The Accreditation Council for Graduate Medical Education (ACGME) residency review committee (RC) for physical medicine and rehabilitation (PM&R) has significantly revised the core competency criteria for electrodiagnostic medicine (EDM). In particular, the number of consultative clinical encounters both performed and observed has been dramatically reduced in total by 25% from 200 to 150. It is concerning that this reduction in patient encounters may negatively impact not only the practical skill set of the newly certified physiatrist but also core foundational knowledge underpinning EDM. Further, the revised EDM core competency criteria have multiple short and long-term unintended clinical practice and reimbursement consequences to both newly certified physiatrists as well as the field of PM&R.

A 56-year-old female presented to her primary care physician (PCP) with years of a chronic right-sided abdominal mass. Initial imaging with an abdominal computed tomography (CT) did not reveal a true hernia but did show significant abdominal muscle wasting, causing outpouching of her abdominal wall. General surgery was consulted and noted a lack of response of the abdominal musculature on the right side when asked to brace her abdomen, prompting referral to physiatry to evaluate a potential neuromuscular source of the mass. Physical examination revealed a protuberant abdomen on the right greater than the left, anteriorly rounded shoulders, and raised scapulae bilaterally. Electrodiagnostic studies (EDX) revealed scattered atypical myotonic discharges and low-amplitude motor unit potentials (MUPs). While these findings were not specific to facioscapulohumeral dystrophy type 1 (FSHD1), her clinical picture prompted genetic testing elucidating a contraction in the D4Z4 gene, consistent with FSHD1. The patient had been managing with supportive therapies, including an abdominal truss. While abdominal weakness is a common feature of FSHD1, it is rarely the main presenting feature. Knowledge of the highly variable and asymmetrical presentations of this disorder may allow a more timely diagnosis and better prognosis while avoiding unnecessary testing.

Regenerative rehabilitation combines rehabilitation science with regenerative medicine approaches to achieve synergistic and more effective outcomes. Within the field of regenerative medicine, there has been a growing number of cell and gene therapies (CGTs) that are either approved for clinical use or actively undergoing clinical trials. Many of these therapies-especially those targeting neurological and musculoskeletal disorders-use functional outcomes as primary or secondary endpoints, prompting discussion about how physical medicine and rehabilitation (PM&R) physicians can support the integration of CGTs into clinical care. In this perspective article, we explain why physicians specializing in PM&R could take a leading role in advancing the clinical translation of CGTs. Currently, CGTs are not confined to a single medical specialty, presenting a timely opportunity for PM&R-working collaboratively with neurology, hematology, and other disciplines-to assume greater leadership and influence the development and implementation of these transformative treatments. To our knowledge, this is the first publication within PM&R literature to emphasize the importance of our specialty serving as a leader and driving force in the adoption of these therapies.