Dysmobility Syndrome: The Future of Fracture Risk Reduction

Dr. Neil Binkley, Professor of Medicine, Divisions of Geriatrics and Endocrinology, University of Wisconsin-Madison

Current approaches to "osteoporosis" treatment are inadequate. It is essential to recognize that low bone mass, i.e., osteoporosis, is only part of a syndrome complex that leads to falls and fragility fractures. Thus, the field needs to move "beyond the bone." Potential considerations in the dysmobility concept include sarcopenia, obesity, diabetes and osteoarthritis among others. It is anticipated that bringing forward the concept of dysmobility will facilitate moving our fracture risk reduction efforts to a focus upon the individual, rather than on their bones. This session will be of value to physiatrists, medical students and residents.

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Roles and guidance for rehabilitation efforts in the humanitarian field

Colleen O'Connell, Research Chief, Stan Cassidy Centre for Rehabilitation and Nabila Soomro, Director, Institute of PM&R, DOW University of Health Sciences, Karachi

Current manufacturing techniques to produce prosthetics and orthotics require extensive manual labor and is time consuming. These factors limit the capacity of prosthetists and orthotists to provide patient care, particularly in resource-limited settings. The use of a digital tool-chain, including 3D scanning of patient residual limbs, computer design of appropriate topologies, and 3D printing of devices potentially reduces the manufacturing time thereby increasing clinical capacities. In partnership with CoRSU Hospital, Uganda, CSPO, Cambodia and CCBRT/Tatcot, Tanzania, non-profit Nia Technologies has carried out a large-scale clinical trial comparing current ICRC methods with 3DPrintability, a software and hardware toolchain it has developed. This toolchain will be explained and initial analysis of results from the trial will be discussed. Preliminary results indicate that 3DPrintAbility devices are performing to the same level of efficacy as traditionally manufactured prosthetics. Current data supports the hypothesis that a digital manufacturing tool-chain is a viable alternative to current methods and may be desirable given the time savings involved. Capabilities and continuing challenges will be explored.

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Post-Stroke Shoulder Pain

Dr. Ricardo Viana

The presentation will endeavour to define post-stroke shoulder pain and provide an approach to help the clinician to identify the most likely etiology of pain. Next I will look at the most common etiologies and explore the evidence based management options in greater detail, including possible oportunities for interventional managment. Target audience: Physiatrists, residents and medical students. Also may be helpful for therapists.

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The World of 3D printing – what it means for you and your patients today

Dr. Matt Ratto, Chief Science Officer, Nia Technologies & Associtate Professor, University of Toronto Faculty of Information

Current manufacturing techniques to produce prosthetics and orthotics require extensive manual labor and is time consuming. These factors limit the capacity of prosthetists and orthotists to provide patient care, particularly in resource-limited settings. The use of a digital tool-chain, including 3D scanning of patient residual limbs, computer design of appropriate topologies, and 3D printing of devices potentially reduces the manufacturing time thereby increasing clinical capacities. In partnership with CoRSU Hospital, Uganda, CSPO, Cambodia and CCBRT/Tatcot, Tanzania, non-profit Nia Technologies has carried out a large-scale clinical trial comparing current ICRC methods with 3DPrintability, a software and hardware toolchain it has developed. This toolchain will be explained and initial analysis of results from the trial will be discussed. Preliminary results indicate that 3DPrintAbility devices are performing to the same level of efficacy as traditionally manufactured prosthetics. Current data supports the hypothesis that a digital manufacturing tool-chain is a viable alternative to current methods and may be desirable given the time savings involved. Capabilities and continuing challenges will be explored.

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Feedback -Saying what you mean without being mean

Nancy Dudek, Associate Professor, University of Ottawa

Useful, timely information on performance (feedback) promotes learning and changes in behavior. Providing this feedback has been a challenge for postgraduate medical education. Residents say they want more but sometimes there are concerns noted with how they receive it. Supervisors identify numerous barriers to providing useful feedback in the busy clinical environments in which they work. As residency programs move towards a CBME curriculum the ability to provide feedback and implement the feedback has become even more relevant.

Feedback does not only exist within our educational context. The ability to provide useful feedback to other healthcare professionals, patients and peers is a key component of successful clinical work. Consideration of feedback skills necessary for success in these contexts will also be discussed.

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

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A Brief Overview of Motivational Interviewing

Rosa Dragonetti, Project Director, Addictions Education and Research, CAMH

This session will be of value to any healthcare provider and will describe an evidence-based method of communication that will help you increase your client's motivation to change any behavior.

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Vitamin D:  The Panacea and the Controversies

Dr. Neil Binkley, Professor of Medicine, Divisions of Geriatrics and Endocrinology, University of Wisconsin-Madison

This session will be of value to physiatrists, trainess and other healthcare providers. We will review the controversy and chaos surrounding the definition of vitamin D "inadequacy" and the potential importance of achieving optimal vitamin D status. Recognize the challenges surrounding measurement of 25(OH)D, the necessity of utilizing standardized 25(OH)D assays and the futility of attempting to perform meta-analyses using non-standardized 25(OH)D measurement. Subsequently a clinical approach to vitamin D status based upon highly sun exposed individuals and appreciating assay variability will be discussed.

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Dysmobility Syndrome

Dr. Neil Binkley, Professor of Medicine, Divisions of Geriatrics and Endocrinology, University of Wisconsin-Madison

Fragility fractures engender major healthcare cost, reduce independence/quality and life and increase mortality risk. Despite availability of multiple therapies to reduce risk for future fracture, few patients are treated even following hip fracture. Clearly, approaches of the past aimed at reducing fragility fracture risk, primarily by diagnosing osteoporosis and initiating bone-active medications, have failed. A different approach is required; such a change in focus is proposed. Briefly, the dysmobility syndrome concept recognizes fragility fracture as the clinical outcome of consequence and appreciates that osteoporosis is only part of the syndrome leading to “osteoporosis-related” fracture. Other components of this syndrome include sarcopenia, obesity, diabetes, osteoarthritis, and potentially multiple other factors that increase risk for falls with attendant increased fracture risk. In summary, the dysmobility syndrome concept moves the field, and also importantly, older adults at risk for fragility fracture, beyond a singular focus on bone to more appropriately focus on an overall approach to fracture risk reduction. This session will be of value to physiatrists, other healthcare providers and medical trainees.

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Physiatry Update - Orthotics

Nancy Dudek, Associate Professor, University of Ottawa

Innovative designs, materials and components can improve the function, ease of use and comfort of orthoses resulting in better outcomes for our patients. This session will focus on these issues with a focus on ankle foot orthoses and knee orthoses.

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

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Pain Overview and Pain in the Butt

Brian C. Liem, MD, FAAPMR

The presentation will provide an overview of the common sources of buttock pain and discuss current evidence behind management strategies for select conditions.

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Scientific Basis of Acupuncture

Narda G. Robinson, President and CEO, CuraCore Integrative Medicine & Education Center

In this presentation, Dr. Narda Robinson will present the scientific basis of acupuncture, especially as it pertains to four areas of focus in physiatry (i.e., areas identified as "key issues" by the American Academy of Physical Medicine and Rehabilitation). These conditions include pain control, stroke rehabilitation, spine problems, and traumatic brain injury. Dr. Robinson will teach about the effects of acupuncture on central, peripheral, and autonomic nervous system pathways as well as its impact on connective tissue structures. She will also discuss research evidence that shows how acupuncture could benefit patients in a PM&R practice.

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Platelet Rich Plasma in Musculoskeletal Pain: Is it the New Future??

Nimish Mittal, Clinical Fellow,Toronto Rehabilitation Institute, University of Toronto

At the end of presentation, the participant are expected to develop a better understanding of the framework of platelet rich plasma nomenclature, mechanism of action, therapeutic potential and utility in various musculoskeletal conditions. The participants may be able to counsel the patients and help make an informed decision about the success of these treatments on the basis of available current medical literature and evidence.

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

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3D printing lower-limb prosthetics and orthotics: insights from clinical trials in Uganda, Tanzania, and Cambodia.

Matt Ratto, Chief Science Officer, Nia Technologies

Current manufacturing techniques to produce prosthetics and orthotics require extensive manual labor and is time consuming. These factors limit the capacity of prosthetists and orthotists to provide patient care, particularly in resource- limited settings. The use of a digital tool-chain, including 3D scanning of patient residual limbs, computer design of appropriate topologies, and 3D printing of devices potentially reduces the manufacturing time thereby increasing clinical capacities. In partnership with CoRSU Hospital, Uganda, CSPO, Cambodia and CCBRT/Tatcot, Tanzania, non-profit Nia Technologies has carried out a large-scale clinical trial comparing current ICRC methods with 3DPrintability, a software and hardware toolchain it has developed. This toolchain will be explained and initial analysis of results from the trial will be discussed. Preliminary results indicate that 3DPrintAbility devices are performing to the same level of efficacy as traditionally manufactured prosthetics. Current data supports the hypothesis that a digital manufacturing tool- chain is a viable alternative to current methods and may be desirable given the time savings involved. Capabilities and continuing challenges will be explored.

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Pelvic dysfunction: The Missing Link

Raza Awan, Medical Director, Synergy Sports Medicine & Rehabilitation

Pelvic pain is a common presenting complaint to physiatrists, and is a challenging clinical syndrome to diagnose and treat. Patients with pelvic pain may present with additional co-morbidities such as urinary, bowel, and sexual dysfunction. Many patients encountered in physiatric practice with non-resolving low back and/or hip pain, may also have underlying occult pelvic muscle dysfunction.  This entity is often under-recognized and if untreated may lead to poor rehabilitation outcomes. This presentation will outline risk factors for underlying pelvic muscle dysfunction in patients with non-resolving low back and/or hip pain, and discuss when it is appropriate to refer a patient to see a pelvic physiotherapist.

This session will be of value to: Physiatrists, Physiotherapists, Gynecologists, Urologists, Midwives, Residents, Medical Students, or any clinicians who treat pelvic pain in their practice.

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Osseointegration in Canada - Dream or reality?

Natalie Habra, Physiatrist, Medical chief of amputee program, Montreal Gingras-Lindsay Rehabilitation Institute

Osseointegration is presently not available in Canada. However, a growing number of Canadian amputee patients are getting the surgery abroad and returning to Canada for their rehabilitation and follow-up.

This SIG will be a forum for discussion amongst Canadian physiatrists concerning osseointegration in Canada. We will review the OI cases in Canada. We will then discuss a standardized assessment protocol, patient registry and implantation of this novel technique in Canada.

The session will be of value to Physiatrists, and less so for residents and medical students.

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Bedside Falls Assessment

Kristin Musselman, Scientist and Assistant Professor, Toronto Rehabilitation Institute-University Health Network and University of Toronto

In this session a comprehensive approach to the assessment of fall risk will be presented. The BBSE (Biological, Behavorial, Social and Economic, Environmental) Model of Fall Risk and the Systems Framework of Postural Control will be reviewed and integrated to guide a comprehensive bedside assessment. The importance of reactive balance control for fall prevention will be discussed, and methods to assess this component of postural control will be demonstrated.

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

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Development of a Best Practice Model in Acute Concussion Care: The Hull-Ellis Concussion and Research Clinic at the Toronto Rehabilitation Institute - Preliminary Findings

Paul Comper, Principal Co-Investigator, Toronto Rehabilitation Institute - UHN and Tharshini Chandra, Clinical Coordinator, Toronto Rehabilitation Institute - UHN

Research in the area of Sport Related Concussion has yielded a wealth of translational research data over the past 10 to 20 years. However, there is a lack of research relevant to patients with acute concussion who are not athletes. The Hull-Ellis Concussion Care and Research Clinic at the Toronto Rehabilitation Institute was designed from the outset to prospectively characterize and understand a multitude of factors associated with concussion, including but not limited to: mechanism of injury (MOI), symptoms at first visit, the ‘normal’ recovery trajectory, gender differences, modifiers of recovery, neurocognitive and psychological dysfunction and recovery, balance impairment, etc., while simultaneously providing routine medical care, monitoring and follow-up among the general population who present to 3 clinic-partnered ERs.

Patients/study participants diagnosed with concussion from 3 ERs in downtown Toronto meeting specific inclusion criteria (e.g., GCS=15; 17-85 years, not admitted to hospital, no positive imaging findings) are referred to the Hull Ellis Clinic via a standardized referral form from 3 partnered ERs. Each patient is contacted by the Clinic Coordinator within 72 hours, with admission to the clinic within one week of referral. Comprehensive multifactorial NIH common data elements are collected at the first visit. Patients are then offered an opportunity to participate in a prospective research REB-approved study, where data on multiple variables are collected at 2, 3, 4, 5, 6, 7, 8, 12 and 16 weeks. Data elements specific to cognitive functioning, balance, psychosocial variables, symptoms, physician related assessments and date of discharge are captured. During the data collection sequence, each patient also receives treatment by a physician, including medical assessment, education, symptom management support, routine monitoring and regular follow-up. Participants who remain symptomatic beyond 16 weeks are offered further treatment outside of the research paradigm.

In this presentation we will discuss development of the H-E from conception to gaining REB approval, then to practical implementation. Preliminary data with respect to demographics, cognition, balance and postural control, characteristics of patients with delayed recovery will be discussed. This session will be of value to physiatrists, medical students and residents.

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Resident Town Hall: A Primer on contract negotiations and job search strategies

Rebecca Titman, Resident, University of Toronto

This session will include a short talk on contract negotiations that will highlight important considerations when signing on the dotted line for your first job as a staff physician. We will also have a panel discussion with four recent graduates to answer any resident questions on finding that job in the first place. This session will be of value to residents at any level of training.

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Spinal Cord Injury Special Interest Group

Colleen O'Connell, Research Chief, Stan Cassidy Centre for Rehabilitation

Networking is invaluable for generation of ideas, fostering collaborations and validating current practice approaches. In this spirit,  SCI physiatrists will share and discuss current activities in clinical innovations and research.  Respiratory care of persons with SCI is an area that the SCI eScan and the Rick Hansen Institute SCI Registry have identified as having significant gaps in resources across the country. With a trained facilitator, we will conduct a focus group session on understanding current practices related to monitoring cough effectiveness and use of airway clearance strategies for individuals with neuromuscular disease and spinal cord injuries, as well as existing barriers, recommendations and potential strategies to mitigate these barriers. The results of this focus group will be utilized in a formal study on airway clearance strategies, and participants will be asked to consent to participate.

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