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Background Post-traumatic headaches (PTH) are a common sequelae of traumatic brain injury (TBI) and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain but have a short duration of effect. Platelet-rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this pilot study is to evaluate whether a randomized control trial of PRP for the treatment of GON in patients with post-traumatic headaches is feasible in regard to recruitment, adherence, retention, and adherence and adverse events. Exploratory aims include improvement in pain, function, and quality of life in patients with post-traumatic GON receiving PRP compared to steroid/anesthetic and normal saline injections. Methods Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: (1) autologous PRP injection, (2) steroid/anesthetic injection (standard care), or (3) placebo injection with normal saline. Injections will be performed to the greater occipital nerve under ultrasound guidance by a trained physician. Daily headache intensity and frequency data will be collected pre-injection and for the duration of the study period. Feasibility will be defined as greater than 30% recruitment, 70% completion of intervention, 70% retention, and less than 2 minor adverse events. Exploratory outcomes will be explored using the Headache Impact Test-6 (HIT-6, a valid and reliable 6-item questionnaire for assessment of the impact of headaches across different diagnostic groups of headaches) and the quality of life in following brain injury questionnaire (QOILIBRI). Discussion This pilot study will be the first to evaluate the feasibility of PRP as a potential treatment of GON in patients with post-traumatic headache. Trial registration ClinicalTrials.gov - NCT04051203 (registered August 9, 2019).

Background: Post-traumatic headaches (PTH) are a common sequalae of TBI and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain but have a short duration of effect. Platelet rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this pilot study is to evaluate whether a randomized control trial of PRP for the treatment of GON in patients with post-traumatic headaches is feasible in regard to recruitment, adherence, retention, and adherence and adverse events. Exploratory aims includes improvement in pain, function and quality of life in patients with post-traumatic GON receiving PRP compared to steroid/anesthetic and normal saline injections. Methods: Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: 1) autologous PRP injection 2) steroid/anesthetic injection (standard care) or 3) placebo injection with normal saline. Injections will be performed to the greater occipital nerve under ultrasound guidance by a trained physician. Daily headache intensity and frequency data will be collected pre-injection and for the duration of the study period. Feasibility will be defined as greater than 30% recruitment, 70% completion of intervention, 70% retention and less than 2 minor adverse events. Exploratory outcomes will be explored using the (HIT-6; a valid and reliable 6-item questionnaire for assessment of the impact of headaches across different diagnostic groups of headaches (42, 43)) and the quality of life in following brain injury questionnaire (QOILIBRI). Discussion: This pilot study will be the first to evaluate the feasibility of PRP as a potential treatment of GON in patients with post-traumatic headache. Trial Registration: ClinicalTrials.gov - NCT04051203 (registered August 9, 2019), available at https://clinicaltrials.gov/ct2/show/NCT04051203?cond=greater+occipital+neuralgia&draw=2&rank=1

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. Post-traumatic headaches (PTH) are a common sequalae of TBI and greatly impact patient function and quality of life. Post-traumatic greater occipital neuralgia (GON) is a type of post-traumatic headache. Conventional treatment includes steroid/anesthetic injections which typically alleviate pain, but have a short duration of effect. Platelet rich plasma (PRP) is an emerging biological treatment for numerous degenerative disorders, including peripheral nerve disorders. The primary aim of this study is to evaluate the pain response of a single perineural PRP injection in the treatment of post-traumatic GON.Methods: Thirty adults (over 18 years of age) with post-traumatic GON will be randomized into one of three groups: 1) autologous PRP injection 2) steroid/anesthetic injection (standard care) or 3) placebo injection with normal saline. Injections will be performed to the greater occipital nerve under ultrasound guidance by a trained physician. Daily headache intensity and frequency data will be collected pre-injection and for the duration of the study period. The primary outcome will be the change in headache intensity, as measured by a reduction on the numerical pain rating scale (NPRS) at 3 months post-injection in the PRP group, versus the normal saline and steroid groups. Secondary outcomes will include adverse effects, prn medication usage, and impact on function and quality of life as measured by the Headache Impact Test 6 (HIT-6) and Quality of Life following Brain Injury (QOILIBRI) questionnaires. Discussion: This trial will evaluate the efficacy of PRP injections as a treatment for post-traumatic GON. This research will further our understanding of PTH, GON, and the treatment of peripheral neuralgias.Trial Registration: ClinicalTrials.gov - NCT04051203 (registered August 9, 2019), available at https://clinicaltrials.gov/ct2/show/NCT04051203?cond=greater+occipital+neuralgia&draw=2&rank=1

Objectives: 1) Assess which electrodiagnostic studies Canadian clinicians use to aid in the diagnosis of carpal tunnel syndrome (CTS). 2) Assess whether Canadian clinicians follow the American Association of Neuromuscular & Electrodiagnostic Medicine/American Academy of Neurology/American Academy of Physical Medicine and Rehabilitation Practice Parameter for Electrodiagnostic Studies in CTS. 3) Assess how Canadian clinicians manage CTS once a diagnosis has been established. Methods: In this prospective observational study, an electronic survey was sent to all members of the Canadian Neuromuscular Group (CNMG) and the Canadian Association of Physical Medicine and Rehabilitation (CAPM&R) Neuromuscular Special Interest Group. Questions addressed which electrodiagnostic tests were being routinely used for the diagnosis of carpal tunnel syndrome. Management recommendations for CTS was also explored. Results: Of the 70 individuals who completed the survey, fourteen different nerve conduction study techniques were reported. Overall, 36/70 (51%) of participants followed the AANEM/AAN/AAPM&R Practice Parameter. The standard followed by the fewest of our respondents with 64% compliance (45/70) was the use of a standard distance of 13 to 14 cm with respect to the median sensory nerve conduction study. Regarding management, 99% would recommend splinting in the case of mild CTS. In moderate CTS, splinting was recommended by 91% of clinicians and 68% would also consider referral for surgery. In severe CTS, most recommended surgery (93%). Conclusions: There is considerable variability in terms of which electrodiagnostic tests Canadian clinicians perform for CTS. Canadian clinicians are encouraged to adhere to the AANEM/AAN/AAPM&R Practice Parameter for Electrodiagnostic Studies in CTS.

Objectives To estimate the prevalences of perceived honorary authorship and International Committee of Medical Journal Editors (ICMJE)-defined honorary authorship, and identify factors affecting each rate in the physical medicine and rehabilitation literature. Design Internet-based survey. Setting Not applicable. Participants First authors of articles published in 3 major physical medicine and rehabilitation journals between January 2009 and December 2011 were surveyed in June and July 2012 (N=1182). Interventions Not applicable. Main Outcome Measures The reported prevalences of perceived and ICMJE-defined honorary authorship were the primary outcome measures, and multiple factors were analyzed to determine whether they were associated with these measures. Results The response rate was 27.3% (248/908). The prevalences of perceived and ICMJE-defined honorary authorship were 18.0% (44/244) and 55.2% (137/248), respectively. Factors associated with perceived honorary authorship in the multivariate analysis included the suggestion that an honorary author should be included ( P P =.0019), listing "reviewed manuscript" as 1 of the nonauthorship tasks ( P =.0013), and the most senior author deciding the authorship order ( P =.0469). Living outside North America was independently associated with ICMJE-defined honorary authorship ( P =.0079) in the multivariate analysis. In the univariate analysis, indicating that the most senior author decided authorship order was significantly associated with ICMJE-defined honorary authorship ( P = Conclusions Our results suggest that honorary authorship does occur in a significant proportion of the physical medicine and rehabilitation literature. Additionally, we found several factors associated with perceived and ICMJE-defined honorary authorship and a discrepancy between the 2 rates. Further studies with larger response rates are recommended to further explore this topic.

Pseudoaneurysm formation is a rare but known complication following amputation. We report the clinical and radiological findings in a 45-year-old man who presented with severe residual limb pain 1 month after an elective left transtibial amputation for chronic regional pain syndrome. The pain did not respond to high doses of opioids and prosthetic fitting was delayed. Duplex ultrasound imaging indicated the presence of a pseudoaneurysm in the anterior tibial artery. Pseudoaneurysm embolectomy using wire coils improved pain level and medications were reduced. Pseudoaneurysms can be a cause of intractable severe residual limb pain in patients after transtibial amputation. Treatment may involve embolectomy with wire coils.

Li Pi Shan RS, Chrusch WM, Linassi AG, Sankaran R, Munchinsky J. Reuse and refurbish: a cost savings delivery model for specialized seating. Objectives To describe a unique specialized seating delivery model for children with disabilities that focuses on cost containment and environmental preservation. To determine whether this delivery model achieves cost containment. Design A retrospective cost analysis using data from billing records and annual statistical reports of the specialized seating program, for the 2004 to 2009 billing period. Setting The specialized seating program is a service provided on a referral basis by the Saskatchewan Abilities Council, which is under contract to Saskatchewan Health. Participants Pediatric patients (N=40) with physical disabilities (cerebral palsy, developmental delay, acquired brain injury, spinal cord injury, Down syndrome, other) who were referred, assessed, and met inclusion criteria. Interventions Not applicable. Main Outcome Measure Relative cost (in Canadian dollars) of providing units with recycled components compared with purchasing new units. Results The average cost of a used wheelchair was Can $698.11. The average cost of a new chair was $2143.69, leading to an average savings per chair of $1445.58. Of the 49 chairs issued, this resulted in a total cost savings of $85,393.97. When labor costs were taken into account ($50,060.26), the savings amounted to $35,333.71. Overall cost reduction was 41.3%. Conclusions A retrospective analysis shows evidence of cost containment. Long-term sustainability of the program requires ongoing analysis of the cost and environmental advantages of a recycling program and review of benefits provided in relation to the ability to meet patient needs. This delivery model does incorporate accountability and a policy framework, which could serve as a model for other centers.