Day 1 :
Keynote Forum
Areerat Suputtitada
International Society of Physical and Rehabilitation Medicine (ISPRM ) Women and Health Task Force
Thailand
Keynote: Spasticity Management: How to optimize
Time : 09:05-09:35
Biography:
Professor Areerat Suputtitada, M.D. is Professor of Rehabilitation Medicine, full time working at Department of Rehabilitation Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital in Bangkok, Thailand. She is the Director of Excellent Center for Gait and Motion at King Chualongkorn Memorial Hospital and Chair of Neurorehabilitation Research Unit of Chulaongkorn University. She has been involved in education, residency training, research, and clinical treatment related to rehabilitation medicine for over 20 years. Her subspecialties are botulinum toxin and neurolysis, gait and motion, pain, and neurorehabilitation. She is an internationally recognized speaker, clinician, and researcher. Her works have been published extensively in numerous medical journals and books, more than 70 articles nationally and internationally. She has four important positions in the International Society of Physical and Rehabilitation Medicine (ISPRM) as the follows; (1) Chair of Women and Health Task Force, (2) Assembly of Individual Members Election Committee for Asia Oceania, (3) International Exchange Committee, and (4) Representative of the Active Individual Members to the Assembly of Delegate
Abstract:
Spasticity is a common problem and quite a major challenge to the neurorehabilitation team. It manifests as an increase in stretch reflexes, producing tendon jerks and resistance appearing as muscle tone. Effects of spasticity range from mild muscle stiffness to severe, painful muscle contractures and repetitive spasms that can prevent or hamper function, cause pain, disturb sleep, and major difficulties for hygiene care. However, spasticity can also be useful, perhaps allowing a person to stand or walk when weakness would not otherwise permit it. It is imperative that management is always patient and function focused rather that aimed at the reduction of spasticity only.Of the course of more than 30 years, the novel therapeutic spectrum of botulinum toxin type A (BTA) has been successively expanding worldwide. Optimizing of BTAtreatment is challenging. The trick in practical management is to use it intelligently and to know when and when not to use it. BTA is better tolerated than neurolysis with phenol or alcohol. It is a relatively safe medication and has few serious side effects but its high cost limits the use. Both BTA and phenol or alcohol have dose ceiling limitation. Neurolysis should be preserved for pure motor innervations muscles to avoid paresthesia. BTA is recommended in the distal muscles which are mixed nerves innervations. The proper use of these treatments requires careful patient assessment and realistic goals, knowledge of the peripheral functional anatomy, and an understanding of how these treatments work and how to bestto administer them. Several techniques, usingelectromyography, electrical stimulation, ultrasound guidance are aimed to increase the accuracy of targeting. Neurorehabilitation after BTA injection and neurolysis also enhance treatment outcomes. Basic and sophisticated instrumental balance and gait training, therapeutic exercises, functional electrical stimulation are also important to increase functional outcome. Extracorporeal shock wave therapy (ESWT) are increasing evidences supported. Optimizing BTA, neurolysis and neurorehabilitation in spasticity treatment is importance.
Keynote Forum
Carolyn McMakin
Fibromyalgia and Myofascial Pain Center of Portland
USA
Keynote: Successful treatment of myofascial pain and trigger points
Time : 09:35-10:05
Biography:
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.
Abstract:
Myofascial pain and trigger points are controversial in part because successful treatment with conventional therapies is challenging and lasting relief is often elusive. Microamperage current modulated by specific frequencies (Frequency Specific Microcurrent, FSM) has been shown to resolve cervical and lumbar myofascial trigger points quickly and efficiently. Chronic myofascial pain in the head, neck and face was reduced from an average of 6.8 to 1.5/10 in 50 patients with an average of 11.2 FSM treatments administered over 7.9 weeks. Chronic low back pain associated with myofascial trigger points was reduced from 6.8 to 1.6/10 in 25 patients in 6 treatments administered over 6 weeks. The known mechanisms of action of FSM and how they could resolve the known pathologies of trigger points are discussed. Myofascial trigger points are thought to arise from focal injury to muscle fibers caused by trauma or overuse. Biopsies of myofascial trigger points reveal a “cluster of numerous microscopic foci of sarcomere contraction knots that are scattered throughout the tender nodule”. These contraction knots are thought to be caused by calcium release from the sarcoplasmic reticulum and are maintained by an “energy crisis” in the now hyper-metabolic muscle once the constant contraction is initiated. Muscle contraction requires the energy of four ATP; muscle relaxation requires two ATP. Microamperage current has been shown to increase ATP production by 500% and could reasonably provide sufficient additional energy to normalize muscle function. Persistence of myofascial trigger point leads to neuroplastic changes at the level of the dorsal horn in the spinal cord leading to central pain sensitization and expansion of the pain beyond its original boundaries into the referred pain area. Active trigger points show significantly elevated levels of the inflammatory peptides TNF-α, Interleukin -1(IL-1), calcitonin-gene-related-peptide (CGRP), substance P, bradykinin, serotonin, and norepinephrine. Frequency specific microcurrent has been shown to reduce all inflammatory cytokines, reduce substance P and effectively treat neuropathic pain. A retrospective study of 20 neuropathic pain patients with a mean chronicity of 6.7 years showed reductions in pain from an average 6.8 to1.8 / 10 (p<.001). It is theorized that microcurrent stimulates membrane receptors and voltage gated ion channels causing them to reconfigure and normalize cellular function. Treating the spinal cord in fibromyalgia associated with spine trauma using microamperage current and one specific frequency combination reduced IL-1(330 to 80 pg/ml, p=0.004), Il-6(239 to 76 pg/ml, p=0.0008), TNF α (305 to 78, p=0.002), and substance P (180 to 54 pg/ml p=0.0001) and increased endorphins (8.2 to 71.1 pg/ml, p=0.003). Frequency modulated microcurrent is low risk, cost effective and widely available making it a reasonable method for treatment of myofascial pain syndrome and trigger points.
Keynote Forum
Ulrike Berzau
Amazing Results
USA
Keynote: Success mindset: Optimize your team’s performance and your patient’s outcomes
Time : 10:05-10:35
Biography:
Ulrike Berzau is a certified Thinking into Results Consultant with an impressive track record as Coach, Mentor and Healthcare Executive in the United States, Egypt and Germany. She leads and coaches individuals and organizations to shift their paradigm and achieve exceptional results. She is the co-author of the international bestseller Imagine a Healthy You and uses her coaching, leadership, healthcare and multicultural skills and experiences to be of service to those who aspire excellence and extraordinary results. She holds a Master’s Degree in Management, a Master’s Degree in Health Science, Physical Therapy and is a Fellow of the American College of Healthcare Executives
Abstract:
Our beliefs and habits that have developed over time affect our life in all areas. By shifting our mindset to a Success Mindset we can optimize our performance and transform our personal life, business, health and wellbeing. We often underestimate the power of our paradigm. It affects how we think, act and ultimately affects our results. Our mindset and self-image are part of our paradigm and the results we are achieving are a direct reflection of the image we hold of ourselves. These invisible barriers limit our success but it is possible to change our programming from the inside out and enhance it from the outside in. The growth we are capable of is amazing! This transformation changes how we work as individuals and teams. Mindset affects not only success; it affects our health and wellbeing and is the catalyst for recovery from illness or injury. Top athletes use mental and physical training to improve performance and the combination of both optimizes the effects. We can transfer this knowledge and the practices to improve physical performance of patients after injury, illness, surgery and to help those with chronic pain and fatigue. These are mighty concepts and when you understand how to flex your mental muscles you will see enhancements to your health, wellbeing, happiness and success.
- Occupational Therapy and Physical Rehabilitation
Location: Texas C
- Exercise and trauma
Location: Texas C
Chair
Ellen L Glickman
Kent State University, USA
Co-Chair
Rhonda L Haley
Wheeling Jesuit University, USA
Session Introduction
Rhonda L. Haley, Wheeling Jesuit University, USA
Wheeling Jesuit University
USA
Title: Physical therapy interventions, including student education, for individuals with chronic kidney disease receiving hemodialysis treatments
Biography:
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.
Abstract:
This educational session is designed to present the most current evidence supporting the benefits of physical therapy interventions for the individual receiving hemodialysis treatments and demonstrate a method to promote this awareness within a Doctor of Physical Therapy curriculum. It will also provide support for the provision of those physical therapy services while the individual is receiving the dialysis treatment. Current research supports physical activity for individuals with chronic kidney disease and describes the benefits of physical activity for these individuals. Physical therapists possess the skills and the tools to effectively prescribe, monitor and educate people with chronic kidney disease on safe physical activities. Diabetes mellitus, obesity, and impaired cardiovascular function are other conditions faced quite often by individuals with chronic renal disease that may result in a lowered quality of life. Physical therapists can become integral members of the medical teams caring for these individuals by providing interventions to increase the quality of life for that population. With the continued rise of this world-wide public health problem, education for current physical therapy students regarding hemodialysis and the role of physical therapists for those suffering from chronic kidney disease is imperative. This session will identify some key elements utilized by one university to educate students while providing a service during hemodialysis treatments.
Allen Marangoni
Wheeling Jesuit University
Wheeling Jesuit University
Title: Physical therapy interventions, including student education, for individuals with chronic kidney disease receiving hemodialysis treatments.
Time : 10:55-11:15
Biography:
Allen Marangoni, is a professor of physical therapy at Wheeling Jesuit University. Dr. Marangoni has been an active participant in service learning many years and has successfully coordinated programs through five different accreditation cycles using a system analysis approach. He earned an Ed.D. from Nova Southeastern University, a Master of Medical Science from Emory University School of Medicine, a B.S degree in Biology and degrees in Physical Therapy from West Virginia University and Wheeling Jesuit University.
Abstract:
This educational session is designed to present the most current evidence supporting the benefits of physical therapy interventions for the individual receiving hemodialysis treatments and demonstrate a method to promote this awareness within a Doctor of Physical Therapy curriculum. It will also provide support for the provision of those physical therapy services while the individual is receiving the dialysis treatment. Current research supports physical activity for individuals with chronic kidney disease and describes the benefits of physical activity for these individuals. Physical therapists possess the skills and the tools to effectively prescribe, monitor and educate people with chronic kidney disease on safe physical activities. Diabetes mellitus, obesity, and impaired cardiovascular function are other conditions faced quite often by individuals with chronic renal disease that may result in a lowered quality of life. Physical therapists can become integral members of the medical teams caring for these individuals by providing interventions to increase the quality of life for that population. With the continued rise of this world-wide public health problem, education for current physical therapy students regarding hemodialysis and the role of physical therapists for those suffering from chronic kidney disease is imperative. This session will identify some key elements utilized by one university to educate students while providing a service during hemodialysis treatments.
Biography:
Marie Vazquez Morgan earned a Bachelors of Science in Physical Therapy in 1993, a Masters in Health Sciences in 1997 from Louisiana State University Health Sciences Center in Shreveport, and her Doctorate in Health Studies from Texas Woman’s University in Denton, Texas in 2006. She has 19 years of clinical rehabilitation experience and has been a faculty member and Assistant Professor at Louisiana State University Health in Shreveport, School of Allied Health Professions since 1997. She has presented research both nationally, internationally, and regionally at continuing educations seminars. Her expertise is in neurological interventions as well as nutrition, wellness, lifestyle modification, and community rehabilitation and occupational health. She was recently featured in National Newsline Magazine for PT speaking on the role of cultural diversity in the physical therapy profession, and was honored in November 2006 by Maybelline NY as outstanding female educator of the year, and featured in People en Espanol December 2006 issue. She was also a recipient of the American Physical Therapy Association Minority Faculty Development National Scholarship in 2003.
Abstract:
Purpose: African Americans (AA) have higher prevalence and mortality rates of cardiovascular disease largely due to barriers in accessing health care and disease risk factors. The purpose of this pilot study was to identify risk factor status in rural AA residents of North Louisiana, who attended target churches and compare those findings with state, regional and national norms for the AA population. Setting/Participants: Sixty-three adults (16 men, 47 women) attending target churches in Northwest and Northeast Louisiana were recruited to participate in health screenings. Measures: Blood pressure, blood glucose, cholesterol, BMI, physical inactivity, smoking prevalence, and percent body fat. Analysis: Descriptive statistics were used to compare results to regional, state, and national norms. Results: The cohort displayed a higher prevalence of hypertension, diabetes, physical inactivity, and percent body fat in comparison to regional, state, and national norms. Conclusion: Results from this pilot screening demonstrate evidence of a trend of elevated health risks for development of cardiovascular disease in targeted group of AA adults. Findings indicate the need for further cultural specific wellness interventions including preventative screenings, to lower the health risks of developing chronic diseases in the AA population in Northern Louisiana. Identifying those at risk can lead to earlier diagnosis, and reduced morbidity and mortality.
Melissa K. Trovato
Kennedy Krieger Institute
USA
Title: Assistive technology to promote community integration
Time : 11:35-12:15
Biography:
Melissa Trovato, MD is board certified in Physical Medicine and Rehabilitation and Pediatric Rehabilitation Medicine. She is an Assistant Professor of Physical Medicine and Rehabilitation at the Johns Hopkins School of Medicine. She is Director of Inpatient Rehabilitation at the Kennedy Krieger Institute, where she has worked for 14 years.
Abstract:
Individuals with developmental disabilities frequently have communication needs and require the support of a Speech-Language Pathologist. A portion of these children and adults will also require use of Alternative and Augmentative Communication (AAC) devices to allow them to not only communicate their basic needs but to also improve social interaction at home and in their community setting. Furthermore, AAC devices often help support spoken speech and provide a model for speech production. Numerous devices are available ranging from low tech to cutting edge. Technological advances are yielding very few limitations to physical access of AAC devices at present and may include eye gaze, proximity switches, and use of key-guards. Selection of the appropriate device is crucial for successful use. An evaluation by a SLP familiar with AAC and devices is necessary to assess for appropriateness of use and device choice. Follow up visits for training and customization are necessary. Carryover of use in the home and school should be reinforced. Funding for devices varies by state, insurance company and school district. We will review several types of AAC including multiple modes of access. Additionally, we will discuss funding and basics for referral.
Lauren R C Tooley
Kennedy Krieger Institute
USA
Title: Assistive technology to promote community integration
Time : 11:35-12:15
Biography:
Lauren Tooley, MS, CCC-SLP is an ASHA certified Speech-Language Pathologist who has worked in the field for nine years. She is the Manager of the Assistive Technology Clinic at Kennedy Krieger Institute in Baltimore, MD. She conducts Assistive Technology Assessments for adults and children with developmental and acquired disabilities who may need assistance with environmental controls, augmentative and alternative communication devices, executive functioning, and written expression.
Abstract:
Individuals with developmental disabilities frequently have communication needs and require the support of a Speech-Language Pathologist. A portion of these children and adults will also require use of Alternative and Augmentative Communication (AAC) devices to allow them to not only communicate their basic needs but to also improve social interaction at home and in their community setting. Furthermore, AAC devices often help support spoken speech and provide a model for speech production. Numerous devices are available ranging from low tech to cutting edge. Technological advances are yielding very few limitations to physical access of AAC devices at present and may include eye gaze, proximity switches, and use of key-guards. Selection of the appropriate device is crucial for successful use. An evaluation by a SLP familiar with AAC and devices is necessary to assess for appropriateness of use and device choice. Follow up visits for training and customization are necessary. Carryover of use in the home and school should be reinforced. Funding for devices varies by state, insurance company and school district. We will review several types of AAC including multiple modes of access. Additionally, we will discuss funding and basics for referral.
Yvonne Eschke
Lymphologic med. Weiterbildung, Aschaffenburg
Germany
Title: Edemas caused by different kinds of angiological problems and their treatment
Biography:
Yvonne Eschke is staatlich geprüfte und staatlich anerkannte Physiotherapeutin since 1996. She completed the Fachschule für Physiotherapie, Wannseeschule e.V. in Berlin (Germany). In 2008 she completed the education for teacher of Manual Lymphatic Drainage/ CDT at Lymphologic med. Weiterbildung in Aschaffenburg and in Leipzig (Germany). Since 17 years she is working at Praxis Aue in Hamburg (Germany) and since seven years teaching in various cities in Germany and giving lectures and workshops in conferences in Brazil, Spain and Austria. Since November 2013 she is studying at Thim International Hogeschool voor Fysiotherapie in Utrecht (Netherlands).
Abstract:
In addition to the blood circulation the lymphatic system transports liquids from the interstitial tissue into the blood vessels and supports and backs up the veins in transporting liquids from peripheral to central regions. According to Starling's hypothesis there should be an equilibrium in microcirculation between filtration and reabsorption. But in orthostasis and in tissues like musculature and skin for example the reabsorption is entirely done by the initial lymphatic vessels. The liquids have to pass the lymphatics on their way to the veins (Schad 1996, 1998). This is another key function of the lymphatic system apart from the well known cardinal function of protein transport. The lymphatics have to compensate what the veins cannot cope (in physiologic as in pathologic situations). If this capacity is exceeded a swelling because of a high-volume insufficiency as well as a combined insufficiency appears in the tissue. In case of a combined insufficiency, stimulating the activity of the lymph vessels can therefore accelerate the healing of wounds and inflammatory processes which are accompanied by a protein rich edema. This acceleration is reached by CDT. Complex Decongestive Therapy combines manual lymphatic drainage with skin care, compression with decongestive lymphatic bandage and physical exercise. The Manual lymphatic drainage and compression is not only used to treat primary and secondary lymph edemas but also the wide spread edemas of inactivity and immobilization, the post surgery and post traumatic edemas even in sport physiotherapy, and the phlebological edemas. The possible results of therapy can be shown in several case reports. The description of the pathophysiology is followed by a demonstration of the very soft strokes of Manual lymphatic drainage (Vodder Method) and by the demonstration of the essential multi-layer
Ellen Glickman
Professor
Kent State University
Title: Effects of a long-term university exercise program on physical activity in previously sedentary individuals
Time : 17:30-17:50
Biography:
Dr. Ellen Glickman is a recognized expert in the area of environmental physiology with ~76 original, full-length papers in scientific journals, 3 technical reports and 1 Book Chapter. She is a Fellow of the American College of Sports Medicine, a reviewer for many of the top journals in her field, including Medicine in Science and Sport and Exercise, European Journal of Applied Physiology and Occupational Physiology and Aviation Space and Environmental Medicine. She has been an invited lecturer at numerous national (i.e., The American College of Sports Medicine, Wilderness Medical Society) and International Conferences (International Conference of Environmental Ergonomics (ICEE), Oxford University Roundtable, government research laboratories (i.e., Brooks AFB, US Army Research Institute Environmental Medicine USARIEM) and Universities. In 2001, The Wilderness Medical Society Awarded Dr. Glickman their Research Award for their Outstanding Scientist. Most recently, Dr. Glickman has partnered with Orbital Research Inc., (Cleveland, OH) a STEM initiative, to enhance our knowledge in the area of environmental physiology with technology to better understand human physiology. Dr. Glickman received her Ph.D. from the University of Pittsburgh from 1989 -1995. She was part of the Department of Kinesiology at Louisiana State University and had an environmental physiology laboratory at Pennington Biomedical Research Center. In 1995 Dr. Glickman joined the faculty at Kent State University and has continued her work in acute cold exposure. She started at USARIEM as a National Research Council Scientist and continues to serve as a contract employee with USARIEM as part of the Military Nutrition Division. Finally, Dr. Glickman has been Principal Investigator or Co-Investigator on numerous externally funded projects during her time at Kent State University. Dr. Glickman has served as Interim Associate Dean of Graduate Studies, at Kent State University.
Abstract:
Purpose: To explore the health-related and physical effects (via an accelerometer) of a 16-month group exercise program among previously sedentary individuals. Methods: 150 individuals were engaged in a faculty staff exercise program, however complete data is only available for the purpose of this analysis on 18 individuals. Therefore, we analyzed the data of 18 faculties and staff aged 52.9±6.2 years who participated in 16 months of supervised group exercise. These individuals participated in group exercise three times per week for 60 min. Participants self-selected into supervised exercise classes offered with an emphasis on aerobic fitness. Pre and post-testing variables measures included body weight, body fat percent, resting heart rate, curl-ups and sit-and-reach. Results: There was a significant decrease (p<0.001) in body weight from pre (89.4±19.4 kg) to post testing (87.4±1705 kg). Percent body fat revealed a significant decrease (p<0.001) from pre (37.5±6.8) to post (30.3±6.5). Resting heart rate demonstrated a significant decrease (p=0.011) from pre (76±11 bpm) to post (71±8 bpm). There was a significant improvement in the amount of curl-ups in one min (p=0.039) from pre (32.8±10.9) to post (44.8±20.5) test. There was a significant gain in flexibility measured by the sit-and-reach (p<0.001) from pre (24.0±9.8) to post (28.5±9.0) test. Of the 11 individuals that regularly wore the MOV band an average of 36.12 miles per week were recorded over the 16 month exercise program (n=11). Conclusion: Participation in the 16 month university group exercise program reduced body weight, percent body fat, and resting heart rate and improved the number of curl-ups and flexibility in previously sedentary individuals. Physical activity levels met the American College of Sports Medicine recommendations of 35 miles per week in the individuals that wore the MOV band. This investigation demonstrates that an on-site supervised exercise program among previously sedentary individuals is beneficial. Future research is needed to evaluate the long term effects of increasing the exercise duration and compliance in this population.
Caterina Abraham
Wheeling Jesuit University
USA
Title: Maternal and fetal benefits of regular exercise and physical activity during pregnancy
Time : 17:50-18:10
Biography:
Caterina Abraham is an Associate Clinical Professor in the Department of Physical Therapy at Wheeling Jesuit University. She has 20 years of physical therapy practice experience with the last 14 being in the academic setting. She earned a Bachelor’s Degree in Physical Therapy (1994) and a Master’s Degree in Public Health (2004) from West Virginia University. She earned her Doctor of Physical Therapy degree (2009) from Temple University. She has authored a chapter on pre-natal and post-partum exercise in the textbook titled: Clinical Pediatric Physical Therapy: From the NICU to Independent Living by Mark Drnach.
Abstract:
This session will present recent evidence supporting the benefits that an active lifestyle, including regular exercise and physical activity have on a woman and her child, both during gestation and after. An overview of the physiologic changes that occur in multiple systems during pregnancy will be presented along with instruction on safe exercises, parameters of exercise, body mechanics instruction and exercises to avoid during gestation and in the immediate post-partum period. Benefits such as assisting in maternal weight management, improved tolerance of the labor process, positive effects on fetal size and improved ability to recover from both vaginal and caesarian deliveries will be presented. Pelvic floor health will also be included in the discussion. The session will identify some of the common neuromusculoskeletal conditions (diastasis recti, diastasis symphysis pubis, etc.) that may occur as a result of fetal growth, a shifting uterine position during pregnancy, the delivery process and adjustments in the post-partum period. Suggested interventional strategies for these conditions will also be presented.