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Clinical Rehabilitation

Pelvic floor muscle training for urinary incontinence in female stroke patients: a randomized, controlled and blinded trial

Objective:

To examine the effects of pelvic floor muscle training (PFMT) on the contractility of pelvic floor muscle and lower urinary tract symptoms in female stroke patients.

Design:

Randomized, single-blind controlled study.

Setting:

Outpatient rehabilitation hospital.

Subjects:

Thirty one female patients who were more than three months post-stroke and stress urinary incontinence.

Interventions:

The subjects were randomized to either a PFMT group (n = 16), or a control group (n = 15). Both groups received general rehabilitation exercise for 6 weeks, but the PFMT group additionally received PFMT for 6 weeks.

Main measures:

Vaginal function test using a perineometer (maximal vaginal squeeze pressure) and intra-vaginal electromyography (activity of pelvic floor muscle), and urinary symptoms and quality of life using a Bristol Female Lower Urinary Tract Symptom questionnaire.

Results:

After intervention, the maximal vaginal squeeze pressures for the PFMT and control groups were 18.35 (5.24) and 8.46 (3.50) mmHg, respectively. And the activities of pelvic floor muscle of the PFMT and control groups was 12.09 (2.24) and 9.33 (3.40) , respectively. After intervention, the changes of scores for inconvenience in the activity of daily living of the PFMT and control groups were –15.00 (6.25) and –0.17 (1.59), respectively. In addition, the changes of score for lower urinary tract symptom was improved more in the PFMT group (-4.17 (4.00)) than in the control group (-0.25 (1.29)) (P < 0.05).

Conclusions:

These findings suggest that PFMT is beneficial for the management of urinary incontinence in female stroke patients.

Concordance and discordance between measured and perceived balance and the effect on gait speed and falls following stroke

Objective:

To ascertain the existence of discordance between perceived and measured balance in persons with stroke and to examine the impact on walking speed and falls.

Design:

A secondary analysis of a phase three, multicentered randomized controlled trial examining walking recovery following stroke.

Subjects:

A total of 352 participants from the Locomotor Experience Applied Post-Stroke (LEAPS) trial.

Methods:

Participants were categorized into four groups: two concordant and two discordant groups in relation to measured and perceived balance. Number and percentage of individuals with concordance and discordance were evaluated at two and 12 months. Walking speed and fall incidence between groups were examined.

Main measures:

Perceived balance was measured by the Activities-Specific Balance Confidence scale, measured balance was determined by the Berg Balance Scale and gait speed was measured by the 10-meter walk test.

Results:

Discordance was present for 35.8% of participants at two months post stroke with no statistically significant change in proportion at 12 months. Discordant participants with high perceived balance and low measured balance walked 0.09 m/s faster at two months than participants with concordant low perceived and measured balance (p < 0.05). Discordant participants with low perceived balance and high measured balance walked 0.15 m/s slower than those that were concordant with high perceived and measured balance (p <= 0.0001) at 12 months. Concordant participants with high perceived and measured balance walked fastest and had fewer falls.

Conclusions:

Discordance existed between perceived and measured balance in one-third of individuals at two and 12 months post-stroke. Perceived balance impacted gait speed but not fall incidence.

Registration of all rehabilitation clinical trials: an ethical and editorial imperative

Registration of randomized controlled trials is essential to reduce the risk of biased data being used when judging the effectiveness of an intervention. This journal will in future require that all randomized trials submitted are registered on a recognized register. This editorial explains why.

An investigation of the validity of the Work Assessment Triage Tool clinical decision support tool for selecting optimal rehabilitation interventions for workers with musculoskeletal injuries

Objective:

To evaluate the concurrent validity of a clinical decision support tool (Work Assessment Triage Tool (WATT)) developed to select rehabilitation treatments for injured workers with musculoskeletal conditions.

Design:

Methodological study with cross-sectional and prospective components.

Setting:

Data were obtained from the Workers’ Compensation Board of Alberta rehabilitation facility in Edmonton, Canada.

Subjects:

A total of 432 workers’ compensation claimants evaluated between November 2011 and June 2012.

Main measures:

Percentage agreement between the Work Assessment Triage Tool and clinician recommendations was used to determine concurrent validity. In claimants returning to work, frequencies of matching were calculated and compared between clinician and Work Assessment Triage Tool recommendations and the actual programs undertaken by claimants. The frequency of each intervention recommended by clinicians, Work Assessment Triage Tool, and case managers were also calculated and compared.

Results:

Percentage agreement between clinician and Work Assessment Triage Tool recommendations was poor (19%) to moderate (46%) and Kappa = 0.37 (95% CI –0.02, 0.76). The Work Assessment Triage Tool did not improve upon clinician recommendations as only 14 out of 31 claimants returning to work had programs that contradicted clinician recommendations, but were consistent with Work Assessment Triage Tool recommendations. Clinicians and case managers were inclined to recommend functional restoration, physical therapy, or no rehabilitation while the Work Assessment Triage Tool recommended additional evidence-based interventions, such as workplace-based interventions.

Conclusions:

Our findings do not provide evidence of concurrent validity for the Work Assessment Triage Tool compared with clinician recommendations. Based on these results, we cannot recommend further implementation of the Work Assessment Triage Tool. However, the Work Assessment Triage Tool appeared more likely than clinicians to recommend interventions supported by evidence; thus warranting further research.

The effects of compression gloves on hand symptoms and hand function in rheumatoid arthritis and hand osteoarthritis: a systematic review

Objective:

to evaluate the effects of compression gloves in adults with rheumatoid arthritis and hand osteoarthritis.

Data sources:

Systematic review of randomized controlled trials identified from MEDLINE, CINAHL, AMED, PEDro, OT Seeker, The Cochrane Library, ISI Web of Knowledge, Science Direct and PubMed from their inceptions to January 2015.

Review methods:

Methodological quality of identified trials was evaluated using the PEDro scale by three independent assessors. Effects were summarized descriptively.

Results:

Four trials (n=8-24; total n=74), comparing night wear of full-length finger compression gloves with placebo gloves, were assessed. Three were of moderate (PEDro score 4-5) and one low (score 3) methodological quality. Effect sizes or standardized mean differences could not be calculated to compare trials due to poor data reporting. In rheumatoid arthritis, finger joint swelling was significantly reduced, but results for pain and stiffness were inconclusive and no differences in grip strength and dexterity were identified. One study reported similar effects in pain, stiffness and finger joint swelling from both compression and thermal placebo gloves. Only one study evaluated gloves in hand osteoarthritis (n=5) with no differences.

Conclusions:

All the trials identified were small with a high risk of Type I and II errors. Evidence for the effectiveness of compression gloves worn at night is inconclusive in rheumatoid arthritis and hand osteoarthritis.

Introductory paragraph

Stroke rehabilitation at home before and after discharge reduced disability and improved quality of life: a randomised controlled trial

Objective:

To evaluate if home-based rehabilitation of inpatients improved outcome compared to standard care.

Design:

Interventional, randomised, safety/efficacy open-label trial.

Setting:

University hospital stroke unit in collaboration with three municipalities.

Subjects:

Seventy-one eligible stroke patients (41 women) with focal neurological deficits hospitalised in a stroke unit for more than three days and in need of rehabilitation.

Interventions:

Thirty-eight patients were randomised to home-based rehabilitation during hospitalization and for up to four weeks after discharge to replace part of usual treatment and rehabilitation services. Thirty-three control patients received treatment and rehabilitation following usual guidelines for the treatment of stroke patients.

Main measures:

Ninety days post-stroke the modified Rankin Scale score was the primary endpoint. Other outcome measures were the modified Barthel-100 Index, Motor Assessment Scale, CT-50 Cognitive Test, EuroQol-5D™, Body Mass Index and treatment-associated economy.

Results:

Thirty-one intervention and 30 control patients completed the study. Patients in the intervention group achieved better modified Rankin Scale score (Intervention median = 2, IQR = 2-3; Control median = 3, IQR = 2–4; P=0.04). EuroQol-5D™ quality of life median scores were improved in intervention patients (Intervention median = 0.77, IQR = 0.66–0.79; Control median = 0.66, IQR = 0.56 – 0.72; P=0.03). The total amount of home-based training in minutes highly correlated with mRS, Barthel, Motor Assessment Scale and EuroQol-5D™ scores (P-values ranging from P<0.00001 to P=0.01). Economical estimations of intervention costs were lower than total costs of standard treatment.

Conclusion:

Early home-based rehabilitation reduced disability and increased quality of life. Compared to standard care, home-based stroke rehabilitation was more cost-effective.

Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study

Objective:

Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision.

Design:

We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: ‘ESD’ n=135 and ‘Non ESD’ n=158 and 84 caregivers. The ‘ESD’ group accessed either of two ESD services operating in Nottinghamshire, UK. The ‘Non ESD’ group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months.

Results:

The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group (n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the >=90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (P<0.01).

Conclusion:

The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.

Does the addition of specific acupuncture to standard swallowing training improve outcomes in patients with dysphagia after stroke? a randomized controlled trial

Objective:

To assess the effect of adding acupuncture to standard swallowing training for patients with dysphagia after stroke.

Design:

Single-blind randomized controlled trial.

Setting:

Inpatient and outpatient clinics.

Subjects:

A total of 124 patients with dysphagia after stroke were randomly divided into two groups: acupuncture and control.

Interventions:

The acupuncture group received standard swallowing training and acupuncture treatment. In comparison, the control group only received standard swallowing training. Participants in both groups received six days of therapy per week for a four-week period.

Main measures:

The primary outcome measures included the Standardized Swallowing Assessment and the Dysphagia Outcome Severity Scale. The secondary outcome measures included the Modified Barthel Index and Swallowing-Related Quality of Life, which were assessed before and after the four-week therapy period.

Results:

A total of 120 dysphagic subjects completed the study (60 in acupuncture group and 60 in control group). Significant differences existed in the Standardized Swallowing Assessment, Dysphagia Outcome Severity Scale, Modified Barthel Index, and Swallowing-Related Quality of Life scores of each group after the treatment (P < 0.01). After the four-week treatment, the Standardized Swallowing Assessment (mean difference – 2.9; 95% confidence interval (CI) – 5.0 to – 0.81; P < 0.01), Dysphagia Outcome Severity Scale (mean difference 2.3; 95% CI 0.7 to 1.2; P < 0.01), Modified Barthel Index (mean difference 17.2; 95% CI 2.6 to 9.3; P < 0.05) and Swallowing-Related Quality of Life scores (mean difference 31.4; 95% CI 3.2 to 11.4; P < 0.01) showed more significant improvement in the acupuncture group than the control group.

Conclusions:

Acupuncture combined with the standard swallowing training may be beneficial for dysphagic patients after stroke.

A comparison between the Static Balance Test and the Berg Balance Scale: validity, reliability, and comparative resource use

Objective:

Within a sample of acute post-stroke patients, to compare the score on the Berg Balance Scale and the Static Balance Test for validity, inter-rater reliability, and the expenditure of time.

Design:

Prospective, intra-individual, cross-sectional evaluation study.

Setting:

Acute stroke unit of a university hospital in Germany.

Participants:

A total of 53 patients with acute stroke who did not have other pathology affecting their balance.

Main outcome measure:

For intra-individual comparisons of the Berg Balance Scale and the Static Balance Test, Pearson correlation coefficients were calculated. For inter-rater reliability, Bland Altman plots were drawn and the corresponding mean difference and limits of agreement were calculated.

Results:

The Static Balance Test took three to five minutes; the Berg Balance Scale 20–30 minutes. There was a high correlation between the scores on the Berg Balance Scale and the Static Balance Test (r = 0.91). For the Berg Balance Scale, the mean difference between the two raters was 0.13 and the limits of agreement were small (–0.25; 0.51). For the Static Balance Test, the mean difference between the two raters was –0.02 and also the limits of agreement (–0.06; 0.02) were even smaller than for the Berg Balance Scale. Both scales showed excellent inter-rater reliability.

Conclusion:

The Static Balance Test was compared with the Berg Balance Scale and turned out to be equally valid, more reliable, and takes much less time. For the moment, the scale can be recommended for the use in acute stroke care, especially for the daily routine therapy.

PM&R

PM&R RSS feed. PM&R is the official scientific journal of the American Academy of Physical Medicine and Rehabilitation (AAPM&R). It is a monthly, peer reviewed, scholarly publication. It aims to be an internationally leading journal that advances education and impacts the specialty of physical medicine and rehabilitation through the timely delivery of clinically relevant and evidence-based research and review information. Contributions from all parts of the world and from all types of professions in rehabilitation are therefore encouraged.Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.The content of PM&R includes articles that are contemporary and important to both research and clinical practice. The various sections of the journal include original research such as clinical trials, outcomes studies, and clinically relevant translational science; reviews (narrative and analytical); case presentations; point/counterpoint debates; ethical/legal topics; practice management updates; statistical themes; editorial and opinion pieces; images; clinical pearls; emerging issues; and letters to the editor.

Acute Calcific Bursitis After Ultrasound-guided Percutaneous Barbotage of Rotator Cuff Calcific Tendinopathy: A Case Report

Ultrasound (US)-guided percutaneous barbotage is an effective treatment for rotator cuff calcific tendinopathy, providing rapid and substantial pain relief. We present the case of a 49-year-old woman with aggravated pain, early after US-guided barbotage of a large calcific deposit in the supraspinatus tendon. Subsequent examination revealed a thick calcification spreading along the subacromial-subdeltoid bursa space, suggesting acute calcific bursitis complicated by barbotage. Additional barbotage alleviated pain completely.

Who may benefit from Armeo Power® treatment? A neurophysiological approach to predict neurorehabilitation outcomes

The Armeo Power® is a rehabilitation exoskeleton that allows early treatment of motor disabilities providing intelligent arm support in a large 3D workspace to perform intensive, repetitive and goal oriented exercises. This device could efficiently induce new connections and plasticity phenomena potentiation. Therefore, the knowledge of the potential brain plasticity reservoir following brain damage constitutes a prerequisite for an optimal rehabilitation strategy.

A Case Series: The Identification of Buried Bumper Syndrome with Abdominal Computed Tomography Scan in Two Severely Brain Injured Rehabilitation Patients

Buried bumper syndrome is a potentially dangerous complication related to percutaneous endoscopic gastrostomy tube placement. Early diagnosis of this condition is important to avoid further complications related to subcutaneous or intraperitoneal administration of tube feeds. However, diagnosis in individuals with altered mental status due to brain injury is challenging due to lack of ability to communicate and report symptoms. We present two case studies that demonstrate both the importance of early diagnosis and management and the lack of adequate sensitivity of gastrografin-aided KUB study.

The Impaired Balance Systems Identified by the BESTest in Older Patients With Knee Osteoarthritis

Balance decreases and activities of daily living (ADL) deteriorate in older people with knee osteoarthritis (KOA); however, little is known about the systems underlying poor balance control and how those impaired systems are related to decreased ADL.

Muscle Weakness and Perceived Disability of Upper Limbs in Persons With Late Effects of Polio

Muscle weakness in one or both upper limbs is common in persons with previous polio, but there is very limited knowledge how it influences daily life.

The Box Plots Alternative for Visualizing Quantitative Data

Although bar charts are popular among researchers and are ubiquitous in quantitative software packages, they do not always provide the best visualization for a dataset. This column discusses a simple, alternative graphical method that is often underappreciated: the box plot, also known as the box-and-whisker plot. The basic elements of the box plot are presented, along with how to correctly interpret box plots, variations that are available to provide more information, and free online software that researchers can use to create box plots for publication.

Functional Effectiveness of Inpatient Rehabilitation After Heart Transplantation

Heart transplantation (HT) is the treatment of choice for many patients with end-stage heart failure who remain symptomatic despite optimal medical therapy, but no study has looked directly into functional improvement of HT patients after an inpatient rehabilitation program.

Knee Kinematics and Joint Moments During Stair Negotiation in Participants With Anterior Cruciate Ligament Deficiency and Reconstruction: A Systematic Review and Meta-Analysis

Biomechanical changes have been reported for patients with anterior cruciate ligament deficiency (ACLD) and anterior cruciate ligament (ACL reconstruction) (ACLR), likely due to loss of stability and changes in proprioception and neuromotor control. This review evaluated kinematics and kinetics of ACLD and ACLR knees, compared with those on the contralateral uninjured sides, as well as and those in asymptomatic controls during stair navigation.

Influence of Menstrual Cycle and Oral Contraceptive Phase on Spinal Excitability

Rates of musculoskeletal injury differ substantially between the genders, with females more likely to experience conditions such as anterior cruciate ligament (ACL) injuries than males in the same sports. Emerging evidence suggests a significant hormonal contribution. Most research has focused solely on how hormonal fluctuations affect connective tissue, but a direct link between hormonal shifts, ligamentous laxity, and ACL injury has not been borne out. There is also evidence to suggest that sex hormones can modulate the central nervous system, but how this affects neuromuscular control is not well understood.

Academy News – February PM&R Journal

As the primary medical society for the specialty of PM&R, your Academy is focused on moving the specialty and you forward. Academy membership supports initiatives to assist our members with:

Physiatry Shorts via MedWorm.com

MedWorm.com provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest items from the ‘Physiatry Shorts’ source.

Nerve Injury Classifications – Seddon’s and Sunderland’s

Understanding nerve injury classification is essential for prognostic value clinically. Some basic anatomy, along with the two classification systems, and their corresponding EMG findings need to be learned and remembered. Two classification systems exist (and are frequently tested): Seddon’s classification (neuropraxia, axonotmesis, neurotmesis) Sunderland’s classification (types 1-5) To understand the systems, you must first review some basic nerve anatomy. WikiMedia There are three connective tissue layers in the CNS and PNS. epineurium perineurium endoneurium Individual nerve fibers (single axons) are covered with varying amounts of myelin and then covered by endoneurium. These individually wrapped nerve fibers are then grouped into bundles of fibers…

Guillain-Barre syndrome (GBS)

MedMemoWeb.com Guillain-Barre syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy (AIDP) caused by an autoimmune antigenic confusion, which causes the attack of the Schwann cells on peripheral nerves. This causes a rapidly progressive (hours to days) symmetric, ascending paralysis, along with complete loss of deep tendon reflexes (areflexia) – with or w/o paresthesias. If not stopped in time, the disease is fatal because of respiratory compromise (diaphragm and intercostal paralysis). Treatment usually consists of immediate administration of intravenous immunoglobulins (IV Ig) for 5 days, or plasmapheresis. Classification: Many variants exists, but I will talk about just two.Acute inflammatory demyelinati…

Posterior Interosseous Nerve

Radial Nerve Compression Sites The posterior interosseous nerve (PIN) is one of those nerves learned best by knowing the exceptions. In this case, the PIN innervates all the muscles on the dorsal side of the forearm, EXCEPT the brachioradialis, extensor carpi radialis longus (ECRL), and anconeus. It may help to remember these 3 exceptions by remembering they are the only muscles in the dorsal forearm that cross the elbow joint So that means, ALL dorsal forearm muscles that do not cross the elbow joint are innervated by the deep radial nerve/PIN (see below) When does the radial nerve become the PIN? In the distal, lateral arm, the radial nerve splits into a superficial and deep radial nerve The superficial radial nerve helps to provide sensation to the dorsal hand The deep radial nerv…

Provocative Tests for Hip Pathology – A Lesson of Sensitivity/Specificity/PPV/NPV

This article looked at the diagnostic validity of multiple provocative hip maneuvers in predicting true hip pathology (as opposed to pain coming from other sources). An 80% improvement on the visual analog scale between pre- and post- intraarticular (hip) injections of anesthetic (2% lidocaine and 0.75% bupivacaine) was used as the gold standard to confirm “true hip pathology”. Four maneuvers were evaluated (see the article for complete descriptions):FABER (Patrick): everyone knows how to do Internal rotation over pressure (IROP): supine; hip and knee flexed to 90o, internal rotation torque put through the femur, while putting down pressure over the opposite side ASIS Scour maneuver: supine; hip and knee flexed to 90o; internal and external rotation torque…

Vitamin D Deficiency and Spinal Cord Injuries

Conclusion of Study: This notes the extremely high prevalence of vitamin D deficiency amongst spinal cord injured patients in our acute inpatient hospitals, and likely points to the necessity to test for, and treat, this common contributor to osteoporosis. Quick Notes about Vitamin D: One of the fat-soluble vitamins Two major forms: vitamin D2 (ergocalciferol) and vitamin D3 (cholecalciferol) We get this vitamin from sun exposure, food, and supplements – but in an inactive form Calcitriol (1,25-dihydroxycholecalciferol) is the active form of vitamin D in the body Major role is promoting absorption of the calcium and phosphorous from the food/supplements in the intestines, and resorption of calcium from the kidneys ⇨ this increases serum levels of calcium needed for bone mine…

Anterior Interosseous Nerve and the “A-OK” muscles

Normal I’ve made it the “A-OK” sign, instead of just the “OK” sign, because the “A” will help to remind you about its innervation…the Anterior interosseous nerve (AIN) the AIN is a pure motor branch of the median nerve; just like the posterior interosseous nerve is a pure motor continuation of the deep branch of the radial nerve. So which muscles allow you to make this A-OK sign, and what is the clinical significance? First you must think about which actions are being performed to make this sign: the forearm is pronated = pronator quadratus the distal phalanx of the thumb is flexed = flexor pollicis longus the index/middle fingers are flexed at the DIP = lateral half of the flexor digitorum profundus Abnormal Now, what happens if the anterior interosseous muscle is damaged…

Median Nerve: Significance of Motor vs Sensory – an EMG case

Did you know that the median nerve motor fibers (in the hand) comes from the lower part of the brachial plexus (C8/T1; lower trunk; medial cord), while the sensory fibers are from the upper part (C6/7; lateral cord)?? **link to pic of brachial plexus and why is that important clinically? I had a patient with a 2-year history of diabetes that was sent to us from a hand surgeon for evaluation of his right upper extremity. He had an ulnar nerve decompression (no transposition apparently) a few years earlier, and the numbness/tingling is worsening/persisting. He had obvious guttering of that hand (interossei atrophy), virtually no 1st dorsal interosseous, and a combination of the hand of Benediction (when asked to close his hand) and claw hand (these two physical signs can…

High Femoral Neuropathy – an EMG case

backpain-guide.com A 50yo black male was referred to us for evaluation of his right lower extremity. Pt had a gunshot injury to the abdomen about two months ago, with a resultant right-sided retroperitoneal abscess that was subsequently drained. He presented today with significantly weakened right hip flexors (3-/5) and knee extensors (2/5), with numbness over the anterior thigh and medial leg. **note that the knee extension was more affected than the hip flexion The usual nerve conduction testing of the peroneal and sural nerves was normal, but the saphenous nerve had no response. EMG of the vastus medialis and intermedius showed profound (4+) positive sharp waves (PSWs) and fibrillations. The iliopsoas also showed significant PSW & fibs. All oth…

Testing for Ulnar Neuropathy Across the Elbow – ADM vs FDI

eOrthopod.com A patient presents to your clinic with a very clear presentation of ulnar neuropathy at the elbow: numbness in the medial hand (palmar and dorsal surfaces and medial 1.5 digits), that is worse when talking on the phone and reading a book – basically all activities when his elbows are flexed 90 degrees or more note: if it was only the palmar surface, then the lesion would be more likely at the wrist, b/c the dorsal ulnar cutaneous nerve supplies the dorsal medial hand and branches off before the wrist — thus not involved in Guyon’s canal lesions NO paresthesias in medial forearm (b/c that would be from the medial antebrachial cutaneous nerve, and therefore a lower brachial plexus lesion) When measuring the motor conduction velocity across the elbow, we typically look for…

Combined Sensory Index (CSI)

THE Ohio State University PM&R If the median sensory latency or median motor latencies are prolonged, this index isn’t needed. But if they are both normal, then perform the CSI. The CSI is a summation of three latency differences: 1) Split thumb: median and radial antidromic conduction at 10cm; reference = 0.5 or less 2) Split ring: median and ulnar antidromic conduction at 14cm; reference = 0.4 or less 3) P8: median and ulnar orthodromic conduction at 8cm; reference = 0.3 or less The individual reference values for the above are “5, 4, 3” (thumb, ring, P8), with a total combined index above 9ms being considered positive. For example, with the split ring, if the median latency is 3.8ms, and the ulnar latency is 3.2ms, that’s a difference of 0.6 = positive. Otherwise, add…

Farr Healthcare, Inc. – Physiatry Jobs & Physiatry Practice Opportunities

Physiatry Jobs & Physiatry Practice Opportunities

Medical Director, Rehab, Minot

  • Little to no competition • Built-in referral sources with the hospital’s employed doctor arrangement • Experienced therapy team Location: North central ND, 2 hours from Bismarck, 4 hours to Fargo, ½ hour to the MT border Population: 56,000 (city), 100,000 (area) Practice Features: • 20-bed, 14-year-old rehab unit at the only hospital in the […]

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Inpatient/outpatient academic practice opportunity, Rochester

The position can be an academic or clinical track. 1) Cover assigned 10 inpatients on average 2). Admit an average of 1-3 patients per day. 3) On-call responsibilities one week day per week and one full weekend per month (weekend coverage defined as from Friday at 5:00 p.m. until Monday at 8:30 a.m.), with sharing […]

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Post-acute work, northern NJ

  • Physiatry group practice that services multiple post-acute care sites in northern NJ • Forward-thinking group that is primed for continued and future success, e.g. utilizes cloud=based EMG’s and practice management software that measures and quantifies the value brought to the patient • This practice values excellence in patient care and site engagement, a work/life […]

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How much do you want to make?

How much do you want to make? What is your desired compensation? These are typical interview questions. Should you dodge the question or answer it? Dodging the question gives you the ability to not be pegholed into a salary by your new employment. Answering the question may suit your personality style more by being direct. […]

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Medical Director, Rehab practice opportunity, near Hot Springs

Facility Features: Newly operational 40-bed rehab hospital that is a joint venture with St. Vincent’s Hospital. HealthSouth acquired a physician surgical hospital and has converted it into a rehab hospital. Responsibility: Inpatient/outpatient work, caseload of approximately 20 patients Affiliation: Independent contractor with HealthSouth Compensation: 0,000 stipend plus professional receipts Candidate Qualifications: Board Certified/Qualified physiatrist with […]

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Why is the New Hire Not Working out?

Sometimes you think you do everything right when recruiting a doctor and then it doesn’t turn out. How could that be after all the time and effort you put into the process? You aren’t alone. Why does this happen? There are a few possible reasons for this unfortunate outcome for both parties. Perhaps you didn’t […]

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