Objective
The primary aim of this study was to compare osseointegration limb replacement prosthesis users to normative published Prosthetic Limb Users Survey of Mobility (PLUS-M) values for traditional socket prosthesis users. The secondary aim was to investigate whether patient factors were predictive of PLUS-M scores.
Design
Retrospective review of all patients who underwent osseointegration maintained in a prospectively maintained registry. All patients (N = 63) were invited to complete a PLUS-M survey. Thirty patients completed the survey (15 femoral osseointegration, 15 tibial osseointegration).
Results
The osseointegration limb replacement prosthesis users cohort’s composite median scores and interquartile ranges for the PLUS-M Raw Score, PLUS-M T-score, and PLUS-M percentile score were 57 (46–60), T-score 62.5 (51.275–71.4), and 89.5 (54.95–98.4). PLUS-M T-scores were higher in the osseointegration limb replacement prosthesis users compared with the age and etiology matched literature-reported outcomes in traditional socket prosthesis users for above-knee (P = 0.027) and below-knee (P = 0.029) amputees. Tibial osseointegration scores were slightly higher than femur osseointegration scores but did not reach statistical significance. PLUS-M raw (P = 0.047) and PLUS-M percentile scores (P = 0.041) were significantly improved for younger patients at the time index amputation. Regression analysis supported this finding.
Conclusions
Osseointegration limb replacement prosthesis users demonstrate improved functional mobility outcome scores relative to traditional socket prosthesis users. PLUS-M functional scores were improved for younger patients at time of index amputation. 
Objective
This study aimed to compare the effects of ipsilateral electroacupuncture at the site of exercise-induced pain and those of contralateral electroacupuncture on delayed-onset muscle soreness, muscle injury markers, and oxidative stress after eccentric exercise.
Design
Nineteen young men were randomly assigned to receive either contralateral electroacupuncture or ipsilateral electroacupuncture. All participants performed eccentric exercise using the biceps brachii muscle of the nondominant arm to induce muscle damage. Six sets of five repetitions were completed at 70% of maximal muscle strength. Electroacupuncture stimulation was applied to the dominant arm in the contralateral electroacupuncture group and the nondominant arm in the ipsilateral electroacupuncture group. Electroacupuncture stimulation was applied in both groups from 7 days before exercise to 4 days after exercise.
Results
Palpation pain was significantly lower in the ipsilateral electroacupuncture group than the contralateral electroacupuncture group at 72 and 96 hours after exercise. The muscle injury markers increased after exercise, but these changes were not significantly influenced by ipsilateral electroacupuncture stimulation. Ipsilateral electroacupuncture suppressed exercise-induced oxidative stress at 72 hours after exercise.
Conclusions
This study suggests that the direct electroacupuncture on the damaged muscle before and after eccentric exercise effectively reduces delayed-onset muscle soreness. Electroacupuncture might suppress increases in oxidative stress elicited by eccentric exercise. 
Objective
This study was conducted to evaluate the diagnostic performance and to establish cutoff values of median nerve cross-sectional area for classifying the severity of carpal tunnel syndrome.
Design
The study dataset included 1069 wrists from 1034 patients with carpal tunnel syndrome (May 2017–December 2022). A machine learning algorithm was used to predict carpal tunnel syndrome severity based on median nerve cross-sectional area, adjusting for sex, age, body mass index, and disease duration.
Results
The multivariable model showed a multiclass area under the receiver operating characteristic curve of 0.753 and s single-class area under the receiver operating characteristic curves of 0.733, 0.635, and 0.780 for mild, moderate, and severe syndrome, respectively. Optimal cross-sectional area cutoffs were identified as 16 mm2 for severe syndrome, with area under the receiver operating characteristic curve values of 0.773 and 0.794, respectively. The model showed high sensitivity for mild and high specificity for severe syndrome but had a low performance for moderate carpal tunnel syndrome (area under the receiver operating characteristic curve = 0.568).
Conclusions
Median nerve cross-sectional area is a valuable tool for diagnosing mild and severe carpal tunnel syndrome. While cross-sectional area provides limited accuracy for moderate carpal tunnel syndrome, it remains a useful adjunct to other diagnostic methods, potentially reducing the need for more invasive procedures. 
Objective
The aim of the study was to assess oral sensory deficits and their correlation with mastication and swallowing in patients with stroke.
Design
This prospective observational study was conducted in the stroke unit of a rehabilitation hospital. The inclusion criterion was first occurrence of stroke with a unilateral lesion. Patients underwent oral sensory tests, including tactile sensation (light touch, two-point discrimination) and proprioception, along with mastication and swallowing assessments via videofluoroscopic swallowing study and Test of Masticating and Swallowing Solids.
Results
Among 36 patients, contralesional sides exhibited reduced oral sensory function (light touch, two-point discrimination, and proprioception of lips) compared with ipsilesional sides (P = 0.003, P = 0.001, P = 0.046, respectively). Oral proprioception was negatively correlated with mastication and swallowing. Proprioception of tongue showed negative correlation with mastication (P = 0.035), while combined value of proprioception of teeth, lip, and tongue showed negative correlation with time per swallow. Contralesional light touch and two-point discrimination influenced swallow items in Test of Masticating and Swallowing Solids and pharyngeal phase items in videofluoroscopic swallowing study.
Conclusions
Patients with stroke demonstrated contralesional oral sensory deficits, which were associated with impaired mastication and swallowing. Oral proprioception was correlated with mastication and swallowing, whereas tactile sensation correlated with the pharyngeal phase. 
Objective
Spurling’s test is commonly used to diagnose cervical radiculopathy (CR); however, its diagnostic accuracy varies across studies. This systematic review and meta-analysis aim to evaluate the diagnostic performance of Spurling’s test for cervical radiculopathy.
Design
A systematic search of PubMed, ClinicalTrials.gov, Cochrane Library, and Physiotherapy Database was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies assessing Spurling’s test against imaging or electrodiagnostic tests were included. A bivariate random-effects model calculated pooled sensitivity, specificity, likelihood ratios, and log diagnostic odds ratios.
Results
Eight studies met the inclusion criteria. The pooled sensitivity of Spurling’s test was 0.53 (95% confidence interval: 0.29–0.78), higher with imaging (0.67) than with electrodiagnostic testing (0.31) as the reference standard. Combining neck rotation or extension increased sensitivity to 0.67, compared to 0.31 without. The pooled specificity was 0.92 (95% confidence interval: 0.88–0.96), 0.93 with imaging and 0.91 with electrodiagnostic testing as the reference standard. The pooled positive likelihood ratio was 3.28, negative likelihood ratio was 0.28, and the log diagnostic odds ratio was 2.74.
Conclusions
Spurling’s test is highly specific but has low sensitivity for cervical radiculopathy diagnosis, making it better suited for confirmation than screening. Sensitivity may improve with added maneuvers and imaging as a reference.
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CME Objectives
Upon completion of this article, the reader should be able to: 1) Understand the diagnostic performance of Spurling’s test for cervical radiculopathy. 2) Identify strategies to improve diagnostic performance during clinical testing. 3) Recognize the clinical role of Spurling’s Test in the diagnosis and management of cervical radiculopathy.
Level
Advanced
Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. 
Objective
The aim of the study was to comprehensively survey the impact of botulinum neurotoxin on muscle volume or mass in treating lower limb spasticity in individuals with spastic cerebral palsy.
Design
We searched PubMed, Embase, Web of Science, and the Cochrane Library up to May 15, 2024. We focused on changes in the volume or mass of the gastrocnemius, triceps surae, or entire distal lower limb muscles at various follow-up periods. Meta-regression analysis was conducted to assess the moderating effects of age and gross motor function classification system level.
Results
Our analysis included 11 cohort studies. A significant decrease in gastrocnemius muscle volume or mass was observed 2–3 mos after botulinum neurotoxin treatment (standardized mean difference −0.496, 95% confidence interval [−0.810, −0.181]) but not at earlier (standardized mean difference −0.134, [−0.397, 0.129]) or later (standardized mean difference −0.223, [−1.199, 0.752]) periods. The triceps surae and entire distal lower limb muscles showed no changes. Older patients (P = 0.026) and those with Gross Motor Function Classification System I–II levels (P = 0.0191) had more pronounced decreases.
Conclusion
The present study showed a decrease in muscle volume or mass of the botulinum neurotoxin–injected gastrocnemius after a short follow-up period but not in the triceps surae or the distal lower limb in individuals with spastic cerebral palsy. 
Objective
A concomitant traumatic brain injury is often seen in patients with acute traumatic spinal cord injury. Unfortunately, the exact epidemiology of concomitant traumatic brain injury–traumatic spinal cord injury remains unknown. Our objective was to determine the incidence of concomitant traumatic brain injury–traumatic spinal cord injury and identify clinical factors associated with its occurrence.
Design
A prospective cross-sectional study of 476 traumatic spinal cord injury patients was conducted. In all patients, baseline characteristics were routinely collected and the presence of a traumatic brain injury was sought prospectively by a specialized neurosurgeon using standardized diagnostic criteria based on clinical and radiological variables.
Results
Of the 476 included patients, 250 (53%) had isolated traumatic spinal cord injury and 226 (47%) had concomitant traumatic brain injury–traumatic spinal cord injury. Almost 85% of diagnosed traumatic brain injuries were mild. At the univariate level, patients with concomitant traumatic brain injury–traumatic spinal cord injury were more likely to present a history of drug/alcohol abuse (P = 0.014), be involved in a motor vehicle accident (P 
Objective
The aim of the study was to determine clinical effectiveness of an 8-wk functional restoration program compared with conventional medical management in patients with chronic pain after work-related injury in the workers’ compensation system.
Design
This is an observational retrospective chart review of 485 patients treated between January 1, 2020, and December 31, 2022. Included patients with chronic pain after work-related injury who participated in a multidisciplinary evaluation and were considered appropriate for functional restoration program. Outcomes were analyzed for two groups: functional restoration program group completed an 8-wk program, and conventional medical management group did not receive functional restoration program treatment. The ordinary least squares regression model was used to control confounding factors, and an independent t test was performed to assess functional restoration program effectiveness.
Results
Functional restoration program graduates demonstrated improvements in depression, anxiety, self-efficacy, and physical function; Center for Epidemiologic Studies Depression Scale (P ssociated with work-related injury; and ○ Enhance clinical applications of multidisciplinary treatment for treating delayed recovery from chronic pain in individuals with work-related injuries.
Level
Advanced
Accreditation
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity. 
Objectives
To present our experience with 4 para-athletes implanted with intrathecal baclofen pump and spinal cord stimulation, detailing their management and the potential complications these patients may face.
Design
For spinal cord stimulation, data collected included stimulation level, surgical complications, and pain scale assessment before the procedure and at 3-mo follow-up. For intrathecal baclofen, data collected included catheter level, surgical complications, baclofen concentration and dosage, and Modified Ashworth Scale.
Results
The sports practiced by the patients include sitting volleyball, shooting, handcycling, and table tennis. Concerning patients implanted with spinal cord stimulation, the first patient showed benefits on her phantom limb pain allowing her to resume training while the second patient presented an electrode fracture. Patients receiving intrathecal baclofen improved their spasticity. One of the patients required only a continuous infusion, while the other needed a bolus infusion adapted to training hours.
Conclusions
The use of spinal cord stimulation and intrathecal baclofen in para-sports is not contraindicated. Only the use of intrathecal morphine requires a therapeutic use exemption. Spinal cord stimulation and intrathecal baclofen require special monitoring, considering the needs of para-athletes and the particularities of the sport they practice. Further studies will be needed to assess the sporting performance of patients implanted with spinal cord stimulation or intrathecal infusion pumps. 
No abstract available 
No abstract available 
The rehabilitation field is advancing in the implementation of evidence-based practices into clinical care. Significant gaps remain, however, because of the complexity of patient populations and interventions, and resource intensive implementation strategies. Furthermore, implementation strategies are often designed for how clinicians ought to behave not how they actually behave. Translating evidence-based practices into practice requires behavior change among clinicians within organizational constraints. Behavioral economics is a field that combines insights from economics and psychology to explain human decision making and its impact on behavior. Nudges are strategies that are rooted in behavioral economic principles and guide decision-making without restricting choice. Nudges seek to make the optimal choice the easiest choice, without increasing clinician burden. This paper explores five applications from previous work that may accelerate implementation of evidence-based practice in the rehabilitation field: (1) embedding nudges within the electronic health record, (2) developing clinical decision support tools, (3) framing of performance feedback, (4) aligning nudges with existing workflows, and (5) applying the Easy-Attractive-Social-Timely Framework to ensure nudges are appropriately designed for the clinician and setting. Lastly, we discuss the special considerations of designing a nudge to avoid unintended consequences such as increased clinician burnout or alert fatigue. 
This review aimed to systematically identify and compare randomized controlled trials of poststroke upper extremity rehabilitation interventions conducted in low-middle-income countries and high-income countries over time and their differences in study characteristics and quality. Searches were conducted in CINAHL, Embase, PubMed, Scopus, and Web of Science up to April 1, 2021. Randomized controlled trials were included if ≥50% of the study population had stroke, if participants were adults (≥18 yrs), and if the randomized controlled trial examined an intervention to the hemiparetic upper extremity. A total of 1276 randomized controlled trials met inclusion criteria, and of these, 978 randomized controlled trials were conducted in high-income countries and 298 in low-middle-income countries. The number of randomized controlled trials increased at a comparable rate to high-income countries since 2011 although from a lower baseline. A higher percentage of randomized controlled trials in high-income countries were conducted in the chronic poststroke phase, and a higher percentage of randomized controlled trials in low-middle-income countries were conducted in the subacute phase. While the randomized controlled trials in low-middle-income countries were found to have comparable quality to randomized controlled trials of high-income countries, they were published in aggregate in journals with lower impact factors. It is important to better understand the potential barriers to publication in higher impact journals for randomized controlled trials conducted in low-middle-income countries. 
Amyotrophic lateral sclerosis is a progressive neurodegenerative disease affecting upper and lower motor neurons that control voluntary muscles. With no known cure, clinical care is focused on symptom management to maximize function and quality of life. Assistive technology plays a crucial role and enables some restoration of movement and function despite disease progression. This scoping review assesses the effectiveness of assistive technologies tested in people living with amyotrophic lateral sclerosis, specifically those designed to compensate for upper and lower extremity, trunk, and cervical muscle weakness. A comprehensive search was conducted across PubMed, CINAHL, ERIC, and Google Scholar and through citation chasing. We included 26 articles that tested an assistive device on at least one person living with amyotrophic lateral sclerosis and evaluated the device’s effectiveness in restoring movement or providing stabilization to support functional mobility or activities of daily living. Most studies were pilot feasibility or usability trials, with small numbers of amyotrophic lateral sclerosis participants. The devices showed various benefits, including improved range of motion, function, and participation in daily activities. This review highlights the potential for assistive devices to enhance function in people living with amyotrophic lateral sclerosis and underscores the need for comprehensive studies involving larger cohorts of individuals at different stages of amyotrophic lateral sclerosis. 
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