Factors associated with gains in performance during rehabilitation following pediatric brain injury: growth curve analysis Objective Predicting recovery of functional performance within pediatric rehabilitation following brain injury is important for health professionals and families, but information regarding factors associated with change in functional skills ("what the child can do") and functional independence ("what the child does") is limited. This study examined change in functional skills and independence over time in children with moderate-severe brain injury during prolonged inpatient rehabilitation. Design Retrospective cohort design. Longitudinal data from N=139 children (age 1.6-20.6y), hospitalized for 115.4±72 days, were examined. Growth curve analysis was used to examine factors associated with change in the Pediatric Evaluation of Disability Inventory (functional skills and caregiver assistance, i.e. functional independence) in mobility and self-care. Typical estimates for change per hospitalization day were obtained. Results Traumatic brain injury and older age at injury, but not sex, were associated with faster recovery. Length of stay was associated with rate of change in functional skills but not in functional independence, suggesting that improvement in functional independence during rehabilitation may be associated with other factors. Conclusion Identifying the factors associated with individual profiles of functional improvement can provide valuable information for clinicians and decision-makers in order to optimize performance following prolonged inpatient rehabilitation. Corresponding author: Dr. Tal Krasovsky, Department of Physical Therapy, Faculty of Social Welfare and Health sciences, University of Haifa, tkrasovsk@univ.haifa.ac.il ** The authors declare that they have no competing interests. No external funding was provided for this project. Authors received no financial benefits. This research was not previously presented in any form. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Isolated oculomotor nerve palsy in mild traumatic brain injury: A literature review Background Isolated oculomotor nerve palsy is rarely encountered after mild traumatic brain injury. It is difficult to offer patients accurate management strategies or prognostic assessments because only a few reports have described the management of oculomotor nerve palsy. Methods We performed a search for all clinical studies of isolated oculomotor nerve palsy after mild traumatic brain injury published up to July 9, 2019. We placed no restrictions on language or year of publication in our search, and we searched the following keywords: traumatic brain injury, isolated oculomotor nerve palsy, mild head trauma, management, and prognosis. Results We identified 14 cases of isolated oculomotor nerve palsy after mild traumatic brain injury. In three cases, steroids were used to manage the oculomotor nerve palsy. Five patients who had underlying brain lesions underwent surgery, and seven patients were observed and followed up. The time to partial or complete resolution was 6.0months ± 5.3 months with a range of 0.5 to 18 months. Conclusion This review includes a survey of surgical treatment for the management of traumatic brain injury that underlies oculomotor nerve palsies, steroid therapy to reduce related brain edema, and oculomotor rehabilitation with training eye movement behavior. Corresponding author: Kiyeun Nam, M.D., Dongguk University College of Medicine, Donguk University Ilsan Hospital, 27, Dongguk-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea, postcode :10326. Tel: 82-31-961-8460 FAX: 82-54-770-8500. E-mail: rusl98@hanmail.net Acknowledgments: None Conflict of Interest: All authors declare that they have no conflicts of interest Funding sources: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP; Ministry of Science, ICT & Future Planning) (No. NRF-2017R1C1B5018006) Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Sudden paraplegia in a patient with chronic myelopathy: Two faces of spinal cavernous hemangioma No abstract available

Ultrasound Imaging and Guided Injection for an Overlooked Medial Patellar Retinaculum Tear No abstract available

The Vital Role of Professionalism in Physical Medicine and Rehabilitation Professionalism in medicine is universally embraced, and it is the foundation for core competencies in medical education, clinical practice, and research. Physical Medicine and Rehabilitation physicians must master a complex body of knowledge and use this to responsibly care for patients. Rehabilitation professionals work in various settings; however, each one must establish and maintain ethical standards consistent with the specialty and national standards. For example, the Accreditation Council for Graduate Medical Education lists professionalism as 1 of its 6 core competencies which trainees must master. There is a growing interest in professionalism and some of the ethical issues that it encompasses. This report provides a general overview of professionalism. Future reports are needed, and there is an opportunity to consider many facets of professionalism in greater detail. This report was undertaken as a collaboration from the Association of Academic Physiatrists Women’s Task Force and the Education Committee. Authors who contributed equally to this work: Julie K. Silver and Sara Cuccurullo Corresponding Author: Julie K. Silver, MD, 300 1st Avenue, Charlestown, MA 02025, Email: julie_silver@hms.harvard.edu, Phone: 508-718-4035, Fax: 508-718-4035 Author disclosures: Julie K. Silver, MD – none, Lyn Weiss, MD - none, Christopher Visco, MD - none, Mooyeon Oh-Park, MD – none, Danielle Perret Karimi, MD – none, Walter R. Frontera, MD, PhD – none, Talya K. Fleming, MD – none, Glendaliz Bosques, MD – none, Saurabha Bhatnagar, MD – none, Anne Felicia Ambrose, MD – none, Vu Q. Nguyen, MD – none, Sara Cuccurullo, MD - none Funding Information: No funding was received for this work. Financial Benefits to Authors: The authors will not benefit financially from publication of this material. Previous Presentation: This work has not been presented elsewhere in any form. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Does a hand strength focused exercise program improve grip strength in older patients with wrist fractures managed non-operatively? A Randomized Controlled Trial Objective Distal radius fractures in the older population significantly impairs grip strength. This study aimed to investigate whether a hand strength focused exercise program during the period of immobilization for non-operatively managed distal radius fractures in this population improved grip strength and quality of life. Design Single centre randomized controlled trial with concealed allocation, assessor blinding and intention-to-treat analysis. Fifty-two patients, age>60 who suffered distal radius fractures managed non-operatively with cast immobilization. The intervention group(n=26) received a home hand strength focused exercise program from 2and6 weeks after injury whilst immobilized in a full short arm cast. The control group(n=26) performed finger range of motion exercises as per protocol. Primary outcome was grip strength ratio(GSR) of injured arm compared to uninjured arm. Secondary outcome included functional score of QuickDASH. Outcomes were measured at 2, 6 and 12 weeks after injury. Results The intervention group significantly improved GSR at both 6 and 12 weeks (6 weeks:40% vs 25% (p=0.0044) and 12 weeks:81% vs 51% (p=0.0035)). The intervention group improved the QuickDASH score at 12 weeks however this was not statistically significant (25vs40 p=0.066). Conclusion A hand strength focused exercise program for elderly patients with distal radius fractures whilst immobilized significantly improved grip strength. The research study was performed at Concord Hospital, NSW Australia. Corresponding Author Details: Antony Nguyen,antony_nguyen@hotmail.com, Mobile: +61430048642, Address: PO BOX 2231, Carlingford Court, NSW 2118 Author Disclosures: Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article. The study was self-funded. No funding or research grants were obtained Each author certifies that he or she has not received any financial benefits. The material in this study has not and will not be submitted for publication elsewhere. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Pediatric rehabilitation therapies differ in intensity: Pilot study to highlight the implications for dose-response relationships Objective When investigating dose-response relationships in rehabilitation studies, dose is often equated with duration of therapy. However, according to the American College of Sports Medicine, dose consists of the factors frequency, intensity, time and type. Thereby, especially quantification of intensity needs improvement to have a more precise estimate of the dose. Thus, the aim was to investigate the intensity during mobility-focused, real-life pediatric rehabilitation therapies. Design Eleven participants (5 girls; 12.5±2.1y old) with neurological disorders and independent mobility wore accelerometers at wrists and ankles and a portable heart rate monitor during several of the following therapies: sports therapy, mobility-focused physiotherapy, medical training therapy, and robot-assisted gait training. Intensity of physical activity was quantified by activity counts (measured via accelerometers) and heart rate. Results Therapy duration did not correlate with intensity. At the same time we found significant differences between intensities of different therapies. Conclusion Different therapies elicit different levels of intensity in children with neuromotor disorders. Heart rate and activity counts are suited to estimate the intensity of a therapy and provide complementary information. We recommend against using the duration of a therapy as a proxy for the dose to make statements about dose-response relationships. Corresponding author: Dr. Rob Labruyère, Rehabilitation Center for Children and Adolescents, Children’s University Hospital Zurich, Muehlebergstrasse 104, CH-8910 Affoltern am Albis, Switzerland. Phone: +41447625297. Email: rob.labruyere@kispi.uzh.ch Competing interests statement: The authors declare no conflict of interest. This research was financially supported by the Fondation Gaydoul, the CRPP Neurorehabilitation of the Medical Faculty of the University of Zurich, Switzerland and PluSport Behindertensport Schweiz, Volketswil, Switzerland. No author benefits financially from the publication of this manuscript. This research has been presented in poster form at the 2. Congress on NeuroRehabilitation and Neural Repair on May 22-24 2017 in Maastricht, the Netherlands. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The effect of therapeutic exercises on balance, quality of life and pain in patients who were receiving neurotoxic chemotherapy Objective To evaluate the effect of lower extremity strengthening and balance exercises on balance, quality of life (QoL) and neuropathic pain (NP) of the cancer patients receiving neurotoxic chemotherapy (N-CTX). Design Patients who were planning to receive N-CTX agents were included in the first group. They were trained before the N-CTX sessions with the 10-week home-based exercise program including lower extremity strengthening and balance exercises. The second group of patients who had received the 3rd cycle of N-CTX had no exercise program. Both groups were evaluated after the 3rd cycle. Neurocom Balance Master and Berg Balance Scale (BBS) were used to evaluate balance. The NP was questioned by PainDETECT questionnaire (PD-Q) and the QoL was assessed with EORTC QLQ-C30. Results Sixty patients were admitted to this study. Twenty-four patients were in the exercise group (F=14, M=10) and 36 patients were in the control group (F=17, M=19). Socio-demographic and clinical data of both groups were similar. BBS (p=0.005), EORTC QLQ-C30 global QoL, physical function and emotional status were higher, symptom scores and PD-Q score were lower in the exercise group (p<0.05). Balance tests were different between the groups. Conclusion Strengthening and balance exercises have a valuable effect on balance, QoL and NP in patients receiving N-CTX. Corresponding author: Yeliz Bahar Ozdemir, MD, Physiatrist, Hitit University Erol Olcok Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Hitit University Erol Olcok Training and Research Hospital, Department of Physical Medicine and Rehabilitation, Corum / Turkey, Çepni Mah. İnönü Caddesi No:176 Merkez ÇORUM, Telephone: +90. (364) 219 30 00, Fax: +90. (364) 219 30 30, E-mail:yelizbahar1@gmail.com, ORCID ID:https://orcid.org/0000-0003-2253-3767 Gulseren Akyuz, MD, Professor, Marmara University Medical School, Department of Physical Medicine and Rehabilitation and Division of Pain Medicine, Marmara University Medical School, Department of Physical Medicine and Rehabilitation, Istanbul, TURKEY, Fevzi Çakmak Mahallesi, Tepe Sokak, No: 41, Üst Kaynarca, Pendik, İstanbul, TURKEY, Phone: +90 216 657 06 06 Extension: 1629, Fax: +90 216 625 47 50, E-mail:gulserena@gmail.com, ORCID ID:https://orcid.org/0000-0002-3724-571X Melihat Kalkandelen, Physiotherapist, Marmara University Medical School, Department of Physical Medicine and Rehabilitation, Marmara University Medical School, Department of Physical Medicine and Rehabilitation, Istanbul, TURKEY, Fevzi Çakmak Mahallesi, Tepe Sokak, No: 41, Üst Kaynarca, Pendik, İstanbul, TURKEY, Phone: +90 216 657 06 06 Extension: 1629, Fax: +90 216 625 47 50, E-mail:milsa.ftr@hotmail.com, ORCID ID:https://orcid.org/0000-0002-0125-768X Fulden Yumuk, MD, Professor, Marmara University Medical School, Department of Thoracic Surgery, Marmara University Medical School, Department of Clinical Oncology, Istanbul, TURKEY, Fevzi Çakmak Mahallesi, Tepe Sokak, No: 41, Üst Kaynarca, Pendik, İstanbul, TURKEY, Phone: +90 216 625 45 45, Fax: +90 216 625 46 39, E-mail:fuldenyumuk@yahoo.com, ORCID ID:https://orcid.org/0000-0001-8650-299X Contributions Study conception and design: GA, YBO, FY Acquisition of data: YBO, MK Analysis and interpretation of data: YBO, MK Drafting of manuscript: GA, YBO Critical revision: GA, YBO Author Disclosures Conflict of interest: The authors have no relevant financial relationships to disclose Funding source: No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript. Acknowledgements: The authors would like to express their gratitude to the patients who participated in this study. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Paralysis following Lumbar Interlaminar Epidural Steroid Injection in the Absence of Hematoma: A Case of Congestive Myelopathy due to Spinal Dural Arteriovenous Fistula and a Review of the Literature Paraplegia after interlaminar epidural steroid injection (ESI) is a rare event and has typically been described after epidural hematoma or direct spinal cord injury. We present a case of an 87 year-old man who experienced transient lower extremity weakness after a lumbar interlaminar ESI due to an alternative cause, congestive myelopathy related to an underlying vascular malformation, namely a spinal dural arteriovenous fistula (SDAVF). This is a poorly recognized and potentially treatable cause of progressive myelopathy. We present this case and review the literature on paraplegia after ESI due to SDAVF. Notably, this case of paralysis occurred in association with the lowest volume of epidural injectate reported in the literature to date (4 mL); importantly, this volume is consistent with current clinical practice guideline standards for the safe performance of interlaminar epidural steroid injections. Physicians should be aware of this potential complication of ESI, and remain vigilant for the possibility following a procedure, even when performed according to current practice standards. Corresponding author: Ziva Petrin, MD, 590 Wakara Way, Salt Lake City, UT 84108, Phone: 801-587-5458, Fax: 801-587-7112, Email: ziva.petrin.work@gmail.com Author Disclosures: The authors disclose no competing interests. No funding or grants or equipment were provided for the project from any source. There are no financial benefits to the authors from this publication. This study conforms to CARE guidelines and reports the required information accordingly (see Supplemental Checklist, Supplemental Digital Content 1, http://links.lww.com/PHM/A896). This case has previously been presented as a poster abstract at Association of Academic Physiatrists Annual Meeting in 2017, with the abstract published as: Petrin Z, Oleson C, Marino M. Leg Paralysis after Epidural Steroid Injection in a Patient with AV Dural Fistula. AJPM&R, Volume 96, Number 3(Suppl), March 2017; Page a63. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.ajpmr.com). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Arm-Subscore of Motricity Index to Predict Recovery of Upper Extremity Dexterity in Patients with Acute Ischemic Stroke Objective The aim of this study was to determine if the arm-subscore of the Motricity Index (AMI) 1 week following stroke can predict recovery of upper extremity function according to the Action Research Arm Test (ARAT) prior to inpatient rehabilitation facility (IRF) discharge and at 3-months outpatient follow-up. Design This was a prospective cohort study of patients with acute ischemic stroke admitted to a single acute care hospital and affiliated IRF between 2016 and 2018. Upper extremity dexterity of the impaired limb was assessed using the AMI and ARAT. Receiver operating characteristic (ROC) curve analysis was used to determine optimal cut-offs of the initial AMI for a good functional outcome defined as ARAT≥45. Results Ninety-five patients were evaluated at median 6, 26, and 98.5 days following stroke. Median [interquartile range (IQR)] AMI at 1-week was 77 [20.3-93]. Median [IQR] ARAT scores prior to IRF discharge and at 3-months outpatient follow-up were 33 [3.5-52] and 52 [34-55.8], respectively. The optimal AMI to predict ARAT≥45 prior to IRF discharge and at 3-months outpatient follow-up were 71 and 58, respectively. Conclusion Early AMI at 1-week predicts upper extremity functional capacity prior to IRF discharge and at 3-months outpatient follow-up. CORRESPONDENCE: Laura Malmut, MedStar National Rehabilitation Network, 102 Irving St, NW, Washington, DC 20010, Phone: 202-877-1000, Fax: 202-291-8147, Email: laura.j.malmut@medstar.net AUTHOR DISCLOSURES: There are no competing interests. No funding, grants, or equipment were provided by any source. No financial benefits were received by the authors. The submitted material has not previously been presented. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.