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Discover the most talked about and latest scientific content & concepts.

Journal: PM & R : the journal of injury, function, and rehabilitation

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Membership in medical societies is associated with a number of benefits to members that may include professional education, opportunities to present research, scientific and/or leadership training, networking and others. In this perspective article, the authors address the value that medical specialty society membership and inclusion have in the development of an academic physician’s career and how underrepresentation of women may pose barriers to their career advancement. Because society membership itself is not likely sufficient to support the advancement of academic physicians, this report focuses on one key component of advancement that can also be used as a measure of inclusion in society activities-the representation of women physicians among recipients of recognition awards. Previous reports demonstrated underrepresentation of women physicians among recognition award recipients from two physical medicine and rehabilitation (PM&R) specialty organizations; including examples of zero or near-zero results. This report investigated whether zero or near-zero representation of women physicians among recognition award recipients from medical specialty societies extended beyond the field of PM&R. Examples of the underrepresentation of women physicians, as compared to their presence in the respective field, was found across a range of additional specialties, including dermatology, neurology, anesthesiology, orthopedic surgery, head and neck surgery, and plastic surgery. The authors propose a call for action across the entire spectrum of medical specialty societies to: 1) examine gender diversity and inclusion data through the lens of the organization’s mission, values and culture; 2) transparently report the results to members and other stakeholders including medical schools and academic medical centers; 3) investigate potential causes of less than proportionate representation of women; 4) implement strategies designed to improve inclusion; 5) track outcomes as a means to measure progress and inform future strategies; and 6) publish the results in order to engage community members in conversation about the equitable representation of women.

Concepts: Medicine, Surgery, Physician, Pediatrics, Medical school, Psychiatry, Internal medicine, Specialty

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1) Provide a critical analysis of the contemporary published research pertaining to complementary, alternative, and other non-Complete Decongestive Therapies (CDT) for treatment of lymphedema (LE); and 2) Provide practical applications of that evidence to improve care of patients with or at risk for LE. TYPE: This study meets the defining criteria as a systematic search and review since it includes varied study types. All studies that met the inclusion criteria were evaluated for weight of evidence and value.

Concepts: Medicine, Critical thinking, Therapy, Study skills, Cultural studies, Lymphedema, Type, Type system

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OBJECTIVE: The purpose of this study is to assess the effect of exercise training using the Nintendo Wii Fit videogame and balance board system on balance and gait in adults with Parkinson Disease (PD). DESIGN: Prospective Interventional Cohort Study. SETTING: Outpatient group exercise class. PARTICIPANTS: 10 subjects with PD, Hoehn and Yahr Stages 2.5 or 3, with a mean age of 67.1 years; 4 men, 6 women. INTERVENTIONS: Subjects participated in supervised group exercise sessions 3 times per week for 8 weeks, practicing three different Wii balance board games (marble tracking, skiing and bubble rafting) adjusted for their individualized function level. Subjects trained for 10 minutes per game, a total of 30 minutes training per session. MAIN OUTCOME MEASURES: Pre-and post-exercise training, a physical therapist evaluated subjects' function using the Berg Balance Scale (BBS), Dynamic Gait Index (DGI), and Sharpened Romberg with eyes open and closed. Postural Sway was assessed at rest and with tracking tasks using the Wii balance board. Subjects rated their confidence in balance using the Activities-specific Balance Confidence (ABC) scale and depression on the Geriatric Depression Scale (GDS). RESULTS: Balance as measured by the BBS improved significantly, with an increase of 3.3 points (p = .016). The DGI improved as well (mean increase 2.8, p = .004), as did postural sway measured with the balance board (decreased variance in stance with eyes open by 31%, p = .049). Though the Sharpened Romberg with eyes closed increased by 6.85 points and with eyes opened by 3.3 points, improvements neared significance only for eyes closed (p = .07 versus p = .188). There were no significant changes on patient ratings for the ABC (mean decrease -1%, p = .922) or the GDS (mean increase 2.2, p = .188). CONCLUSIONS: An 8-week exercise training class using the Wii Fit balance board improved selective measures of balance and gait in adults with PD. However, no significant changes were seen in mood or confidence regarding balance.

Concepts: Wii, Nintendo, Wii Balance Board, Wii Fit, Wii Menu, Wii Play, History of video game consoles, Wii Remote

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In this review, the role of high resolution ultrasound in the diagnosis of neuromuscular disease, as a complementary tool to electrodiagnostic techniques, will be discussed, including indications, advantages, limitations, and potential for future research. Ultrasound-guided needle placement can be used to increase accuracy and safety of nerve conduction studies (NCS) and needle electromyography (EMG). Ultrasound imaging of nerve and muscle can provide additional diagnostic information when performed in conjunction with NCS and needle EMG in the setting of nerve entrapment, nerve inflammation, and muscle disease. Its unique features include the ability to image structures dynamically in real time and the technique of sonopalpation. Because neuromuscular ultrasound is a rapidly evolving diagnostic tool, with significant changes in technology facilitating its increased use, there is a steadily growing body of literature in this area. There remains, however, an ongoing need for high-quality studies evaluating the role and cost-effectiveness of neuromuscular ultrasound, both when used alone and in combination with electrodiagnosis.

Concepts: Diagnosis, Muscle, Electromyography, Medical ultrasonography, Nerve, Myasthenia gravis, Neuromuscular disease, Nerve conduction study

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Maintaining the integrity of the capsule along with infusing a sufficient amount of fluid is one of the therapeutic concept in intra-articular hydraulic distension (IHD) for adhesive capsulitis. It has been known that hypertonic saline decreases tissue edema and increases the fluid volume within the epidural space, causing microdissection, in epidural adhesiolysis.

Concepts: Concepts in metaphysics, Epidural, Laser capture microdissection, Adhesive capsulitis of shoulder, Hydrodilatation, Epidural space

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Orthopaedic trauma is an unforeseen life-changing event. Serious injuries include multiple fractures and amputation. Physical rehabilitation has traditionally focused on addressing functional deficits after traumatic injury. But, there are important psychological factors that can dramatically affect recovery over the short and long-term. This review presents: 1) the effects of orthopaedic trauma on psychological distress; 2) potential interventions for distress reduction after trauma; and 3) implications for participation in rehabilitation. Survivors commonly develop post-traumatic stress syndrome (PTSD), depression and anxiety, all of which interfere with functional gains and quality of life (QOL). Over 50% of survivors have psychological distress that can last decades after the injury has been treated. Early identification of patients with distress can help care teams provide the resources and support to offset the distress. Several options that help trauma patients navigate their short-term recovery include holistic approaches, pastoral care, coping skills, mindfulness, peer visitation and educational resources. Long-term physical and mental health of the trauma survivor can be enhanced by strategies that connect the survivor to a network of people with similar experiences or injuries, facilitate support groups and social support networking (The Trauma Survivors Network). Rehabilitation specialists can help optimize patient outcomes and QOL by participating in and advocating these strategies.

Concepts: Bone fracture, Psychological trauma, Injury, Cognitive behavioral therapy, Posttraumatic stress disorder, Stress, Amputation, Physical trauma

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Currently, extracorporeal shockwave therapy (ESWT) is widely used for treatment of various musculoskeletal disorders. We report a case of ulnar neuropathy secondary to the application of ESWT. A 48-year-old male was diagnosed with medial epicondylitis and underwent 2 sessions of ESWT. Immediately after the second session, he experienced paresthesia and weakness in the right hand. On physical examination, atrophy of the first dorsal interosseus and weakness of the abductor digiti minimi were observed. Electrophysiologic study demonstrated ulnar neuropathy at the elbow with severe partial axonotmesis. Our case report demonstrates that ESWT might cause or contribute to peripheral nerve injury at the site of application.

Concepts: Medical terms, Action potential, Neurology, Philosophy of science, Demonstration, Physical examination, Musculoskeletal disorders, Extracorporeal shockwave therapy

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OnabotulinumtoxinA is approved for the treatment of upper and lower limb spasticity in adults. Guidance on common postures and onabotulinumtoxinA injection paradigms for upper limb spasticity has been developed using a Delphi Panel. However, similar guidance for lower limb spasticity has not been established.

Concepts: Upper limb, Limb

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Work related neck disorders (WRNDs) are among the most common dysfunctions in office workers. Understanding cervical myofascial mechanical characteristics that differentiate symptomatic and asymptomatic office workers is crucial for the understanding of musculoskeletal dysfunctions in workers with neck pain.

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Medical specialty societies are important resources for physicians in advancing their careers. There is a gap in the literature regarding gender disparities within these societies. This study assesses one area where disparities may exist: recognition awards.

Concepts: Medicine, Oncology, Physician, Pediatrics, Specialty