Biography:

Milo Sewards, MD, is an Associate Professor at Temple University in the Department of Orthopaedic Surgery and Sports Medicine. He completed his medical education at Jefferson Medical College in Philadelphia, served in the Military at Naval Hospital in Beaufort, SC and completed his Residency in Orthoapedic Surgery in 2005 at Temple University Hospital. Dr. Sewards was board certified in Orthopaedic Surgery in 2007 and is a Fellow of the American Academy of Orthopaedic Surgeons. He directs the Ortohpaedic Surgery Residency program at Temple University Hospital and has published multiple articles in peer reviewed journals related to his field of work.

Heidi Ojha is an Assistant Professor at Temple University in the College of Public Health. She conducts research in guideline adherent conservative musculoskeletal pain evaluation and management. She has published numerous articles on primary care in peer reviewed journals, received grants to fund her research, and is currently conducting a randomized controlled trial on the first risk stratification program for employees with musculoskeletal pain in the country at Temple University.She has received training from Keele University, where Jonathon Hill developed the STarT tool, to guide her primary care research in the USA.

Abstract:

In primary care, low back pain is the second most frequent symptom-related cause for patient visits. Management of low back pain is increasingly relying on guideline discordant care, resulting in growing health care costs, and risks to the patient including iatrogenic harm. Recent evidence suggests the STarT back screening tool is a safe and effective strategy to guide management of low back pain in primary care. Although the Keele STarT back screening tool is frequently utilized in Europe, it is in its infancy in the United States. This presentation will assist attendees in how to serve as the point of patient contact and stratification with use of this screening tool, and will describe plans for future tool development. The beginning of the program will be instructional, outlining practice guidelines, the current large variability in guideline adherence, and will include how to administer and interpret results of the STarT tool to match interventions to the patient’s prognostic category. The second half of the presentation will focus on how clinicians, educators, and researchers, might transition from a biomedical approach to a biopsychosocial approach in managing low back pain, and barriers to implementing these practice guidelines in education, health care delivery, and policy. Potential solutions will be discussed through panel discussion and audience participation. Multiple patient case examples will illustrate decision-making on appropriate timing of referral, indications for imaging, guideline recommended pharmacological management, and use of biopsychosocial language to increase patients’ confidence in resuming activity. The session will end with sharing multiple resources to identify and/or train support personnel to implement this evidence based approach to primary care management of low back pain.

Biography:

Areerat Suputtitada, M.D. is Professor of Rehabilitation Medicine from Chulalongkorn University and King Chulalongkorn Memorial Hospital, Bangkok, Thailand. She is the Director of Excellent Center for Gait and Motion at King Chualongkorn Memorial Hospital and Chairperson of Neurorehabilitation Research Unit of Chulalongkorn University. She has been involved in education, residency training, research, and clinical treatment related to rehabilitation medicine for more than 20 years. She was invited as international speaker more than 80 times around the world. She received 18 national and international awards, and published more than 60 national and international articles in several areas of Rehabilitation Medicine including Neurological Rehabilitation, Spasticity and Dystonia, Pain, Gait and Motion, and Sport and Exercise Medicine. She has been elected and appointed to important positions in the ISPRM such as the Chairperson of ISPRM Women and Health Task Force and ISPRM International Exchange Committee.

Abstract:

Myofascial pain syndrome (MPS) is a major musculoskeletal pain that occur in every age group, and has been associated with numerous pain conditions including radiculopathies, osteoarthritis, disc syndrome, tendonitis, migraines, tension type headaches, computer- related disorders, spinal dysfunction, and pelvic pain. Myofascial pain is identified by palpating skeletal muscle for myofascial trigger points (MTrPs). A MTrP is classically defined by Professor Janet G Travell and Professor David G Simons as "a hyperirritable spot in skeletal muscle that is associated with a hypersensitive palpable nodule in a taut band’’. Although the specific pathophysiological basis of MTrPs development and symptomatology is unknown, there are evidences of histological, neurophysiological, biochemical, and somatosensory abnormalities. These emerging findings suggest that myofascial pain is a complex form of neuromuscular dysfunction consisting of motor and sensory abnormalities involving both the peripheral and central nervous systems. Sensitization in corresponding spinal segments plays a major role in the formation of continuous pain in a given part of the body. The term called by Professor Andrew A. Fischer for this phenomenon is “spinal segmental sensitization” (SSS). SSS is a hyperactive state of the spinal cord caused by irritative foci sending nociceptive impulses from a sensitized damaged tissue to dorsal horn neurons. The clinical manifestation of dorsal horn sensitization includes hyperalgesia of the dermatome,pressure pain sensitivity of the sclerotome and myofascial trigger points within the myotomes, which are supplied by the sensitized spinal segment. There are significant elevated levels of substance P, calcitonin gene-related peptide (CGRP),bradykinin, tumor necrosis factor-α (TNF-α) and interleukin-1β (IL-1β), serotonin, and norepinephrine in the vicinity of the active myofascial trigger point. Overall, pH was significant lower in the active trigger point. The mechanism consists of the nociceptive stimuli generated in the sensitized areas bombarding the dorsal horn of the spinal cord. This causes central nervous system sensitization with resultant hyperalgesia of the dermatome and sclerotome and spreads from the sensory component of the spinal segment to the anterior horn cells, which control the myotome within the territory of the SSS. The development or amplified activity of MTrPs is one of the clinical manifestations of SSS. The Segmental Desensitization treatment consists of injection of local anaesthetic agents in the involved dermatome to block the posterior branch of the dorsal spinal nerve along the involved paraspinal muscles. Extracorporeal shockwave therapy (ESWT) and High Intensity Laser (HTL) also play a role as desensitization. Prevention of recurrence should focus on appropriate ergonomic changes common in patients’ day to-day activities to avoid repetitive stress to the injured muscles. In conclusion, MPS, a common pain syndrome consists of local pathology and SSS. Hence therapeutic approaches require varieties of techniques for eradiation of trigger point and desensitization of the whole related spinal segment.

Biography:

Vicky Stewart is completing her PhD at the Australian Catholic University in Brisbane, Australia. She is a Senior Vestibular Physiotherapist in Queensland Health
and has more than seven years clinical experience in the vestibular fi eld. She has published a paper on the construction and validation of the vestibular screening
tool for use in the acute hospital setting.

Abstract:

Background: Vestibular disorders are common presentations to the hospital emergency department and are not managed optimally.
Aim: To investigate clinical effectiveness of a physiotherapy-led, hospital-based vestibular service by determining initial and longer term outcomes and comparing immediate/delayed intervention pathways.
Design: A pragmatic, prospective observational study reporting baseline, discharge and follow-up outcomes. Settings: Hospital based vestibular rehabilitation service. Participants: Adults (n=193) presenting to hospital with non-emergent dizziness (mean age=64.21±15.28; female=60%).
Methods: Physiotherapy vestibular diagnostic tests categorised patients as vestibular or non-vestibular. Vestibular rehabilitation commenced immediately (within 48 hours of hospital presentation) or was delayed on the basis of referral and wait-list for an outpatient service (average 22 days). Measures of dizziness impairment (vestibular screening tool and dizziness handicap inventory),
functional vestibular ocular reflex (Dynamic Visual Acuity), static balance, gait velocity and the functional gait assessment were recorded at initial presentation, discharge and three months post-discharge.
Results: Patients had significantly reduced dizziness and significantly improved functional gait at discharge, and was maintained three months post (p=0.000). Both immediate and delayed intervention groups reported signifi cantly reduced dizziness impairment (p=0.000) but only those in the immediately group signifi cantly improved in all functional mobility measures (p≤0.005). Resultant
symptoms and functional impact of a vestibular disorder was not significantly subside to normal levels without physiotherapy, even three weeks after presenting to hospital.
Conclusion: Physiotherapy vestibular rehabilitation was clinically effective in managing patients presenting to hospital with suspected vestibular dysfunction and immediate referral to physiotherapy vestibular therapy should be considered.

Biography:

Tina Cloney is a Health and Nutrition Professor in the Department of Exercise Science and Sport. She has a Bachelor’s degree in Health, Nutrition, and Dietetics; a Master’s degree in Community Health, and a Doctoral degree in Public Health, Health Education and Health Promotion. She is also a Board Certified Registered Dietitian, Board Certifi ed Sport Specialist Dietitian, and a Board Certified Diabetes Educator. Before joining Millikin, she worked for over 20 years as an Educator
and Manager in various clinical and community capacities.

Abstract:

Despite advances in the prevention, early detection and treatment of disease, heart disease, stroke, cancer, diabetes and depression continue to result in reduced quality of life, premature death and disability.Research continues to grow and provides strong evidence of the impact of both diet and exercise in disease prevention, disease management, and rehabilitation. Despite the evidence, many patients/clients are overwhelmed and uncertain of healthy, safe and effective approaches for promoting disease management, rehabilitation, long term health and wellness. Lifestyle coaching and goal setting are vital for promoting client commitment, recovery, and success. This presentation will outline the various nutrition and physical activity related behaviors conducive to reducing rates of disease and disability, promoting daily functioning, overall health and wellness. Behavior change education strategies for individual clients and clients in the group setting will be discussed.

Biography:

David T Denhardt did his undergraduate work in Chemistry from Swarthmore College, USA and earned his PhD in Biophysics from Caltech in 1965. He was a Faculty Member (performing both research and teaching) at Harvard, McGill, University Western Ontario and Rutgers University. He has 250 publications in PubMed in Molecular and Cell Biology and Systems Physiology. He serves as Editorial Board Member of many reputed journals.

Abstract:

“Stress” can be broadly defined as any event that challenges homeostasis to such an extent that the body and brain cannot respond adequately, thus resulting in maladjusted physiology and behavior. Much of the response is mediated via the HPA(hypothalamus-pituitary-adrenal) axis and results in the production of glucocorticoids and other effector hormones. DNA is compacted into chromatin, the genetic constituent of chromosomes, by complexing with a small family of proteins called histones. A dozen or so enzymes have been characterized recently that can modify nucleotides in the DNA (methylation of certain cytosines, often in CpG islands) and amino acids in histones, usually strategically located lysines near promoter regions, which can be modified by the addition of methyl or acetyl groups. These and other modifications, called marks, have the epigenetic (on top of the genetics) consequence of increasing or decreasing the amount of the protein made by that gene. Several types of RNA molecules can also epigenetically regulate gene expression.These epigenetic regulators will be briefl y reviewed. Severe or repeated concussions sustained in contact sports can result in chronic traumatic encephalopathy (CTE), causing prolonged or permanent changes in personality and possibly leading to an early death. Selected research by O Almeida, W Brown, S Horsburgh, and E Lagarde will be briefly discussed to illuminate the epigenetic mechanisms that could contribute to concussion-induced impairments in the quality of life. What is known about the relation between post-concussion syndrome and post traumatic stress disorder following traumatic brain injury will be summarized.

Biography:

Wilton Remigio has completed his Doctoral work at Loma Linda University in the year 2010. He is one of the authors of a book on advances in ion channel purification. He is a Professor at the College of Health Professions of Misericordia University, USA with concurrent research affi liations at Duke University. His research focuses on the use of therapeutic thermal modalities in inflammatory processes.

Abstract:

Thermal therapies have been constitutive components of most ancient systems of medicine and their use is re-emerging. New evidence has captured the interest in the use of therapeutic heat for its ability to sensitize aberrant cells to radiation injury, provide co-stimulatory signals to stir immunocompetence, to precondition tissue in defense against various endogenous injuries and to downregulate pro-inflammatory genes. Copious studies have investigated the modulation of both local and systemic inflammation by exogenous, local or systemic heat applications and these modalities should reclaim their place in the physical medicine shack of available therapeutic tools. The induction of heat stress markedly elevates tissue expression of many heat shock proteins, which comprise a superfamily of molecular chaperones found in most tissues. Heat shock proteins are highly cytoprotective molecules eliciting the appearance of defended tissue phenotypes against several injurious subcellular stresses. The heat shock response (HSR) can powerfully modulate inflammation by triggering over expression of several heat shock protein which in turn mediate the inhibiting the expression level of factors such as NF-kB and thus a cascade of pro-infl ammatory gene profiles. In this presentation, we reviewed the biology of thermal stresses, the current evidence substantiating the uses of heat as an adjunct therapy in several pathological processes with a focus on inflammation.

Biography:

Susan specialises in neuromotor assessment, completed her MSc at the University of Edinburgh, undertaking doctoral research at the Institute of Coaching and Performance at the University of Central Lancashire. She has worked in a research and development capacity with Kitman Labs Ltd. and published in reputed international journals.

Abstract:

Objective: In this paper we present a novel low cost computer-vision athletic movement assessment (overhead squat). The aim of the study was to investigate the reliability of a low cost markerless motion capture system (Capture) against an industry gold standard (Vicon). Rationale: Overhead squat is commonly used to detect asymmetry and immobility during functional movement. Research has shown the overhead squat to be the most discriminant task of the Functional Movement Screen (FMS) i.e. an individual’s ability on the overhead squat is indicative of their overall FMS score and thus injury risk status. Unfortunately, to date, the overhead squat movement has typically relied on subjective, observation based assessment. We suggest that objective and automated assessment of the overhead squat movement could provide a more practical tool for coaches to identify the intricate movement parameters associated with increased injury risk (i.e. knee valgus/varus, trunk flexion, hip translation in the sagittal plane). Results:The findings suggest that low-cost markerless motion capture has potential to provide an objective method for assessing lower limb squat mechanics and trunk control in an applied sports setting. Furthermore, the outcome of the study warrants the need for future research to examine more fully the potential implications of the use of low-cost markerless motion capture in the evaluation of dynamic movement for injury prevention.

Biography:

Guadalupe Genis-Gonzalez is 27 years old is a Licensed Massage therapist and has completed her Associate of Science Degree in Sports and Rehabilitation Therapy and is presently pursuing her Bachelor’s degree in Business leadership from Fremont College where she is also a Charter Member of the Alpha Beta Kappa Honor Society and Student Ambassador. She has previous experience working with professional athletes and worked two seasons with the Los Angeles Sparks WNBA Team and where she also completed her Sports Medicine Internship. She is looking forward to making her special techniques known through the world of Sports Medicine and Rehabilitation therapy.

Abstract:

Russian Sports Massage (RSM) is an advanced manual technique for reducing pain due to Neuro-Muscular Dysfunctions and for maintaining and enhancing functional performance. It is very rare to find an MT who is certified to perform the therapy in California. Learning to work with athletes and witnessing their performance increase as a result of our educated touch is an inspiring and memorable experience. Russian sports massage is strictly performed when using to help athletes reach Peak performance. For instance using, oil and a 14-16 inch bolster is key to this therapy. RSM can also be applied with any modality and be looked at as a therapeutic approach which is very unique as well. Learning how to incorporate these techniques towards anyone who is suffering with pain and any unknown or undiagnosed pathology/disease can be treated and receive comfort. RSM focuses on working with the Nervous System and while being performed the therapist works with the midlines of the body. The person receiving RSM should wait 2-4 hours after a meal or 6 to 8 hours after working out to receive therapy. All Massage interrupts digestion and interferes with rehabilitation after a workout.