taiiuhw@gmail.com) Author Disclosures: The authors have no conflicts of interest directly related to the content of this work. No funds, grants, or facilities were obtained for this project from any sources of funding, and there was no financial gain. This manuscript has not been published previously in any form. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Caring for Patients with Physical Disabilities: Assessment of an Innovative Spinal Cord Injury Session that Addresses an Educational Gap Despite the fact that one-fifth of Americans live with disability, caring for these patients is not routinely part of the undergraduate medical student curriculum. An innovative session addressing care of patients with spinal cord injury (SCI) was developed for medical students and led by physiatrists, faculty experts in communications and individuals with SCI. A mixed-method design was utilized in evaluating students' knowledge, skills and attitudes following this curriculum. Quantitative evaluation was performed with a written essay question and checklist items from an objective structured clinical examination (OSCE) station. The session was given to 296 students from 2016 to 2018. On the OSCE, 94% asked about sexual function, 85% asked about activities of daily living (ADL), 77% asked about instrumental activities of daily living (IADL) and 47% of students evaluated skin health. Students demonstrated respectful (99%) and non-judgmental (99%) attitudes with SCI standardized patients (SPs) and 91% interacted with the SP's caretaker appropriately. Themes emerged from the student survey including: the value of having real patients present during the session, exposure to physical medicine and rehabilitation (PM&R) as a specialty, and the advantage of a small group format. This session provided students with tools necessary to care for patients with SCI. Corresponding author: Janice Thomas John, DO, MS, MPH, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra University, Hempstead, NY 11549, Phone: 516-463-7577 Fax: 516-463-5631; email: janice.t.john@hofstra.edu Author disclosures:Janice Thomas John DO, MS, MPH- nothing to disclose. Lauren Block MD, MPH - nothing to disclose. Adam Stein MD- nothing to disclose. Elizabeth Vasile, MPH- nothing to disclose. Maria-Louise Barilla-LaBarca MD-nothing to disclose Sources of funding: None Previous presentations: 2017 data was presented at: 1. Directors of Clinical Skills (DOCS) Annual Meeting, 2017. Boston, MA (poster). 2. Association of Academic Physiatrist (AAP) Annual Meeting, 2018 Atlanta, GA (platform presentation) Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Does performance on the American Board of Physical Medicine and Rehabilitation initial certification examinations predict future physician disciplinary actions? Objective To determine the relationship between performance on the American Board of Physical Medicine and Rehabilitation (ABPMR) primary certification examinations and the risk of subsequent disciplinary actions (DAs) by state medical boards over a physician's career. The hypothesis is that physicians who do not pass either or both of the two initial specialty certification examinations are at higher risk of disciplinary action (DA) from a state medical licensing board. Design This is a retrospective cohort study which analyzed board certification examination data from all physicians who completed Physical Medicine and Rehabilitation (PM&R) residency between 1968 and 2017. Results Matching examination and license data were available for 9,889 PM&R physicians, who received a total of 547 DA reports through the Federation of State Medical Boards. The results showed a significant correlation between failing an ABPMR certification examination and the risk of subsequent DA by a state medical board. Failure to pass either the written (Part I) or oral (Part II) examination increased the risk of subsequent DA by 5.77-fold (p< 0.0001, 95% Cl 4.07, 8.18). Conclusion Physicians in PM&R who do not pass initial certification examinations and become Board Certified are at higher risk of DA from a state medical licensing board throughout their careers. Dr. Kinney and Dr. Raddatz are employees of the American Board of Physical Medicine and Rehabilitation. No other disclosures. No funding was received for this study. Corresponding author: Carolyn L. Kinney, MD, American Board of Physical Medicine and Rehabilitation, 3015 Allegro Park Ln SW, Rochester, MN 55902, 507-282-1776, Ext. 1743, Email : ckinney@abpmr.org, Fax : 507-282-9242 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Vague Posterior Knee Discomfort in a Soccer Player: A Case Report A 24-year-old male soccer player presented with a 7-year history of left posterior knee "looseness." Evaluation 7 years ago, at the time of initial injury, revealed atraumatic ACL and PCL sprains. On re-presentation, the patient described the pain as a constant, dull ache, 3/10, but his biggest complaint was this feeling of "instability" and "looseness" where his knee would "buckle" 3-4 times a week. Physical exam was positive for grade 1 posterior drawer and grade 1 posterior sag signs. Reverse KT-1000 testing showed a 3 mm side-to-side difference. Sonographic evaluation confirmed MRI findings of PCL laxity and buckling and a small cystic lesion abutting the posteromedial margin of the distal 1/3 of the PCL. After a trial of physical therapy, the patient elected to undergo experimental injection of dextrose hyperosmolar solution. This resulted in resolution of the cyst and reverse KT-1000 measurements improved to a side-to-side difference of 1 mm. The patient's subjective feeling of "looseness" and "instability" resolved by 7 weeks. No funding was received for this study. Corresponding Author: Allison Schroeder, 2626 Tunnel Boulevard Apt 326, Pittsburgh, PA 15203, Email: aschroe1@alumni.nd.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Subtle dysmetria after a hemorrhage in the basal ganglia and lentiform nucleus No abstract available

Rapid decline of a 52-year old female with brain injury during acute rehabilitation A 52-year-old African American female suffered a spontaneous right middle cerebral artery (MCA) aneurysm rupture treated with emergent right craniectomy and MCA artery clipping. She was admitted to inpatient rehabilitation (IPR) 6 weeks after her initial injury and was requiring maximum to total assistance for functional tasks. She made significant functional gains during the first 17 days of IPR admission, she developed headaches, new cognitive deficits, and increased difficulty with standing and eating. Her symptoms worsened at the end of the day. Physical examination demonstrated sunken craniectomy flap. Imaging revealed medialization of the craniectomy flap with local mass effect causing a 4 mm leftward shift with interval decrease in ventricular size consistent with syndrome of the trephined. While in IPR she was placed in the Trendelenburg position during rest breaks and overnight and was transferred to the neurosurgical service for definitive treatment with cranioplasty. After an additional IPR stay and subsequent outpatient therapy, she improved to a modified independent level of function. Corresponding Author: Allison Schroeder, 3471 Fifth Ave, Pittsburgh, PA 15213, Phone: (412) 692-4400, schroederan@upmc.edu The authors of this manuscript, Allison Schroeder, Justin Weppner, and Gary Galang, have nothing to disclose. No funding was received for this study. Justin Weppner is in training. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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