Physical Medicine & Rehabilitation

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Cumulative Efficacy of Longitudinal Repeat Salivary Gland OnabotulinumtoxinA Injection: A Retrospective Study Aim We hypothesized that repeat onabotulinumtoxinA (BTX-A) injections to salivary glands would have a cumulative effect on drooling, leading to prolonged efficacy duration. Methods We retrospectively reviewed medical records and conducted a telephone survey of individuals treated with BTX-A to the salivary glands to investigate ongoing efficacy or side effects. Outcome measures were duration of decrease in drooling, and adverse events. The main independent variable was the number of injections. We identified 52 consecutive individuals (26 females) with cerebral palsy with an average age of 9 years, 3 month ± 5 years, 2 months who had received BTX-A for sialorrhea. Results Linear regression analysis showed that each additional injection resulted in the duration of efficacy being 0.68 months longer (P <0.001, R2=0.47). Age, sex, Gross Motor Function Classification System (GMFCS) level, presence of tube feeding, presence of tracheostomy, gastroesophageal reflex, seizures and concurrent intramuscular injections seizures were not significant contributors to the association between injection number and efficacy duration F (6, 45) = 1.01, p= 0.431. Interpretation There may be a cumulative effect of BTX-A injections to the salivary glands, resulting in longer periods of efficacy with consecutive injection. Corresponding Author: Heakyung Kim, MD, 180 Fort Washington Ave, Harkness Pavilion, St 1-165, New York, NY 10032, Phone 212-305-5337, Fax 212-342-1470. E-mail: hk2641@cumc.columbia.edu This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Hannah Shoval is in training. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

External devices among individuals with spinal cord injury from a developing country Objective To explore the proportion, number, and type of external devices (including mobility devices, ambulatory aides, and orthotics) possessed and used by individuals with spinal cord injury (SCI) from a developing country. Design Cross-sectional study. Participants A total of 163 participants with SCI from several rural communities in a developing country participated in the study from June 2018 to August 2019. Methods The participants were interviewed and assessed for their SCI characteristics and the external devices (i.e., mobility devices, ambulatory aides, and orthotics) possessed and used in their daily living. Results The majority of participants (85%), who lived in rural communities with family income of less than $3,167 per year, possessed external devices (1–5 types), and 80% of all participants actually used the devices (1–3 types) in their daily living. Most participants with motor-complete SCI used a single device, especially a manual wheelchair, whereas those with mild lesion severity used multiple devices for their daily activities, particularly a standard walker. Conclusion Owing to budget and environmental constraints, the external devices used by individuals with SCI from a developing country are different from those reported in a developed country. The findings provide particular insights into the management of external devices for these individuals of a developing country. Corresponding author: Assoc. Prof. Sugalya Amatachaya, PT, PhD., School of Physical Therapy, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen, 40002 Thailand, Tel/Fax: + 66 43 202 085. E-mail: samata@kku.ac.th FUNDING SUPPORT AND CONTRIBUTION: The researchers sincerely thank for funding support and contribution from the Research and Researcher for Industry (RRi) (PHD60I0027), Postgraduate School, and the Improvement of Physical Performance and Quality of Life (IPQ) research group, Khon Kaen University, Thailand. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Rehabilitation protocol following hip arthroscopy. A 2015 to 2020 systematic review Objective Although many rehabilitation protocols following hip arthroscopy have been described, there is still significant variability about duration, goals, restrictions and techniques to apply by the physical therapy (PT) after the surgical procedure. Objective of this study is a systematic review about rehabilitation after hip arthroscopy. Design The data Sources were PubMed, Scopus and Cochrane Library. PRISMA guidelines were used for the systematic review. Level I-IV evidence clinical studies and clinical reviews that focused on rehabilitation protocols after hip arthroscopy have been used as study eligibility criteria. Major limitations include the retrospective nature of most of the studies selected (Level IV evidence) and the use of different clinical scores to report the outcomes. Results This review showed that although a standardized guideline on rehabilitation following hip arthroscopy is still missing, the most recent studies and clinical trials are focusing on a four-phased program which includes goals, recommendations and a progression of exercises. Conclusion Rehabilitation after hip arthroscopy is strongly suggested, but different authors recommended different rehabilitation programs. There is not a defined program, but as of today the current standard of care is composed of phase-based programs. Corresponding author: Alessandro Bistolfi, MD Orthopaedic Surgeon, Orthopaedic and Trauma Centre, CTO. Via Zuretti 29, 10126 Turin. Italy. abistolfi@cittadellasalute.to.it; tel +39.011.6933573; fax +39.011.6933760; orcid 0000 0002 4396 6222 CONFLICT OF INTEREST: The authors declare that: 1) no benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article 2) the work has not been published before in any language, is not being considered for publication elsewhere, and has been read and approved by all authors 3) each author contributed significantly to one or more aspects of the study 4) no funding was received Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Association of Academic Physiatrists Women's Task Force Follow-up Report The Association of Academic Physiatrists (AAP) convened a Women's Task Force in 2016, under the leadership of then AAP President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of women physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the AAP had been successful in supporting gender equity as well as areas in which women physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various AAP committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the AAP Board of Trustees commitment to transparency and gender equity. J.K.S. and S.C contributed equally Corresponding Author: Julie K. Silver, MD, Address: 300 1st Avenue, Charlestown, MA 02025, Email: Julie_silver@hms.harvard.edu Phone: 617-680-9504, Fax: 508-718-4035 Julie K. Silver, MD – None related to this work. As an academic physician, Dr. Silver has published books and receives royalties from book publishers, and she gives professional talks such as grand rounds and medical conference plenary lectures and receives honoraria from conference organizers. She has participated in research funded by The Arnold P. Gold Foundation (physician and patient care disparities), Binational Scientific Foundation (culinary telemedicine research, and the Warshaw Institute and Massachusetts General Hospital Department of Medical Oncology (pancreatic cancer). Dr. Silver is an uncompensated founding member of TIMES UP Healthcare. Sara Cuccurullo, MD – None related to this work. As an academic physician, Dr. Cuccurullo has published textbooks and receives royalties from publishers; which are donated to the JFK Johnson Resident Education fund. She has participated in research funded by The Wallerstein Foundation, The North Eastern Cerebrovascular Consortium and an unrestricted grant from NuStep. Dr. Cuccurullo speaks at Medical Conferences, and all honoraria are donated to education. Anne Felicia Ambrose, MD – None related to this work. As a researcher, Dr. Ambrose has received and is currently receiving funding from National Institute of Aging. Glendaliz Bosques, MD – No related or unrelated disclosures to report. Talya K. Fleming, MD – None related to this work. Dr. Fleming has participated in research funded by The Wallerstein Foundation, The North Eastern Cerebrovascular Consortium, an unrestricted grant from NuStep, and the Fred C. Rummel Foundation. Walter R. Frontera, MD, PhD – Editor in Chief of the American Journal of Physical Medicine and Rehabilitation. Unrelated to this work, Dr. Frontera reports speaker honoraria, book royalties, and National Institutes of Health funding. Danielle Perret Karimi, MD – None related to this work. Unrelated to this work, Dr. Karimi has participated in research funded by the Arnold P. Gold Foundation (humanism in medicine). She has a financial investment as a shareholder in Graceland Hospice. Mooyeon Oh-Park, MD – No disclosures related to this work. Unrelated, Dr. Oh-Park discloses that she has grant funding from the David Ju Foundation for transition of care for stroke rehabilitation. Gwendolyn Sowa, MD, PhD – No disclosures related to this work. Unrelated Dr. Sowa reports funding from National Institutes of Health, Patient-Centered Outcomes Research Institute, and The Pittsburgh Foundation. Unrelated non-financial disclosure member of UPMC for You Board of Directors. Christopher Visco, MD – None related to this work. Unrelated Dr. Visco reports speaking at medical conferences with honoraria. Consulting services to Mimedx for ultrasound and injection topics. Lyn Weiss, MD - None related to this work. As an academic physician, Dr. Weiss has published books and receives royalties from book publishers, and she gives professional talks such as grand rounds and medical conference lectures. Tiffany Knowlton, JD, MBA – No related or unrelated disclosures to report. Article Disclosures: Funding Information – No funding was received for this work. Previous Presentation – No previous presentation of this research, manuscript, or article occurred in the public domain. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Evidence of widespread mechanical hyperalgesia but not exercise induced analgesia in athletes with mild patellar tendinopathy compared to pain-free matched controls: a blinded exploratory study Objective To assess centrally induced pain processing with pressure pain thresholds (PPT) bilaterally and remotely in active volleyball and basketball athletes with mild patellar tendinopathy compared to asymptomatic control athletes. Secondary objective was to explore the role of exercised induced analgesia during a training session in athletes with patellar tendinopathy. Design In this exploratory study, PPTs of 21 patellar tendinopathy athletes and 16 age and sex matched asymptomatic team members were measured by a blinded assessor bilaterally on the patellar tendon and unilaterally on the elbow extensor tendon with a pressure algometer before, during and after a regular training session. Results Patellar tendinopathy athletes had a significantly higher average body mass index compared to asymptomatic athletes (mean difference 1.75 (95%CI 0.35, 3.15), p= 0.02). At baseline, athletes with patellar tendinopathy showed lowered PPTs in the affected knee (p=0.001), unaffected knee (p<0.001), and elbow (p=0.01) compared to controls. No clear patterns were identified to explain between group differences in PPTs before, during and after exercise. Conclusion This exploratory study found primary and secondary mechanical hyperalgesia in athletes with patellar tendinopathy compared asymptomatic athletes. Further research is required on the effects of an acute exercise bout on pain thresholds in this population. Corresponding author: Paul van Wilgen, Transcare, Canadalaan 10-b 9728 EE Groningen, 050-2111495, p.vanwilgen@transcare.nl Conflicts of Interest and Source of Funding: No competing interests, funding/grants/equipment provided for the project, or any financial benefits to the authors are declared. This research has not previously been presented in another manuscript or abstract. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

The Rehabilitation Medicine Scientist Training Program: Updates and Perspectives on Addressing an Ongoing Need in Physiatric Research The shortage of physician-scientists in Physical Medicine and Rehabilitation remains a critical problem. The Rehabilitation Medicine Scientist Training Program (RMSTP) was developed in 1995 to provide structured career development training for aspiring rehabilitation medicine researchers. Initially funded by a 5-year K12 grant from the NIH National Center of Medical Rehabilitation Research (NCMRR), the structure was revised in 2001, continued in a stable format through 3 additional funding cycles (2001-2006, 2006-2012, and 2012-2016), and was again revised to a research education program (NIH R25) model in 2019. With this change in format of the RMSTP we now report the productivity of funded trainees and discuss future directions informed by the RMSTP's current R25 structure. Correspondence: John Whyte, MD, PhD, FACRM, Moss Rehabilitation Research Institute, 50 Township Line Rd, Elkins Park, PA, 19027, jwhyte@einstein.edu DISCLOSURES: The authors received support from The National Institutes of Health (5R25HD098048, Boninger PI). There are no other conflicts of interest. Authors' roles: Drafting manuscript: LM, DM, MB, JW. Revising manuscript content: LM, DM, MB, JW. Approving final version of manuscript: LM, DM, MB, JW. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Demonstration with 3D Volumetric MR sequences of Deep Peroneal Nerve Compression on Os Intermetatarseum Syndrome: A case Report The os intermetatarseum is a rare accessory bone of the foot. It is commonly asymptomatic, as are other such accessory bones of the foot. Nevertheless, when it becomes symptomatic, it can cause "os intermetatarseum syndrome". The case is here reported of os intermetatarseum syndrome, which is extremely rarely seen. To the best of our knowledge, there are very few cases in the literature about os intermetatarseum syndrome. Corresponding author: Hayri Ogul M.D., Kazim Karabekir Mah. Terminal Cad. Site Polat Apt. B Blok, Kat 1, No 2, Erzurum, Turkey, +90 442 2361212-1521 (work), +90(442) 2361301, E-mail : drhogul@gmail.com The authors received no financial support for the research and/or authorship of this article. The authors declare that they have no conflict of interest to the publication of this article. Demonstration with 3D Volumetric MR sequences of Deep Peroneal Nerve Compression on Os Intermetatarseum Syndrome: A case Report Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

Assessment of Muscle activation of Caregivers Performing Dependent Transfers with a Novel Robotic Assisted Transfer Device Compared to the Hoyer Advance Objective The purpose of this study was to compare muscle activity in caregivers while using a novel robotic assistive transfer device (Strong Arm) to a clinical standard of care (Hoyer Advance). Design A Quasi-Experimental design was used in which twenty caregivers (33±15 years old) performed transfers with three surfaces (toilet, bench and shower chair) with the Strong Arm and Hoyer Advance. Transfer completion time (sec), peak percentage surface electromyography (EMG) and integrated EMG of the bilateral erector spinae, latissimus dorsi, pectoralis major and anterior deltoid were measured. Results Caregivers required less transfer time when transferring from wheelchair to surface using the Hoyer Advance (p=.011, f=.39). Lower back: significantly lower pEMG were found using Strong Arm in 50% and for the iEMG in 25% of the cases, with the remaining cases showing no significant differences. Shoulder: significantly lower pEMG were found using Strong Arm in 19% of transfers and lower iEMG was found in 25% of transfers when using the Hoyer Advance, with the remaining cases showing no significant differences. Conclusion While back muscle activation during Strong Arm transfers is statistically, but not clinically, lower, additional features that couple with significantly lower muscle activation make it an alternative to the clinical standard for further research and possible clinical applicability. Corresponding Author: Rory A. Cooper, PhD, Human Engineering Research Laboratories, 6425 Penn Avenue, Pittsburgh, PA 15206, +1 412-822-3700, rcooper@pitt.edu Author Disclosures: Dr Cooper and Dr Grindle are co-inventors and patent holders of Strong Arm and could therefore potentially benefit from the publication. This work is funded by: VA Merit Review (Grant#: F1454R); VA Centre for Excellence for Wheelchairs and Associates Rehabilitation (Grant #: B9250-C and B9269-L); VA Senior Research Career Scientist (B9269-L); Integrative Graduation Education and Research Traineeship (Grant #: DGE1144584); Paralyzed Veterans of America Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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Medicine by Alexandros G. Sfakianakis,Anapafseos 5 Agios Nikolaos 72100 Crete Greece,00302841026182,00306932607174,alsfakia@gmail.com,

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