PM&R最新文献

{"title":"Departments.","authors":"","doi":"10.1002/pmrj.13379","DOIUrl":"https://doi.org/10.1002/pmrj.13379","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"17 3","pages":"E1-E11"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Variability in youth coach concussion education requirements across states.","authors":"Sepehr Asgari, Peter Knowles, Amy K Bugwadia, Christine M Baugh, Lewis E Kazis, Gerald A Grant, Ross D Zafonte, Robert C Cantu, Roy D Pea, Piya Sorcar, Daniel H Daneshvar","doi":"10.1002/pmrj.13274","DOIUrl":"10.1002/pmrj.13274","url":null,"abstract":"<p><strong>Background: </strong>Youth sports coaches play a critical role in proper concussion recognition and management, reinforcing the need for coach concussion education. As of 2021, most states have statutory and policy measures mandating concussion education for coaches. In practice, these mandates have been enacted through state legislatures and their respective youth sport governing bodies. Prior studies have found significant variations in the contents of state-level concussion risk reduction policies and have raised questions about their specificity.</p><p><strong>Objective: </strong>To expand on previous analyses to provide an overview of youth sports coach concussion education, highlighting variations in state policies and discrepancies between state mandates and youth sport governing bodies.</p><p><strong>Methods: </strong>This report utilized qualitative content analysis to characterize and compare U.S. state and governing body concussion education requirements for youth sport coaches. State concussion statutes were identified via the National Conference of State Legislatures and Open States databases, and governing body handbooks/bylaws were obtained via their websites. Two researchers independently coded the policies, and discrepancies were resolved through consensus meetings with additional youth traumatic brain injury experts.</p><p><strong>Results: </strong>We found significant variability in educational requirements and their implementation. A majority (68%; n = 34) of states require the completion of concussion education training for coaches. Notably, many states designate responsibility for enforcement and implementation of provisions to another party but just four state statutes delineate explicit consequences for noncompliance. Additionally, only 12 state statutes extend mandates to noninterscholastic sports, limiting their reach. In most cases, independent sanctioning authorities implement more stringent policies than the minimum acceptable standard established by state law.</p><p><strong>Conclusion: </strong>Our findings provide a coded data set of youth coach concussion laws and independent sanctioning authority guidelines that can be used in future research efforts. Further research investigating a relationship between the strength of coach concussion education policies and relevant youth and adolescent concussion-related metrics is required.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"270-285"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Percutaneous ultrasound-guided A1 pulley release utilizing a modified 20-gauge spinal needle.","authors":"Mark Sederberg, Ragav Sharma, Daniel M Cushman, Jonathan T Finnoff","doi":"10.1002/pmrj.13276","DOIUrl":"10.1002/pmrj.13276","url":null,"abstract":"<p><strong>Background: </strong>Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure.</p><p><strong>Objective: </strong>To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Setting: </strong>Private practice outpatient orthopedics clinic.</p><p><strong>Participants: </strong>Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release.</p><p><strong>Interventions: </strong>Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure.</p><p><strong>Results: </strong>Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection.</p><p><strong>Conclusions: </strong>Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"286-292"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142666399","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Student concussion symptoms and tailored accommodations during use of a return to learn program in 13 public high schools.","authors":"Erik B Philipson, Aspen Avery, Julian Takagi-Stewart, Qian Qiu, Thomas Jinguji, David B Coppel, Monica S Vavilala","doi":"10.1002/pmrj.13282","DOIUrl":"10.1002/pmrj.13282","url":null,"abstract":"<p><strong>Background: </strong>Youth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.</p><p><strong>Objective: </strong>To examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.</p><p><strong>Design: </strong>Secondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program.</p><p><strong>Setting: </strong>Thirteen public high schools during the 2021-2022 academic year.</p><p><strong>Participants: </strong>Sixty-two students diagnosed with concussion who reported symptoms to school personnel.</p><p><strong>Interventions: </strong>The school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations.</p><p><strong>Main outcome measures: </strong>Symptom profile, accommodation type, and accommodation duration.</p><p><strong>Results: </strong>A total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.</p><p><strong>Conclusions: </strong>Students with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"262-269"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889523/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Why genetic testing is important in patients with developmental disabilities-a unique case of progressive hypertonia and chorea: VARS2-related disorder.","authors":"Shannon Strader, Marissa Vawter-Lee, Loren Pena, Heather Huxol, Corrie Harris","doi":"10.1002/pmrj.13267","DOIUrl":"10.1002/pmrj.13267","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"344-346"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142036670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lower limb kinematic changes during stair navigation 3 and 5 months after anterior cruciate ligament reconstruction: A longitudinal analysis in real-world settings.","authors":"Tomer Yona, Bezalel Peskin, Arielle G Fischer","doi":"10.1002/pmrj.13342","DOIUrl":"https://doi.org/10.1002/pmrj.13342","url":null,"abstract":"<p><strong>Background: </strong>Despite advancements in anterior cruciate ligament reconstruction (ACLR), achieving symmetrical movement patterns during stair negotiation remains challenging. Therefore, this study examines lower limb kinematics during stair ambulation at the early and mid-rehabilitation stages after ACLR in a real-world environment.</p><p><strong>Objective: </strong>To describe lower limb kinematics during stair ambulation at 3 and 5 months after ACLR and evaluate changes between these time points. We hypothesized that between-limb asymmetries would improve over this period.</p><p><strong>Design: </strong>Longitudinal study.</p><p><strong>Participants: </strong>Twenty-seven patients 3 months post ACLR were recruited, and 18 were followed up at 5 months post ACLR. Surgeries were performed by one of five surgeons using various grafts (hamstrings, bone-patellar tendon-bone, or quadriceps). Exclusion criteria were multiligament injuries, major meniscus injuries, other concomitant injuries, or previous knee surgeries. An additional group of matched healthy controls (n = 16) was also recruited.</p><p><strong>Setting: </strong>Public health care campus.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Maximum and minimum joint angles, and continuous kinematic patterns during stair ascent and descent were measured on a 20-step staircase at self-selected speed using seven inertial measurement units, with sagittal knee kinematics as the main outcome and hip and ankle kinematics as secondary outcomes. Between-limb differences and longitudinal changes were analyzed using discrete points and statistical parametric mapping.</p><p><strong>Results: </strong>At 3 months after ACLR, the injured knee was less flexed compared to the contralateral knee during stair ascent (mean difference = -11.3°, confidence interval [CI, -14.4 to -8.1], p < .001) and descent (mean difference = -6.3°, CI [-10.2 to -2.4], p = .002). Statistical parametric mapping analysis showed decreased flexion at 0%-35% and 87%-99% of the stair ascent cycle (p < .005). By 5 months, flexion differences during ascent improved (mean difference = -4.7°, CI [-8.1 to -1.4], p = .008), but asymmetry persisted, with decreased flexion at 10%-32% of the cycle during ascent and 20%-29% during descent (p < .017). Flexion improvements were observed from 3 to 5 months during ascent (mean increase = 6.1°, p < .001) and descent (mean increase = 9.3°, p = .004).</p><p><strong>Conclusions: </strong>Persistent lower limb kinematic asymmetries remain 5 months after ACLR during stair ambulation.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143531856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anomalous education: You can't bypass electrodiagnostic training in PM&R residency.","authors":"Ileana M Howard, Faye Chiou Tan, Robert W Irwin, Ruple S Laughlin, Anthony Chiodo, Peter A Grant, Shirlyn Adkins, Monika Krzesniak-Swinarska, Gautam Malhotra, Colin K Franz, Dianna Quan","doi":"10.1002/pmrj.13281","DOIUrl":"10.1002/pmrj.13281","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"347-348"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of cardiopulmonary exercise testing to identify mechanisms of exertional symptoms in children with long COVID.","authors":"Adam Lowe, Arash Sabati, Rajeev Bhatia","doi":"10.1002/pmrj.13263","DOIUrl":"10.1002/pmrj.13263","url":null,"abstract":"<p><strong>Background: </strong>Little is known about the mechanisms of exercise intolerance and exertional symptoms in children with long COVID. Through utilization of cardiopulmonary exercise testing (CPET), this study is the first of its kind to evaluate exertional symptoms and attempt to identify potential mechanism of long COVID-19 in children.</p><p><strong>Objective: </strong>To determine if CPET will uncover potential reasons for persistent symptoms of long COVID when there is no indication of cardiopulmonary or upper airway disease.</p><p><strong>Methods: </strong>We performed a retrospective chart review study involving children 6-17 years of age with symptoms of long COVID at Phoenix Children''s Hospital from January 1, 2021, to June 1, 2022. Symptoms included but were not limited to exercise intolerance, fatigue, shortness of breath, dyspnea on exertion, and chest pain. We recorded any measurable abnormalities present on CPET after comparing it to established normal reference ranges. Range, median, and SD of data points were calculated and p values were determined using the Mann-Whitney U and Fisher's exact test.</p><p><strong>Results: </strong>Twenty-three children with exertional symptoms consistent with long COVID were identified. The most frequent symptoms reported during exercise include dyspnea on exertion (35%), followed by chest pain (30%) and dizziness (13%). Nearly half of the children (47%) demonstrated decreased exercise capacity with 30% displaying limitations due to deconditioning, 22% limited by body habitus, and 13% due to bronchospasm. Other contributing factors include ventilation to perfusion mismatch and volitional hyperventilation.</p><p><strong>Conclusion: </strong>Decreased aerobic activity due to multiple factors was found in 47% of children with a history of COVID-19. This study illustrates the importance of ongoing research into this phenomenon to elucidate its mechanism and assist physicians in making decisions regarding referral to specialists for further testing.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"246-253"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142352494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound visualization of Botulinum toxin injection: Identifying clinical correlates to optimize outcomes in spasticity management.","authors":"Kristen A Harris, Stacey Jou, Lora Kasselman, Steven V Escaldi","doi":"10.1002/pmrj.13269","DOIUrl":"10.1002/pmrj.13269","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin injections are well established and commonly used for spasticity management. Clinicians strive to optimize outcomes from toxin injections. One potential complication is toxin spread beyond the intended muscle, which can lead to unwanted weakness. The utilization of ultrasound allows direct visualization of target muscles and identification of toxin leakage from the target muscle. Ultrasound evaluation of clinical factors that correlate to toxin leakage have not been studied.</p><p><strong>Objective: </strong>To identify cases of botulinum toxin injectate leak beyond the targeted muscle during ultrasound-guided spasticity injections and associate cases of leak with predictive clinical factors, which include muscle size, fibroadipose changes, and number of previous injections.</p><p><strong>Design: </strong>This was a prospective observational study.</p><p><strong>Setting: </strong>An outpatient clinic in an academic medical center.</p><p><strong>Patients: </strong>Patients who demonstrated wrist flexor spasticity warranting intervention were invited to participate.</p><p><strong>Interventions: </strong>Patients received standard-of-care spasticity management with injection of onabotulinumtoxinA into the flexor carpi radialis muscle based upon clinical presentation and prescribing guidelines. Ultrasound video was recorded, and a blinded review was conducted by the study team.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was visualized leak of injectate on recorded ultrasound video. Documented leak was then associated with clinical factors including diameter of the flexor carpi radialis, volume of injectate used, history of prior injections, and fibrotic change of the muscle.</p><p><strong>Outcomes: </strong>The study included 54 patients, 77.8% of whom had an underlying diagnosis of cerebrovascular accident. Injectate leak was observed in 18.5% of injections and could not be confirmed in 9.3% of injections. Multivariable analysis demonstrated increased odds of leak with higher Modified Heckmatt Scale score. No statistically significant increase in leak was noted with higher volume of injectate or smaller muscle diameter.</p><p><strong>Conclusion: </strong>Extramuscular leak of botulinum toxin injection may be associated with fibroadipose muscle change.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"254-261"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472934","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Academy News - March 2025 PM&R.","authors":"","doi":"10.1002/pmrj.13380","DOIUrl":"https://doi.org/10.1002/pmrj.13380","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":"17 3","pages":"353-354"},"PeriodicalIF":2.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143586696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}