Session descriptions


Post Stroke Spasticity. Early Intervention Consensus from the Allergan Medical Institute

Descriptions:
An international expert panel was formed to provide a consensus on early intervention for post stroke spasticity. Developed to guide primary care and most responsible physicians as well as physiotherapists and occupational therapists to identify patients in need of specialist spasticity management. The consensus was drawn on clinical experience, review of the literature and feedback from peers around the world. This session will be of value to physiatrists, residents and medical students.

Learning Objectives

At the end of the session, participants will be able to:

  • Recognize the risk factors for the development of post stroke spasticity.
  • Review the relevant literature on early intervention.
  • Offer feedback and critique on a tool for international roll out.
  • Improve the appropriateness of referrals to the clinician’s practice.

Speakers: Paul Winston


Transformative discoveries leading to improved care in Neuromuscular Disease

Speakers: Robin Parks


Nerve Transfers – Surgery & Outcomes

Descriptions:
Nerve transfers borrow fascicles from a healthy nerve and use them to power a synergistic, non-functional nerve. A recent paradigm shift has led to nerve transfers being the gold standard option with outcomes significantly better than nerve grafts or tendon transfers. This talk will discuss some of the potential nerve transfer options used to restore upper and lower extremity nerve function and will highlight out outcomes at the Peripheral Nerve Trauma Clinic in Ottawa.

This session will be of value to physiatrists, medical students, residents, fellows, therapists and other health care workers treating patients with nerve injuries.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe what a nerve transfer is
  • List some potential applications for nerve transfer surgery
  • Describe the superior outcomes of nerve transfer surgery in comparison to nerve grafting and tendon transfers.

Speakers: Kirsty Boyd


Beyond Steroid Injections for UE Compressive Mononeuropathies: Interventional Therapies for Neural Regeneration

Descriptions:
This session will provide the attendees with a brief overview of the current literature and evidence for use of platelet rich plasma and dextrose prolotherapy in entrapment mononeuropathies.

The session will be of value to: Physiatrists, General Practitioners, Medical Students, and Residents

Learning Objectives

At the end of the session, participants will be able to:

  • Discuss the need for interventional therapies beyond steroid injections in the non-operative management of peripheral nerve entrapment
  • Identify the role of platelet-rich plasma and dextrose prolotherapy in the treatment of peripheral nerve entrapment
  • Recognize the current medical evidence for platelet-rich plasma and dextrose prolotherapy in the treatment of peripheral nerve entrapment

Speakers: Nimish Mittal


Nerve Transfer Rehab for Function

Descriptions:
This short presentation provides an overview of the Donor Activation Focused Rehabilitation Approach to the treatment of nerve transfers. The session will be of value to medical staff and therapists who work with the nerve transfer client.

Learning Objectives

At the end of the session, participants will be able to:

  • Identify three rehabilitation factors incorporated through the three phases of nerve recovery to maximize return of function following a nerve transfer
  • Identify a rehabilitation framework which can be shared with therapists who are developing their approach to nerve transfer treatment

Speakers: Carolyn VanGool


Competence by Design – What is it and why should we all care?

Descriptions:
For over 100 years, medical education has not changed. Yet Medicine, especially physiatry, has evolved significantly since the days of the Flexner Report (1910). While the medical education system isn’t broken, it needs to meet the changing societal needs and to respond to emerging themes across the entire medial education spectrum from undergraduate training through to continuing professional development for practicing physiatrists.

Competence by Design (CBD) is the Canadian version of competency-based medical education (CBME) and the Royal College of Physicians and Surgeons of Canada’s response to meeting the changing needs of trainees, teaching faculty, practicing physiatrists and the populations that we serve. CBD will change medical education across all Canadian residency programs and will impact the maintenance of certification program for all physicians.

This session will provide a brief background of CBME and CBD, review the rationale for change and highlight the essential elements of CBD and how those features compare to our exiting education model. Physiatrists will be able to reflect on their own practice and how CBD will impact on their work as clinicians, teachers and educators.

The session will be of value to:

  • All medical students and residents.
  • Physiatrists with a Royal College of Physicians and Surgeons of Canada (RCPSC) fellowship designation.
  • Physiatrists that provide teaching in any clinical setting.
  • Physiatrists that create educational curricula and assessment strategies for their physiatry residency training programs.
  • Physiatrists that conduct medical education research.
  • Physiatrists that mentor junior colleagues and trainees.

Learning Objectives

At the end of the session, participants will be able to:

  • Differentiate between CBME and CBD as it relates to medical education.
  • Describe the impact of CBD on physiatrists in practice and on physiatry residency training programs.
  • Identify the essential elements of CBD and how they differ from the existing residency training model elements.
  • Review the proposed physiatry entrustable professional activities (EPA) and identify how these may be used in your clinical and learning environments.

Speakers: Sue Dojeiji


Stem Cell Therapy for MSK Conditions

Descriptions:

Regenerative medicine research has advanced considerably over the last two decades. Regenerative therapies, such as stem cell treatment, have thus been brought to the forefront as treatment considerations for patients with irreversible or persistent musculoskeletal disorders. Musculoskeletal pathologies, such as osteoarthritis (OA), which are accompanied by degenerative changes or alterations in musculoskeletal tissues (e.g. cartilage, bone, muscle) seem ideal conditions for treatment with regenerative therapies. This session will review the evidence supporting stem cell therapy for OA and other MSK conditions.

The session will be of value to physiatrists, medical students, residents, and other clinicians treating patients with OA and other chronic MSK conditions.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe the evidence supporting the use of stem cell therapy for OA
  • Identify other MSK conditions for which stem cells have been considered
  • Apply the currently-available knowledge regarding stem cell therapy to develop an evidence-based approach towards this treatment option

Speakers: Mark Campbell


Pearls for UMN upper extremity exam

Descriptions:

A number of therapeutic options for spasticity are available, but treatment needs to be tailored to the goals of the individual receiving care. These goals vary widely across the patient spectrum, at times making it challenging for the clinician to “get it right”. The physical exam is one of the essential tools clinicians can use to gather the information needed in order to make treatment decisions.

The session will be of value to physiatrists, medical students, residents, and other clinicians treating patients with upper motor neuron (UMN) pathology.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe an approach to examining the upper extremity in patients with UMN findings, such as spasticity
  • Distinguish the anatomic contributors to common neuromusculoskeletal findings in patients with UMN disorders, such as stroke
  • Apply physical exam findings towards developing a goal-directed treatment plan

Speakers: Mark Campbell


The Use of Big Data in Ageing in Place Research

Descriptions:

Recently there has been increased interest in home monitoring for adults with physical, cognitive or chronic health issues. This presentation will highlight advances in using one type of bed-based pressure sensor, focusing on the generation of big data. The future challenges of home monitoring will also be discussed. This session will be of value to: Physiatrists, medical learners and researchers.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe how home sensing technology will contribute to the generation of new patient data in the future.

Speakers: Frank Knoefel


Tendon Transfers in Upper Extremity Neuropathies

Descriptions:

This session will review the history, principles, applications,, current techniques, and outcomes of tendon transfers for neuropathies of the upper extremity. It is targeted at physiatrists, surgeons, residents, medical students, and physiotherapists or occupational therapists with an interest in hand and wrist surgery.

Learning Objectives

At the end of the session, participants will be able to:

  • Appreciate the history and principles of tendon transfers in the upper extremity
  • Recognize the typical indications for tendon transfers in the treatment of neuropathies of the upper extremity,
  • Review the technique, benefits and expected outcomes of common tendon transfers for neuropathies of the upper extremity

Speakers: Sarah Shiga


CRPS – Diagnosis and Medical Management

Descriptions:

The session will provide an overview of the nuances of diagnosing CRPS. It will also highlight the evidence supporting various medical treatments for CRPS as well as gaps in the evidence.
The session will be of value to: Physiatrists, residents, and therapists

Learning Objectives

At the end of the session, participants will be able to:

  • Review key aspects of diagnostic criteria for CRPS
  • Outline evidence for various treatments for CRPS
  • Stimulate discussion regarding treatment paradigms that
    are only loosely based on supported research

Speaker: Gerald Wolff


Potential Nerve Transfers in Stroke

Descriptions: This session highlights the concept of nerve transfer surgery as it might be applied to patients following stroke to restore upper extremity function. Nerve transfers borrow redundant fascicles from healthy nerves and use them to power synergistic non-functional nerves. A review of the scant literature on this topic will be included.

This session will be of value to health care providers to have an interest in stroke, treatment of stroke, and nerve transfer surgery. Learning Objectives

At the end of the session, participants will be able to:

  • Describe the concept of a nerve transfers
  • Describe how nerve transfer surgery might be applied to patients post-stroke to restore upper extremity function.

Speakers: Kirsty Boyd


Evaluation of Tetraplegics for Nerve Transfers: Clinical & EMG

Descriptions: This session will review an approach to assessing a tetraplegic for suitability for nerve transfer surgery to improve upper extremity function.
The session will be of value to: Physiatrists, residents, and therapists.

Learning Objectives

At the end of the session, participants will be able to:

  • Review approach to nerve transfers to restore hand and elbow function in tetraplegics.
  • Outline an approach to mapping the zone of injury

Speakers: Gerald Wolff


Rehabilitation Models of Care for Patients with NM Conditions

Speakers: Anna McCormick


Mechanism-Informed Rehabilitation of Complex Regional Pain Syndrome: Use of Emerging Technologies

Descriptions:

There are a number of potential pathophysiological mechanisms proposed to create the cascade into the development and maintenance of complex regional pain syndrome (CRPS). This contributes to the unique combinations of presentations found clinically in this population. Clinicians frequently feel unsure as to what treatments will be the most effective for the patient in front of them. This presentation will present a critical synthesis of the rehabilitation literature, and propose a mechanism-specific management algorithm to guide personalized treatment of CRPS. Levels of evidence for the proposed treatments will be identified. The presentation will discuss areas where the evidence is minimal and opportunities exist for further research to advance treatments around specific mechanisms. Finally, this presentation will discuss emerging areas of research around the use of virtual reality to target visuospatial perception dysfunctions frequently found in the more complex CRPS presentations.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe the various rehabilitation targets to be addressed in the patient presenting with CRPS
  • Tailor CRPS rehabilitation plans around specific mechanistic factors
  • Discuss with interdisciplinary clinical peers other possible targets of treatment
  • Embrace new technologies as a potential means of addressing visuospatial perception dysfunctions
  • Consider the treatment strategies presented for possible other conditions with similar mechanistic factors

Speakers: Janet Holly


Ethical Considerations in Funding Health Care: What sort of life should not be prolonged?

Description:

Physicians and others frequently make decisions about prolonging lives that have the potential to create significant and life long disabilities, and without considering the resources that will subsequently be required to assure quality of life. This presentation will explore those issues and the complex and controversial notion of what we mean by quality of life, and what sort of life is worth living. The session will be of value to physiatrists, medical students and resident.

The session will be of value to: Physiatrists, Residents and Medical Students.

Learning Objectives

At the end of the session, participants will be able to:

  • Be able to describe the different ways of thinking about the concept of quality of life
  • Have a knowledge of the ethical concepts underpinning these issues
  • Understand the factors that go into making a decision about life prolonging therapies

Speakers: Jeff Blackmer


Medical Device Innovation in PM&R

Description:

A perfect storm is brewing: the proportion of seniors in our population is steadily increasing and the number of physicians is not keeping pace. In order to mitigate the inevitable increased burden on the healthcare system, physicians can look to technology in order to meet growing demands. As physiatrists, with our already high utilization of medical technology, we are ideally poised to help bridge this gap.

Learning Objectives

At the end of the session, participants will be able to:

  • Apply tools to identify high impact healthcare problems to solve in PM&R.
  • Create a structured needs statement to clearly outline the scope of the problem, the population it addresses, and the quantifiable outcome it will achieve if solved.
  • Identify high impact, low risk opportunities for medical device innovation through the use of objective and quantifiable filters.
  • Understand the overall pathway of how to create and commercialize a new medical device that can make major positive impacts on patient lives.

Speakers: Derek Thong


Principles of Pulmonary Care in Children with Neuromuscular Conditions

Descriptions:

At the end of this session, participants will have an understanding of the respiratory complications of neuromuscular disease, appreciate diagnostic evaluations for restrictive lung impairment and sleep disordered breathing and be aware of management strategies to address airway clearance and ventilator failure in children with neuromuscular disease. The session will be of interest to Physiatrists, Medical Students, Residents and Allied Health Professionals.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe respiratory complications of neuromuscular disease, including impaired cough and sleep-disordered breathing
  • Examine diagnostic and monitoring strategies for respiratory complications in children with neuromuscular disease
  • Examine management strategies including infection prevention, airway clearance and non-invasive ventilation

Speakers: Sherri Katz


Virtual Reality Therapy in Stroke Rehab Trials

Descriptions:

Virtual reality can be defined as “a simulation of a real world environment that is generated through computer software and is experienced by the user through a human–machine interface”. It can be used as a primary or adjunctive modality for stroke rehabilitation. Recent reviews suggest that virtual reality produces recovery results as good as or better than conventional rehabilitation for standing balance, gait and upper extremity function. Virtual reality can be used in inpatient and outpatient settings. It can also be used for home-based therapy, as telerehabilitation, in the subacute and chronic phases after stroke. This session will describe the integration of virtual reality research into stroke rehabilitation at Bruyère Continuing Care. Results from studies using virtual reality for standing balance, sitting balance, telerehabilitation will be presented, along with a platform for knowledge translation. This session will be of value to: Physiatrists, Medical Students, Residents, General Internists, Neurologists, Neuroradiologists, Physiotherapists, Occupational Therapists, and Nurses.

Learning Objectives

At the end of the session, participants will be able to:

  • Understand the benefit of virtual reality for stroke rehabilitation.
  • Describe 3 types of virtual reality systems and 3 settings in which it can be used for stroke rehabilitation
  • Formulate plans to incorporate virtual reality into their own practice
  • Apply VR principles learned, to stroke rehabilitation practice
  • Determine VR feasibility in Physiatric practice

Speakers: Lisa Sheehy & Hillel Finestone


Emerging Therapies in Pediatric Neuromuscular Disease

Descriptions:

This presentation will review the genetics and epidemiology of spinal muscular atrophy (SMA) and Duchenne muscular dystrophy (DMD). I will discuss therapies that have been used to treat DMD as well as emerging gene-based therapies that are aimed at treating patients with neuromuscular diseases.

The session will be of value to Physiatrists, Residents, Medical Students.

Learning Objectives

At the end of the session, participants will be able to:

  • Review genetics and epidemiology of spinal muscular atrophy (SMA) and Duchenne muscular dystrophy
  • Discuss new antisense oligonucleotide treatments
  • Evaluate emerging gene-therapy trials & potential treatments

Speakers: Hugh McMillan


Expectations of Residency programs

Descriptions:

This session will review the expectations of individual physiatrists and residency programs with respect to assessment. Assessment within CBD relies heavily on frequent, documented observations of resident performance in the workplace by individual clinical teachers. Rating scales for these observations use entrustment anchors. These documented observations also have an increased focus on narrative comments. Decisions about successful achievement of entrustable professional activities are made by a Competence Committee (CC). The CC makes these decisions using the information provided to them via the regular, documented observations completed by individual clinical teachers.

The session will be of value to: Physiatrists, Residents and Medical Students.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe the best practices for documenting trainee observations of achievement
  • Identify the roles and functions of the Competence Committees within the context of a residency training program

Speakers: Nancy Dudek


New Frontiers in Amputee Care – Osseointegration

Descriptions:

Some individuals with lower limb amputations have issues with the interface between their prosthetic socket and their residual limb resulting in reduced use of their prosthesis and a lower quality of life. Osseointegration results in a structural and functional connection between living bone and a metal implant allowing the prosthesis to be directly attached to the residual limb and eliminating the interface issues. Different implants and protocols have been developed. This presentation will review the literature regarding the risks, benefits, outcomes, indications and contraindications for osseointegration. An update on the development and status of osseointegration programs in Canada will be provided.

The session will be of value to: Physiatrists, Residents and Medical Students.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe the role of osseointegration for individuals with amputations who do not tolerate socket prostheses

Speakers: Nancy Dudek


Surgical Management of Neuromas in Residual Limbs

Descriptions:

Targeted muscle reinnervation (TMR) surgically transfers amputated nerves to nearby motor nerves that no longer have function because of amputation. This was originally developed to offer better control of a myoelectric prosthesis. Researchers observed that individuals with TMR reported less neuroma and phantom pain. Recently, prospective trials have demonstrated a reduction in phantom and residual limb pain for individuals with TMR done at the time of amputation as well as a reduction in phantom limb pain in individuals who had TMR performed at a later date for the treatment of chronic neuroma associated pain.

The session will be of value to: physiatrists, residents and medical students with an interest in the care of individuals with amputations.

Learning Objectives

At the end of the session, participants will be able to:

  • List current surgical approaches for the management of neuromas in amputated limbs

Speakers: Nancy Dudek


Robotics for Upper Extremity Rehab in Stroke

Descriptions:

This session will be a brief overview of the uses of robotic devices for assessment and rehabilitation of the upper extremity following stroke.

Learning Objectives

At the end of the session, participants will be able to:

  • Identify some of the common robotic devices used in upper extremity rehabilitation.
  • Discuss some of the literature related to robotic rehabilitation and upper extremity therapy following stroke.

Speakers: Sean Dukelow


Somatic Symptom Rehabilitation

Descriptions:

We will review the diagnostic framework for somatoform disorders, discuss the role of each member of our multidisciplinary team, and share case examples. Participants will learn tools to recognize somatoform disorders in daily clinical practice, learn the correct terms to diagnose and describe these symptoms and conditions, and learn skills to inform treatment. This session will be of value to physiatrists, residents, medical students, and all clinicians who participate in multidisciplinary care.

Learning Objectives

At the end of the session, participants will be able to:

  • Learn the diagnostic classification for somatoform disorders
  • Recognize symptoms of somatoform disorders
  • Develop an understanding of the various treatment

Speakers: Vithya Gnanakumar, Tyler Pirlot


Post Stroke Fatigue

Descriptions:

This presentation will discuss post stroke fatigue syndrome and its impact on patient’s recovery and reintegration to community. It will help to raise awareness of the common sequela of stroke and its vocational challenges so patients can participate, and problem solve in returning to work. The session will be of value to: Physiatrists, Residents, Allied Health Professionals and Medical Students.

Learning Objectives

At the end of the session, participants will be able to:

  • Identify post stroke fatigue syndrome
  • Evaluate impacts of fatigue on return to work and driving
  • Practice the use of knowledge when dealing with vocational rehab issues

Speakers: Christine Yang


Canadian Advances in Neuro-Orthopedics for Spasticity Congress Update

Descriptions:

We recently hosting world leading experts on both cutting-edge novel treatments for spasticity as well as tried and true methods such as casting, TENS and the very old technique of percutaneous tenotomy at the bedside. We will explore the novel approach of ultrasound guided nerve blocks to assess for key muscles in spastic muscles overactivity. We will underscore the need for multi, inter and transdisciplinary care. Our experts are assigning short summaries for this presentation. The session will be of value to: Physiatrists, Medical Students, Residents.

Learning Objectives

At the end of the session, participants will be able to:

  • Describe the role of the fascicular arrangement of nerves and their contribution to spastic muscle overactivity.
  • Describe the usefulness of the Modified Tardieu Scale.
  • List the benefits of ultrasound guided and e-stim nerve blocks.
  • Describe with innovations from around the world.

Speaker: Paul Winston


SCI SIG

Speaker: Viet Vu

MAID in Canada. The Challenges of MAID in the Rehab Setting
Group discussion on the implementation of MAID and what we have experienced at GF Strong.

At the end of the session, participants will be able to:

Describe the Amendment to the Criminal Code of Canada
List the criteria for MAID and describe the process
Plan for MAID in your rehab centre


TBI SIG – Physiatry Feedback on Current Guidelines for Rehabilitation of Moderate to Severe TBI and Concussion/mTBI and Persistent Symptoms

Descriptions:

Guidelines have been developed for moderate to severe TBI rehabilitation as well as Concussion/mTBI and persisting symptoms. As a SIG, this session will focus on the expertise of the group to explore improvements for the guidelines as well as strategies to implement with the ultimate aim of improving consistency of care and patient outcomes.

Learning Objectives

At the end of the session, participants will be able to:

  • Provide and develop feedback from a Physiatry perspective on Current Guidelines for Rehabilitation of Moderate to Severe TBI and Concussion/Mild Traumatic Brain Injury and Persistent Symptoms
  • Identify implementation strategies to improve uptake and use of guidelines by primary care providers and patients

Speakers: Shawn Marshall, Deanna Quon
Moderator
: Chantal Vaidyanath

 


Amputee SIG – Osseointegration

An Update of the Situation Around Canada.
Moderators: Ariane Rajotte-Martel, Amanda Mayo

To discuss national updates on Ossseointegration across Canada, including recent initiatives in Alberta.

Learning Objectives At the end of the session, participants will be able to:

  • At the end of this session, participant will be able to
  • Distinguish the advancement of osseointegration in Quebec, Ontario and Alberta.
  • Identify potential patients who would be good candidate for the procedure
  • Summarize the main issues related to osseointegration to their patients and colleages/ coworkers.

Speaker: Jacqueline Hebert

Osseointegration in Quebec

Descriptions:

Update on osseointegration in Quebec including a description of the Montreal Osseointegration Clinic and its outcomes to date

The session will of be value to Physiatrists, Medical Students and Residents.

Learning Objectives

At the end of the session, participants will be able to:

  • Distinguish the advancement of osseointegration in Quebec, Ontario and Alberta.
  • Identify potential patients who would be good candidate for the procedure
  • Summarize the main issues related to osseointegration to their patients and colleagues/ coworkers.

Speakers: Natalie Habra


Stroke SIG – Virtual Reality Therapy in Stroke Rehabilitation

Presenters:
Lisa Sheehy, PhD
Hillel Finestone, FRCPC
Heather MacNeill, FRCPC
Bill Dai (CEO/VNovus and Philip Black, Co-founders of Emersewell

Overview
Augmented/ Virtual Reality (AR/VR) provides a human- computer interface to interact in virtual environments, affording opportunities for stroke rehabilitation provision that otherwise may not be possible. This session will review the evidence, opportunities and challenges in providing VR in stroke rehab care, through didactic and hands on sessions that will allow participants to learn about and experience firsthand immersive (Gonio VR) and non immersive (Jintronix VR) technology as well as applications for google cardboard.

20 min: background, research and practical application of non-immersive VR technology in stroke rehab- personal experience with the Jintronix technology at University of Ottawa, Bryere (Lisa Sheehy)
10min- overview, potential applications and evidence on immersive VR technology (Heather MacNeill)
30 min- hands on stations (participants to rotate between):

  1. Non-immersive VR (Jintronix)- Lisa Sheehy and Hillel Finestone
  2. Immersive VR (Gonio VR)- Bill Dai and Philip Black
  3. Google Cardboard- Heather MacNeill

Learning Objectives: At the end of the session, participants will be able to:

  1. Recite the evidence for VR in stroke rehabilitation
  2. Debate the opportunities and challenges to incorporating VR into practice
  3. Operate immersive and non-immersive VR technologies available in the session

CBD facilitated discussion
Speaker: Jennifer Yao


MedicoLegal SIG Ottawa

At the end of the session, participants will be able to:

  • Update colleagues on the jurisdictional variations
  • Review interesting characteristics specific to the IME Report
  • Bring up to date the use of today’s technology in IME work
  • Identify a new Chair for ML SIG

A look at the program content:

  • Who is a MedicoLegal Expert
  • What can you Charge (a changing environment)
  • Where can you practice (i.e. must you have a License to conduct IME’s)
  • Use of Video in IME’s (saving time and travel)
  • The Rebuttal Report (what to look for)
  • The Independent MedicoLegal Report: Format and Style

Speaker: E. Lyle Gross


Pain SIG Symposium – “Herbal Cannabis in Chronic Pain Management – How do we deliver high-quality clinical care with low-quality evidence?”

Moderator: Nimish Mittal

Description: The lack of convincing high-quality evidence and well-known side effects of herbal cannabis for chronic pain has not dissuaded patients from accessing this plant. The recent legalization of cannabis for recreational use has obviated the need for physician authorization. Herbal cannabis for chronic pain management, when undertaken with little or no guidance/knowledge of product composition, pharmacology, or dose titration may increase the risk of treatment failure and harm for patients. Despite the limited evidence for efficacy pain remains the primary reason for initiating cannabis. In this context, a measured and thoughtful approach may help guide patients to the appropriate use of cannabis and in some instances provide benefit with minimal harm in patients who have failed other treatment modalities in chronic pain.
The symposium will provide the attendees with a brief overview of cannabis pharmacology as it relates to pain medicine, the extant evidence that exists for the use of cannabis and cannabinoids in pain medicine and outline the considerations of potential harm and adverse effects of cannabis use including its effect on driving and potential for cognitive impairment. Attendees will participate in practical case-based learning to explore practical tips for medical cannabis use in appropriate situations while promoting harm reduction.

Speaker 1: Amol Deshpande (1310-1330)

Speaker 1 Abstract: While there is still much debate about the indications and quality of evidence for cannabis and cannabinoids in pain medicine, the reality is that pain patients are actively using cannabis to manage symptoms. This talk will briefly review the pharmacology and evidence of cannabis while highlighting some common practical tips for instructing patients on the use of cannabis while minimize harm.

Speaker 1 Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Describe the pharmacology of cannabinoids as it relates to pain
  2. Be aware of the evidence that exists for the use of cannabis and cannabinoids in pain medicine

Speaker 2: Andrea Furlan (1330 -1350)

Speaker 2 Abstract: Driving a motor vehicle is a complex task that requires attention, concentration, sensory, motor and cognitive functions. Cannabis impacts some cognitive and psychomotor skills such as learning, balance, coordination, tracking ability, memory, perception (visual, auditory, sensory and time), motor impulsivity and attention in a dose-dependent manner. At high doses, cannabis may cause hallucinations. Cannabis also causes euphoria, relaxation and facilitation of social interactions. Self-awareness of the effects of cannabis is maintained. Frequent users do not develop tolerance to the effects of cannabis. An estimated 12.3% of the adult Canadian population reported using cannabis at least once in the past 12 months, and approximately 3% use cannabis daily for medical purposes, recreational enjoyment or both. A recent survey among young Canadians (age 18-34) showed that 23% would not plan for alternative travel arrangements (e.g. designated driver or taxi) after using cannabis , and 30% said they either drove after smoking cannabis or had been in an automobile driven by someone who had recently smoked cannabis. Detection of impairment by cannabis is not possible based on measures of Δ9-tetrahydrocannabinol (THC), 11-hydroxy-THC (11-OH-THC), or 11-nor-9-carboxy-THC (THCCOOH) in body fluids such as blood, urine, or saliva, as these levels do not correlate well with levels of sensory, motor and cognitive impairment required for driving.
Currently, detecting driving impairment includes the application of the Standardized Field Sobriety Test, which has been validated for impairments related to alcohol but not to cannabis. Roadside saliva tests using the Drager DrugTest 5000 has been legalized since the summer 2018 but many police officers are reluctant about its ability to demonstrate impairment or just recent use.

Speaker 2 Learning Objectives:

At the end of this presentation, participants will be able to:

  1. Describe the effects of THC and CBD on psychomotor function that are relevant to driving and working in safe-sensitive jobs
  2. Inform their clients about how to self-assess for impaired driving due to cannabis products

Title: Practical tips for good prescribing of herbal cannabis using problem-based learning

Speaker 3: Nimish Mittal (1350-1410)

Speaker 3 Abstract: This problem-based learning interactive session will provide practical tips on the medical use of cannabis in chronic pain management.

The session will be of value to Physiatrists, Pain Fellows, Medical Students, Residents and Physicians who work with chronic pain patients.

Speaker 3 Learning Objectives:

At the end of this presentation, participants will be able to:

  • Identify modes of administration and dosing strategies for herbal cannabis in chronic pain conditions
  • Illustrate titration tactics and monitoring to minimize adverse events while promoting harm reduction

Nerve transfer surgery: Types, Timing, Patient Evaluation

Description:The session will outline the basics of nerve transfer surgery to facilitate recovery after severe peripheral nerve injury. It will also review patient screening and ideal timing of referral for surgical intervention.
The session will be of value to Physiatrists, residents and therapists.
Learning Objectives

At the end of the session, participants will be able to:

  • Outline the rationale for nerve transfer surgery
  • Identify who may be a candidate for nerve transfers
  • Outline an approach to prognostication of recovery in incomplete injuries
  • Outline pros and cons of surgical intervention in neuralgic amyotrophy

Speaker: Gerald Wolff


NM SIG: Preparing for Competence by Design – Neuromuscular competence leveling to the Generalist Physiatrist

Facilitators: Sue Dojeiji and Gerald Wolff
Identify essential Neuromuscular Physiatry competencies as they apply to the Generalist level Physiatrist
We need your help! In July 2020, Competence by Design (CBD) will roll-out for all Canadian Physiatry programs. NM physiatrists are invited to review competencies identified by the Competence by Design (CBD) RCPSC Specialty Committee. We need to validate our understanding of the expectations of the generalist level Physiatrist as it relates to NM Medicine and Rehabilitation – i.e., what can we expect our new Physiatry graduates to be do when it comes to electrodiagnostics practice and NM rehabilitation patient populations.


Rehabilitation Models of Care

Emerging trends in molecular biology and next generation genomic sequencing will play a role in the identification and possible treatment of many conditions. This session will review the impact on persons with neuromuscular diseases (NMD) and the models of care required in order to facilitate the ongoing care requirements of these complex patient populations.
This session will be of value to all Physiatrists, residents and medical students as the impact of these emerging diagnostic and therapeutic options will not only impact on the care requirements of persons with NMD, but other patient populations commonly encountered in Physiatry.

Learning Objectives At the end of the session, participants will be able to:

  • Identify various rehabilitation models of care and the challenges in applying them within the NMD population.
  • Describe the unique role of Physiatry in caring for individuals with NMD.
  • Describe the process of transition from pediatric to adult rehabilitation care as a pertinent opportunity for quality improvement.

Speaker: Sue Dojeiji


Transformative discoveries leading to improved care in Neuromuscular Disease

Speaker: Robin Parks


Basic scope of competence in CBD

This will be a brief discussion with physiatrists in subspecialty practices to better understand what types of clinical competencies and contexts would be considered within or out of scope for a new, general physiatrist. This discussion will help inform the future of physiatry training in Canada.

Learning Objectives At the end of the session, participants will be able to:

  • Determine what subspecialty practice competencies and contexts are considered within or out of scope for a new, general physatirst.

Speaker: Jennifer Yao


Update on Clinical Research and Care of Patients with ALS

This session will review advances in clinical management of ALS patients and the results of recent clinical research studies. Topics highlighted will include new disease-modifying therapies, familial ALS, respiratory management, and end-of-life care. The session will be of value to: physiatrists, medical students, and residents.

Learning Objectives At the end of the session, participants will be able to:

  • Provide updates on genetic diagnosis of ALS
  • Review advances in disease-modifying treatment for ALS
  • Highlight recent Canadian guidelines for respiratory care
  • Highlight challenges in providing end-of-life care for advanced ALS patients

Speaker: Ari Breiner


Competence by Design – Expectations for Individual Physiatrists

Coaching is a method of instruction in the clinical environment that aligns with progressive acquisition of competence.  This session will highlight key elements of coaching that are incorporated into a Model of Coaching for Competence by Design as well as outline the essential components of a Coaching framework that can be applied in a CBME setting.

Learning Objectives At the end of the session, participants will be able to:

  • Describe key elements of Coaching in the clinical environment and how they support trainee learning and faculty competence in guiding learning in a CBME system.
  • Utilize a framework to facilitate coaching.

Speaker: Denyse Richardson


An Eclectic Selection of Novel US-Guided Procedures Useful in the Neurologically Impaired Upper Extremity

Learning Objectives At the end of the session, participants will be able to:

  • Discuss the principles of Hydrodissection
  • Discuss the role of Hydrodissection in common entrapment neuropathies
  • Outline the evidence for Hydrodissection in CTS
  • Discuss the high incidence of Frozen Shoulder in the neurologically impaired upper extremity
  • Discuss the role of CSI in Frozen Shoulder
  • Discuss the benefit of image guidance in injections of the GH joint in Frozen Shoulder
  • Discuss the principles and added benefit of capsular distension in GH joint injections for Frozen Shoulder

Speaker: Harpreet Sangha


Community SIG – Practice Lifecycle

1505-1535

Practice Management, Ontario Medical Association (OMA)

Presented by Ryan Banach, CCFP

Controlling Expenses

  • Overhead: Cost projections, leases and location

Staffing

  • Using and managing staff effectively
  • Employee contracts
  • Finding the right staff Office Efficiency
  • Reducing expenses and revenue management

1535-1605

Transition into Practice and Succession Planning, HealthForceOntario (HFO)

Presented by Alison Green, MHA, CHE

  • Introduction to HealthForceOntario – Practice Ontario Service
  • Background: Demographics as it relates to recruitment and retention
  • Transition into Practice
  • Options Available
  • Transition out of Practice (Succession Planning)
  • Timelines
  • Preparation

1605-1630 Q&A


Healthcare on the Reservation in the USA: Success and Challenges of One Community and the Power of PL-638

Nam Le-Morawa

A brief overview of one Tribal community and its survival of the historical trauma experienced, and the power of Public Law 638 in changing Healthcare service delivery for Native Americans. This session will be of value for all medical/healthcare professionals who work with First Nations people on/off Reservations, public health workers, social workers, case managers, policy makers, hospital and/or community based workers, administrators.

At the end of the session, participants will be able to:

  1. Summarize Public Law 638 as it pertains to Tribal Sovereignty and US Federal Obligations
  2. Acquire an understanding of the historical context of the San Carlos Apache people.
  3. Describe how PL-638 impacted Tribal Healthcare in the USA
  4. Identify the success and challenges on the San Carlos Apache Reservation
  5. Compare and discuss the challenges of healthcare service delivery on Reserves in the USA vs. Canada