Effectiveness of hydrotherapy on balance and paretic knee strength in patients with stroke: A systematic review and meta-analysis of randomized controlled trials Objective To compare the effects of hydrotherapy and land-based conventional therapy (CT) on postural balance and knee strength in stroke patients. Designs A comprehensive search was done via databases (PubMed, EMBASE, and Web of Science) until April, 12th, 2019 to select randomized controlled trials. The methodological quality was assessed by the PEDro scale. Berg Balance Scale (BBS) was pooled as the primary outcome, and Forward Reach Test (FRT), Timed Up and Go test (TUG), and paretic knee flexor (KF), knee extensor (KE) torque as secondary outcomes. Results Eleven articles were included. Pooled results showed that hydrotherapy was more beneficial in stroke patients on BBS (mean difference (MD)=1.60, 95% confidence interval (CI): 1.00-2.19), FRT (MD=1.78, 95% CI: 0.73-2.83), TUG (MD=-1.41, 95% CI: -2.44--0.42), and KE torque (MD=6.14, 95% CI: 0.59-11.70) than CT. In subgroup analysis according to stroke-onset duration, hydrotherapy for chronic stroke patients exhibited significant effectiveness on BBS (MD=1.61, 95% CI: 1.00-.21); no significant effect was observed in subacute stroke patients (MD=1.04, 95% CI: -2.62-4.70). Conclusion Stroke patients showed improvement in postural balance and paretic knee extensor strength with hydrotherapy. Hydrotherapy exhibited significant effects on improving postural balance in chronic patients than in subacute patients. Corresponding author: Professor. Geun-Young Park, MD, PhD, Department of Rehabilitation Medicine, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 327 Sosa-ro, Wonmi-gu, Bucheon-si, Gyeonggi-do 14647, Korea, Tel: +82-32-340-2170; Fax: +82-32-340-2173 E-mail: rootpmr@catholic.ac.kr Disclosures section Competing interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Any associations such as consultancies, equity interests, or patent-licensing arrangements are not reported Funding: This research received no specific grant from any funding agency in public, commercial or not-for-profit sectors. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Occult Morel-Lavallee Lesion within the Superior Gluteal Region in a Collegiate Lacrosse Player No abstract available

Retraction: Sato et al.: Am J Phys Med Rehabil: 1999;78:317-22, and Sato et al.: Am J Phys Med Rehabil: 2001;80:19-24. No abstract available

The Relationship between MS Symptom Severity Measures and Performance on Driving Variability Metrics in a Virtual Reality Simulator Objective Driving ability can be compromised in individuals with multiple sclerosis (MS); however, the progressive nature of MS makes it difficult for clinicians to assess when performance on functional tasks, such as driving, has started to decline. The objective of this study was to evaluate the relationship between two measures of MS severity, the Expanded Disability Status Scale (EDSS) and the Multiple Sclerosis Functional Composite (MSFC), and minor driving errors in a virtual reality driving simulator (VRDS). Design Symptom severity was measured in thirty-one active drivers with MS using the EDSS and MSFC. Driving performance was measured using a standardized VRDS route. Executive functioning, a cognitive function commonly related to driving, was evaluated using the Trail Making Test-B. Results Greater impairment on the MSFC was related to increased difficulty maintaining lane positioning (r=-.49, p=.01) and poorer executive functioning (r=-.52, p<.01). In contrast, the EDSS was not related to either measure. Conclusion These findings suggest that poorer performance on the MSFC, and not the EDSS, may indicate vulnerability to minor driving errors as an early sign of driving compromise. The use of screening tools like the MSFC could help clinicians identify increased driving risk and consider comprehensive driving evaluations earlier, before a major driving violation or accident occurs. Corresponding Author: Dr. Maria Schultheis, Drexel University, 3201 Chestnut Street, Suite 123, Philadelphia, PA 19104. Phone: 215-895-6105. Fax: 215-895-4930. schultheis@drexel.edu Author Disclosures: The authors declare that there is no conflict of interest. This work was supported by the National Multiple Sclerosis Society [Grant #RG 3353B2] and in part by a grant from the National Institute of Child and Human Development [Grant #1R01HD050718-01A2]. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ultrasound Imaging and Rehabilitation of Muscle Disorders Part 2. Non-Traumatic Conditions Owing to its several advantages, ultrasound (US) imaging has started to take place in the diagnostic and therapeutic algorithms of a wide range of musculoskeletal disorders. After the 1st part on traumatic conditions; in this review, the authors aim to discuss the applicability of US imaging for non-traumatic muscle disorders in the daily clinical/academic practice. While trying to summarize the whole spectrum (e.g. myofascial pain syndrome, inflammatory diseases, neuromuscular disorders), special emphasis will be given to sarcopenia which is, by far, the most challenging clinical condition in the era of ‘aging world’. Of note, rehabilitation as regards the exemplified problems will also be briefed throughout. Corresponding author: Levent Özçakar, MD, Hacettepe University Medical School, Department of Physical and Rehabilitation Medicine Ankara, Turkey. Email:lozcakar@yahoo.com Author Disclosures: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Funding information: No funding was received. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Swallowing outcomes and discharge destinations in acute-stroke tube-feeding-dependent dysphagia patients treated with neuromuscular-electrical-stimulation during inpatient rehabilitation Objective Inpatient-rehabilitation (IR) study comparing swallowing outcomes and discharge destinations in acute-stroke tube-feeding-dependent dysphagia patients treated with neuromuscular-electrical-stimulation (NMES) and traditional-dysphagia-therapy (TDT) versus those treated with only TDT. Design Retrospective case-control study including 359 patients with acute-stroke having initial Functional-Oral-Intake-Scale (FOIS) scores of 3 or lower (profound to severe tube-feeding-dependent dysphagia). One-hundred-ninety participants received NMES with TDT, and 169 controls received only TDT. Treatment occurred in hourly sessions 5-days/week. Main outcome measures were comparison of FOIS scores after treatment (N=359) and comparison of discharge destinations (N=267). Results NMES post-treatment mean FOIS score was 4.21+/-2.1 versus 2.94+/-1.96 for controls (t=5.85;p<.001). NMES group post-treatment mean FOIS gain was 3.24+/-2.26 points versus 1.87+/-2.01 for controls (t=6.05;p<.001). Post-treatment, 51.6% (98/190) NMES patients had minimal or no swallowing restrictions (FOIS scores 5-7), whereas only 26.6% (45/169) controls improved to FOIS scores of 5-7, (χ2 =23.3;p<.0001). Groups differed by discharge destinations: NMES having more discharges to community than controls, 60% versus 44% (χ2=9.16;p=.003), and NMES having fewer acute-care transfers compared to controls, 8% versus 25%, (χ2=32.7;p<.0001). Conclusions NMES with TDT was associated with better discharge swallowing outcomes and FOIS scores than TDT alone during IR in treating acute-stroke feeding-tube-dependent dysphagia; and was associated with more discharges to community and less transfers back to acute-care. Disclosures: Preliminary data from this study were accepted for presentation in May 2019 at the American Academy of Neurology annual conference in Philadelphia, PA in a poster. The authors of this study have no other disclosures or conflicts of interest. Grant and Financial Support: None Corresponding Author: David S. Kushner M.D., FAAN, Clinical Professor, Department of Physical Medicine & Rehabilitation, University of Miami Miller School of Medicine 1120 NW 14th Street, CRB 955| Miami, FL 33101; Cell# 305-632-1361; dkushner@med.miami.edu Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

“Dysphagia in myositis: A study of the structural and physiologic changes resulting in disordered swallowing.” Objectives Dysphagia in patients with myositis is associated with an increased risk of aspiration pneumonia. However, the pathophysiology of dysphagia is poorly understood. The goal of this study was to understand how myositis affects swallowing physiology on videofluoroscopic swallow study (VFSS). Design Retrospective review of video fluoroscopic swallowing studies on 23 myositis patients with dysphagia from 2011 to 2016. Swallow studies were analyzed by timing of swallowing events and duration of swallowing events, diameter of upper esophageal sphincter opening (UESO), Modified Barium Swallow Impairment Profile, and Penetration-Aspiration Scale. The outcome measures for patients were compared to archived VFSS from healthy, age-matched participants by Wilcoxon rank-sum tests. Results Patients with myositis had a shorter duration of UESO (p<0.0001) and laryngeal vestibule closure (p<0.0001) than healthy subjects. The diameter of upper esophageal sphincter opening did not differ between groups. Patients with myositis presented with higher scores on the MBSIMP than healthy subjects, indicating great impairment particularly during the pharyngeal phase of swallowing, and a higher frequency of penetration and aspiration. Conclusion Dysphagia in patients with myositis may be attributed to reduced endurance of swallowing musculature rather than mechanical obstruction of the retropharyngeal space. Correspondence: Tae Hwan Chung, MD, 5505 Hopkins Bayview Circle, Physical Medicine and Rehabilitation – room B410, Baltimore, MD 21224. Tel: 410-550-1715. tchung7@jhmi.edu Author Disclosures: No conflicts of interest to report. THC was financially supported by NIH K08 AG058483 This work was presented as an oral presentation at the 2018 Muscle Study Group Annual Scientific Meeting, Oxford, UK and as a poster at the 2019 Global Conference on Myositis in Berlin, Germany Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Immediate Improvement of Deep Fibular Nerve Palsy Following US-Guided Tibiofibular Joint Ganglion Cyst Aspiration No abstract available

Association of participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification program and physician disciplinary actions Objective The study analyzed the relationship between participation in the American Board of Physical Medicine and Rehabilitation (ABPMR) maintenance of certification (MOC) program and the incidence of disciplinary actions (DAs) by state medical boards over a physician's career. The hypothesis is that physicians who do not maintain their board certification have a higher likelihood of state medical board DAs. Design This retrospective cohort study analyzed ABPMR MOC data from all board-certified physiatrists who were enrolled in the ABPMR MOC program from 1993-2007. Results Matching examination and license data were available for 4,794 physicians, who received a total of 212 disciplinary action reports through the Federation of State Medical Boards (FSMB). The results showed that physicians who have a lapse in completing the ABPMR MOC program have a 2.5-fold higher incidence of receiving a DA report through the FSMB (95% confidence interval 1.76 - 3.63) and had higher severity violations (X(2) = 7.14, p < 0.05) than physicians whose certificate never lapsed. Conclusions For physicians in physical medicine and rehabilitation (PM&R), loss of board certification through failure to fulfill the MOC program requirements is associated with an increased risk of disciplinary action from a state medical licensing board. Dr. Kinney and Dr. Raddatz are employees of the American Board of Physical Medicine and Rehabilitation. Drs. Sliwa, Driscoll and Robinson are directors 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, Phone : 507-282-1776, Ext. 1743, Fax : 507-282-9242, Email : ckinney@abpmr.org No funding was received for this study. Association of participation in the American Board of Physical Medicine and Rehabilitation Maintenance of Certification program and physician disciplinary actions Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Recommendations for Enhancing Sports Medicine Fellowship Training Physical medicine and rehabilitation (PM&R) trained physicians are increasingly interested in caring for patients with musculoskeletal and sports disorders. Sports medicine fellowships are designed to provide competency in sports medicine and musculoskeletal care. The authors, with endorsement from the Association of Academic Physiatrists (AAP), provide a framework and tools that Accreditation Council for Graduate Medical Education (ACGME) accredited sports medicine fellowship programs can use to enhance and meet the ACGME program requirements. Based on the position statement from the American Medical Society for Sports Medicine (AMSSM), we propose recommendations for ACGME accredited sports medicine programs to achieve standards of excellence. We also provide recommendations for research requirements during the course of a sports fellowship. With the proposed recommendations, a sports medicine fellowship program can achieve excellence and enhance fellowship training by increasing proficiency in PM&R-based skills relevant to sports and musculoskeletal medicine. Given the multi-disciplinary nature of musculoskeletal and sports medicine, it is also key that fellowship programs (regardless of the department that they are accredited through) have faculty members that represents these disciplines and accept applicants with residency training in PM&R, internal medicine, family medicine, pediatrics, and emergency medicine. Corresponding Author: Nitin B. Jain, MD, MSPH, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 Children’s Way, Suite 1318, Nashville, TN 37212, United States of America, Phone: (615) 936-8508; Fax: (615) 322-7454, Email: nitin.jain@vumc.org Funding: None Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.