Session descriptions


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:

  • Understand 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.

This presentation aims to demystify and foolproof the inventing process. A practical and structured approach to medical device innovation will be outlined which will be useful to both newcomers and veterans to medical devices. It will provide physicians with practical methods that can be implemented in daily clinical practice to discover high impact areas in PM&R that would benefit from new medical technologies.

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:Dr. 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.

This presentation aims to demystify and foolproof the inventing process. A practical and structured approach to medical device innovation will be outlined which will be useful to both newcomers and veterans to medical devices. It will provide physicians with practical methods that can be implemented in daily clinical practice to discover high impact areas in PM&R that would benefit from new medical technologies.

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:

  • 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:Dr. 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:

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

Speakers:Dr. 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

Speakers: Lisa Sheehy & Hillel Finestone


Pediatric NM Clinical Research & Available Treatments & Trials

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:Dr. 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:

  • Be aware of 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:

  • Be aware of 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:

  • At the end of this session, participants will be able to identify some of the common robotic devices used in upper extremity rehabilitation.
  • At the end of the session, participants will be able to 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:Dr. Vithya Gnanakumar , Tyler Pirlot


Post stroke Fatigue

Descriptions:

This presentation will discuss post stroke fatigue syndrome and its impact on patients 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
  • Us of knowledge when dealing with vocational rehab issues

Speakers:Dr .Christine Yang


Neuro-Orthopedics 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:

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

Speakers:Paul Winston


SCI SIG

30 min Educational Topic Speaker Karen Ethans
30 min Round Table “MAiD” Speaker Viet Vu

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:Dr. Shawn Marshall and Dr. Deanna Quon
Moderator: Chantal Vaidyanath


Amputee SIG

Osseointegration: an update of the situation around Canada.
Moderators: Dr Ariane Rajotte-Martel, Dr Amanda Mayo

Speakers:  Dre Nathalie Habra, Dre Nancy Dudek, Dre Jacqueline Hebert

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 colleages/ coworkers.

Stroke SIG

VR’s Use in Healthcare
At the end of the session, participants will be able to:

  • To apply VR principles learned, to stroke rehabilitation practice
  • To determine VR feasibility in Physiatric practice

Speaker: Hillel Finestone

Virtual Reality Demonstration
Speaker: Bill Dai (CEO/VNovus)

Stroke and CBD facilitated discussion
Speaker: Jennifer Yao


 

Outcomes and challenges of nerve transfers in tetraplegics

Description:
The presentation will discuss the minimal data available on outcomes of nerve transfers in tetraplegics and highlight some of the limitations. Considerations for timing of surgery and staged surgery will be discussed. This session will be of value to physicians and allied health who treat tetraplegics. Information will help them answer questions from their patients regarding nerve transfer suitability.

Learning Objectives

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

  • Counsel tetraplegic patients on potential functional improvements post nerve transfer
  • Counsel patients on limitations of nerve transfer in tetraplegics
  • Identify tetraplegics most likely to benefit from a nerve transfer

Speaker: Dr. Gerald Wolff


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, MD, FRCPC, FRACP (NZ)
LyleGrossMD@grcvirtual.com


Pain SIG Symposium

Moderator: Dr. Dinesh Kumbhare/Dr. Nimish Mittal

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

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: Dr. 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: Dr. 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

Speaker 3: Dr. Nimish Mittal (1350-1410)

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

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

Speaker 3 Learning Objectives:

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

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