Day 2 :
- Rehabilitation techniques
Location: Texas C
Chair
Philippines Cabahug
Kennedy Krieger Institute, USA
Co-Chair
Albert Recio
Kennedy Krieger Institute, USA
Session Introduction
Philippines Cabahug
Kennedy Krieger Institute
USA
Title: Activity-based restorative therapies: Successful innovations in neurorehabilitation
Time : 09:00-09:20
Biography:
Philippines Cabahug is a Physician in the paralysis restoration program at the International Center for Spinal Cord Injury (ICSCI) and Faculty Clinical Instructor within the Department of Physical Medicine and Rehabilitation at the Johns Hopkins University School of Medicine. Her professional honors include the Johns Hopkins Healer Award from the Johns Hopkins Department of Physical Medicine and Rehabilitation in 2010 and 2012 and the Frank L. Coulson, Jr. Award for Clinical Excellence in 2012. Her research interests include spasticity management and aging in spinal cord injury, and the use of vibration plates in spasticity management.
Abstract:
Traditional rehabilitation following spinal cord injury focuses on teaching compensatory techniques to enable the individual to perform daily activities despite significant neurologic deficits. Once thought to be irreparable, recent evidence has shown that the central nervous system is capable of plasticity, regeneration and recovery. Activity Based Restorative Therapies (ABRT) is a new fundamental approach to deficits induced following neurological paralysis. ABRT involves lifelong interventions based on the principle of activity-dependent neural plasticity. The goal is to drive changes in the nervous and muscular systems by repetitive activation of the neuromuscular system, both above and below the injury level using rehabilitation therapies. This optimizes the neurologic system and offsets the rapid aging, physical deterioration and secondary complications associated with SCI. It is characterized by high intensity practice, task specific and patterned activity above and below the level of the lesion. Key components include weight loading activities, Functional Electrical Stimulation (FES), neuromuscular electrical stimulation, locomotor training, massed practice and task-specific training. Though activity based interventions is not the cure for paralysis, it is important to note that it utilizes activity and physical exercise as tools for neurologic recovery rather than to merely achieve a compensatory function.
Albert Recio
Kennedy Krieger Institute
USA
Title: Use of a virtual reality ride-on sailing simulator as a rehabilitation tool for recreational sports and community integration
Time : 09:20-09:40
Biography:
Albert Recio is a physician in the paralysis restoration program at the International Center for Spinal Cord Injury (ICSCI), and the Medical Director for the Aquatics Medicine Program at Kennedy Krieger Institute. His research interests center on activity-based restoration therapies (ABRT). In an effort to provide patients with long-term spinal cord injuries or paralysis greater independence, his research evaluates the ability of ABRT to help patients recover neurological sensation and physical movement. His field of interest also includes electrical stimulation in the treatment of recalcitrant pressure wounds and the use of functional electrical stimulation (FES) to activate nerves innervating extremities affected by paralysis resulting from spinal cord injury (SCI).
Abstract:
This research is pilot study demonstrating use of a virtual therapeutic sailing simulator as an important part of rehabilitation. The main objective of this initial proof-of-principle trial is to develop a therapeutic sailing program for individuals with SCI using the VSail-Access system that will have measurable improvements on physical and psychological health.The subjects were asked to complete the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23) at the beginning and the end of training program. They engaged in a simulator sailing program once a week, 1-hour/session for 12 weeks.All subjects demonstrated a substantial improvement in their sailing scores and SCI QL-23 scores. Following completion of the simulator course, all subjects were able to successfully sail on the water demonstrating ability to perform sailing maneuvers (i.e. steering, gybing, etc.). Subjects reported that for the very first time they participated in a sports activity with their respective family members and experienced a sense of optimism about the future.For many individuals living with paralysis, participation in recreational sports may seem impossible or even unimportant. This study is one of the first to scientifically quantify the positive impact of therapeutic sailing following a spinal cord injury, including a significant increase in overall self-confidence and sense of accomplishment among participants. The Virtual Sailing VSail-Trainer is the first sailing simulator available for people with paralysis. Its stationary, motorized sailboat cockpit features specialized software that enables patients to navigate the boat around a virtual course in the same way as an actual sailboat in the water. Electronic sensors give the participant real-time feedback that matches their movements and allows them to control wind strength and water conditions.
Kristine M Hallisy
University of Wisconsin
USA
Title: Tai Chi- Meditative movement therapy as a biopsychosocial intervention for persistent pain: A clinical application
Time : 09:40-10:00
Biography:
Kristine M 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 course work, 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.
Abstract:
Background: Persistent pain is a complex biopsychosocial condition that despite research efforts and innovative interventions remains a prevalent, disabling and costly challenge. It exacts a significant health burden in regards to quality of life costs (e.g. organic pathology and pain, psychological and psychosocial factors) as well as direct (medical) and indirect (economic workforce) costs. As such, management of persistent pain requires a 5-step psychologically-informed interprofessional collaborative approach to optimize management. Description: Meditative movement therapy (MMT), a new category of exercise, defined by: 1) some form of movement or body positioning, 2) a focus on breathing and 3) a calm state of mind with the goal of deep states of relaxation will be discussed as a physical therapy mind-body intervention for the management of persistent pain. Summary of Use: A clinical application of a specific form of MMT; a simplified version of Yang-style Tai Chi (Tai Chi Fundamentals Program3) will be described. Tai Chi mind-body principles and guidelines for Tai Chi practice will be outlined. Specific Tai Chi movement patterns and their therapeutic, biomechanical and functional implications for the management of persistent pain will be delineated. Importance to Audience: This medical model tai chi program was developed in collaboration with physical therapists and utilizes a neurodevelopmental progression, and as such, is accessible to clients of all ages and functional abilities. As a MMT, Tai Chi has been shown to convincingly positive evidence for fall prevention and improvement of psychological health, as well as associated health benefits for many chronic health conditions (e.g. musculoskeletal and neurologic conditions, cardiovascular health, bone density, muscle strength and pain). As a MMT, Tai Chi is one example of a broad range of self-management mindbody exercise programs that may be beneficial for persons with persistent pain.
Kischa S Reed
Florida A&M University
USA
Title: An assessment of bamboo as a potential low-cost material for exoskeleton design in normal walking
Time : 10:00-10:20
Biography:
Kischa S Reed is an Assistant Professor in the Division of Physical Therapy since 2012. She graduated with a BS degree in Physical Therapy at FAMU in 1998. She earned her Doctorate in 2011 from Utica College, NY. Prior to joining the Faculty, she held a variety of clinical and administrative positions. She served as a Leading Rehabilitation Consultant to many industry leaders in television and music. Her background is in the areas of manual therapy and spine rehabilitation. She is a Member of the Florida Physical Therapy Association‘s (FPTA) and serves as a Florida Assembly representative.
Abstract:
In spite of the great progress made in the design and implementation of exoskeleton-type walking assistive devices, there is room for further improvement, especially if the cost of these exoskeletons is to be reduced. Some of the methods that can be explored include finding alternative materials and/or addressing the issue of design. Considering that bonesetters have utilized bamboos in developing world for splinting fractures as a means of immobilization. In this study, a detailed analysis of the properties of bamboo was carried out which revealed that the material is lightweight, has good flexibility and high strength. These are requisite properties of the structural components of the exoskeleton-type walking assistive devices. Property comparison with the currently known low-cost duralumin material used in exoskeleton revealed that bamboo compares favorably well. A correlation between kinematics and kinetics of human walking as well as bamboo property is presented. An evaluation of lower extremity loading and energy expenditure was analyzed to further investigate the relationship between exoskeleton design, lower-limb loading capacity and energy expenditure encountered during dynamic ambulation.
Hikmat Hadoush
Jordan University of Sciences & Technology
Jordan
Title: Optimization of mirror therapy to excite ipsilateral primary motor cortex
Time : 13:25-13:45
Biography:
Hikmat Hadoush graduated from Jordan University of Science and Technology (JUST) with BSc degree in PT. After almost two years of being PT Therapist and Teaching Assistant in JUST, he left to Japan to start his professional and academic journey. There, he did MSc in Locomotor and Neurological Rehabilitation and PhD in Neurological Rehabilitation focusing in cortical plasticity in response to various neurological conditions and neurological rehabilitation approaches. The journey ended and he returned again to JUST as Assistant Professor, where he started his new journey in cortical stimulation therapy and in developing new approach of pediatric rehabilitation.
Abstract:
Mirror therapy is based on the experimental substrate of a visual illusion of active hand movement to excite ipsilateral primary motor cortex. This study tested whether ipsilateral primary motor cortex excitability could be modulated by enabling or disabling the vision of the active hand during mirror therapy. Motor cortical activations of healthy right-handed participants (n=10) were identified by Magnetoencephalography (MEG) system. Participants performed voluntary index finger extension of their dominant and non-dominant hands, separately, while viewing mirror reflection images of their active hand superimposed upon their hidden inactive hand. This was performed either with vision of the active hand (uncovered viewing condition) or without vision of the active hand (covered viewing condition). In the covered viewing condition, the ipsilateral primary motor cortex could be excited in all participants (n=10) and this excitation did not differ whether the active hand was the dominant or non-dominant hand. However, in the uncovered viewing condition, dominant and non-dominant hands were able to excite ipsilateral primary motor cortex only in a number of participants (n=4 and n=7, respectively). Moreover, the participants’ responses to the illusion validation questionnaire revealed that the covered viewing condition could cause greater visual illusion for the active hand than the uncovered viewing condition. In conclusion, disabling vision of the active hand during mirror therapy was more effective to excite ipsilateral primary motor cortical responses, it was better to create a greater visual illusion of the active hand, and it could ensure the same mirror therapy effectiveness between dominant and non-dominant hands.
Carolyn McMakin
Fibromyalgia and Myofascial Pain Center of Portland
USA
Title: Treatment of neuropathic pain by modulation of inflammatory mediators using specific frequencies and microamperage current
Time : 13:45-14:05
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:
Neuropathic pain for which there is often no effective therapy is mediated by inflammatory cytokines IL-1, IL-6, TNF α and substance P. Microamperage current has been shown to increase ATP production by 500%. It is theorized that microcurrent stimulates membrane peptides and voltage gated ion channels causing them to reconfigure in the correct orientation to normalize cellular function. Treating neuropathic pain 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 54pg/ml, p=0.0001) and increased endorphins (8.2 to 71.1 pg/ml, p=0.003). Pain scores were reduced from an average of 7.3+/-1.2 to 1.3+/- 1.1 in 45 of 54 patients (P=0.0001). Studies have shown an association between induction of Cox-2 increased prostaglandin release and nociception.FSM demonstrated a reproducible, application time dependent and frequency specific 62% reduction in Lox and Cox inflammation in a mouse model controlled trial. 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+/-1.8 to1.8+/-2.1(p<0.001). Frequency modulated microcurrent is low risk, cost effective and widely available making it a reasonable method for treatment of neuropathic pain.
- Pain and injury management
Location: Texas C
Chair
Philippines Cabahug
Kennedy Krieger Institute, USA
Co-Chair
Albert Recio
Kennedy Krieger Institute, USA
Session Introduction
Denise Jagroo
VA Hospital
USA
Title: Understanding and developing treatment strategies for pelvic pain syndromes
Time : 14:05-14:25
Biography:
Denise Jagroo earned her Doctoral Degree from NYU. She is also a Board Certified Clinical Specialist in Women’s Health Physical Therapy. Along with being certified in both Pelvic Physical Therapy and Manual Physical Therapy, she is the author of Your Best Pregnancy: The Ultimate Guide to Easing the Aches, Pains and Uncomfortable Side Effects DuringEach Stage of Your Pregnancy. She has lectured at several national conferences, teaches her own full day course and has her own private practice in NYC. She pioneered a pelvic clinic at the Manhattan Veterans Hospital and is a pelvic pain survivor.
Abstract:
There are many intertwined causes that may lead to pelvic pain. These causes include musculoskeletal, neural, visceral and hormonal factors among others. Common injuries often become compounded and chronic and begin to involve neighboring systems in the body. This lecture will delve into the anatomy of the pelvic structure as well as the overlapping symptoms, referred pain patterns and clinical presentations of pelvic pain syndromes. The common misdiagnoses, mistreatments and mistakes in managing these patients will be reviewed. Recommendations for clinical questioning of the patient, evidence based treatment strategies and proper management of the pelvic pain patient will be discussed. Specific conditions such as coccxydynia, pelvic floor syndromes and pudendal neuralgia will be discussed as well as influential neural processes such as central sensitization. This lecture will provide the attendees with practical application and a broader understanding of the complex pelvis.
Hilde Krans Schreuder
Bethesda Medical Center
The Netherlands
Title: Amputation for CRPS-I?
Time : 14:25-14:45
Biography:
Hilde Krans-Schreuder, MD, has completed her specialization as a physiatrist at the age of 29 years from University Medical Center Groningen and finished Medicine at the Erasmus University Rotterdam before. During her specialization, she did research on amputation for CRPS-I, which resulted in an article, published in J Bone Joint Surg Am. 2012 Dec 19;94(24):2263-8. She works as a physiatrist at Bethesda Medical Center, Hoogeveen, where a treatment program for patients with CRPS-I is implemented with good results: PEPT. This program was started due to the efforts of J.W. Ek, GP.
Abstract:
Between May 2000 and October 2008, 22 patients from the University Medical Center Groningen (The Netherlands) underwent amputation of a non-functional limb because of longstanding and therapy-resistant CRPS-Ι. A study was started to gain insight in consequences of an amputation on pain, participation in daily life activities, quality of life, use of prosthesis and risk of recurrence in patients with longstanding, therapy resistant Complex Regional Pain Syndrome type I (CRPS-Ι). All patients were interviewed through a semi-structured interview and underwent a physical examination. Main outcome measures were: Pain, perceived changes after amputation, participation in daily life activities, quality of life, use of prosthesis, recurrence of CRPS-I. Twenty patients (95%) reported an improvement of their lives. Nineteen patients (90%) reported a reduction in pain, 17 patients (81%) reported an improvement of mobility and 14 (67%) reported an improvement in sleep. Quality of life was rated as good by 14 patients. Reconsidering, 18 out of 21 patients would again choose to undergo an amputation. Ten of the 15 lower limb amputees and 1 of the 6 upper limb amputees regularly used a prosthesis. There was a recurrence of CRPS-Ι in the residual limb of 3 patients (14%) and (recurrence of) symptoms were reported in another limb for 2 patients (10%). Conclusions: Amputation may positively contribute to the lives of patients with longstanding, therapy-resistant CRPS-Ι. Use of a prosthesis is likely for lower limb amputees. Risk of recurrence of CRPS-I was 24%.
Jan-Willem Ek
Bethesda Medical Center
The Netherlands
Title: Pain exposure physical therapy may be a safe and effective treatment for longstanding complex regional pain syndrome type 1: a case series.
Time : 14:45-15:05
Biography:
J.W. 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 (Clin Rehabil December 2009 vol. 23 no. 12 1059-1066) and a job at the rehabilitation department of the Bethesda Medical Center in Hoogeveen. Here he works with Drs Hilde Krans-Schreuder, who is also interested in CRPS type 1 and chronic pain.
Abstract:
Objective: To determine if treatment of longstanding complex regional pain syndrome type 1, focusing on functional improvement only while neglecting pain, results in clinical improvement of this syndrome. Design: Prospective description of a case series of 106 patients. Setting: Outpatient clinic for rehabilitation. Interventions: Physical therapy of the affected limb directed at a functional improvement only while neglecting the pain, was performed following an extensive explanation. Normal use of the limb between the treatments was encouraged despite pain. A maximum of five of these sessions were performed in three months. Measures: Radboud Skills Test was used to monitor functional improvement of the arms. Speed and walking distance was used as the measure of outcome for the legs. Results: The function of the affected arm or leg improved in 95 patients. Full functional recovery was experienced in 49 (46%) of them. A reduction in pain presented in 75 patients. In 23 patients functional recovery was reached despite an increase in pain. Four patients stopped early due to pain increase. Conclusions: Our results suggest that ‘pain exposure physical therapy’ is effective and safe for patients who are unresponsive to accepted standard therapies. Avoiding the use of a limb due to pain will result in loss of function. Forced usage of limbs restores the function, reverses these adaptive processes and leads to regain of control by practice with a reduction of pain in most cases. Discussion: Considering there is no evident therapy and the validity of the diagnosis is doubted , the results of this prospective case-series in combination with other results, raise some important questions about aetiology, diagnosis and treatment. (We did a follow-up study of which the results are very promising. A case study can illustrate the treatment)
Robert Weiss
Lymph Activist’s Site
USA
Title: Functional outcomes measurement in the absence of disability: The lymphedema example
Time : 15:05-15:25
Biography:
Robert Weiss is a retired aerospace systems engineer with a Master of Science degree from the University of California at Los Angeles. He has completed 80 hours of Dr. Vodder lymphedema therapy training, and is a graduate of the NLN LSAP Program, NBCC Project LEAD and Quality Care LEAD. He has co-authored a systematic review of manual therapy for breast cancer-related lymphedema for the Cochrane Collaboration. He is a member of the ALFP Steering Committee, is a PCORI Merit Reviewer and lectures at lymphedema conferences on incidence and prevalence of lymphedema, breast lymphedema, cost-efficacy of lymphedema treatment, and lymphedema insurance, reimbursement and legislation.
Abstract:
Background: Treatment of lymphedema falls mainly into the scope of practice of therapists. Unfortunately the measurement tools employed by therapists over the years have been developed to measure functional disability, and the goal of lymphedema treatment is to treat it in an early enough stage to prevent disability. Furthermore there are currently few lymphedema measures or outcome tools to measure midline lymphedema (breast, torso, genital, head and neck). Methods: We review new devices being evaluated that may be suitable for objective measurement of non-extremity lymphedema, such as lymphedema of the breast and chest, torso, head and neck and abdomen. We review status of protocols using skin thickness measurements by ultrasound and MRI, skin tissue water content using bio-impedance and dielectric constant instruments, and elasticity measurements. We discuss new questionaires that are being specifically designed for the subjective measurement of lymphedema in accordance with the ICF framework. These new instruments promise to be more sensitive to changes in lymphatic system function and severity than the currently utilized general measures of function and current specific measurement instruments. Results: We identify a number of promising new objective measurement devices for measurement of extremity and midline lymphedema severity, and we list promising new subjective measurement instruments with high sensitivity to changes in lymphedema severity even before it becomes disabling. Conclusions: With the inexorable advance of “pay for performance” replacing “pay for service” reimbursement it is of vital importance that new functional outcome measurement instruments be developed to support reimbursement for treatment of lymphedema.
Abdullah M Al-Shenqiti
Taibah University
Saudi Arabia
Title: The use of low intensity laser therapy in peripheral nerve regeneration: An updated critical review
Time : 16:00-16:20
Biography:
Dr. Abdullah Al-Shenqiti received his PhD from University of Manchester 2002, and his research had got FDA approval (2005) for the use of Low intensity laser therapy in the treatment of trigger points that are associated rotator cuff tendoinitis. He was also the director of Medical Rehabilitation Hospital in Madinah city, Saudi Arabia (2005-2012).He is currently a dean for the faculty of Medical Rehabilitation Science, and assistant professor in the School of Physical Therapy in University of Taibah, Madinah city in Saudi Arabia. He is also president of Saudi Physical Therapy Association (Western region branch).
Abstract:
Objectives: This review describes the possible factors that may have contributed to the variability of the results between studies that have assessed the effects of Low Intensity Laser Therapy (LILT) on peripheral nerve regeneration. Furthermore, it aims to make recommendations to overcome the methodological shortcomings identified. Methods: A comprehensive search of the literature using ‘peripheral nerve injury’, ‘laser therapy’, ‘phototherapy’, ‘nerve repair’ and ‘nerve regeneration’ was conducted via Medline, Embase, Cinahl and the Cochrane Controlled Trial Register followed by a hand search. In vitro, in vivo experimental studies and clinical trials were included. Results: 25 studies were critically reviewed and showed considerable variability in irradiation parameters, techniques, approaches, length of irradiation courses, experimental injury tools and procedures. Discussion: Many studies that have investigated the use of LILT in nerve regeneration produce positive results. However, the majority of these studies suffered from a number of shortcomings: No evidence of blinding and/or randomizing procedures, lack of specification of irradiation parameters, unspecified and/or inadequate tests in their experimental injury procedures, inappropriate irradiation parameters and/or poor experimental conditions. Conclusions: The results of the studies that investigated the use of LILT in nerve regeneration were variable. This was probably due to different irradiation parameters, techniques, approaches, length of irradiation courses and experimental injury procedures.