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The COVID-19 global pandemic has resulted in significant changes to delivery of care in the field of physiatry. Most prominently, in-person visits have fast tracked to virtual visits. As we are forced to quickly adopt this new technology for our doctor-patient interactions, many questions remain with regard to structuring telemedicine visits for optimal outcomes. Little has been written on virtual evaluations of patients with spasticity. The intent of this article was to provide a framework for conducting a virtual spasticity assessment via telemedicine. We will provide tips on how to conduct a person-centered virtual examination assessment and how to document goals related to the virtual assessment.

Entrustable professional activities have emerged as a means for the evaluation of resident competency that is expressed in terms of the assessed need for supervision. Recently, 19 physical medicine and rehabilitation-specific entrustable professional activities were published (Am J Phys Med Rehabil. 2017;96:762-764). The electrodiagnostic entrustable professional activity and six new electrodiagnostic entrustable professional activities subcategories (observable practice activities) were piloted as an entrustable professional activities/observable practice activities set within five residency programs. Survey-based (quantitative) and open-ended (qualitative) feedback was collected from participants. Participating attendings found this method feasible and generally reported satisfaction with the entrustable professional activities/observable practice activities as a means of providing feedback to residents. Residents were less clear on the added value of this approach. Qualitative data supported the need for adjustments to the entrustment scale to allow for more gradations within supervisory levels, a standardized orientation of residents to the use of observable practice activities and an increased quantity of assessments for each observable practice activities category to allow for demonstration of resident progress toward independence. Use of the electrodiagnostic entrustable professional activity/observable practice activities set shows promise as a means for observational competency assessment in the outpatient setting. However, feedback acquired through this pilot study suggests changes that could be made to improve future implementation.

This consensus paper is derived from a meeting of an international group of 19 neurological rehabilitation specialists with a combined experience of more than 250 years (range 4-25 years; average 14.1 years) in treating post-stroke spasticity with botulinum toxin A. The group undertook critical assessments of some recurring practical challenges, not yet addressed in guidelines, through an extensive literature search. They then discussed the results in the light of their individual clinical experience and developed consensus statements to present to the wider community who treat such patients. The analysis provides a comprehensive overview of treatment with botulinum toxin A, including the use of adjunctive therapies, within a multidisciplinary context, and is aimed at practicing clinicians who treat patients with post-stroke spasticity and require further practical guidance on the use of botulinum toxin A. This paper does not replicate information published elsewhere, but, instead, aims to provide practical advice to help optimize the use of botulinum toxin A and maximize clinical outcomes. The recommendations for each topic are summarized in a series of statements. Where published high-quality evidence exists, the recommendations reflect this; however, where evidence is not yet conclusive, the group members issued statements and, in some cases, made recommendations based on their clinical experience.

Purpose To observe the relative change in foot-strike pattern, pressure characteristics, surface electromyography (sEMG) recordings, and stride characteristics in forefoot strike runners wearing both minimalist and traditional shoes during a 50-km run. Methods Four experienced minimalist runners were enrolled in this study. Each runner ran a 50-km simulated run in both minimalist shoes and traditional shoes. Pressure data, sEMG recordings, and limited 3D motion capture data were collected during the initial 0.8 km and final 0.8 km for each trial. Results Three runners in the traditional shoe type condition and one runner in the minimalist shoe type condition demonstrated a more posterior initial contact area (midfoot strike (MFS) pattern) after the 50-km run, which was supported by increased activity of the tibialis anterior in the pre-contact phase (as per root mean square (RMS) values). In addition, in both pre- and post-run conditions, there were increased peak pressures in the minimalist shoe type, specifically in the medial forefoot. Muscle fatigue as defined by a decreased median frequency observed in isometric, constant force contractions did not correspond with our hypothesis in relation to the observed foot strike change pattern. Finally, step rate increased and step length decreased after the 50-km run in both shoe type conditions. Conclusion More runners adopted a more posterior initial contact area after the 50-km run in the traditional shoe type than in the minimalist shoe type. The runners who adopted a more posterior initial contact area were more closely associated with an increased median frequency of the medial gastrocnemius, which suggests there may be a change in motor unit recruitment pattern during long-distance, sustained velocity running. The increased peak pressures observed in the medial forefoot in the minimalist shoe type may predispose to metatarsal stress fractures in the setting of improper training.

Objective To determine the prevalence of prostate cancer in patients with chronic spinal cord injury (SCI), with regard to the duration, level, and severity of injury. Design Retrospective chart review study. Setting Inpatient and outpatient Veterans Affairs spinal cord unit. Participants The electronic medical records of 350 veterans with chronic SCI and 344 veterans without SCI as a control group were reviewed. Main Outcome Measure Prevalence of prostate cancer in patients with chronic SCI with regard to the duration, level, and severity of injury. Results Of 350 veterans with chronic SCI, 7 individuals (2%) had prostate cancer. In comparison, of 344 age-matched veterans without SCI, 18 (5.2%) had prostate cancer. In SCI group with prostate cancer, 2 patients had motor complete injury (American Spinal Cord Injury Association Impairment Scale [AIS] A and B), and 5 patients had motor incomplete injury (AIS C, D, and E). Patients with SCI and with prostate cancer were slightly older (mean [SD] age, 72.14 ± 8.25 years) than the control group (mean [SD] age, 69.83 ± 8.79 years) with cancer. Conclusion Findings from this study indicate a lower prevalence of prostate cancer among veterans with chronic SCI in comparison with age-matched veterans without SCI. Given the small number of patients with SCI and with prostate cancer in this study, we did not find any statistically significant correlation between the prevalence of prostate cancer and the level, duration, and severity of injury.