Painful Myoclonus Triggered By Lateral Antebrachial Cutaneous Nerve Entrapment at Brachioradialis Muscle: A Case Report Compression of the lateral antebrachial cutaneous nerve (LACN) is a rare clinical entrapment syndrome often overlooked as an initial etiology of pain 1. We present a case of an episodic upper extremity painful movement disorder (myoclonus) in a 16 year old female with a remote history of a surgically stabilized supracondylar humeral fracture who was later found to have entrapment of the LACN. The incidence of a painful myoclonus triggered by a peripheral nerve entrapment is unknown 1. Combining a history and physical examination, electromyography, nerve conduction studies and ultrasound enabled us to make an accurate diagnosis that was confirmed by resolution of symptoms after surgical release. This study conforms to all CARE guidelines and reports the required information accordingly (see Supplemental Check list, Supplemental Digital Content 1, http://links.lww.com/PHM/A855). Correspondence: Heidi Prather, DO, Department of Orthopaedic Surgery, 14532 South Outer Forty Road, Chesterfield, MO 63017, Phone: 3145143544. Email: pratherh@wustl.edu Authors Disclosures: None No funding was received for this research 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.

The Use of Ultrasonography in Expediting Septic Joint Identification and Treatment: A Case Report No abstract available

Second-Order Peer Reviews of Clinically Relevant Articles for the Physiatrist: Is platelet rich plasma injection more effective than corticosteroid for treatment of gluteal tendinopathy? No abstract available

An Uncommon Cause of Lateral Hip Pain After Multi-Trauma: A Clinical Vignette No abstract available

Repetitive transcranial magnetic stimulation on motor recovery for patients with stroke: A PRISMA compliant systematic review and meta-analysis Objective A systematic review and meta-analysis were conducted to determine the efficacy of repetitive transcranial magnetic stimulation (rTMS) in recovering motor function in patients with stroke. Design A comprehensive literature search was performed to identify studies published before September 20th, 2018. Electronic databases were searched. Standard mean differences (SMD) and 95% confidence intervals (CI) were used to evaluate the effects of rTMS. The stability and sensitivity of the results and sources of heterogeneity were also analyzed. The Cochrane Risk of Bias Tool was used to determine the quality of the studies. Result Twenty randomized controlled trials (n=841 patients) were included. The results showed that rTMS is beneficial to patients with post-stroke hemiplegia, as demonstrated by four scales: the Fugl-Meyer Assessment (SMD=0.635, 95% CI: 0.421–0.848); grip strength (SMD=1.147; 95% CI: 0.761–1.534); Barthel Index (SMD=0.580; 95% CI: 0.377–0.783); and National Institutes of Health Stroke Scale (SMD=-0.555; 95% CI: -0.813–-0.298). Few adverse events were observed. Conclusion The analysis showed that low-frequency rTMS has a positive effect on grip strength and lower limb function as assessed by FMA. Correspondent Author: Dingqun Bai, The First Affiliated Hospital of Chongqing Medical University, the department of Rehabilitation; Chongqing, China. Tel/Fax:18623380876. E-mail: baidingqun2014@163.com Declarations of interest: None. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Clinical Trial Registration Information: PROSPERO under the identification CRD42017058219 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Exercise in the Aquatic Environment for Patients with Chronic Spinal Cord Injury and Invasive Appliances: Successful Integration and Therapeutic Interventions Objective Our primary objective of this initial “proof-of-principle” trial was to evaluate the interventions used in skilled aquatic therapy and to identify any clinical benefits for individuals with spinal cord injuries (SCI) who use invasive appliances including pressure ulcer dressings, supra-pubic catheters, indwelling catheters, colostomy bags, and tracheostomy tubes. Design Retrospective chart review of patients with chronic SCI using invasive appliances who had also undergone skilled aquatic therapy. Results 49 patients with traumatic SCI spinal cord injuries demonstrated scores showing statistically significant improvement using their total mobility and self-care of SCIM III (p-values ≤0.021, 0.039, 0.021) scores. 45 patients with traumatic SCI demonstrated significant improvement of AIS motor scores (p-value ≤0.002) and 9 patients with traumatic SCI walked longer distance in 6MWT (p-value ≤0.011). SCIM III efficiency of 0.26 per hour (95% CI=0.037-0.475). There was one reported unplanned bowel evacuation that occurred but did not prevent future therapy. All patients successfully completed aquatic therapy. Conclusion SCI patients with various invasive appliances can safely participate in specialized aquatic therapy without complications and appear to achieve clinically significant benefits. We recommend that SCI rehabilitation centers seek out and connect with opportunities for aquatic therapy within their institutions and communities. Correspondence: All correspondence and requests for reprints should be addressed to Albert C. Recio, MD, International Center for Spinal Cord Injury, Kennedy Krieger Institute Outpatient Center, 801 N. Broadway, Baltimore, MD 21205 Conflict of Interest and Disclosures: Albert C. Recio, Eva Kubrova and Steven A. Stiens, have no disclosures to declare. This article does not contain any studies with human or animal subjects performed by any of the authors and written patient consent forms have been collected. This material is original and has not been presented previously. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. This study was conducted with the approval of the Johns Hopkins Medicine institutional review board reference number IRB00103188: AQUA-Aquatics, Quantify, Understand, Analyze. What is Known Water, the major ingredient within the body and the predominant substance covering the Earth, long known to provide healing benefits from its inherent properties (buoyancy, resistance, compression, and energy transmission) has been an underutilized environment of exercise for patients with SCI. What is New This retrospective review of aquatic therapy for chronic SCI patients who utilized invasive devices showed it could be safe and effective. With therapeutic pools at many rehabilitation centers, community pools and multiple water recreation activities now accessible to people with disabilities, patients utilizing invasive devices ought not to be excluded and should be encouraged to participate. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

Ultrasound Imaging for Painful Lipomatosis: Cutaneous Nerves Really Matter! No abstract available

A Model-Based Cost-Effectiveness Analysis of an Exercise Program for Lung Cancer Survivors Following Curative-Intent Treatment Objective The cost-effectiveness of exercise interventions in lung cancer survivors is unknown. We performed a model-based cost-effectiveness analysis of an exercise intervention in lung cancer survivors. Design We used Markov modeling to simulate the impact of the Lifestyle Interventions and Independence for Elders (LIFE) exercise intervention compared to usual care for stage I-IIIA lung cancer survivors following curative-intent treatment. We calculated and considered incremental cost-effectiveness ratios (ICERs) <$100,000/quality-adjusted life-year (QALY) as cost-effective and assessed model uncertainty using sensitivity analyses. Results The base-case model showed that the LIFE exercise program would increase overall cost by $4,740 and effectiveness by 0.06 QALYs compared to usual care and have an ICER of $79,504/QALY. The model was most sensitive to the cost of the exercise program, probability of increasing exercise, and utility benefit related to exercise. At a willingness-to-pay threshold of $100,000/QALY, LIFE had a 71% probability of being cost-effective compared to 27% for usual care. When we included opportunity costs, LIFE had an ICER of $179,774/QALY, exceeding the cost-effectiveness threshold. Conclusions A simulation of the LIFE exercise intervention in lung cancer survivors demonstrates cost-effectiveness from an organization but not societal perspective. A similar exercise program for lung cancer survivors may be cost-effective. Correspondence:Scott M. Lippman, MD; 9500 Gilman Drive, MC 0658; La Jolla, CA 92093; Telephone: 858-822-1222; Email: slippman@ucsd.edu. Author Disclosures: a) Conflict of Interest: All authors declare no conflict of interest exists b) Funding: This work was supported by the National Institutes of Health (L30CA208950 and 1T32HL134632-01); and the American Cancer Society (PF-17-020-01-CPPB). c) Financial Benefits to Authors: none d) Previous manuscript: A pre-print version of this manuscript is available at https://www.biorxiv.org/content/10.1101/533281v1 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The Impact of One’s Sex and Social Living Situation on Rehabilitation Outcomes Following a Stroke Objective To investigate sex differences and the impact of social living situation on individual Functional Independence Measure (FIM™) outcomes after stroke rehabilitation Design A retrospective observational study utilizing Medicare fee-for-service beneficiaries (N=125,548) who were discharged from inpatient rehabilitation facilities in 2013 and 2014 after a stroke. Discharge individual FIM™ score, dichotomized as ≥5 and <5, was the primary outcome measure. A two-step generalized linear mixed model was used to measure the effect of sex on each FIM™ item while controlling for many clinical and sociodemographic covariates. Results After adjusting for sociodemographic and clinical factors, females had higher odds of reaching a supervision level for 14/18 FIM™ items. Males had higher odds of reaching a supervision level on 2/18 FIM™ items. Individuals who lived alone prior to their stroke had higher odds of reaching a supervision level than individuals who lived with a caregiver or with family for all FIM™ items. Conclusions When sociodemographic and clinical factors are controlled, females are more likely to discharge from inpatient rehabilitation at a supervision level or better for most FIM™ items. Individuals who live alone prior to their stroke have higher odds of discharging at a supervision level or better. Dr. Hay is now affiliated with Texas Woman’s University and TIRR Memorial Hermann Dr. Graham is now affiliated with Colorado State University Dr, Reistetter is now affiliated with UT Health San Antonio Correspondence: Catherine Cooper Hay Ph.d, OTR, Texas Woman’s University, 6700 Fannin Street, Houston, Texas 77030, Chay1@twu.edu, 713-794-2112 Author Disclosures: No competing interests to disclose. Funding Source: This project was supported by grants from the National Institutes of Health (P2C HD065702; T32 AG000270), National Institute on Disability, Independent Living, and Rehabilitation Research (90IF0071), and the Agency for Healthcare Research & Quality (HS022134), and National Institute of Child Health and Human Development (K12 HD055929) No financial benefits to disclose, Preliminary results of this study were presented in a poster presentation at ACRM: Hay, C. C., Graham, J., Pappadis, M.R., Ottenbacher, K., & Reistetter, T. A. (2017, October).The impact of gender and social support on goal attainment after stroke rehabilitation.Abstract accepted for poster presentation at the 2017 American Congress of Rehabilitation Medicine (ACRM) Conference, October 23 – October 28, Atlanta, GA. Final results of the study were presented as a platform discussion at the OT summit of Scholars in June, 2018 in Kansas City, Kansas. Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

The ‘Nuts ‘n Bolts’ of Evidence-Based Physiatry (EBP): Core Competencies for trainees and clinicians No abstract available