A Conversation Between Past and Present Chairs of the American Board of Physical Medicine and Rehabilitation: Four Decades of History and the Future of Board Certification.

On the 75th anniversary of the founding of the American Board of Physical Medicine and Rehabilitation, 11 of the surviving chairs of the board convened virtually to reflect on the past 40 years of major trends for the accrediting body of physiatrists. The field rapidly expanded in the 1980s, driven by changes in the reimbursement environment. This rapid expansion drove an improvement in the caliber of residents choosing the field and in the quality of training programs.

Spinal cord injured women's treatment of breast carcinoma: alert to complications.

Introduction: Women with spinal cord injury (SCI) and who develop breast cancer are a vulnerable and potentially overlooked population. They experience risk factors owing to decreased mobility and are at risk for unique complications from their oncologic treatment.

Case Presentation: A 54-year-old woman who suffered a T6 AIS A traumatic SCI in 1981, who was diagnosed 32 years later with estrogen receptor and progesterone receptor positive and human epidermal growth factor receptor 2-negative invasive ductal carcinoma.

Linking spinal cord injury rehabilitation between the World Wars: The R. Tait McKenzie legacy.

Spinal cord injury (SCI) medicine emerged after World War II due to mass casualties, which required specialized treatment centers. This approach to categorical care, however, was first developed during World War I, led by pioneers R. Tait McKenzie and George Deaver, who demonstrated that soldiers disabled by paralysis could return to society through fitness/mobility, recreational and vocational training.

Franklin Delano Roosevelt: The Diagnosis of Poliomyelitis Revisited.

Revisiting the ailments of famous historical persons in light of contemporary medical understanding has become a common academic hobby. Public discussion of Franklin Delano Roosevelt's (FDR) diagnosis of poliomyelitis after his sudden onset of paralysis in 1921 has received just such a revisitation. Recently, this 2003 historical analysis has been referenced widely on the Internet and in biographies, raising speculation that his actual diagnosis should have been Guillain-Barré Syndrome, a noncontagious disease of the peripheral nervous system rather than poliomyelitis.

Influence of Age Alone, and Age Combined With Pinprick, on Recovery of Walking Function in Motor Complete, Sensory Incomplete Spinal Cord Injury.

Objective: To determine if age, pinprick scores in the lower extremities, and neurologic severity of injury influence recovery of ambulation in persons with motor complete, sensory incomplete (American Spinal Injury Association Impairment Scale [AIS] grade B) spinal cord injury (SCI) 1 year after initial injury.

Design: This retrospective analysis examined subjects with AIS grade B from the Spinal Cord Injury Model System (SCIMS) database from 2006 to 2015. The baseline neurologic examination at rehabilitation admission (2-4wk postinjury) was used for comparison with 1-year outcome measures of locomotion.

Advances in the rehabilitation management of acute spinal cord injury.

Aggressive assessment and management of the secondary complications in the hours and days following spinal cord injury (SCI) leads to restoration of function in patients through intervention by a team of rehabilitation professionals. The recent certification of SCI physicians, newly validated assessments of impairment and function measures, and international databases agreed upon by SCI experts should lead to documentation of improved rehabilitation care. This chapter highlights recent advances in assessment and treatment based on evidence-based classification of literature reviews and expert opinion in the acute phase of SCI.

A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study.

Background: Traumatic spinal cord injury is a serious disorder in which early prediction of ambulation is important to counsel patients and to plan rehabilitation. We developed a reliable, validated prediction rule to assess a patient's chances of walking independently after such injury.

Methods: We undertook a longitudinal cohort study of adult patients with traumatic spinal cord injury, with early (within the first 15 days after injury) and late (1-year follow-up) clinical examinations, who were admitted to one of 19 European centres between July, 2001, and June, 2008.

The reproducibility and convergent validity of the walking index for spinal cord injury (WISCI) in chronic spinal cord injury.

Background: The Walking Index for Spinal Cord Injury II (WISCI II) is a hierarchical scale that measures improvements in walking following spinal cord injury (SCI). The WISCI II has good face validity, concurrent validity, and reliability following acute SCI; however, psychometric properties need to be determined for chronic SCI. Because prior studies have demonstrated a relationship between lower-extremity motor scores (LEMS) and walking, outcome measures for walking should demonstrate a linkage between the underlying impairment (weakness) and walking-convergent validity.

Walking index for spinal cord injury version 2 (WISCI-II) with repeatability of the 10-m walk time: Inter- and intrarater reliabilities.

Objective: To demonstrate the inter-/intrarater reliability of the Walking Index for Spinal Cord Injury version 2 scale and the repeatability of the time to walk 10 m in chronic subjects.

Design: In this reliability study, 26 subjects from the United States and Italy with spinal cord injury/disorder were tested by two blinded raters on two separate days to determine self-selected and maximum Walking Index for Spinal Cord Injury levels and the time to complete a 10-m walk. Subjects were progressed from self-selected to maximum Walking Index for Spinal Cord Injury incrementally until they failed the higher level.

Outcome measures for gait and ambulation in the spinal cord injury population.

Background: At the 2006 National Institute on Disability and Rehabilitation Research (NIDRR) sponsored pre-conference on spinal cord injury (SCI) outcomes, several gait and ambulation measures were evaluated for utility in clinical practice, validity, and reliability as research measurement tools. The Conference Subcommittee on Gait and Ambulation chose to review the Walking Index for Spinal Cord Injury II (WISCI II), 50-Foot Walk Test (50FTWT), 6-Minute Walk Test (6MWT), 10-Meter Walk Test (10MWT), and Functional Independence Measure-Locomotor (FIM-L).

Methods: A subcommittee of international experts evaluated each instrument for test construct, administration, population applicability, reliability, sensitivity to change, and validity.

Clinical relevance of gait research applied to clinical trials in spinal cord injury.

The restoration of walking function following SCI is extremely important to consumers and has stimulated a response of new treatments by scientists, the pharmaceutical industry and clinical entrepreneurs. Several of the proposed interventions: (1) the use of functional electrical stimulation (FES) and (2) locomotor training have been examined in clinical trials and recent reviews of the scientific literature. Each of these interventions is based on research of human locomotion.

Functional recovery measures for spinal cord injury: an evidence-based review for clinical practice and research.

Background/objective: The end goal of clinical care and clinical research involving spinal cord injury (SCI) is to improve the overall ability of persons living with SCI to function on a daily basis. Neurologic recovery does not always translate into functional recovery. Thus, sensitive outcome measures designed to assess functional status relevant to SCI are important to develop.

The assessment of walking capacity using the walking index for spinal cord injury: self-selected versus maximal levels.

Objectives: To assess (1) the frequency and magnitude of differences between self-selected and maximal walking capacity following spinal cord injury (SCI) by using the Walking Index for Spinal Cord Injury (WISCI) and (2) how these levels differ in efficiency and velocity.

Design: Prospective cohort.

Setting: Academic medical center.

Validity of the walking scale for spinal cord injury and other domains of function in a multicenter clinical trial.

Objective: To demonstrate criterion (concurrent and predictive) and construct validity of the Walking Index for Spinal Cord Injury (WISCI) scale and other walking measures in the Spinal Cord Injury Locomotor Trial (SCILT).

Design: Prospective multicenter clinical trial of a walking intervention for patients with acute traumatic spinal cord injury (SCI). PARTICIPANTS/ METHODS: Body weight-supported treadmill training was compared to overground mobility training in 146 patients with incomplete SCI (C4 to L3) enrolled within 8 weeks of onset and treated for 12 weeks.

Plasticity of spinal centers in spinal cord injury patients: new concepts for gait evaluation and training.

Recent data on spinal cord plasticity after spinal cord injury (SCI) were reviewed to analyze the influence of training on the neurophysiological organization of locomotor spinal circuits in SCI patients. In particular, the authors studied the relationship between central pattern generators (CPGs) and motor neuron pool activation during gait. An analysis of the relations between locomotor recovery and compensatory mechanisms focuses on the hierarchical organization of gait parameters and allows characterizing kinematic parameters that are highly stable during different gait conditions and in recovered gait after SCI.

Neurological and functional capacity outcome measures: essential to spinal cord injury clinical trials.

We intend to demonstrate that future treatment strategies in spinal cord injury (SCI) rehabilitation to restore function (SCI rehabilitation) should be based on the success of rigorous clinical trials with demonstrated effective interventions. Knowing the course of neurological recovery, its mechanism, and its measures will be essential in designing and executing these trials. We reviewed selected recovery outcomes and measures from multicenter studies and a large SCI database.