Clinical, Radiographic, and Ultrasound Findings between Simple and Complicated Baker’s Cysts Purpose To compare the clinical, radiographic, and ultrasound findings between simple and complicated Baker’s cysts (BCs). Methods Forty-seven knees with BCs in 45 patients with knee pain were identified from a chart review. BCs were classified as simple or complicated according to ultrasound findings. Clinical data, including duration of knee pain, visual analogue scale score, Kellgren-Lawrence grade, ultrasound findings including the size and sonomorphology of the BC, severity of osteophytosis, thickness of joint effusion, meniscal tear, and synovial proliferation of the two types of BC, were compared. Results There were 22 knees with a simple cyst and 25 knees with a complicated cyst. The thickness of the suprapatellar effusion in complicated BCs (5.7±3.0 mm) was significantly greater than that in simple BCs (3.8±3.2 mm), and the presence of synovial proliferation in the suprapatellar recess was significantly higher in complicated BCs (22 knees, 88.0%) than in the simple BCs (12 knees, 54.5%). However, there were no significant differences in demographic, radiographic, and other ultrasound parameters between the two types of BC. Conclusion Synovial proliferation with larger effusion in the suprapatellar recess was more associated with complicated BC than simple BC. Corresponding author: Dae Gil Kwon, M.D., Department of Rehabilitation Medicine, Catholic University of Daegu School of Medicine, 33 Duryugongwon-ro 17-gil, Nam-Gu, Daegu, 42472, South Korea. Telephone number: 82-53-650-4894, Fax number: 82-53-622-4687. E-mail: cateyesn@naver.com or dgkwon@dcmc.co.kr Conflict of interest No other financial support was provided for the creation of this manuscript, and no author had any conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Dual-task cost of discrimination tasks during gait in people with multiple sclerosis Purpose The objective of this study was to assess dual-task cost to spatio-temporal gait parameters in people with multiple sclerosis (MS) and a matched control group. Method The MS group was composed of 17 participants with a diagnosis of MS and an Expanded Disability Status Scale (EDSS) score < 6. A total of 17 healthy participants were allocated to the Control Group by stratification. Controls were matched on the basis of age, sex, sociocultural habits and body structure. Dual-task cost was determined by within-group repeated-measures ANOVA. Participants were instructed to ambulate under normal conditions and perform a discrimination and decision-making task concurrently. Then, between-group ANOVA was used to assess differences in mean dual-task cost between groups and determine dual-task cost differential. Testing was performed using 3-D photogrammetry and an electronic walkway. Results Based on dual-task cost differential, gait cycle time increase (-5.8%) and gait speed decrease (6.3%) due to MS-induced impairment. Conclusions During single-task and dual-task conditions, gait speed was lower in MS participants, due to a shorter step length and increased swing time. Increased gait time might be the result of compensatory mechanisms adopted to maintain stability while walking specially during the double-support phases. CORRESPONDENCE: Francisco Javier Rojas Ruiz, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Carretera de Alfacar, s/n, 18071 Granada, Spain. e-mail: fjrojas@ugr.es Conflict of interest statement The authors certify that they have NO affiliations with or involvement in any organization or entity with any financial interest, or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. Funding: This work Project DEP2016-75460-R has been supported by the State Research Agency (SRA) and European Regional Development Fund (ERDF) Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Weekend Admission to Inpatient Rehabilitation Facilities is Associated with Transfer to Acute Care in a Nationwide Sample of Patients with Stroke Objective To determine the impact of weekend versus weekday admission to an inpatient rehabilitation facility (IRF) on the risk of acute care transfer in patients with stroke. Design This was a retrospective analysis using the Uniform Data System for Medical Rehabilitation, a national database comprising data from 70% of U.S. IRFs. A total of 1,051,436 adult (age ≥18 years) stroke cases were identified between 2002-2014 that met inclusion criteria. Logistic regression models were developed to test for associations between weekend (Friday-Sunday) versus weekday (Monday-Thursday) IRF admission and transfer to acute care (primary outcome) and IRF length of stay (secondary outcome), adjusting for relevant patient, medical, and facility variables. A secondary analysis examined acute care transfer from 2002-2009 prior to passage of the Affordable Care Act (ACA), 2010-2012 post-ACA, and 2013-2014 after implementation of the Hospital Readmissions Reduction Program (HRRP). Results Weekend IRF admission was associated with increased odds of acute care transfer (OR 1.06, 95% CI 1.04-1.08) and slightly shorter IRF length of stay (p<0.001). Overall, the risk of acute care transfer decreased following the ACA and HRRP. Conclusion Weekend admission to IRF may pose a modest increase in the risk of transfer to acute care in patients with stroke. Shirley L. Shih and Marisa Flavin: Denotes shared first authorship (both authors contributed equally) Correspondence: Jeffrey Schneider, MD, 300 1st Avenue, Charlestown, MA 02129, jcschneider@partners.org. Phone: 617-952-5299, Fax: 617-952-5934 Author Disclosures: This research has not been presented. The authors received no specific funding for this work. There are no conflicts of interest Author Contributions: Design and conceptualization of the study: Marisa Flavin Shirley L. Shih Jeffrey C. Schneider Analysis and interpretation of the data: Shirley L. Shih Marisa Flavin Richard Goldstein Jeffrey C. Schneider Drafting and revising the manuscript for intellectual content: Shirley L. Shih Marisa Flavin Richard Goldstein Chloe Slocum Colleen M. Ryan Aneesh Singhal Jason Frankel Ross Zafonte Jeffrey C. Schneider Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Anti-inflammatory and healing effects of pulsed ultrasound therapy on fibroblasts Objective The aim of this study was to analyze the effects of low intensity pulsed ultrasound therapy under different pulse regimes on cultures of semi-confluent L929 fibroblasts, evaluating cell viability, anatomical structural alterations, modulation of VEGF (Vascular endothelial growth factor), IL-6 (Interleukin – 6), Col1α1, Col1α2 (Type 1 alpha 1 and alpha 2 collagens) and FgF7 (Fibroblast growth factor 7), and the amount of inflammatory mediators IL-2, IL-4, IL-6, IFN-γ, TNF, IL-17A and IL-10 at 24, 48 and 72 hours. Design The design was experimental study. Methods The treatments consisted of 0.2 W/cm2 doses at a frequency of 1 MHz, pulsed as 10 and 20%. Viability was assessed by the MTT assay [3-(4,5-dimethylthiazole)-2,5-diphenyltetrazolium bromide], gene expression by RT-qPCR and cytokine quantification by flow cytometry. Results At 48 hours, ultrasound enhanced cell viability, and affected IL-6 cytokine production and VEGF, IL-6, Col1α1, Col1α2 and FgF7 gene modulation. Conclusions Low-intensity pulsed ultrasound therapy had a biostimulatory effect on semi-confluent in vitro L929 fibroblast cells, where the group with a dose of 0.2 W/cm2-10% (G2) presented higher responses, in all the analyzed aspects, towards the dose pulsed to 20%, confirming its therapeutic properties related to the initial phases of tissue healing. Correspondence: Priscila Daniele de Oliveira Perrucini, Universidade Anhanguera UNIDERP (Universidade para o Desenvolvimento do Estado e da Região do Pantanal). Departamento de Pós-graduação Stricto Sensu. Rua Ceará, 333. Bairro Miguel Couto. Caixa Postal 2153. CEP 79003-010 - Campo Grande – Mato Grosso do Sul, Brasil. e-mail: prisciladanielefisio@hotmail.com; +5543984318494. ORCID Priscila Daniele de Oliveira Perrucini https://orcid.org/0000-0002-4069-3556 Regina Célia Poli Frederico https://orcid.org/0000-0003-4631-4606 Deise Aparecida de Almeida Pires-Oliveira https://orcid.org/0000-0002-5765-1897 Larissa Dragonetti Bertin https://orcid.org/0000-0001-9755-6432 Flavia Beltrão Pires https://orcid.org/0000-0002-8029-6790 Walkiria Shimoya Bittencourt https://orcid.org/0000-0003-2350-8897 Viviane Martins Santos https://orcid.org/0000-0009-3230-0959 Julice Medeiros Coelho https://orcid.org/0000-0002-6240-3687 Rodrigo Franco de Oliveira https://orcid.org/0000-0001-8074-8083 Abbreviations IL-6 Interleukin 6 LIPUS Low intensity pulsed ultrasound MEM Minimum Essencial Medium MTT Brometo de [3-(4,5-dimetiltiazol)-2,5-difeniltetrazólio] RT-qPCR Reverse Transcriptation- Polymerase chain reaction quantative real time TPP Polystyrene Petri W/cm2 Watts per square centimeter μ LMicroliter What is Known? Therapeutic ultrasound is widely diffused in clinical practice, aiming at tissue repair in the most diverse musculoskeletal lesions, so that the occurrence of cytomechanical events depends on the dosimetry used. What is New? Low intensity pulsed therapeutic ultrasound had a biostimulating effect on semi-confluent fibroblast cells in vitro. The pulse of 10% and intensity of 0.2 W/cm2 presented superior responses in relation to the pulsed dose at 20%. Especially, after 48 hours of irradiation, the treatment affected the IL-6 cytokine production and genetic modulation. CONFLICTS OF INTEREST All authors state that there is no potential conflict of interest regarding this article. FUNDING The authors would like to express their gratitude for the financial support of the National Foundation for the Development of Private Higher Education (FUNADESP) and the National Council for Scientific and Technological Development (CNPq). Description: UNIVERSAL EDITAL - CNPQ Process: 442412 / 2014-2 Call: MCTI / CNPQ / Universal 14/2014. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Compensation strategies in response to fatiguing propulsion in wheelchair users: Implications for shoulder injury risk Objective To examine if fatigue-inducing wheelchair propulsion changes neuromuscular activation and propulsion biomechanics and to determine predictor variables of susceptibility to fatigue. Design This study with a quasi-experimental, one-group, pretest posttest design investigates a population-based sample of wheelchair users with a spinal cord injury (n=34, age: 50.8±9.7 years, 82% males). Muscular activation and propulsion biomechanics during treadmill propulsion at 25W and 45W were assessed before and after a protocol designed to cause fatigue. Results With the induced fatigue, wheelchair users propelled with increased muscular activation in the pectoralis major pars sternalis, deltoideus pars acormialis and upper trapezius (45W, p<0.05) and a slightly reduced push angle (25W: 75° to 74°, p<0.05, 45W: 78° to 76°, p<0.05). Wheelchair users susceptible to fatigue (47%) were more often complete, injured at an older age and had less years since injury. This group propelled in general with shorter push angle and greater maximum resultant force, had a greater anaerobic capacity and less muscular activation. Conclusions Compensation strategies in response to fatiguing propulsion could increase the risk of shoulder injury. Predictor variables of susceptibility to fatigue inform interventions preserving shoulder health and include lesion characteristics, propulsion technique, anaerobic capacity, and muscular activation. Correspondence: Fransiska M. Bossuyt, Swiss Paraplegic Research, Guido A. Zäch Strasse 4, 6207 Nottwil, Switzerland, Phone: +41 41 939 65 78, Fax: +41 41 939 65 79, Email: fransiska.bossuyt@paraplegie.ch Author disclosures: Authors have nothing to disclose. This project is supported by the Administration on Community Living, National Institute on Disability, In- dependent Living, and Rehabilitation Research (NIDILRR) (grant no. 90SI5014). NIDILRR is a Center within the Administration for Community Living (ACL) within the Department of Health and Human Services (HHS). The contents of this paper do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the U.S. Government. This project has also been supported by the International Society of Biomechanics with the International Travel Grant (July 1st, 2016). This study has been financed in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch), supported by the Swiss Paraplegic Foundation. The members of the SwiSCI Steering Committee are: Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); N.N. (Swiss Paraplegic Association, Nottwil); Daniel Joggi (Swiss Paraplegic Foundation, Nottwil); Hardy Landolt (Representative of persons with SCI, Glarus); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Christine Fekete (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil). Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Quantitative evaluation of interference patterns on electromyography in neuropathy Objective The purpose of this study was to develop a quantitative evaluation method of interference patterns on needle electromyography (EMG) that is easy to apply in clinical use and to examine its usefulness. Diagnostic electrophysiological assessments are important for physiatrists, and correct diagnosis and assessment are essential for proper rehabilitation. Design A total of 112 maximum interference patterns of upper extremity muscles suspected of being affected by neuropathy were quantitatively evaluated based on the parameters of integration values, mean amplitudes, the number of peaks, and activity. “Activity” was defined as the sum of the time during which myoelectric signals were recorded during 1 s with maximum voluntary contraction, and it was expressed as a percentage. The relationships of the above parameters with spontaneous pathological potentials and polyphasic motor unit potentials (MUPs) were examined. Results The area under the curve (AUC) of the receiver operating characteristic curve (ROC) for the diagnosis of neuropathy was the highest using activity (0.917). The integral value and mean amplitude were useful for the diagnosis of cases with chronic neuropathy showing slightly decreased interference patterns. Conclusion The quantitative evaluation of the maximal contraction interference pattern in this study was useful for the diagnosis of neuropathy. Correspondence: Kazuto Akaboshi, Keio University Hospital 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. Tel, Fax: +81-3-3536-3833. E-mail: redstar@td6.so-net.ne.jp; Reprint requests: Yukiko Kobayashi, Keio University Hospital, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan. E-mail: ykkobayashi.rh@gmail.com Ethical Publication Statement We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines. Disclosure of Conflicts of Interest None of the authors has any conflict of interest to disclose. A financial statement No financial support was received for this study. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Physiatry Reviews for Evidence in Practice (PREP) Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist Early Surgery or Physical Therapy for Nonobstructive Meniscal Tears No abstract available

An Unusual Case of Foot Weakness Caused by Proximal Extensor Hallucis Longus (EHL) Rupture No abstract available

Patients with spinal muscular atrophy use high percentages of trunk muscle capacity to perform seated tasks Objective To investigate trunk function during seated upper extremity tasks in patients with spinal muscular atrophy (SMA) type 2 and 3. Design 17 persons with SMA and 15 healthy controls (HC) performed several tasks when sitting unsupported, such as reaching (and placing) forward and sideward. Joint torque and muscle activity were measured during maximum voluntary isometric contractions (MVIC). Three-dimensional kinematics and normalized muscle activity were analyzed when performing tasks. Results Trunk joint torques were significantly decreased, approximately 45%, in patients with SMA compared to HC. Active range of trunk motion was also significantly decreased in all directions. When performing tasks, the average back muscle activity was 27% and 56% of MVIC for respectively HC and SMA, and for abdominal muscles respectively 10% and 44% of MVIC. Trunk range of motion did not differ when performing daily tasks. Conclusion The trunk of patients with SMA is weaker compared to HC, reflected by reduced trunk torques and decreased active range of motion. Additionally, patients with SMA use high percentages of their trunk muscle capacity to perform tasks. Clinicians should take this into account for intervention development, because using high percentages of the maximum muscle capacity results in fatigue and muscle overloading. Full address corresponding author: Laura H.C. Peeters, MSc, Department of Rehabilitation, Radboudumc, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands, Email address corresponding author: laura.hc.peeters@radboudumc.nl Author disclosures: • Conflicts of interest: Nothing to declare. • Funding: This work was supported by the Netherlands Organisation for Scientific Research (NWO) (Grant number 13524, 13525). • Financial benefits to the authors: no financial benefits. Previous presentation of the research: a manuscript was published about trunk movement of the healthy controls. This group is also used to compare with the SMA patients. However, the focus of the published manuscript was on the movement of individual trunk segments, whether this manuscript describes and compares the trunk as one segment. Therefore figures, or data, does not overlap. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Resident Education of Ultrasound Guided Procedures: A Homemade Practice Model Pilot Study The goal of this study was to evaluate an agar model that could be used to train physicians to perform ultrasound-guided (USG) procedures. Eleven (N = 11) PM&R residents volunteered to be subjects. All subjects completed a questionnaire about their experience and comfort with USG procedures. In Phase I, subjects were instructed to identify specific structures and perform specific procedures on the agar models; these tasks were timed. All subjects were then given a short lecture on fundamentals of USG procedures and percutaneous needle tenotomy (PNT). In Phase II, subjects then performed the same tasks again on the agar model and completed the questionnaire again. Analysis was performed using paired t-tests. The number of structures successfully identified significantly increased from Phase I (mean = 1.45) to Phase II (mean = 2.54) (p=0.003). Time to complete the needle access task in Phase II (mean = 258 s) significantly decreased compared to Phase I (mean = 394s) (p=0.04). Subjectively, our participants reported that they felt more comfortable performing USG procedures (p=0.005) and felt more familiar with PNT (p=0.00004) after using the model. In conclusion, residents demonstrated improvement in USG procedural skills and reported increased comfort performing these procedures after training on the agar model. Correspondence: Dr. Jesse Charnoff, email: jcharno1@gmail.com, cell: 516-567-7254, fax: 305-355-2424, 1611 NW 12th Avenue Institute 532B, Miami, FL 33136 No funding was received for this study Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.