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.

The Effect of Neuromuscular Electrical Stimulation during Walking on Muscle Strength and Knee Pain in Obese Women with Knee Pain: A Randomized Controlled Trial Objective To assess the effectiveness of a hybrid training system with walking (HTSW) that simultaneously applies electrical stimulation to the knee extensors/flexors during walking in obese women with knee pain. Design Randomized, single-blind (assessor), controlled trial. 28 obese women with knee pain randomized to 12 weeks of biweekly walking with either HTSW or with transcutaneous electrical nerve stimulation (control). Primary outcomes (maximum isokinetic knee extensor torque (KET) and maximum isokinetic knee flexor torque (KFT)) and secondary outcomes (20-meter walk time, chair-stand time, stair-climb time, knee pain, and knee-related quality life) were evaluated. Change-point regression analyses were employed to model the interaction for the primary outcomes. Two sample T-tests were employed on pre-post change scores in secondary outcomes. Results KET increased significantly more in the HTSW group than the control group when baseline KET was >57.2Nm (p=.0033). When baseline KFT was at 30Nm or 50Nm, KFT there was a trend toward greater increase in the HTSW group than the control group (p=.0566, p=.0737, respectively). There were no significant differences between groups in secondary outcomes. Conclusion These results suggest HTSW is effective for improving KET in obese women with knee pain. However, the superiority of HTSW may vary depending on baseline knee muscle strength. Corresponding Author: Hiroo Matsuse, M.D. Division of Rehabilitation, Kurume University Hospital 67 Asahi-machi, Kurume, Fukuoka 830-0011, JAPAN. Tel: +81-(0)942-31-7568, Fax: +81-(0)942-46-6002 E-mail: matsuse_hiroh@kurume-u.ac.jp Author Disclosures: The authors have no conflicts of interest to disclose. This study was supported in part by the Milbank Foundation Chronic Pain Management Research Grant through the Foundation for Physical Medicine and Rehabilitation. This work was supported in part by a CTSA grant from NCRR and NCATS awarded to the University of Kansas Medical Center for Frontiers: The Heartland Institute for Clinical and Translational Research # UL1RR033179 which is now at NCATS # UL1TR000001. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH or NCATS. This research was presented at the American Academy of Physical Medicine and Rehabilitation 2018 Annual Assembly. This clinical trial was registered at clinicaltrials.gov (study ID NCT02730598). This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Clinical Tests of the Shoulder: Accuracy and Extension Using Dynamic Ultrasound Shoulder pain is a common musculoskeletal disorder that has a significant impact on the patient’s quality of life and functional health. Since the shoulder joint is a complex structure, the relevant symptoms of shoulder pain may not directly reflect the underlying pathology. Hence, several shoulder tests have been developed to examine shoulder problems, and their diagnostic accuracy varies. Familiarization with the performance of those physical tests and their strength and limitation is of utmost importance for physicians dealing with shoulder disorders. Therefore, the present narrative review focuses on summarizing the most commonly used tests in physical examination and their diagnostic performance on several shoulder pathologies. This article also discusses how ultrasound imaging can serve as an extension of those tests. Corresponding author: Ke-Vin Chang, MD, PhD, Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch and National Taiwan University College of Medicine, Taipei, Taiwan. Email: kvchang011@gmail.com; pattap@pchome.com.tw 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.

Effects of load addition during gait training on weight-bearing and temporal asymmetry after stroke: a randomized clinical trial Objective To evaluate the effects of adding load to restrain the non-paretic lower limb during gait training on weight-bearing and temporal asymmetry after stroke. Design Thirty-eight (38) subjects were randomized into treadmill training with load (5% of body weight) on the non-paretic limb (experimental group) and treadmill training without load (control group). Interventions lasted 30 min per day for 2 weeks (9 sessions). Both groups performed home-based exercises and were instructed to increase the use of paretic limb in daily life situations. Ground reaction force (GRF) was obtained by a force plate during standing position (static) and gait (dynamic). Temporal gait parameters were assessed by a motion system analysis. Outcome measures were evaluated at baseline, post-training and after a 40-day follow-up. Results The experimental group increased static GRF of the paretic limb at post-training (P= 0.037) and the control group increased dynamic GRF of the paretic limb at post-training (P= 0.021), both with maintenance at follow-up. Neither group showed a change in the swing time symmetry ratio after training (P= 0.190). Conclusion Treadmill training associated to behavioral strategies/home-based exercises seemed to be useful to minimize weight-bearing asymmetry, but not to improve temporal gait asymmetry. Load addition did not show additional benefits. Corresponding author: Tatiana S. Ribeiro, PT, PhD, Departamento de Fisioterapia, Universidade Federal do Rio Grande do Norte, Av. Senador Salgado Filho, 3000, Campus Universitário, Lagoa Nova, Post office box: 1524, Natal, RN, Zip Code: 59072-970, Brasil. Tel: +55(84)3342-2010; Fax: +55(84)3342-2010. e-mail: ribeiro_tatiana@outlook.com Author disclosures: This study was presented in part as an abstract in the 12th International Society of Physical and Rehabilitation Medicine World Congress: T. Ribeiro, E. Silva, S. Silva, I. Regalado, A. Lindquist. Effects of Gait Training with Unilateral Leg Load on Weight Bearing Asymmetry of Individuals with Stroke: A Randomized Clinical Trial. Ann Phys Rehabil Med 2018; 61S:e435–e557. This study was financed in part by the CAPES – Brazilian Federal Agency for Support and Evaluation of Graduate Education within the Ministry of Education of Brazil – Finance Code 001. No conflicts of interest have been reported by the authors or by any individuals in control of the content of this article. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The effect of stabilization exercises along with self-care training on transverse abdominal activity, pain, and disability in mothers with low back pain having children with CP: a RCT Objective Many mothers of children with cerebral palsy (CP) experience low back pain (LBP), so the purpose of this study was to investigate the effect of stabilization exercises along with self-care training on transverse abdominal muscle activity, pain, disability and depression in them. Design In this single-blinded randomised clinical trial, 32 mothers with CP children were selected were randomly divided into two groups. Both groups received self-care training individually. For the experimental group, in addition to the self-care training, 24 sessions of stabilization exercises were held. Outcome measures included Visual Analog Scale, Roland-Morris Disability Questionnaire, Persian version of Beck Depression Inventory-II and ultrasonography. Results In the experimental group the transverse abdominal muscle activity during abdominal hollowing exercises were significantly increased (p <0.05). There was no significant difference between the two groups in pain, disability and depression (p >0.05). Conclusion Stabilization exercises could improve the voluntary activity of transverse abdominal muscle of mothers of children with cerebral palsy. Correspondence: Zahra Ahmadizadeh, Address: Department of Occupational therapy, School of rehabilitation, Semnan University of Medical Sciences, Km 5 Semnan to Damghan road, Semnan, Iran, Zip (postal) code: 3519899951. Email: ahmadizadeh.z@semums.ac.irAhmadizade.z@gmail.com, Phone number: 00989125312182 Author Disclosures: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. This study was supported by neuromuscular rehabilitation research center of Semnan University of Medical sciences. The authors would like to thank all of mothers who participated in this study Funding: this study has received funding from Neuromuscular Rehabilitation Research Center, Semnan University of Medical Sciences. Funding number 821. Competing interests: The authors declare that they have no conflict of interest. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Reorganization of hand motor function to the primary somatosensory cortex in a patient with primary motor cortex infarct: Functional MRI and diffusion tensor tractography assessments No abstract available