Physical Medicine Research Articles

Shifting the Curve: Mastery Learning to Teach Nerve Conduction Studies in Physical Medicine and Rehabilitation Residency.

Nerve conduction studies are a commonly performed procedure and a core competency for physical medicine and rehabilitation residents. Nerve conduction studies are complex to learn and no standardized training protocols exist across physical medicine and rehabilitation programs. The aims of this study are to standardize training and assessment of resident proficiency in nerve conduction studies skills and to evaluate the impact of an educational intervention on skills development. This was a repeated measures design wherein 36 physical medicine and rehabilitation residents underwent a pretest, followed by a mastery learning-based intervention, including deliberate practice. Residents were then expected to meet or exceed a minimum passing score at posttest. Performance improved from a median score of 4.5/66 on the pretest to a median score of 63/66 on the posttest. Thirty-three of 36 residents achieved the minimum passing score on the first attempt; three residents required additional deliberate practice and met the minimum passing score on the second attempt. A curriculum featuring deliberate practice dramatically increased checklist scores of residents performing nerve conduction studies. This mastery learning program shows a reliable and reproducible method to achieve procedural competency within a physical medicine and rehabilitation residency program and can shift the curve to allow residents to immediately start performing nerve conduction studies at the start of their clinical experience.

Onabotulinum toxin injections for shoulder and chest wall muscle pain in breast cancer survivors: retrospective study – preliminary report

ObjectivesThe primary objective of this retrospective review is to describe patient-reported improvement in muscular pain after initial treatment with onabotulinum toxin. A secondary objective was to determine other physiatry (physical...

A Qualitative Study of Strategies to Improve Occupational Well-being in Physical Medicine and Rehabilitation Physicians.

Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout. The aim of the study is to identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-mo period. We employed two quantitative surveys spaced 6-9 mos apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey time points. These physiatrists were subsequently recruited to participate in a qualitative study using semistructured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment. Online surveys and interviews. Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile. Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges. Our findings illustrate that in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.

A qualitative study of strategies to improve occupational well-being in physical medicine and rehabilitation physicians.

Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout. To identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-month period. We employed two quantitative surveys spaced 6 to 9 months apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey timepoints. These physiatrists were subsequently recruited to participate in a qualitative study using semi-structured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment. Online surveys and interviews. Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile. Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index. One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges. Our findings illustrate that, in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.

Revisions to Accreditation Council for Graduate Medical Education's Program Requirements for Physical Medicine & Rehabilitation: Input From the Tri-Organizational Graduate Medical Education Committee.

Revisions to Accreditation Council for Graduate Medical Education's Program Requirements for Physical Medicine & Rehabilitation: Input From the Tri-Organizational Graduate Medical Education Committee.

Revisions to Accreditation Council for Graduate Medical Education's program requirements for Physical Medicine & Rehabilitation: Input from the Tri-Organizational Graduate Medical Education Committee.

Revisions to Accreditation Council for Graduate Medical Education's program requirements for Physical Medicine & Rehabilitation: Input from the Tri-Organizational Graduate Medical Education Committee.

Collaborative Care for Chronic Pain After Traumatic Brain Injury

Chronic pain after traumatic brain injury (TBI) is prevalent and associated with poor outcomes. By providing multidisciplinary care through expert consultation, a collaborative care (CC) treatment approach may reduce pain interference. To compare CC with usual care (UC) in decreasing pain interference. This randomized clinical trial was conducted from July 2018 through April 2021 at 2 hospital-based academic rehabilitation medicine clinics in Seattle, Washington. Participants included adults with mild-to-severe TBI (at least 6 months before enrollment) and chronic pain. Data analysis was performed from March 30, 2022, to August 30, 2023. The CC intervention (called TBI Care) included up to 12 in-person or telephone visits over 16 weeks with a care manager (CM) who provided person-centered cognitive behavioral treatment. The CM met weekly with members of the expert team to review participants and discuss recommendations to optimize treatment. The primary outcome was pain interference on the Brief Pain Inventory at treatment conclusion (4 months after randomization). Secondary outcomes included pain interference at 8 months; pain severity; symptoms of depression, anxiety, and sleep disturbance; pain-related emergency department visits; community participation; and participant satisfaction. Linear mixed-effects regression was used for analysis. A total of 1379 individuals were screened for eligibility, and 158 were randomized (79 to CC and 79 to UC). The participants were mostly women (92 participants [58%]) with a mean (SD) age of 46.8 (13.2) years and a mean (SD) of 15.3 (3.0) years of education. TBI occurred a mean (SD) of 4.0 (5.9) years (median [IQR], 1.9 [0.8-4.5] years) before enrollment. All TBI severities were included, and of 149 participants for whom TBI severity was known, the majority (97 participants [65%]) had mild TBI. In the CC group, 71 participants (90%) completed at least 11 sessions, and, at 4 months, this group had significantly lower pain interference scores compared with the UC group (mean [SD], 3.46 [2.17] vs 5.03 [2.28]). This difference was maintained at 8 months after randomization, with mean (SD) TBI care pain interference scores of 3.61 (2.22) for CC vs 4.68 (2.51) for UC. At 4 months, there was significantly lower pain severity in the CC group vs UC group (mean [SD] score, 3.63 [1.95] vs 4.90 [1.96]), as well as symptoms of depression (mean [SD] score, 8.07 [5.34] vs 11.31 [6.37]) and anxiety (mean [SD], 6.20 [5.17] vs 9.58 [6.00]). Satisfaction with pain treatment (mean [SD] score, 2.99 [1.23] vs 2.52 [1.25]), clinical care (mean [SD] score, 3.28 [1.00] vs 2.84 [1.26]), and overall health care (mean [SD] score, 3.25 [0.88] vs 2.82 [1.00]) were significantly higher in the CC group vs the UC group; global impression of change was significantly lower in the CC group vs the UC group (mean [SD] score, 2.74 [1.02] vs 3.47 [1.26]) (lower scores denote a better impression of change). In this randomized clinical trial of CC compared with UC for patients with TBI, CC was effective at reducing pain interference and was sustained at 8-month follow-up. Further research is needed to examine the implementation and cost-effectiveness of CC for TBI in other health care settings. ClinicalTrials.gov Identifier: NCT03523923.

The National Competency-Based Catalogue of Learning Objectives for Medicine 2.0 for the subject Physical and Rehabilitative Medicine, Naturopathic Medicine. Consensus of Scientific Medical Societies

The learning objectives in the current cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" have been revised as part of the further development of the National Competency-Based Catalogue of Learning Objectives for Medicine (NKLM) to its new version 2.0. Since the NKLM is designed as an interdisciplinary catalogue, a subject assignment seemed necessary from the point of view of various stakeholders. Thus, the German Association of Scientific Medical Societies (AWMF) and the German medical faculties initiated a subject assignment process. The assignment process for the subject "Physical and Rehabilitative Medicine, Naturopathic Medicine" (PRM-NHV; according to the subject list of the first draft of the planned novel medical license regulations from 2020) is presented in this paper. The AWMF invited its member societies to participate in the assignment of learning objectives of chapters VI, VII, and VIII of the NKLM 2.0 to the individual subjects to which they consider to contribute in teaching. For "PRM-NHV", representatives of the societies for rehabilitation sciences (DGRW), physical and rehabilitation medicine (DGPRM), orthopaedics and traumatology (DGOU), as well as for naturopathy (DGNHK) participated. In a structured consensus process according to the DELPHI methodology, the learning objectives were selected and consented. Subsequently, subject recommendations were made by the AWMF for each learning objective. From the NKLM 2.0, a total of 100 competency-based learning objectives of chapters VII and VIII for the subject "PRM-NHV" were consented by the representatives of the involved societies for presentation on the NKLM 2.0 online platform. In the context of the revision process of medical studies in Germany and under the umbrella of the AWMF and the German medical faculties, a broad consensus of competency-based learning objectives in the subject "PRM-NHV" could be achieved. This provides an important orientation for all medical faculties both for the further development of teaching in the cross-sectional subject "Rehabilitation, Physical Medicine, Naturopathic Medicine" according to the 9th revision of the medical license regulations, which has been valid for twenty years, and for the preparation of the corresponding subjects in the draft bill of the novel license regulations.

Medicaid Acceptance Varies by Physician Seniority and Specialty in California.

Given varied insurance acceptances and differing pay between insurances, our objective was to examine the number of California physicians enrolled in Medicare and Medicaid (Medi-Cal), stratified by specialty and graduation year. Medi-Cal and Medicare providers were extracted from publicly available databases (Centers for Medicare & Medicaid Services and California Health and Human Services) and were subsequently merged into one dataset using National Provider Identifier. From there, we stratified physicians by specialty and graduation year. We found that emergency medicine, radiology, pathology, anesthesiology, general surgery, and internal medicine had the highest percent of Medi-Cal-accepting physicians, whereas dermatology, psychiatry, physical medicine & rehabilitation, and plastic & reconstructive surgery physicians had the lowest. There also appears to be an inverse relationship between acceptance of Medi-Cal and earlier year of graduation (P < 0.05). This study demonstrated striking variability in Medi-Cal acceptance based upon physician years in practice and specialty. Older, experienced physicians, as well as physicians of certain specialties, are less likely to accept Medi-Cal.

Application of Intravenous Laser Irradiation of Blood (ILIB) in Physical Medicine: A Narrative Review

Application of Intravenous Laser Irradiation of Blood (ILIB) in Physical Medicine: A Narrative Review

Breast Cancer Management During the COVID Pandemic.

To explore the impact of COVID-19 among both the newly diagnosed patients and patients under follow-up for breast cancer by focusing on patients' accessibility to management and comparing the distribution of them before and during pandemic. Single-centric retrospective study. Place and Duration of the Study: Departmentof General Surgery and Department of Physical Medicine and Rehabilitation, Atilim University, Medicana International Ankara Hospital, Ankara, Turkiye, from March 2018to 2022. The data were collected to analyse numbers and distributions of physician visits regarding breast cancer. The mean age of patients was 55.98 ± 12.60 years. The percentages of newly diagnosed cases showed similarity (7.37% vs. 9.79%) before and during the pandemic (p = 0.18).The number of imaging studies decreased by 53.33% in patients under follow-up (p = 0.006), despite screening tests showed a similar trend (p = 0.145). General surgery visits marked up (+44.6%), in contrast to plastic surgery visits (-42.04%, p <0.001). Patients' admissions decreased in many COVID-19 related clinics (pulmonology, emergency, internal medicine, and intensive care), but cardiology (+96.59%) and rehabilitation (+75%) admissions increased during the pandemic (p <0.001). The number of medical oncology and radiation oncology visits did not change (p >0.05). Total number of physician visits was similar before and during the pandemic despite the changing distribution. While COVID-19 led to markedly rising trends of surgical, cardiological, and rehabilitative management in patients with breast cancer, falling trends were seen in other specialities except oncology which showed a plateau during two years. The falling trends of visits to pulmonology, emergency, internal medicine, and intensive care clinics may be explained by crowded COVID-19 cases. Breast cancer, COVID-19, Surgery, Oncology, Rehabilitation.

Comparison of Effects of Ultrasound Therapy and Nerve-Gliding Techniques on Patients with Carpal Tunnel Syndrome: A Randomized Clinical Trial.

Carpal tunnel syndrome (CTS) is a common neuropathy caused by pressure on the median nerve in the wrist, affecting 1% to 5% of the population. Treatment options include pharmacologic management, rest, splints, local steroid injections, and physical therapy. Conservative treatments, such as ultrasound therapy and nerve-gliding exercises, can also be effective. This study aimed to compare the effects of ultrasound therapy and nerve-gliding exercises on reducing symptoms, improving hand function, and electrodiagnostic tests in patients with CTS. This randomized clinical trial was conducted on patients with CTS at the specialized physical medicine and rehabilitation clinic at Birjand University of Medical Sciences. The study included 48 patients with CTS, divided into two groups. The ultrasound group received therapy at a frequency of 1 MHz and a current intensity of 1 watt/cm², with each session lasting 5 minutes. The nerve-gliding group underwent 10 sessions of treatment, three times a week. Pain intensity was evaluated using VAS criteria, symptom intensity using the BOSTON Questionnaire, and median nerve latency with EMG-NCS. The study included 48 patients with CTS, divided into two groups. Both groups showed improved severity of symptoms and function scores at the end of the study (P < 0.001). The ultrasound group significantly reduced the sensory and motor median nerve latency scores (P < 0.001 and P = 0.001, respectively), and the pain score diminished significantly in both groups (P < 0.001). Ultrasound and neural-gliding techniques are effective in reducing patients' symptoms and pain intensity in the short term. Additionally, ultrasound can improve electrodiagnostic indicators.

Understanding the factors associated with nurse employment in clinics: Experiences in Taiwan.

The shortage and distribution of nurses affect healthcare access in aging societies. Limited research has explored the nursing workforce in clinics, which is vital for healthcare delivery. This study aimed to investigate the shortage and distribution of nurses in clinics in Taiwan, considering geographical, institutional, and specialty variations. We conducted a cross-sectional analysis of the national nursing workforce in Western medicine clinics in Taiwan using open government data. The nursing practice rate (NPR) was calculated. The ratio of clinics employing nurses (RCN) was determined by calculating the percentage of clinics with nurses in each category. A logistic regression model was fitted to examine the factors associated with nurse employment, including urbanization level and different specialty clinics. Adjusted odds ratios (OR) and 95% CIs were calculated. The study revealed an overall NPR as low as 59.1%, and a decreasing trend with age. Among the 11 706 clinics in the study, nearly a quarter did not employ nurses, with an overall RCN of 72.3%. Urbanization level and clinic specialty were associated with nurse employment ( p < 0.05). After adjusting for urbanization level, the fitted regression model identified the top three specialties as plastic surgery (OR = 11.37, RCN = 96.8%), internal medicine (OR = 1.94, RCN = 84.1%), and orthopedics (OR = 1.89, RCN = 83.6%), while the bottom three were otolaryngology (OR = 0.59, RCN = 61.5%), psychiatry (OR = 0.49, RCN = 57.1%), and rehabilitation medicine (OR = 0.30, RCN = 45.2%). Nurses were more likely to be employed in areas at urbanization level 1 (OR = 1.17), 3 (OR = 1.37), and 6 (OR = 1.48), which represent highly urbanized areas within the urban, suburban, and rural categories, respectively, than in urbanization level 4. Clinics in Taiwan showed nursing shortages and maldistribution, with 72.3% RCN and variations based on urbanization and specialty. These factors may be considered in nursing research conducted in other countries to inform future workforce planning.

The Role of Physical Medicine and Rehabilitation in the Management of Multiple Sclerosis: A Review of the Literature

The progression of multiple sclerosis, whether treated or not, can sooner or later lead to the onset of disability that is not limited to locomotor disorders alone, despite therapeutic advances. Generated by years of relapses, followed by the insidious but continuous onset of motor, sensory, cerebellar, sensory or cognitive deficits, the consequences are physical, psychological and even socio-economic, and include functional rehabilitation, the efficacy of which now seems to be well established. Various types of treatment are available, involving a wide range of healthcare professionals (physiotherapists, occupational therapists, nurses, psychomotor therapists, orthoprosthetists, speech therapists, etc.), coordinated by a doctor specializing in physical medicine and rehabilitation. Programs are usually multidisciplinary, including rehabilitation techniques, functional exercises and even exercise training

Simulation-Based Telemedicine Training Program for Residents in Physical Medicine and Rehabilitation: A Virtual Standardized Patient Activity

Background: The COVID-19 pandemic has ushered in a new era of healthcare delivery, emphasizing the crucial role of telemedicine. This study aimed to address the training needs of physical medicine and rehabilitation (PM&amp;R) residents in telemedicine through an Interactive Virtual Telemedicine training program utilizing standardized patient methodology. Methods: A tailored virtual standardized patient simulation module was developed for PM&amp;R residents. Prior to the training, residents completed pre-training questionnaires. The training consisted of (1) a 2-hour classroom didactic session covering telemedicine strategies for conducting physical examinations and triaging, as well as anticipated challenges. (2) a 2-hour zoom telemedicine simulation training exposed residents to three distinct patient scenarios (sickle cell crisis, acute low back pain, and neurorehabilitation). (3) a three-stage debriefing tool was employed for post-training reflection. Results: Eight PM&amp;R residents, predominantly males, with varying prior exposure to telemedicine, participated in the study. Post-training evaluations indicated that residents overwhelmingly found the simulation-based telemedicine training valuable and worth the didactic time invested. Data analysis demonstrated a significant increase in residents’ knowledge and confidence in telemedicine skills. Discussion: The study’s findings suggest that the telemedicine training program effectively enhanced residents’ understanding and confidence in telemedicine skills. Future research endeavors could involve a larger and more diverse group of residents to further assess training effectiveness and gather a wider array of perspectives on telemedicine. Expanding the use of standardized patients in telemedicine simulation training holds promise for advancing medical education in this evolving healthcare landscape.

Biomechanical and Neuromuscular Insights into Deadlift Variations: Implications for Sports Science, Strength Training, and Rehabilitation

The deadlift is a fundamental exercise in resistance training, essential for the development of overall strength and power. This review synthesizes current research on kinematics and electromyographic (EMG) activity during deadlifts, highlighting the effects of different variations and techniques on performance and muscle activation. Kinematic studies have revealed significant differences in joint angles and movement patterns between conventional and sumo deadlifts, emphasizing the importance of technique and experience in optimizing performance and reducing injury risk. EMG analysis has also revealed distinct muscle activation profiles for key muscles, such as the vastus lateralis, gluteus maximus, and hamstrings, across different deadlift variations. These findings are critical for designing effective, individualized training programs in strength and conditioning, as well as developing targeted rehabilitation and injury prevention strategies in sports medicine. By understanding the biomechanical and neuromuscular dynamics of the deadlift, practitioners can improve performance, minimize injury risk, and tailor interventions to the specific needs of athletes. Thus, this review provides a comprehensive overview of the current understanding of deadlift kinematics and EMG activity, offering valuable insights for optimizing training and rehabilitation protocols.

ANALYSIS OF HEALTHCARE QUALITY: PUBLIC CLINICS AND PRIVATE REHABILITATION CENTERS FROM PATIENTS' PERSPECTIVE

Introduction: Continuous analysis of healthcare quality is crucial to ensure optimal health experiences for patients. In this study, we focus on comparing the quality of care provided between public clinics and private rehabilitation centers, considering the perspective of patients. Objective: To examine the attitudes of the general population towards satisfaction with care provided in private rehabilitation centers compared to public institutions of physical medicine. Materials and methods: In this cross-sectional study conducted in February 2023, 125 participants were surveyed via an online Google Form to gather sociodemographic data and explore perceptions of physical therapy. The subsequent statistical analysis, using Microsoft Excel 2007 and IBM SPSS 23.0, encompassed descriptive and inferential statistics, revealing significant insights into respondents' perspectives and forming the foundation for a comprehensive discussion. Results: Research results indicate higher satisfaction with care provided in private centers compared to public institutions, while simultaneously highlighting issues with the organization of the public sector system. The findings suggest that both types of institutions excel in specific areas, with other areas identified as potential areas for improvement. Conclusion: Based on the analysis of patient perspectives, we conclude that both public clinics and private rehabilitation centers play a pivotal role in providing quality healthcare. While public clinics emphasized their role inaccessibility and comprehensive care, private rehabilitation centers stood out for their personalized approach, prompt patient reception, and utilization of manual techniques. Keywords:healthcare quality analysis, public clinics, private rehabilitation centers, patients' perspective

Construction and Verification of Urinary Tract Infection Prediction Model for Hospitalized Rehabilitation Patients with Spinal Cord Injury

ObjectiveTo explore the influencing factors of urinary tract infection in hospitalized patients with spinal cord injury, and to construct and verify the nomogram prediction model. MethodsThis study is a retrospective cohort study. From January 2017 to March 2022, 558 patients with spinal cord injury admitted to the Department of Rehabilitation Medicine of a tertiary hospital in Anhui Province, China were selected as the research objects, and they were randomly divided into training group (n=390) and verification group (n=168) according to the ratio of 7: 3, and clinical data including socio-demographic characteristics, disease-related data and laboratory examination data were collected. Univariate analysis and multivariate Logistic regression were used to analyze the influencing factors of urinary tract infection in hospitalized patients with spinal cord injury. Based on this, a nomogram prediction model was constructed with the use of R software, and the risk prediction efficiency of the nomogram model was verified by the receiver operating characteristic(ROC) curve and calibration curve. ResultsLogistic regression analysis showed that ASIA-E grade (compared with ASIA-A grade) was an independent protective factor for urinary tract infection in hospitalized patients with spinal cord injury (OR<1, P<0.05), while white blood cell count and indwelling catheter were independent risk factors for urinary tract infection in hospitalized patients with spinal cord injury (OR>1, P<0.05). Based on this, a nomogram risk predictive model for predicting urinary tract infection in hospitalized rehabilitation patients with spinal cord injury was constructed, which was proved to have good predictive efficiency. In the training group and the verification group, the area under the ROC curve(AUC) of the nomogram model is 0.808 and 0.767, and the 95%CI of the AUC of the nomogram in the training group and the verification group is 0.760∼0.856 and 0.688∼0.845, indicating the nomogram model has good discrimination. According to the calibration curve, the prediction probability of the nomogram model and the actual frequency of urinary tract infection in the training group and the verification group are in good consistency, and the results of the Hosmer-Lemeshow bias test also suggest that the nomogram model has good calibration degree in both the training group and the verification group (P=0.329, 0.067). ConclusionASIA classification level, white blood cell count and indwelling catheter are independent influencing factors of urinary tract infection in hospitalized patients with spinal cord injury. The nomogram prediction model based on the above factors can simply and effectively predict the risk of urinary tract infection in hospitalized patients with spinal cord injury, which is helpful for clinical medical staff to identify high-risk groups early and implement prevention, treatment and nursing strategies in time.

Effects of Fu's subcutaneous needling at myofascial trigger points on pain and lumbar mobility in patients with lumbar disc herniation： a randomized controlled trial.

To explore the therapeutic effect of Fu's subcutaneous needling at myofascial trigger points (MTrPs) on pain, lumbar mobility and the quality of life in patients with lumbar disc herniation (LDH), so as to provide clinicians with new ideas and methods in treating LDH. One hundred patients with LDH admitted to department of rehabilitation medicine of the affiliated hospital of Chengdu University of Traditional Chinese Medicine from January 2022 to January 2023 were collected as the subjects, and they were randomly divided into an observation group and a control group, 50 cases in each one. In the observation group, the spreading technique of Fu's subcutaneous needling was delivered at MTrP. In the control group, the routine acupuncture was applied to Shenshu (BL23), Weizhong (BL40) and MTrP. The treatment was given 3 times weekly, for 2 weeks in the two groups. The score of visual analogue scale (VAS) was evaluated before treatment, at the moment after the 1st treatment completion and after 2 weeks of treatment, separately, and the inclinometer was adopted to measure the range of motion (ROM) of the lumbar flexion, extension and lateral flexion. The numbers of MTrPs and their distribution were recorded before treatment and after the completion of a 2-week treatment in the two groups. Before treatment and in 4 weeks of follow-up, using SF-36 scale, the score of the quality of life was evaluated. The incidence of adverse effects was recorded. At the moment of the 1st treatment completion and after 2 weeks of treatment, VAS score and ROM of the lumbar region were significantly improved in comparison with those before treatment in the two groups and the improvement was superior in the observation group compared with the control group (P<0.05, P<0.01). After 2 weeks of treatment, the total number of MTrPs and the counts of MTrPs in each muscle zone were reduced when compared with those before treatment (P<0.05). In the observation group, the total number of MTrPs and numbers of MTrPs in the zones of quadratus lumborum, musculi multifidus and musculi iliocostalis lumborum decreased significantly when compared with the control group (P<0.05), while the difference was not significant in the numbers in the zone of musculi glutaeus medius between the two groups. In 4 weeks of follow-up, the scores of SF-36 scale were improved in comparison with those before treatment in each group and the result in the observation was better (P<0.05). No any adverse events occurred during treatment in the two groups. Fu's subcutaneous needling is effective for reducing the numbers of MTrPs and improving analgesia, ROM of the lumbar region, as well as the long-term quality of life in the patients with LDH.

Adaptation in the spinal cord after stroke: Implications for restoring cortical control over the final common pathway.

Control of voluntary movement is predicated on integration between circuits in the brain and spinal cord. Although damage is often restricted to supraspinal or spinal circuits in cases of neurological injury, both spinal motor neurons and axons linking these cells to the cortical origins of descending motor commands begin showing changes soon after the brain is injured by stroke. The concept of 'transneuronal degeneration' is not new and has been documented in histological, imaging and electrophysiological studies dating back over a century. Taken together, evidence from these studies agrees more with a system attempting to survive rather than one passively surrendering to degeneration. There tends to be at least some preservation of fibres at the brainstem origin and along the spinal course of the descending white matter tracts, even in severe cases. Myelin-associated proteins are observed in the spinal cord years after stroke onset. Spinal motor neurons remain morphometrically unaltered. Skeletal muscle fibres once innervated by neurons that lose their source of trophic input receive collaterals from adjacent neurons, causing spinal motor units to consolidate and increase in size. Although some level of excitability within the distributed brain network mediating voluntary movement is needed to facilitate recovery, minimal structural connectivity between cortical and spinal motor neurons can support meaningful distal limb function. Restoring access to the final common pathway via the descending input that remains in the spinal cord therefore represents a viable target for directed plasticity, particularly in light of recent advances in rehabilitation medicine.