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.