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One innovation currently influencing physical medicine and rehabilitation is brain-computer interface (BCI) technology. BCI systems used for motor control record neural activity associated with thoughts, perceptions, and motor intent; decode brain signals into commands for output devices; and perform the user's intended action through an output device. BCI systems used for sensory augmentation transduce environmental stimuli into neural signals interpretable by the central nervous system. Both types of systems have potential for reducing disability by facilitating a user's interaction with the environment. Investigational BCI systems are being used in the rehabilitation setting both as neuroprostheses to replace lost function and as potential plasticity-enhancing therapy tools aimed at accelerating neurorecovery. Populations benefitting from motor and somatosensory BCI systems include those with spinal cord injury, motor neuron disease, limb amputation, and stroke. This article discusses the basic components of BCI for rehabilitation, including recording systems and locations, signal processing and translation algorithms, and external devices controlled through BCI commands. An overview of applications in motor and sensory restoration is provided, along with ethical questions and user perspectives regarding BCI technology.

Exposure to musculoskeletal ultrasound (MSUS) is now a mandatory component of physical medicine and rehabilitation (PMR) residency training. However, reports on the extent of the implementation and efficacy of MSUS education are lacking in the literature.To determine the extent to which PMR residencies are implementing MSUS education.Cross-sectional.Institutional.Thirty-six of the 78 United States PMR residency programs accredited by the Accreditation Council for Graduate Medical Education.All 78 programs were solicited with an online survey via the residency program director and coordinator in July 2014. The 25 questions on the survey were aimed at determining program MSUS educational characteristics and their effectiveness.Description of teaching methods used for MSUS, residency demographics, characteristics of MSUS faculty expertise, and faculty-perceived competency in MSUS examinations and procedures among residents. Data were analyzed using both descriptive statistics and tests for independence to identify correlations between program characteristics and resident MSUS competency.A response was received from 36 of the 78 residency programs (46.2%). Of the 36 residency programs that responded, 97.2% provide exposure to MSUS (a figure that drops to 44.9% when nonrespondents are included); 61% had mandatory MSUS training (28.2% when including nonrespondents); and 44.4% had a formal curriculum (20.5% when including nonrespondents). The most common MSUS educational tools used were lecture (88.9%), outpatient clinic (86.1%), and hands-on workshops (86.1%). Sixty-one percent of responding programs evaluate residents with formal assessment tools. Overall, faculty at 38.8% and 44.4% of programs believed that at least 50% of residents who graduate are competent in diagnostic and interventional MSUS, respectively. These rates were significantly associated with the use of formal assessment.MSUS education is growing in PMR, but many programs still have not adopted a formal educational curriculum. Formal assessment to evaluate resident MSUS skills significantly improves faculty-perceived MSUS competency.

reactions. Results or Clinical Course: Records from 254 consecutive patients were reviewed; 93 patients fulfilled the inclusion criteria. Patients were 16e82 years of age (mean 46.5 years) at the start of treatment and 59.1% were male. Spasticity was mainly due to stroke (40.9%), cerebral palsy (25.8%) or multiple sclerosis (18.3%). Patients had been treated with onabotulinumtoxinA for 3e55 months (mean 16 months) before receiving incobotulinumtoxinA for 7e73 months (mean 39 months). At the last 3 onabotulinumtoxinA treatments, the mean doses administered were 143.3U, 147.2U and 143.9U, given on average 125.2, 141.5 and 194.2 days after the previous injection. At the first 3 incobotulinumtoxinA treatments after switching, patients received mean doses of 156.0U, 140.9U and 136.9U, given on average 163.8, 167.4 and 135.5 days after the previous treatment. No adverse reactions occurred with either BoNT-A formulation. Conclusion: In our spasticity outpatient clinic, switching BoNT-A formulation from onabotulinumtoxinA to incobotulinumtoxinA at a 1:1 unit dose ratio did not affect dose requirements or treatment intervals, indicating that both products were similarly efficacious. Tolerability profiles were also similar, with no adverse reactions recorded for either formulation.