3^rd International Conference and Exhibition on Physical Medicine & Rehabilitation May 18-20, 2015 San Antonio, USA

Rhonda Haley is a Clinical Assistant Professor and Director of Clinical Education in the Doctor of Physical Therapy program at Wheeling Jesuit University in Wheeling, West Virginia, USA and a staff physical therapist for Wheeling Hospital. She is a Clinical Specialist in Geriatric Physical Therapy and a certified Athletic Trainer. Rhonda presented Cardiorespiratory Rehabilitation, an International Training Workshop, at Universidad Autonoma de Yucatan in Merida, Yucatan, Mexico, a concurrent session at the APTA Combined Sections National Conference in San Diego, California, USA, and a research paper roundtable discussion at the 5th International Symposium Service-Learning at Stellenbosch University, Stellenbosch, South Africa.

Background: The prevalence of knee pain has increased substantially over the last 20 years, independent of age and body mass index. Safe, effective, and inexpensive treatments are increasingly desirable due to this rising incidence. Although copper and compression therapies have been researched exclusively, the use of copper therapy in conjunction with compression therapy has not been examined in the literature. Objective: The purpose of this pilot study was to examine the effects of a Tommie Copper knee sleeve on pain, function, and confidence for individuals experiencing chronic knee pain. Methods: Ten subjects who met inclusion criteria were fitted with a Tommie Copper knee sleeve and instructed to wear the sleeve continuously for one week. Baseline and final measurements of pain, function, and confidence were obtained using the Numerical Rating Scale (NRS) and American Physical Therapy Association (APTA) Outpatient Physical Therapy Improvement in Movement Assessment Log (OPTIMAL) form for function and confidence. Results: Dependent t-tests demonstrated a significant difference for pain (P<0.003) and function (P<0.015), indicating improvement after wearing the sleeve for one week. No significance for confidence was found (P<0.150). Conclusion: This pilot study demonstrates the potential for a Tommie Copper knee sleeve to improve subjective ratings for both knee pain and functional abilities for individuals with chronic knee pain and urges additional research to further study the effects of the combination of compression with copper.

Ketki Rana has completed her Bachelors in Physical Therapy at the age of 23 years from Maharashtra University of Health Sciences, India. She was keen to have a deep understanding of joint biomechanics and to study how external and internal forces affect the skeletal system of the human body. She completed her Master’s program in Kinesiology with Biomechanics specialization at the age of 25 years from Texas Woman's University. She gave local paper and posters presentations in her research project. She strongly believes in evidenced based practice and currently working as a Senior Physical Therapist in an orthopedic outpatient clinical setting.

The purpose of this study was to compare the peak moments and peak power at hip, knee and ankle joints between the walk approaches and stand approach. The walk approach included components of level walking and stair walking whereas the stand approach included only stair walking component. Fourteen young, healthy adults (6 males; 8 females) participated in the study. A three step customized stairway with an additional walkway (~2.4m) was used for the motion trials. For both the approaches, the limb striking the second step was lead limb and the limb striking the topmost step (step 1) was trail limb. Walk approach showed a significantly higher hip abductor moment (p=0.006), knee extensor moment (p=0.049) and knee eccentric power (p=0.003) for the trail limb during controlled lowering phase compared to stand approach. No significant difference was found in any variable for the lead limb between the two approaches. The results imply that the effects of velocity during stair descent initiation from a walk approach diminish on the second step and maximum balance control occurs when transitioning from level walk to stair walk. This study highlights the necessary adjustments made by the healthy young adults to achieve a safe stair descent, which might help reduce the risk of fall in older adults.

Jan Willem Ek studied medicine at the Erasmus University of Rotterdam. In the same place he specialized as general practitioner. As well as general practitioner, he worked several years at the University of Amsterdam and Groningen as coach and teacher. After he was confronted by accident with a treatment that seemed successful for long lasting CRPS type 1, he studied this syndrome and got interested in pain, especially chronic pain, in general. This resulted in a publication and a job at the rehabilitation department of the Bethesda Hospital in Hoogeveen.

Introduction: In 2009 a treatment directed at the function while neglecting the pain showed good results for patients with longstanding complex regional pain syndrome type 1 (also shown on a poster). The therapy was named Pain Exposure Physical Therapy (PEPT). The aim of this study is to investigate if the results remained, improved or declined. Patients and Methods: Patients (199) treated with PEPT in the period 2003-2006 at the Bethesda Hospital in Hoogeveen were approached by mail and invited to participate in this follow-up investigation. For patients visiting the clinic with CRPS type 1 of the leg we used speed and walking distance as measurements and for patients with CRPS of the arm we used the RST. For both groups we used a VAS for functionality. For the patients we interviewed by telephone we used a NRS for functionality. All patients were asked if they had improved, declined or had not changed since the last appointment. Results: 146 patients participated in the study. Seventy-nine visited the clinic and sixty-seven were interviewed by telephone. The functionality (VAS) of the patients that visited the clinic improved from 15.4 at T1 to 67.5 at T2 and 80.9 at T3. The patients interviewed by telephone also improved: 3.1, 5.7 and 6.79 (NRS). Conclusions: The present follow-up study shows that the improvement in almost all cases is stable and even progresses by daily use and practice.

Kristi Hallisy, PT, DSc, OCS, CMPT is an Assistant Professor at the University of WI-Madison Doctor of Physical Therapy Program. Her teaching responsibilities include musculoskeletal coursework, health promotion and wellness, orthotics and prosthetics. She received a Bachelor of Science degree in Physical Therapy from the University of Wisconsin-Madison (1984), a Master of Science in Kinesiology from the University of Michigan-Ann Arbor (1992) and a Doctorate of Science in Physical Therapy from Andrews University in Berrien Springs, Michigan (2011). Her clinical appointment includes patient care at University Health Services (student health) and professional staff development at UW-Health Princeton Club East Outpatient PT Clinic. She serves as a faculty member, instructor and Director of Mentoring for the Post-Professional Orthopaedic Clinical Residency Program offered at the UW-Health and Meriter hospitals. She provides service to the Wisconsin Physical Therapy Association (WPTA) as a member of the WPTA Board of Directors, Co-Chair of the Health Promotion and Wellness Committee and special liaison to the WPTA Continuing Education Committee.

Chronic low back pain (cLBP) is a complex, multi-factorial condition that despite research efforts and innovative interventions remains a prevalent, disabling and costly challenge.1 Factors that play into cLBP include age, gender, location and cause of symptoms, co-morbidities, physical fitness, cultural beliefs, and socioeconomic, legal and psychological factors.1-3 This case study(poster) illustrates a specific mind-body intervention, the Tai Chi Fundamentals(TCF) training program,4as a potential intervention to address the complex multi-faceted problems associated with cLBP.

Tripti R A Gyan completed her BSc (Hons) and MSc in Physiotherapy at Coventry University in the UK. She has over 18 years’ clinical experience, including 12 years in private practice. She was a member of the Physiotherapy Team at the London 2012 Olympic Games, the 2014 Commonwealth Games in Scotland and is hoping to be part of the 2016 Medical Team at the Rio 2016 Olympics. She is committed to raising the profile of the Physiotherapy profession, and enjoys collaborating with her international colleagues.

It is well known fact that we now live in an aging population where people are working for longer. Patients want to recover from their injuries quickly, improve their strength, flexibility and fitness levels, and function at a higher level to meet their daily demands. As private practice physiotherapists, we have an ethical obligation to meet our clients’ needs. As business owners we need to achieve that profitably by customizing our service provision to meet the expectations of our clients. Creating a positive experience for all those who walk through our clinic doors will develop an organizational culture where patients feel appreciated and valued, and will in turn be walking billboards for our practice and our profession. At the core of each physiotherapy practice will be a manager who needs the confidence in leadership to streamline the business operations behind the provision of a high value physiotherapy service. Transparency, client engagement and strategic collaboration with fellow professionals in the field are key elements of running a successful business. Further, the wise practice manager will be able to skillfully adjust the business goals and objectives amidst a changing political atmosphere and socioeconomic climate. Financial knowledge incorporating scenario planning and additional revenue channels will serve to ensure that every practice remains profitable with loyal clients at its core.

Carolyn McMakin developed Frequency Specific Microcurrent (FSM) in 1996. She has a part-time clinical practice and does Clinical Research and Teaches FSM seminars in the US and abroad. She consults with and treats professional teams and elite athletes. She has lectured at the National Institutes of Health and at conferences on fibromyalgia and the differential diagnosis and treatment of chronic pain syndromes. She has authored seven peer-reviewed articles, four book chapters and two abstracts in the areas of chronic pain and differential diagnosis. Her textbook, “Frequency Specific Microcurrent in Pain Management” was published by Elsevier in 2010.

Purpose: Patients who have Fibromyalgia syndrome (FMS) associated with spine trauma have moderate to severe pain levels and distinct pain descriptors and physical examination findings. Currently there is no effective treatment for this type of fibromyalgia. Microamperage current provides physiologic current flow and has been used in the treatment of pain syndromes. Two frequencies, 40 Hz and 10 Hz were observed to reduce pain in FMS associated with spine trauma. This retrospective analysis of patients receiving microcurrent treatment for FMS associated with spine trauma uses subjective pain scores as a primary outcome measure. Accompanying changes in inflammatory cytokines are examined in a subgroup of the same patient population to test the hypothesis that microcurrent treatment using two specific frequencies produces substantial measurable objective and subjective outcomes supporting the efficacy of this treatment. Methods: A total of 54 consecutive patients meeting the ACR diagnostic criteria for fibromyalgia were treated with two frequencies, 40Hz and 10Hz on a two channel microamperage current device. Blood samples on a subset of six patients were analyzed using a recycling immune affinity chromatography system to identify objective changes accompanying subjective pain scores. Results: Five patients did not tolerate treatment. The remaining 49 patients reported reduction in pain on a 10-point visual analog scale (VAS) from an average baseline score of 7.3±1.2 to 1.3±1.1 with the first treatment (P<0.0001). Thirty-one patients reported symptomatic relief from fibromyalgia following an average of 8 treatments. Median time to improvement was 2 months and the actuarial recovery curve reached 100% at 4.5 months. Interleukin-1, Interleukin-6 and substance P levels were all reduced from 330 pg/ml to 80 pg/ml (p=0.004) from 239 pg/ml to 76 pg/ml (p=0.0008) and from 180 pg/ml to 54 pg/ml (p=0.0001) respectively in the first 90-minute treatment. Tumor Necrosis Factor (TNF-a) was also reduced from 305 pg/ml to 78 pg/ml (p=0.002). During the same time period, beta-endorphin and cortisol both increased from an average of 8.2 pg/ml to 71.1 pg/ml (p=0.003) and 14.7 mg/ml to 105.3 mg/ml (p=0.03) respectively. Conclusions: In a retrospective study based on analysis of subjective VAS pain scores for 54 patients, symptoms of fibromyalgia associated with spine trauma were successfully treated with two specific frequencies, 40Hz and 10Hz and microamperage current. In a sub group of the same patients, subjective pain improvement scores were accompanied by substantial reduction in serum levels of the inflammatory cytokines IL-1, IL-6 and TNF-a and the neuropeptide substance P. Beta-endorphin release and increases in serum cortisol were also observed in these patients during the same treatment period. The subjective outcomes scores and changes in biological markers for pain and pro-inflammatory cytokines observed in response to this treatment protocol are important preliminary findings. Based on the observations reported in this analysis, controlled prospective clinical studies to evaluate the clinical efficacy of microcurrent treatment of FMS associated with cervical spine trauma are warranted.

Jan Willem Ek studied medicine at the Erasmus University of Rotterdam. In the same place he specialized as general practitioner. As well as general practitioner, he worked several years at the University of Amsterdam and Groningen as coach and teacher. After he was confronted by accident with a treatment that seemed successful for long lasting CRPS type 1, he studied this syndrome and got interested in pain, especially chronic pain, in general. This resulted in a publication and a job at the rehabilitation department of the Bethesda Hospital in Hoogeveen.

Background and aims: To investigate a new and promising functional approach neglecting the pain (Pain Exposure Physical Therapy) for chronic CRPS type 1. Methods: Patients with longstanding CRPS (meeting the IASP-criteria for CRPS type 1) were included and treated with a functional approach, neglecting the pain. This approach is not in line with the usual approach with radical scavengers and physiotherapy restricted by pain tolerance. The mobility of the affected limb was measured with functional tests (Radboud Skills Test (arm), 7 meters walking, 3 steps up and down, walking distance (leg)). Pain was measured with an NRS. Results: In 94 out of 102 patients with end stage CRPS type 1, earlier treated with various accepted therapies, the function of the affected extremity improved. Pain, although not directly treated, decreased in 75 patients. In a total of 45 patients function was completely restored. Conclusion: This pilot study provides evidence that this approach is safe and effective. The treatment is short, monodisciplinary, cheap and no side effects were observed. The main issue in the treatment is that pain in CRPS 1 has no physiological aim and should not interfere with functional use by the patient, or with treatment by the therapists. The therapist ignores the pain, verbally and non-verbally. This must also be understood by the patients (and their relatives).

Saber Fallatah is a 35 year old Saudi Citizen with Bachelor degree in Physical Therapy from King Saud University in 2002. Currently he is a Postgraduate student in KSU. He is also working in Rehabilitation Medical Hospital as Physical Therapist in Madinah city since 2005. He also participated as Organizer with Madinah Physical Therapy Club in 1st, 2nd and 3rd Madinah rehabilitation conference.

Background: TENS major function in physical therapy field is to reduce pain but recent studies reported that TENS can reduce spasticity improve ADL and increase muscle strength. The purpose of this study is to investigate the effect of TENS on upper limb hand function and grip strength in children with hemiplegic Cerebral palsy. Subjects: 29 children with hemiparetic CP were recruited in randomized control trial for 8 weeks, age between 6-12 years. Then, they were divided into two groups, TENS group (n=15) and control group (n=14). Method: In TENS group the child received TENS on wrist extensor (once a day/3 day per week for eight weeks for 30 minute with pulse duration of 250 µs, 100 Hz ), in control group the child received placebo TENS both groups receive therapeutic exercise. Outcome Measures: The primary outcome measurements include modified Jebsen Taylor Hand Function Test (JTHFT) and hand grip strength via Jamar dynamometer, the secondary outcome measurement include ABILHAND-KID questionnaire. Results: After using TENS for 8 weeks, the results show significant increase in HAND GRIP strength of TENS group (p=0.015) p<0.05, also the estimate time to complete JTHFT task was decrease by 48%, in addition the manual ability of TENS group is improved by 23%. However, there were no significant difference of JTHFT and ABILHAND-KID questionnaire between both groups p>0.05. Conclusion: The finding of this study support that applying TENS in combination with therapeutic exercise give much better improvement of strength and hand function.

Introduction: Employment rates of people with lower limb disabilities are lower than that of the overall population. Persons with lower limb disabilities like to work equally with others to gain a living. However, they need job opportunities and vocational training. Jobs involving fine movements and skills are grossly affected by lower limb disability. Objective: This study aims at describing the impact of lower limb disability associated with musculoskeletal disorders and its effects on employment among the community dwelling residents in urban Sri Lanka. Method: A qualitative study was done among adults aged 18 to 59 years including both males (n=5) and females (n=7) with unilateral lower limb disability in Kandy Municipal Council area in Central Sri Lanka. In-depth interviews were conducted based on a structured in-depth interview guide based on a conceptual framework produced using a literature review and expert panel opinions. Unilateral lower limb disability was identified using a clinical examination and World health Organization Disability Assessment Schedule II. Informed written consent was obtained from all study participants and ethical approval was granted by the Ethical Review Committee of University of Peradeniya, Sri Lanka. Results: The persons with lower limb disability were engaged in various types of employment: teaching, selling vegetables, selling sweep tickets, making flower pots, art and craft work, driving, computer repair etc. Majority were engaged in self-employment rather than government or private sector employment. Selection of type of employment was mainly affected by their limb disability status: site of lower limb disability, severity and physical appearance. Further it was affected by geographic location of residence and place of work, transportation to and from the work place, accessibility to buildings, rest rooms and tea shops, attitudes of the employees, individual education status and social stigma. Self-employed persons revealed that, no strict adherence to rules and regulations, less travelling and limited social interactions led them to their choice of employment type. Many did not have proper vocational training which is essential for a reasonably paid productive work while two had changed their jobs frequently displaying inability to maintain and secure the employment. Still, people with limb disability try to be employed as it directly affects their income. Majority had been employed prior to the onset of lower limb disability. They had to get more leave; some had to change to a different job to maintain their employment status while some quit their jobs. Conclusions & Recommendations: Considering the types of employment of people with lower limb disability, many are engaged in the informal economy with a considerable number engaged in self-employment. Factors affecting employment of the persons with lower limb disability need to be addressed both at individual and community level in Sri Lanka together with launching disability and employment awareness programs for the public.