American Journal of Physical Medicine & Rehabilitation最新文献

{"title":"Fibrocartilaginous Embolism Presenting as Isolated L2-3 Radiculopathy Without Spinal Cord Infarction.","authors":"Ji Yun Kim, Min Kyung Park, Hong Bum Park, Ki Hoon Kim, Dong Hwee Kim","doi":"10.1097/PHM.0000000000003002","DOIUrl":"10.1097/PHM.0000000000003002","url":null,"abstract":"<p><p>Lumbosacral radiculopathy often presents as back pain and lower limb weakness and is frequently encountered in rehabilitation medicine. Fibrocartilaginous embolism (FCE) is an uncommon but significant vascular cause of radiculopathy. It occurs when the disc-derived fibrocartilaginous material enters the spinal vasculature, leading to embolic infarction. We present the case of a 54-year-old female who developed right lower limb weakness and sensory impairment after lifting an adult male. Lumbosacral MRI revealed infarctions involving the L3 vertebral body, right L3 dorsal root ganglion, and paraspinal muscles. CT angiography demonstrated embolic occlusion of the right third lumbar artery, and electromyography confirmed right L2-3 radiculopathy. The patient was conservatively treated with aspirin and physical therapy. Over time, the motor weakness and electromyographic amplitudes in the affected lower limb improved. To our knowledge, this is the first reported case of FCE causing isolated L2-3 radiculopathy without spinal cord infarction.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":"e130-e133"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148325254","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":"Effects of Differing Nutritional Supplementation Combined With High-Intensity Aerobic Interval Training on Functional Exercise Capacity, Cardiac Function, and Quality of Life in Patients With Heart Failure and Reduced Ejection Fraction: A Randomized Trial.","authors":"Ivo Petrov, Kamen Stoichev, Okan Aliman, Yana Kashilska, Dolina Gencheva, Georgi Goranov, Dorothea Tsekoura, Gabriel Parisotto, Arthur Sa Ferreira, Agnaldo José Lopes, Nigyar Dzhafer, Hristo Bozov, Kiril Panayotov, Jannis Papathanasiou","doi":"10.1097/PHM.0000000000002932","DOIUrl":"10.1097/PHM.0000000000002932","url":null,"abstract":"<p><strong>Objective: </strong>The aim of the study was to compare the effects of two nutritional supplementation strategies Amendcor (creatine, D-ribose, coenzyme Q10, and vitamin E) versus biquinol+D-ribose, combined with a 12-wk group-based high-intensity aerobic interval training on functional exercise capacity, health-related quality of life, left ventricular ejection fraction, and perceived exertion, in patients with heart failure with reduced ejection fraction.</p><p><strong>Design: </strong>Sixty-eight patients with heart failure with reduced ejection fraction were randomly assigned to a creatine + D-ribose + CoQ10 + Vit. E ( n  = 35) or a ubiquinol + D-ribose group ( n  = 33) and performed group-based high-intensity aerobic interval training. The primary outcome was functional exercise capacity, assessed via the 6-min walk test, peak VO₂, and peak respiratory exchange ratio. Secondary outcomes included health-related quality of life, left ventricular ejection fraction, and perceived exertion.</p><p><strong>Results: </strong>Study participants supplemented with creatine + D-ribose+ CoQ10 + Vit. E demonstrated significantly greater improvements in functional exercise capacity (6-min walk test: +19.88%, VO₂ peak: +25.46%, perceived exertion: -38.53%), health-related quality of life: -25.64%, left ventricular ejection fraction: +40.94%, compared with subjects supplemented with ubiquinol + D-ribose ( P  < 0.05).</p><p><strong>Conclusions: </strong>Patients with heart failure with reduced ejection fraction who received multi-ingredient supplementation combined with group-based high-intensity aerobic interval training demonstrated superior improvements in functional exercise capacity, health-related quality of life, left ventricular ejection fraction, and perceived exertion, compared with those supplemented with ubiquinol + D-ribose.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":"814-822"},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146058567","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":"Adaptive Sports Exposure Across Physical Medicine and Rehabilitation Residency and Sports Medicine Fellowship Programs: A National Cross-Sectional Website Analysis.","authors":"Chantal Nguyen, Emily Moya, Mehul Chowdarapu, Durga Monica Ghosh, Miriam Agaibi, Jacob Nguyen, Molly Timmerman","doi":"10.1097/PHM.0000000000003150","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003150","url":null,"abstract":"<p><p>Adaptive sports improve health and quality of life for people with disabilities, yet the extent of adaptive sports exposure in physical medicine and rehabilitation (PM&R) training is unclear. This cross-sectional study reviewed the public websites of 115 accredited physical medicine and rehabilitation residency programs and 26 sports medicine fellowship programs for any mention of adaptive sports, characterizing exposure type, target populations, and associated program characteristics. Adaptive sports were mentioned by 32 residency programs (27.8%) and 8 fellowship programs (30.8%). Mention varied significantly by geographic region in both cohorts (residency, West 64% vs. South 19%, P=.017; fellowship, Midwest 80% vs. South 0%, P=.035) and, among residencies, was associated with larger program size and a greater number of associated subspecialty fellowships. Residency exposure was predominantly volunteer-based, whereas fellowship exposure was exclusively clinical or undisclosed; target populations served were frequently unspecified. Programs have an opportunity to expand structured adaptive sports training and to clearly convey these opportunities to applicants and patients.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148863227","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":"Reconceptualizing Cerebral Palsy as a Lifelong Condition Characterized by Systemic and Accelerated Biological Decline: Implications for Physiatry Residency Education.","authors":"Shannon R Strader, Joline E Brandenburg, Andrea A Domenighetti","doi":"10.1097/PHM.0000000000003144","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003144","url":null,"abstract":"<p><p>Cerebral palsy (CP), the most common childhood-onset disability worldwide, affects an estimated 50 million individuals globally. Although most individuals with CP are adults, CP education and training remain heavily concentrated within pediatric subspecialties, contributing to substantial gaps in adult care. At the same time, emerging evidence demonstrates that CP is associated with progressive multisystem, metabolic, musculoskeletal, and cellular changes across the lifespan, despite the original brain injury being nonprogressive. Current educational models, however, continue to frame CP primarily as a pediatric motor disorder, limiting clinician preparedness to address the complex health needs of aging adults with CP. This perspective paper argues that physiatry is uniquely positioned to lead a paradigm shift in residency education by reframing CP as a lifelong condition characterized by systemic involvement and accelerated biological aging. We propose a lifespan-oriented educational framework that integrates contemporary understanding of CP pathophysiology, multimorbidity, functional decline, and rehabilitation needs across adulthood. Expanding CP-focused education within physiatry residency training may improve clinician preparedness and represents one component of broader efforts to improve healthcare access, interdisciplinary care coordination, and long-term outcomes for adolescents and adults aging with CP.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148839267","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":"Clinical and Electrophysiological Effects of Downhill Treadmill Walking in Patients With Ischemic Stroke: A Randomized Controlled Trial.","authors":"Burak Yıldız, İpek Midi, Evrim Karadağ-Sayg, Özge Keniş-Coşkun","doi":"10.1097/PHM.0000000000003147","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003147","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the clinical and electrophysiological effects of downhill treadmill walking performed at different inclines in patients with stroke.</p><p><strong>Design: </strong>Thirty-five patients with stroke were randomized to level treadmill walking (control), -7.5% downhill walking, or -15% downhill walking. In this assessor-blinded trial, the intervention consisted of five sessions delivered over 5 consecutive days. Clinical outcomes assessed before and after the intervention were the Modified Ashworth Scale, Fugl-Meyer Lower Extremity Scale, 2-Minute Walk Test, Timed Up and Go Test, and Berg Balance Scale. The H-reflex maximum-to-M-wave maximum ratio was measured at baseline, after the first session, and after the final intervention session. The primary end point was the change in this ratio from baseline.</p><p><strong>Results: </strong>After a single session, the ratio decreased only in the -15% group. After five sessions, decreases were observed in the paretic leg in both the -7.5% and -15% groups, whereas no significant change was observed in the control group. The 2-Minute Walk Test and Timed Up and Go Test improved in all groups; these improvements were greater in the -15% incline group than in the level-walking control group. No significant changes were observed in the Modified Ashworth Scale or Berg Balance Scale scores.</p><p><strong>Conclusion: </strong>Downhill treadmill walking was associated with short-term modulation of spinal reflex excitability after stroke, suggesting that incline magnitude and repeated exposure may influence the electrophysiological response. Although the 2-Minute Walk Test and Timed Up and Go Test improved across all groups after five sessions, the greater improvements observed in the -15% incline group compared with the level-walking group suggest that a steeper downhill walking stimulus may be associated with greater early functional gains. However, these findings should be interpreted with caution given the short intervention duration, small sample size, and absence of follow-up assessments; therefore, their clinical significance and durability remain uncertain.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148824009","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":"Progressive Symmetric Distal Lower Extremity Weakness, Sensory Loss, and Gait Dysfunction in a Young Adult: A Clinical Vignette.","authors":"Eric Toan Phong Nguyen, Anne Kuwabara","doi":"10.1097/PHM.0000000000003143","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003143","url":null,"abstract":"","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148817176","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":"Hidden Risks of Multimodal Neuromodulation: Suspected Intrathecal Baclofen Pump Motor Stall Induced by a Vagus Nerve Stimulator Magnet.","authors":"Priya Sharma, Brigid Deck, Gregor J Dudiak, Weibin Shi, Thiru Annaswamy","doi":"10.1097/PHM.0000000000003135","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003135","url":null,"abstract":"<p><p>The increasing use of implantable neuromodulation devices in patients with chronic post-stroke sequelae raises the possibility of unintended device-device interactions. We report a case of recurrent intrathecal baclofen pump motor stalls in a patient with longstanding spasticity following an intracranial hemorrhage, ultimately attributed to magnetic interference from a recently implanted vagus nerve stimulator (VNS) activator magnet. Recognition of this interaction led to prompt resolution and highlights the importance of interdisciplinary awareness and patient education in individuals with multiple implanted neuromodulation systems.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787237","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":"Additional/Sonographic Insight into the Distal Intersection Syndrome: Superficial Radial Nerve Dorsal Medial Branch Entrapment.","authors":"Wei-Ting Wu, Ke-Vin Chang, Levent Özçakar","doi":"10.1097/PHM.0000000000003137","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003137","url":null,"abstract":"","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787046","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":"Association Between Quadriceps Myosteatosis and Muscle Strength and Physical Function in Patients With Knee Osteoarthritis- A Systematic Review.","authors":"Reema Ummer Farook, Karvannan Harikesavan, Nithin Prakash","doi":"10.1097/PHM.0000000000003140","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003140","url":null,"abstract":"<p><strong>Objective: </strong>To synthesize the available evidence on the association between quadriceps myosteatosis and muscle strength and physical function in individuals with knee osteoarthritis.</p><p><strong>Design: </strong>A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Joanna Briggs Institute (JBI) guidelines and was prospectively registered with PROSPERO. PubMed, EMBASE, Web of Science, Scopus, and CINAHL were searched from inception to February 2026. Studies quantifying quadriceps myosteatosis using objective imaging and reporting muscle strength or physical function were eligible. Methodological quality was assessed using the JBI critical appraisal tools. Due to clinical and methodological heterogeneity, findings were synthesized narratively following the Synthesis Without Meta-analysis (SWiM) framework.</p><p><strong>Results: </strong>Seven studies were included. Most demonstrated low to moderate risk of bias. Quadriceps myosteatosis may be associated with reduced muscle strength and poorer physical function, with the association varying by muscle region, fat compartment, and imaging modality. The most consistent associations were observed for vastus medialis and intermuscular fat, and in MRI-based studies with multivariable adjustment.</p><p><strong>Conclusion: </strong>Quadriceps myosteatosis may be associated with poorer muscle function in knee osteoarthritis, most consistently for vastus medialis. Findings should be interpreted cautiously, given the limited evidence base and methodological heterogeneity.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787266","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":"Efficacy of Transcranial Direct Current Stimulation in Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Stimulation Montages and Timing.","authors":"Qianqian Yao, Xiantong Gao, Quanye Ding, Zhuokun Li","doi":"10.1097/PHM.0000000000003134","DOIUrl":"https://doi.org/10.1097/PHM.0000000000003134","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of transcranial direct current stimulation (tDCS) initiated strictly within the acute ischemic stroke.</p><p><strong>Design: </strong>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted via PubMed, Embase, and Cochrane Library. Outcomes included neurological deficit, upper limb and lower limb motor function, and functional independence. Data were synthesized using random-effects models to calculate weighted mean differences (WMD) and standardized mean differences (SMD).</p><p><strong>Results: </strong>Ten RCTs involving 419 participants were included. Active tDCS significantly reduced neurological deficits compared to sham stimulation (WMD=-0.86, 95% CI: -1.38 to -0.34, P=0.001). While tDCS did not significantly improve short-term or long-term upper limb function, it demonstrated a significant improvement on lower limb motor recovery (SMD=3.50, 95% CI: 2.56 to 4.44, P<0.001), which was sustained at follow-up. No significant difference was found in functional independence or safety outcomes between groups.</p><p><strong>Conclusions: </strong>tDCS initiated in the acute phase is safe and effective for reducing neurological deficits and enhancing lower limb motor recovery. The discrepancy between lower and upper limb outcomes suggests distinct neuroplastic mechanisms, highlighting the potential of tDCS, particularly bilateral montages, as a targeted intervention for early gait rehabilitation.</p>","PeriodicalId":7850,"journal":{"name":"American Journal of Physical Medicine & Rehabilitation","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148787320","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}