Disparities in Health Care for Hispanic Patients in Physical Medicine and Rehabilitation in the United States: A Narrative Review In the United States, the number of people with Hispanic backgrounds is rapidly increasing. This growth, along with other factors, may put them at increased risk for healthcare disparities. Thus, Physical Medicine and Rehabilitation (PM&R) should evaluate disparities in health services through the lens of the evidence base. To our knowledge, this is the first review describing the literature on healthcare disparities for Hispanic patients in the field of PM&R. This review explores healthcare utilization, risk factors, access, and health conditions specific to Hispanic populations. Articles used in this narrative review were collected over a 10-year span (2009-2018) from online databases. Our findings highlight disparities across common conditions and injuries in the PM&R literature, including post stroke rehabilitation, hip fracture treatment and rehabilitation, spinal cord injury, and traumatic brain injury. Our review suggests that Hispanic patients may be at risk for worse outcomes following these conditions, due to low access to rehabilitation services and disparities in the referral process. Similar results are reported for pain management and Parkinson’s disease. As we strive to provide optimal care to an increasingly diverse patient population, researchers and clinicians must consider effects of race and ethnicity on access to and utilization of rehabilitation services. Corresponding Author: Laura E. Flores, Address: University of Nebraska Medical Center, 984000 NE Medical Center, Omaha NE 68198-4000, Email: laura.flores@unmc.edu, Phone: 402-599-6923 Funding Source: This project received no funding, grants or equipment from any source. Disclosures: Julie K. Silver, MD reports no disclosures related to this work. Unrelated to this work, Dr. Silver discloses that she has personally funded the Be Ethical Campaign and proceeds from the campaign support disparities research. 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. Dr. Silver has grant funding from 1) Arnold P. Gold Foundation (physician and patient care disparities research) and 2) Binational Scientific Foundation (culinary telemedicine research). Monica Verduzco-Gutierrez, MD, Laura E. Flores and Diana Molinares, MD report no disclosures related to this work. Previous Presentation: This manuscript and the material contain herein have not been previously presented or published. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

A curious case of acute onset bilateral hand weakness in a youth hockey player: A case report No abstract available

Role of Instruction Adherence During Highly Structured Robotic Arm Training on Motor Outcomes for Individuals after Chronic Stroke The aim of this study was to examine the effects of instruction adherence on upper extremity motor outcomes after highly structured intervention. A secondary data analysis was completed using mixed linear modelling design. Thirty chronic stroke survivors with moderate-to-severe arm impairment were assigned explicit movement instructions and completed 12 robotic therapy sessions over four weeks. Instruction adherence was measured weekly using the Manipulation Check Questionnaire (MCQ). Motor outcomes were measured at baseline, discharge, and at 4-week follow-up using the Fugl-Meyer Assessment-Upper Extremity (FMA-UE) and Wolf Motor Function Test–Functional Ability Scale (WMFT-FAS). There were no effects of adherence-related variables on upper extremity motor outcomes (p values > .2). Participant scores improved for both FMA-UE and WMFT-FAS from baseline to follow-up (p values < .001). Participants improved motor function after 12 weeks of robotic training, however, instruction adherence did not affect motor improvement. Adherence to explicit information may play a limited role in motor learning for stroke survivors with moderate-to-severe arm impairment during highly structured training protocols. Corresponding author: Grace Kim OTR/L, PhD, 82 Washington Square East, Pless Hall, 6th Floor, New York, NY 10003. Phone: +1-212-998-5846. Email: gjk207@nyu.edu Funding: No funding was received for this study. Author Disclosures: Authors have no conflicting interests to declare. Clinical Trial Registration No (primary study): NCT02890446 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Multiple Accessory Lower Limb Muscles Identified Using Ultrasonography in An Asymptomatic Individual No abstract available

Effects of Upper Limb Loss or Absence and Prosthesis Use on Postural Control of Standing Balance Objective Persons with upper limb loss or absence (ULL/A) experience a high prevalence of falls. While upper limb prostheses help perform upper extremity tasks, fall likelihood increases by six times with prosthesis use. The effects of ULL/A and prosthesis use on postural control are poorly documented. Design Static posturography characterized postural control of standing balance between persons with unilateral ULL/A not wearing a prosthesis and wearing either a customary prosthesis or prosthesis that matched the mass, inertia, and length of their sound limb. Able-bodied controls were also compared to persons with unilateral ULL/A not wearing a prosthesis. Center-of-pressure anterior-posterior range, medial-lateral range, and sway area was measured, as well as weight-bearing symmetry. Results Persons with ULL/A display greater standing postural sway than controls. While wearing a prosthesis improved weight-bearing symmetry, this condition increased postural sway, which was pronounced in the medial-lateral direction. Conclusion The presence of ULL/A increased postural control demands as reflected in greater postural sway than able-bodied individuals, which was further exacerbated with the use of prosthesis. Results suggest that ULL/A and prosthesis use may affect the internal models that guide motor commands to maintain body center-of-mass position equilibrium. The relatively greater postural control demands might help explain the increase fall prevalence in this patient group. Corresponding author contact information: Matthew Major, Northwestern University Prosthetics-Orthotics Center, 680 N Lake Shore Dr., St 1100, Chicago IL 60611. Phone: 312-503-5731; Email: matthew-major@northwestern.edu Disclosures: The authors declare no conflict of interest, financial or otherwise, with this work. This work was presented at: the 2019 Gait and Clinical Movement Analysis Society Annual Conference, Frisco, TX, March 26-29, 2019; 2019 ISPO Trent International Prosthetics Symposium (TIPS), Salford, United Kingdom, March 20-23, 2019; 45th American Academy of Orthotists & Prosthetists Annual Meeting & Scientific Symposium, Orlando, Florida, March 6-9, 2019; and the 42nd Annual Meeting of the American Society of Biomechanics, Rochester, Minnesota, August 8-11, 2018. Funding: This work was supported by the United States Department of Veterans Affairs Rehabilitation Research and Development Service (Grant awards #1IK2RX001322 and #1I21RX001388), and the Northwestern University Undergraduate Research Assistance Program (Office of Undergraduate Research). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Complete Restoration of Respiratory Muscle Function in Subjects with Spinal Cord Injury (SCI) Interventional Clinical Trial No abstract available

Tibial Tunnel Cyst After Anterior Cruciate Ligament Reconstruction No abstract available

Complete restoration of respiratory muscle function in three subjects with spinal cord injury? No abstract available

Variability of Steady State Oral Baclofen Dosing in Pediatric Patients with Cerebral Palsy The primary objective of this study was to identify oral baclofen dosing variability at steady state based on weight and Gross Motor Functional Classification System (GMFCS) level using a retrospective cross-sectional study design. The medical records of 500 pediatric aged patients (age 1-21) were reviewed to obtain 144 pediatric patients who met inclusion criteria. One way ANOVA tests revealed increasing mean doses in baclofen (in mg/kg) with higher GMFCS levels (p=0.001). Post-hoc Tukey analysis showed patients with higher ambulatory ability (GMFCS I-II) received a lower total daily dosage than did patients with less ambulatory ability (GMFCS III-V). A moderate correlation was observed with increasing oral baclofen dose as weight increased (r=0.43, p<0.0001). Due to the variability in dosing between GMFCS levels, prescribing oral baclofen for pediatric patients with CP may not follow the traditional model of weight-based dosing seen in other pediatric conditions. Corresponding author: Matthew J. McLaughlin, MD, MS, Assistant Professor, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108. 816-234-1570. 816-983-9845 (fax). mjmclaughlin@cmh.edu Author Disclosures: Funding for this project was supported by NICHD 5T32HD069039 and NICHD 1K12HD093427. Previous local poster presentation of some of the material at a medical school research summit. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Changes in Muscle Activation and Ground Reaction Force of the Lower Extremities according to Foot Placement during Sit-to-stand Training in Stroke Patients Objective The purpose of the study was to investigate the kinetic effects of sit-to-stand training in various foot positions on the coronal plane in patients with strokes and to suggest appropriate exercises. Design Thirty-six post-stroke subjects participated in this study. The subjects performed three sit-to-stand trials in the following foot positions: (1) symmetric foot positioning (Symmetric), (2) affected foot placed to the side (Asymmetric 1), (3) and less affected foot placed to the side (Asymmetric 2). They were asked to perform sit-to-stand training at a spontaneous velocity and remain standing for 5 seconds while the vertical ground reaction force was measured using force platforms. The activation of lower extremity muscles was evaluated using surface electromyography, and the peak and mean vertical ground reaction force and weight bearing symmetry ratio were evaluated using force platforms. Results Our results showed significant increases in the muscle activation, peak and mean vertical ground reaction force, and weight bearing symmetry ratio of the lower extremities using the Asymmetric 2 strategy (P < 0.05). Conclusions Our results suggest that sit-to-stand training with the less affected foot placed to the side by the width of the subject’s foot may be the most beneficial in the rehabilitation of patients with hemi-paretic stroke. Corresponding author: Hyeong-Dong Kim, RPT, PhD, Department of Physical Therapy and School of Health and Environmental Science, College of Health Science, Korea University, Hana Science Building B, Korea University, Anam-ro, Seongbuk-Gu, Seoul, 136-701, Republic of Korea. E-mail: hdkimx1234@daum.net Acknowledgements: Authors are grateful to all subjects involved in this study, as well as authors/publishers/editors of all articles, journals, and books reviewed and discussed for this study. This study was supported by a Korea University Grant (K1605431). IRB or Ethics Committee registration: All procedures used in this study were approved by the Human Research Sciences of local ethics committee and registered with University Clinical Trials Registry (IRB No.: KU-IRB-15-73-A-1). Conflict of interest statement: All authors were fully committed to absolute integrity and remained unbiased throughout the study. None of the authors had any conflicts of interest or carried any commitments that would influence their duties. The roles of the authors in this study are as follows: Hyeon-Je Noh* and Chang-Yong Kim* - primary author, manuscript writing, experimental procedures, interpretation of the results, management of the study, and critical discussion; Hyeong-Dong Kim - experimental procedures, critical discussion, and corresponding author; Suhng-Wook Kim - discussion. These authors contributed equally to this work (Hyeon-Je Noh and Chang-Yong Kim). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.