Day 3 :
- Disability and Management
Location: Texas C
- Spinal Cord Injury
Location: Hilton San Antonio
- Pain and injury management
Location: Texas C
Chair
K Dean Reeves
University of Kansas, USA
Co-Chair
Kaydar M Al Chalabi
Neuro-Spinal Hospital, UAE
Session Introduction
Linqiu Zhou
Thomas Jefferson University
USA
Title: The Anatomy of Lumbar Dorsal Ramus Nerves and Its Significance in Lower Back Pain
Time : 09:00-09:20
Biography:
Dr. Zhou has received his bachelor degree of medicine and master degree in orthopaedic spinal surgery in China during the periods of 1979 to 1984 and 1987 to 1990. He completed an orthopaedic residency and spine fellowship in China before moving to the United States. He worked for several years as a visiting scholar at MCP Hahnemann University, before completing his second residency in Physical Medicine and Rehabilitation at the University of Pennsylvania. After that, he received his pain fellowship training at Thomas Jefferson University. He is board certified by the American Board of Physical Medicine and Rehabilitation, and is also board certified in Pain Management. Dr. Zhou has extensive experience in the basic and clinical research and with the diagnosis and treatment of spinal and musculoskeletal disorders, and various pain syndromes. His research has included cryoanalgesia, spinal dorsal ramus anatomy and clinical implication, cervicogenic headache, pudendal neuralgia. Dr. Zhou teaches in several medical universities as a professor, and has published more than 40 articles and chapters. He is serving as an editorial member of several journals and expert Reviewers for Journals like Neuromodulation. He also invented several medical devices and received numerous awards and honours.
Abstract:
This presentation will review the anatomy of the spinal dorsal ramus system and its implication of lower back pain, including clinical findings, pathogenesis and treatment. Each spinal dorsal ramus arises from the spinal nerve and then divides into a medial and lateral branch. The medial branch supplies the tissues from the midline to the zygapophysial joint line and innervates two to three adjacent zygapophysial joints and their related soft tissues. The lateral branch innervates the tissues lateral to the zygapophysial joint line. The clinical pain presentations follow these anatomic distributions, which can be used for localizing the involved dorsal ramus. The diagnosis can be confirmed by performing a single dorsal ramus block that results in relief of pain and muscle spasm. Etiologically, any factor that stimulates the spinal dorsal ramus can cause low back pain, which is distinct from zygapophysial joint syndrome. Clinically, L1 and L2 are the most common sites of dorsal rami involvement. Treatment includes spinal dorsal ramus injection therapy and percutaneous neurotomy. We will present our resent clinical study of lumbar vertebra compression fracture induced lower back pain and outcome of treatment. Summarily, irritation of the spinal dorsal ramus system is a potential source of low back pain. Based on the anatomy and clinical presentation, the involved spinal dorsal ramus can be localized and treated.
K Dean Reeves
University of Kansas
USA
Title: Groin pain: Structural or neurogenic? Changing treatment and research options
Time : 09:20-09:40
Biography:
K Dean Reeves, MD, is a leading Researcher in the field of regenerative injection and is currently focusing on research in chronic pain mechanisms and treatment. He is board certified in Physical Medicine and Rehabilitation and is on adjunct faculty (Clinical Associate Professor) at the University of Kansas. He is on the Board of Directors of the American Association of Orthopaedic Medicine and serves on the Institutional Review Board of the International Cellular Medicine Society.
Abstract:
Groin pain presents in several ways, one is typically sports related, also termed athletic pubalgia or misleadingly termed sports hernia. There is seldom any actual herniation, although inguinal canal asymmetries may be present. A variety of abnormalities can be seen on MRI in athletic pubalgia, and regenerative injection or surgical approaches appear to have a high degree of success in treatment. The challenging presentation of groin pain is chronic vulvar/ scrotal/ rectal/ general perineal burning pain in men or women. This complaint is common in the general population, although it is a diagnosis of exclusion after negative OB/GYN or GU evaluation for infections or chronic skin conditions. These patients commonly associate with pelvic floor dysfunction. Allodynia and/or hyperalgesia are common, indicative of neuropathic pain. Neurogenic pain symptoms are only partially remediable with medication approaches.
K M Al-Chalabi
Neuro-Spinal Hospital
UAE
Title: Spinal cord injuries in UAE: Retrospective, demographic & overview study of patients admitted & managed in Neuro-Spinal Hospital Dubai during last 12 years
Time : 14:05-14:25
Biography:
Dr.Kaydar M. Al-Chalabi is a physiatrist working in the Neuro-Spinal Hospital of Dubai, UAE. He is also a Specialist Physician In Physical Medicine ,Rheumatology And Rehabilitation in RMRC(Rheumatology, Rehabilitation Medicine And Physiotherapy Clinic) Dr. Chalabi used to be the CEO & Chairperson of JCI Accreditation Committee at Neuro-Spinal Hospital Dubai (2005 till 2011). In addition, he practiced as consultant physician and a general director of the Iraqi National Spinal Cord Injuries Center (NSCIC), 2003 till 2005. Dr. Chalabi has been actively involved in many national and international conferences both as a key speaker and an attendee.
Abstract:
Study Design: Retrospective Demographic Statistical Analysis & Overview of the Concept of Comprehensive Management & Rehabilitation in UAE. Settings: Neuro -Spinal Hospital /Dubai UAE Objectives: 1) Demographic Statistical Analysis of 232 patients (age, gender, nationality, etiology/nationality: UAE locals, Expats: Arabs & Non Arabs, levels & types of injuries, surgical & conservative managements). 2) Overview of quality, concepts, status of comprehensive care, management & rehabilitation In UAE. Patients: Spinal cord injured patients admitted in Neuro-Spinal Hospital during the period February 2003 till December 2014 was 232 patients. UAE locals were 114(49%), expats 118(51%). Males were 176(76%) and females 56(24%). Tetraplegia 66(28%), paraplegia 166(71.5%). Age: 153 (66%) are below 40 years. Etiology: RTA 135(58%), fall from heights 44 (19%), sport injuries 23 (10%), diseases 20 (8.5%). Surgical procedures (fixation, decompression laminectomy, excision, baclofen pumps, spinal cord stimulation, sacral roots stimulations, etc.) were done on 140 patients (60%) while the rest were admitted for conservative treatment. These figures are as per total number of the group, however for demographic purposes, they were subdivided into three main subgroups: UAE Locals, Arab Expats & Non Arab Expats just to show the variations between them as far as etiology, age, gender, level & types of injuries. For example RTAs among locals were 71%, while Arab expats 47 % & 44% in non Arab expats, and accordingly there are differences in the other variables. UAE is multinationality country and according to 2013 population census 88.5% are expats while locals constitute only 11.5%. On the other hand, in UAE there is huge construction works, all kinds of sport activities, high speed modern vehicles. In each kind of work, the domain is from certain countries and each of them has different interests, hobbies as per their culture, habits, religion, traditions etc. Concept & status of SCI management & Rehabilitation in UAE differs from other countries where there are holistic SCI centers, such are not available & for that reason it is very difficult to obtain national data or registry of such cases or incidence, adding to that patients usually receive their acute treatment and then disappear (return home) being unable to cover treatment costs & no insurance covers that for good. Even the local people, the government used to send them abroad to continue their treatment and rehabilitation after the initial acute management. Only we see them afterwards if there is complication or for certain procedures. Conclusions: In spite of all modern life facilities, services &high standard health care whether governmental or private which are afforded by local emirates or federal governments for all people, locals or residents, concept of SCI comprehensive care ,management & rehabilitation is still not coping with the international standards. No national data about incidence, impact & awareness of such issue can be obtained or retrieved & no SCI center per se neither in the capital/Abu Dhabi nor in the other emirates.
K Dean Reeves
University of Kansas
USA
Title: Results from multinational independent randomized controlled trials on practical, inexpensive and effective treatment of temporomandibular dysfunction
Time : 14:05-14:25
Biography:
K Dean Reeves, MD, is a leading researcher in the field of regenerative injection and is currently focusing on research in chronic pain mechanisms and treatment. He is board certified in Physical Medicine and Rehabilitation and is on adjunct faculty (Clinical Associate Professor) at the University of Kansas. He is on the Board of Directors of the American Association of Orthopaedic Medicine and serves on the Institutional Review Board of the International Cellular Medicine Society.
Abstract:
Longitudinal studies of subjects with temporomandibular dysfunction (TMD) show residual symptoms in many and nearly 25% have unabated symptoms. TMJ injection of dextrose without anesthetic had been noted empirically to have analgesic effect on local pain and to promptly reduce bruxism. A pilot study in Hong Kong demonstrated that simple intraarticular hypertonic dextrose injection using a 30 gauge needle was clinically and significantly more effective in the treatment of pain and dysfunction of TMD than intraarticular anesthetic injection. Hypertonic dextrose injection results in a brief stimulation of the inflammatory cascade, with resultant production of growth factors. However, non-inflammatory dextrose effects on growth factor production have been demonstrated, and more recently 5% dextrose has been found to treat neurogenic inflammation (pain from upregulation of the TRPV1 receptor on peptidergic nerves). The latter has the theoretical benefit of reducing pain, regardless of the status and position of the intraarticular cartilage or degree of degenerative change of the TMD. Following the pattern of the pilot study in Hong Kong, researchers in three separate countries, (China, Argentina and Canada), began adequately powered stand-alone RCTs. Each study compares one group receiving 0.2% lidocaine in hypertonic (20%) dextrose to a control group receiving 0.2% lidocaine in normal saline. Subjects are those with moderate to severe chronic facial pain and jaw dysfunction. The method is minimally uncomfortable and easily reproducible. Results from each site and their implications will be discussed.
Lisa Beck
Mayo Clinic
USA
Title: The Journey through Co-Existing Injuries: Spinal Cord and Brain Injury
Time : 14:25-14:45
Biography:
Lisa A. Beck MS, RN, CNS-BC, CRRN is an Assistant Professor of Nursing, College of Medicine Mayo Clinic. She is currently a Clinical Nurse Specialist in the Spinal Cord Injury Program at Mayo Clinic. She is a contributing author of “Mayo Clinic Guide to Living with Spinal Cord Injury”. Ms. Beck is the Past President of the Nursing Section and Secretary of the Governance Board for the Academy of Spinal Cord Injury Professionals. She is a member of the Steering Committee of the Consortium for Spinal Cord Medicine. She has presented and published a variety of topics related to SCI.
Abstract:
The co-occurrence of spinal cord injury (SCI) and traumatic brain injury (TBI) is common; however, the clinical ramifications are complex. Persons sustaining co-existing injuries are simply not the sum of two injuries, both SCI and TBI medical and psychosocial entities. Cognitive sequelae can hamper the acquisition of new knowledge and skills needed to regain functional independence and facilitate recovery. There is a paucity of specialized care for persons with co-existing injuries, thus a more robust understanding of the impact of TBI on SCI can assist the rehabilitation team, patient and family through the journey of recovery. This educational program will review the data and research on co-existing injuries regarding acute and rehabilitative care, functional outcomes and costs compared to persons sustaining SCI only. A case will be used to describe the effect of co-existing injuries on the patient/family system. Finally, a series of cases will be presented to outline the risks of secondary SCI complications. It is essential the rehabilitation team understand the implications of co-existing injuries. Program enhancement or specialized care is critically needed to improve rehabilitation outcomes and lifelong health and wellness of persons with co-existing injuries. Learning Objective 1: Identify trends and research outcomes of persons with co-existing injuries Learning Objective 2: Describe the effect of co-existing injuries on the patient/family system Learning Objective 3: Recognize additional risks for secondary complications in persons with co-existing injuries.
Oya Umit Yemisci
Baskent University
Turkey
Title: Low-level laser therapy- Does it affect hand function and quality of life in carpal tunnel syndrome?
Time : 14:45-15:05
Biography:
Oya Umit Yemisci, MD is an Associate Professor of Physical Medicine and Rehabilitation, and is currrently working at the Department of Physical Medicine and Rehabilitation, Baskent University Hospital, Ankara, Turkey. She is actively involved in education, residency training, research and clinical treatment at the inpatient rehabilitation hospital especially in the field of rehabilitation medicine including serebrovascular events and spinal cord injury. She is also currently performing electrodiagnosis and involved in research and residency training at the electroneuromyography (ENMG) laboratory.
Abstract:
Objective: To evaluate the effects of low-level laser therapy (LLLT) on clinical and electrophysiological parameters and health-related quality of life in patients with idiopathic carpal tunnel syndrome (CTS). Design: A prospective randomized, controlled clinical trial. Setting: Outpatient clinic of a university-affiliated hospital. Participants: A total of 98 hands of 52 female patients with a clinical and electrophysiological diagnosis of CTS were included in the study. Interventions: The patients were randomly assigned into two groups. Group 1 received 12 sessions of LLLT (670 nm, 4 J per session) over the carpal tunnel area for 4 weeks. Group 2 was given only neutral wrist splint. Patients in both groups were not permitted to receive any medical treatment or any other physical treatment for CTS during the study. Main Outcome Measures: Clinical assessment included the Tinel, Phalen and Buda tests, sensory evaluation, motor evaluation, hand grip and pinch grip strengths, Symptom Severity Scale, Functional Status Scale and levels of health-related quality of life were determined by using the Short Form-36. Electrophysiological test included nerve conduction studies and needle electromyography. Clinical evaluations of the patients included in the study were performed at the baseline, after the treatment and 3 months follow-up. Electrophysiological studies were performed before and 3 months after the treatment by the same physiatrist. Results: The hand-pinch grip strength, Functional Status Scale and Short Form-36 scores improved only in the LLLT group at post-treatment and at 3 months follow-up. Additionally, electrophysiological parameters showed significant improvement in the LLLT group. There was no statistically significant difference in terms of any other parameters between the two groups. Conclusions: These results suggest that LLLT may be a good conservative treatment method for CTS patients due to the improvement in clinical and electrophysiological parameters and quality of life.
Ä°lkin Mirzayev
Baskent University
Turkey
Title: Relationship between level of injury and urodynamic findings in spinal cord injury patients
Time : 15:25-15:45
Biography:
Ä°lkin Mirzayev, professor at Baskent University, Turkey. His research interests focuses on spinal cord injury.
Abstract:
Objective: To investigate the relationship between lesion level and urodynamic findings in spinal cord injury (SCI) patients. Materials and Methods: The medical records of 236 newly injured SCI patients admitted to our inpatient rehabilitation hospital were evaluated retrospectively and 131 patients who had urodynamic evaluation for neurogenic bladder were included in the study. Neurological levels of the patients were compared with the detrusor dysfunction as determined by urodynamic investigation. Results: There were 91 (69.5%) males and 40 (30.5%) females with a mean age of 39.1±15.17 years. The spinal cord lesion was cervical in 31(24%) patients, thoracal in 83 (63%) patients and lumbosacral (13%) in 17 patients. Forty-five percent (45%) of the patients with cervical cord injury, 32% of the patients with thoracal cord injury, and 29% of the patients with lumbosacral cord injury had detrusor hyperactivity. The ratios of low compliance bladders in the cervical, thoracic, and lumbosacral lesions were 58%, 54%, and 64%, respectively. There was no statistically significant relationship between detrusor hyperactivity or compliance and lesion level (p>0.05). According to the The American Spinal Injury Association Impairment Scale (AIS) classification, 83 (63%) patients had a complete lesion and 48 (37%) patients had an incomplete lesion. Hyperactive detrusor was determined in 31% of the patients with complete injury and 42% of the patients with incomplete injury. There were 45 (54%) bladders with low compliance in the complete lesion group and 29 (60%) bladders with low compliance in the incomplete lesion group. No statistically significant relationship was found between detrusor hyperactivity or compliance and AIS grade (p>0.05). Conclusion: We concluded that it not possible to determine the type of neurogenic bladder depending on the level and severity of lesion in SCI patients and urodynamic evaluations are essential for neurogenic bladder management in these patients.
Trent Jackman
Idaho State University
USA
Title: Exploratory Comparison of Students’ and Clinical Instructors’ Report of Frequency and Importance of Professional Behaviors
Time : 15:45-16:05
Biography:
Trent Jackman is a Clinical Associate Professor of Physical Therapy at Idaho State University. He is the Academic Coordinator of Clinical Education in the Physical Therapy Program.
Abstract:
Purpose: The purpose of this study was to explore the comparison of students’ and clinical instructors’ report of importance and frequency of professional behaviors during clinical education affiliations. Number of Subjects: 136 Materials/Methods: Using the clinical instructor characteristic statements developed by Emery & Wilkinson1, a survey was developed on Survey Monkey®. It contained the 43 statements about professional behaviors. The survey was sent to 142 clinical instructors (CIs) actively serving as CIs and to 118 students while on their various clinical affiliations. The CI was asked to self-report the importance of each behavior and the frequency with which she/he demonstrated the behavior using a 5 point Likkert scale. The student was also asked to report their belief of the importance of each behavior and the frequency with which the CI demonstrated the behavior on the same scale. Results: 60 CIs and 76 students completed and returned the survey resulting in a 42% and 64% return rate respectively. Characteristics rated the top in importance by the CIs included: point out student performance discrepancies, plans effective learning experiences, perceives self as extension of academic program, defines specific objectives for the experience. Characteristics rated the top in importance by the students included: CI points out performance discrepancies, CI is extension of academic program, CI demonstrates professional behavior, CI provides unique learning experiences, CI schedules regular meetings. Characteristics demonstrated with the highest frequency according to the CIs included: questioning/coaching in a way to facilitate student learning, providing a variety of patients, pointing out discrepancies in student performance, explaining the psychological basis of PT evaluation, making yourself understood. Characteristics the CI demonstrated with the highest frequency according to the students included: pointing out discrepancies in your performance, questioning/coaching in a way that facilitates learning, explaining psychological basis of PT evaluation, providing unique learning experiences, observing performance in a discreet manner. When comparing student and CI perceptions of frequency, both groups gave high frequency to pointing out discrepancies, coaching that facilitates learning, and explaining the psychological basis of PT evaluation. They differed when rating providing a variety of patients, providing unique learning experiences, observing performance in a discreet manner, CI consistent extension of PT program, CI manages time well. Conclusion: Both CIs and students report observing “pointing out discrepancies in student performance”, “coaching in a way that facilitates learning”, and “explaining the psychological basis of PT evaluation” with the highest frequency. Further research should be done to compare student and CI reports.
Tripti R A Gyan
Practice Manager NottinghamUK
Title: The evolving physiotherapist in a modern world
Time : 16:05-16:25
Biography:
Tripti R A Gyan completed her BSc (Hons) and MSc in Physiotherapy at Coventry University in the UK. She has over 19 years’ clinical experience including 13 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.
Abstract:
One of the principal responsibilities of a physiotherapist is to create the appropriate balance between managing a patient’s expectations and essential intervention. The concept of personalized care can be described as providing the right treatment for the right patient at the right time, ideally giving the best treatment for each individual patient. However, physiotherapy treatment must remain founded on the same evidence-based approach that has made effective intervention standardized. Having a flexible and open mind in our approach to treatment does not infer naivety or ignorance. It instead acknowledges that new questions regarding the efficacy of physiotherapy treatment will always be asked with new perspectives offered in light of new research continuously emerging. Assessment and treatment skills aside, if we want to support the empowerment of our patients for the rest of their lives, we need to have a genuine passion for helping people, an open but discerning mind and a commitment to self-development. We must of course stay abreast of what is being researched and observe the best of practice. Having a healthy skepticism to new research is not an excuse to be uninformed but can rather be viewed as an opportunity to rise to the challenges they present, instead of being dictated to. We must gather knowledge, synthesize it and apply it with relevance and confidence to our patients with the understanding that any new research is only a snapshot that it is part of a larger picture.
Mohamad Reza Nikoo
Hamadan university of medical science
Iran
Title: Effect of Cardiac Rehabilitation Program on Exercise Capacity in Women Undergoing Coronary Artery Bypass Graft in Hamadan-Iran
Time : 16:25-16:45
Biography:
Dr. Mohammad Reza Nikoo is currently working as an assistant professor of Physical Medicine and Rehabilitation department in the University of Social Welfare and Rehabilitation in Iran. He is an active member in Medical Council of Iran and Iranian Society of Physical Medicine and Rehabilitation. He has been an editorial board member of Iranian Rehabilitation Journal. His research interest includes electrodiagnostic medicine, cardiac rehabilitation and therapeutic exercise. He has published a number of articles and presented in a large number of International meetings.
Abstract:
Objectives: The purpose of this study was to determine the effects of cardiac rehabilitation program (CRP) on exercise capacity and rate pressure product (RPP) in Iranian female patients undergoing coronary artery bypass grafting (CABG) in Hamadan, Iran. Methods: Sixty women after CABG were assigned into an exercise group (n = 30, mean age 58.5 ± 10.8 years), who performed physical training for 12 weeks, or a control group (n = 30, mean age 59.3 ± 8.6 years) who received usual care. Functional capacity and RPP were evaluated by six minute walking test (6MWT) and exercise test. Results: In comparison to before training, significant increases of estimated exercise capacity (10.72 ± 1.30 vs. 7.72 ± 1.6 MET's,respectively) as well as 6MWT (556 ± 66.1 vs. 375.2 ± 28.1 meters, respectively) were observed in exercise group after 12 weeks training (P<0.001). Women increased their exercise duration time (464.6 ± 107.3 vs. 311.2 ± 101.7 seconds, respectively) by 49.2% and RPP (22361 ± 3206 vs. 20270 ± 2704.1, respectively) by 10.3% after training (P<0.001). However, no significant differences were found before and after CRP in the control group. Conclusions: Women referred for rehabilitation have similar levels of compliance and improvement in exercise capacity and supply of oxygen to cardiac muscles (measured by peak myocardial oxygen consumption). After CRP, women demonstrated significant improvements in exercise duration time, 6MWT, RPP and supply of oxygen to cardiac muscles. CRP can play an important role in improving functional independence in women.
Guadalupe Genis-Gonzalez
Fremont College School of Sports and Rehabilitation Therapy
USA
Title: RSM-Russian Sports Massage
Biography:
Guadalupe Genis-Gonzalez studied Massage Therapy in Ontario CA and became a Licensed Massage therapist in 2008. In 2010 she studied Russian Sports Massage therapy in San Diego CA and has completed her associate of science degree in sports and rehabilitation therapy, from Fremont College in Cerritos CA, where she was also a charter member of the Alpha Beta Kappa Honor Society. 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. And is looking forward to making her special RSM techniques known through the world of Sports Medicine and Rehabilitation therapy.
Abstract:
Russian Sports Massage (RSM) is an advanced manual techniques 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, memorable experience. Russian sports massage is very strictly performed when using to help athletes trying to reaching 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 management and any unknown or undiagnosed pathology/ disease can be treated and get some 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 can be interrupt digestion and interfere with rehabilitation after a workout.