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OBJECTIVE: To assess the prevalence of benign paroxysmal positional vertigo (BPPV) in traumatic brain injury population. STUDY DESIGN: In this cross-sectional design, each subject completed screening for BPPV, which included subjective questioning and positional testing. Subjects were asked if they experienced dizziness with bed mobility. All were tested with the Dix-Hallpike and the roll test to determine if nystagmus consistent with BPPV was present. SETTING: Brain injury inpatient rehabilitation unit. PARTICIPANTS: Subjects admitted to the rehabilitation unit during a 6-month time frame who had a traumatic mechanism of brain injury or experienced a fall resulting from a neurologic event. INTERVENTIONS: Diagnostic interventions included the Dix-Hallpike and roll tests. MAIN MEASURES: The primary outcomes of this study were the prevalence of BPPV and symptom reports. RESULTS: Seventy-six subjects met the inclusion criteria. Three subjects were transferred to acute care before screening for BPPV could be completed. Of the 73 subjects who completed the screening process, 42 (58%) tested positive for BPPV, of which only 7 (10%) reported subjective symptoms of dizziness and/or vertigo. χ2 Analysis of the two screening methods demonstrated a statistically significant difference in the positivity rate between tests (χ21 = 5.715, p = 0.017, Cohen's W = 0.279). If subjects responded yes to both screening questions, they were significantly more likely to test positive for BPPV with a moderate effect size of 0.279. CONCLUSION: There was a high prevalence of BPPV within an inpatient rehabilitation facility in subjects with traumatic brain injury, with a small percentage of patients reporting dizziness with subjective questioning.

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Second impact syndrome (SIS) is an uncommon, but devastating sports-related structural brain injury that results from a second head injury before complete recovery from an initial concussion. The pathophysiology of second impact syndrome is poorly understood, but is hypothesized to involve loss of autoregulation, diffuse cerebral edema, with progression to rapid brain herniation syndromes. Here, we present a case of second impact syndrome in an adolescent high school football player who experienced acute brain herniation and coma. Following stabilization, the patient underwent comprehensive, multidisciplinary rehabilitation in order to achieve significant recovery. A narrative detailing the patient's recovery from one-year post-injury is reviewed.

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BACKGROUND: Hodgkin lymphoma (HL) is highly curable, but survivors often develop function-limiting impairments. Screening guidelines for neuromuscular and musculoskeletal late effects are not as well recognized across medical disciplines. Early identification and management of functional late effects are instrumental in improving the longitudinal care of HL survivors. OBJECTIVE: To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life (QOL) in HL survivors. DESIGN: A retrospective cohort analysis. SETTING: Outpatient cancer rehabilitation clinic. PARTICIPANTS: One hundred HL survivors. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects contributing to functional impairment and disability in HL survivors. RESULTS: Among the 100 HL survivors, 43% received chemotherapy, 94% radiation therapy, and 38% a combination of chemo-radiation for their initial cancer treatment. Nearly all HL survivors were diagnosed with myelopathy (83%), radiculoplexopathy (93%), mononeuropathy (95%), and localized myopathy (93%). Musculoskeletal sequelae included dropped head syndrome (83%), cervicalgia (79%), shoulder girdle dysfunction (73%), and dysphagia (42%). Visceral disorders included cardiovascular (70%), pulmonary (44%), endocrine (63%), gastrointestinal (29%), and genitourinary (11%) dysfunction. Lymphedema affected 21% of survivors and 30% had a history of a secondary malignancy. Pain (71%), fatigue (45%), and dyspnea (43%) were major function-limiting impairments. Nearly all (95%) of survivors were referred to at least one therapy discipline including physical therapy, occupational therapy, speech and language pathology, and/or lymphedema therapy. CONCLUSION: Neuromuscular, musculoskeletal, visceral, oncologic, and other late effects are extremely common in HL survivors seeking physiatric evaluation. Multiple function-limiting disorders can coexist in HL survivors with the potential to severely compromise function and QOL. Safe and effective rehabilitation may depend on the physiatrist's ability to identify, evaluate, and manage the multitude of complex and often interrelated functional late effects seen in HL survivors.

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Objective: To provide a proof-of-concept for a novel stroke-gait-specific augmented reality (AR)-guided treadmill intervention by evaluating its effect on temporospatial and functional outcomes of mobility.Methods: Two females with hemiplegia post stroke were recruited for participation in a 4-week intervention, and a single healthy control was recruited for baseline comparisons. The stroke-intervention (SI) participant (aged 54-years), completed 12 sessions of AR-guided treadmill intervention. The stroke-control (SC) participant (aged 59-years) completed 12 sessions of conventional treadmill intervention. Temporospatial and functional mobility were assessed pre-intervention, post-intervention, and at 1-month follow-up. Physical ACtivity Enjoyment Scale (PACES) was administered post-intervention.Results: The SI participant showed clinically meaningful improvements in functional outcomes post-intervention and at 1-month follow-up (Berg balance score (BBS): +6 and +10 points; Dynamic Gait Index (DGI): +2 at post-intervention only; walking speed: +0.19 and +0.24 m/s; 6-minute walk test (6MWT): +51.9 and +38.9) respectively. The SC showed clinically meaningful improvements in BBS (+3 and +3) and walking speed (+0.06 at post-intervention). The PACES scores showed that the SI participant had a significantly higher (23 points) enjoyment level during the intervention compared to the SC participant. The SI participant was more asymmetric compared to the SC participant at pre and post-intervention visits.Conclusions: The SI participant showed greater improvement in functional assessments compared to the SC participant post intervention. The AR-guided approach may have added benefits compared to traditional treadmill training, while providing better customization, patient enjoyment, and engagement. Further investigation with a larger sample is warranted.

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Studies have shown that physical medicine and rehabilitation residents have poor surface anatomy palpation accuracy, suggesting that new methods of teaching musculoskeletal (MSK) examination need to be found. This study describes the design of a novel MSK ultrasound course that integrated ultrasonography skills with palpation skills. Ultrasound was used to teach, validate, and refine physical medicine and rehabilitation residents' palpation of MSK structures. Surface anatomy palpation is intimately related to ultrasonography as clinicians should use palpation to guide their ultrasound examination rather than purely follow an algorithm. This study assessed whether the ultrasound course improved physical medicine and rehabilitation resident palpation accuracy at 12 upper limb structures. Palpation accuracy was tested at the beginning of their residency training and retested several weeks after completion of the ultrasound course's upper limb component, to assess retention of skill. There was significant improvement (P < 0.05) in 9 of 12 sites from pretesting to posttesting. Mean postcourse palpation accuracy was within 1 cm for 8 of 12 structures. This study demonstrates that an integrated MSK ultrasound and palpation curriculum improves palpation accuracy at multiple MSK structures and this improvement is retained. Physical medicine and rehabilitation residencies should consider integrating palpation skills into their ultrasound curriculum to improve the caliber of their trainees.

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OBJECTIVE: The objective of this paper was to propose an algorithm for approaching hypertensive hemodialysis patients admitted to the hospital for hypertensive urgency. METHODS: A literature search was conducted using PubMed (Medline). Articles selected were limited to humans and the English language. RESULTS: WE IDENTIFIED EIGHT MANAGEMENT MODALITIES INCLUDING: short-daily and nocturnal dialysis, sodium restriction, sodium profiling, antihypertensive medications, sympathetic denervation, bilateral nephrectomy, and bioimpedance spectroscopy. The benefits and drawbacks of each were investigated and discussed before implementation into the algorithm. DISCUSSION: The algorithm presented suggests a linear approach to patient care, but treatment modalities may not be mutually exclusive, and additional factors, such as patient compliance and individual health status, should be taken into account to provide patients with optimum care.