2013 Program

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Preview the Jam-packed Onsite Program Now!

pirr13 program cover lrWednesday, 13 NOV
Thursday, 14 NOV
Friday, 15 NOV
Saturday, 16 NOV
Presenter Disclosures

The ACRM 90th Annual Conference, Progress in Rehabilitation Research, is already breaking records as the largest conference in ACRM history with 16 pre-and post-conference Instructional Courses and more than 70 educational symposia and lectures.

High-Caliber Faculty — comprised of researchers, clinicians, physicians and nurses, including many who are nationally and internationally recognized for their contributions to rehabilitation medicine.

NEW this year, choose your own content scope.

  • Attend sessions for FIVE diagnostic areas, including brain injury, spinal cord injury, stroke, neurodegenerative diseases and pain.
  • If you prefer, select NON-STOP content in a SINGLE diagnostic area 
  • Many sessions have an interdisciplinary emphasis.
  • Now you can also choose sessions by focus, including Clinical Practice; Outcomes Research/ Epidemiology; Health/Disability Policy, Ethics, Advocacy; Research Methods; Neuroscience; and Technology (e.g., prosthetics/orthotics, robotics, assistive technology).
VIEW SCHEDULE AT-A-GLANCE BY DIAGNOSIS
VIEW JAM-PACKED ONSITE PROGRAM

KEY: 

BI: Brain Injury
SCI: Spinal Cord Injury
NDD: Neurodegenerative Diseases
*Additional fee (see PRICING page for details)

*Courses, scheduling, and faculty are subject to change.


 PRE-CONFERENCE

TUESDAY, 12 NOVEMBER
8:00 AM – 5:00 PM


Cognitive Rehabilitation Training – Day 1

12 November: 8:00 AM – 4:30 PM

>>>Learn more . . .


PRE-CONFERENCE
WEDNESDAY, 13 NOVEMBER
8:00 AM – 5:00 PM


 BREAKFAST SYMPOSIUM

13 November: 7:00 AM – 8:00 AM
Breakfast Symposium Flyer
Pseudobulbar Affect and Other Post-Stroke Hidden Disabilities

Faculty:
Cristin McKenna, MD, PhD, Outpatient Physiatrist Kessler Institute for Rehabilitation; Research Scientist Kessler Foundation, West Orange, NJ; Assistant Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey – New Jersey Medical School, Newark, NJ

Diagnosis: Pseudobulbar affect, spatial neglect, spasticity, stroke
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Post-stroke hidden disabilities can impair function, be distressing to patients and caregivers, and can be improved with correct diagnosis and treatment. Post-stroke hidden disabilities which are frequently underdiagnosed include pseudobulbar affect, spatial neglect which is a disability of functional vision, unawareness of deficits, abnormal regulation and recognition of emotional states of both oneself and others, and spasticity. Pseudobulbar affect can be detected by patient history, physical examination and the Center for Neurologic Study-Lability Scale (CNS-LS). Nuedexta is the only medication with an FDA indication for treatment of pseudobulbar affect. Differentiation of pseudobulbar affect from depression is critical to selecting appropriate treatment. Spatial neglect adversely impacts patient function, increases fall risk, and presents other safety risks. Dysregulation of emotion is present in both pseudobulbar affect and spatial neglect. The presence of involuntary laughing and/or crying is the hallmark of pseudobulbar affect. Spatial neglect can be associated with an impaired ability to recognize and respond appropriately to the emotions of others. Unawareness of deficit can prevent patients from seeking treatment and can present a barrier to rehabilitation. Spasticity limits movement and can be misdiagnosed as an isolated muscle weakness. Appropriate treatment for spasticity can improve patient mobility, function, and hygiene.

Learning Objectives:
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Define pseudobulbar affect and identify it in individual patients
  2. Select appropriate treatment for pseudobulbar affect
  3. Detect hidden disabilities of functional vision, unawareness of deficit, and spasticity in stroke patients.


avanirlogor web     
Sponsored by Avanir Pharmaceuticals

 

 

Cognitive Rehabilitation Training – Day 2

13 November: 9:00 AM – 3:30 PM

>>>Learn more . . .

 

Early Career Development Course

13 November: 8:00 AM – 5:00 PM

 >>>Learn more . . .

 

Instructional Courses Learn More! Details here . . .

13 November

MORNING SESSIONS: 8:00 AM – 12:00 PM
(includes lunch)

1)  An Introduction to Longitudinal Data Analysis — Part I  [#17] 2)  Early Integration of Vision into Stroke Rehabilitation [#23] 3)  Practical and Academic Perspectives on Rehabilitation of the Pain Patient: An Expert Panel [#54] 4)  Affordable Care Act: A Road Map to Transformation in Rehabilitation Policy, Research, and Practice [#73] 5)  CANCELLED: Virtual Reality Systems in Neurorehabilitation: Clinical Decision-Making and Motor Learning Applications [#75]

>>>Complete Course Descriptions HERE . . .

AFTERNOON SESSIONS: 1:00 PM – 5:00 PM
(Lunch included)

6)  An Introduction to Longitudinal Data Analysis (Part II) [#19] 7)  Electrical Stimulation for Affected Limb Function after Stroke: Theory, Evidence, and Clinical Application [#25] 8)  Post-Deployment Polytrauma: What’s the Problem and How Should We Treat It? [#31] 9)  Affordable Care Act: Healthy Life Expectancy for People with Disability [#74] 10)  Women’s Pelvic Health in the Context of Physical Disability: An Interdisciplinary Team Approach [#87] 11)  Development of the NIH Toolbox for Neurological and Behavioral Functioning: Implications for Rehabilitation Research and Practice [#27]

>>> Complete Course Descriptions HERE . . .

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Introduction to ACRM ISIGs and Networking Groups

5:00 PM – 5:30 PM

Meet representatives from ACRM interdisciplinary special interest groups and networking groups to learn about their purpose, current projects, and ways to become involved.

Early Career Networking Group Reception

5:30 PM – 7:30 PM

Connect with early career colleagues and ACRM leaders in a relaxed setting.


Past Presidents Reception
 (by invitation only)

5:30 PM – 6:30 PM


CORE CONFERENCE – DAY 1
THURSDAY, 14 NOVEMBER


ACRM ISIG, NETWORKING GROUP, TASK FORCE AND COMMITTEE MEETINGS

  • Membership Committee (by invitation only)
    7:00 AM – 8:00 AM
  • Stroke-ISIG Executive Committee (by invitation only)
    7:00 AM – 8:00 AM
  • Stroke-ISIG Movement Interventions Task Force
    7:00 AM – 8:00 AM
  • SCI-ISIG Business Meeting
    7:00 AM – 8:00 AM

  • Early Career Networking Group Physicians Task Force
    7:00 AM – 8:00 AM
  • Military and Veterans Networking Group
    7:00 AM – 8:00 AM
  • BI-ISIG Girls & Women with TBI Task Force
    7:00 AM – 8:00 AM

WELCOME REMARKS AND PLENARY:

The Intersection of Technology and Neurorehabilitation
14 November: 8:00 AM – 10:00 AM

Faculty
Michael Goldfarb, PhD; Michael Boninger, MD; Frans C.T. van der Helm, MSc, PhD; Jennifer French, MBA

This plenary session features three internationally known speakers on advances in technology related to neurorehabilitation. The session will specifically address advances in brain computer interfaces, advances in rehabilitation robotics, and the role of multichannel EEG monitoring in assessing neuroplasticity. >>>Learn more . . . 


THURSDAY, 14 NOVEMBER
CONCURRENT SESSIONS: 10:30 AM – 12:00 PM


Why We Need More Case Studies of Cognitive Rehabilitation [#110]

14 November: 10:30 AM – 12:00 PM

Faculty
Keith D. Cicerone, PhD, Director of Neuropsychology, JFK – Johnson Rehabilitation Institute, Edison, NJ and Clinical Professor, Physical Medicine and Rehabilitation, Robert Wood Johnson Medical School, UMDNJ, New Brunswick, NJ; Robyn Tate, PhD, Professorial Research Fellow, Professor, Rehabilitation Studies Unit, Northern Clinical School, Sydney Medical School, University of Sydney, AU

Diagnosis: Brain Injury, Stroke, Neurodegenerative disorder (e.g., MS, Parkinson’s disease), Diagnosis-independent
Focus: Research methods (e.g., measurement, research design analytic/statistical methods)

The demonstration of clinical effectiveness remains a priority for rehabilitation research, and this typically relies on the use of group-based, controlled trials. However, single-subject intervention research still plays a critical role in the process of clinical research and can make an elegant contribution to the process of knowledge translation and using research to guide clinical practice. Furthermore, single-subject intervention research supports a scientist-practitioner model and elevates the quality of evidence-based practice. This symposium will explore the use of single-subject intervention research as a means of translating research into clinical practice. We will address the role of single-subject intervention studies in the developmental stages of rehabilitation research. Single-subject designs can be relevant to the earliest stage of formulating theoretically sound interventions and relevant objects and targets of treatment, and can also demonstrate the application of empirically-based treatments in clinical practice. The relevance of single-subject intervention research will be illustrated with examples from PsycBite and ACRM systematic reviews of cognitive rehabilitation. The incorporation of single-subject designs into clinical practice will be further illustrated through presentation of a Model for Assessing Treatment Effects that provides specific criteria for developing single-subject intervention trials with methodological rigor. We will address the selection of interventions based on patient characteristics, variations in single-subject design, use of repeated measures, and various levels of outcome assessment. This process will be elaborated through interaction with symposia participants in developing a single-subject intervention trial for cognitive impairment.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Participants will be able to discuss the role of single-subject intervention studies in the context of developmental stages of rehabilitation research
  2. Participants will be able to describe PsycBite and discuss current evidence for effectiveness of cognitive rehabilitation derived from studies using single-subject designs
  3. Participants will describe methodologic quality indicators of single-subject designs based on the Model for Assessing Treatment Effects (MATE)
  4. Participants will be able to apply the MATE to design a single-subject intervention and evaluate the effectiveness of the intervention for cognitive impairment
  5. Participants will identify how single-subject research can effectively guide their clinical practice

 

Effects of Endogenous Reproductive Hormones Fluctuations in TBI Short-Term Recovery [#142]

14 November: 10:30 AM – 12:00 PM

Faculty
Janet P. Niemeier, PhD, ABPP (RP), Senior Director of Research, Carolinas Rehabilitation, Carolinas Medical Center, Charlotte, NC; Jean-Luc Mougeot, PhD, Director of Research, Cannon Research Center, Carolinas Healthcare System, Charlotte, NC; Brad Hurst, MD, Obstetrician/ Gynegologist/ Endocrinologist; Carolinas Medical Center, Charlotte, NC; Lori Grafton, MD, Attending, Carolinas Rehabilitation Brain Injury Unit, Carolinas Medical Center, Charlotte, NC

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Background and Significance: Brain injury documents gender differences in TBI outcomes, in favor of women. Hormonal neuroprotection is hypothesized. However, findings are mixed. Few researchers have measured levels of reproductive hormones in peripheral blood at time of injury or considered normal fluctuations in hormone levels during the menstrual cycle.

Objectives:  Review of research to reveal controversy and gaps of knowledge in the field. Discuss neurobiological complexities that may in part explain mixed findings in the literature related to gender differences following TBI and hormonal neuroprotection. Characterize relationships between reproductive hormones at time of injury and outcomes for adult women in optimum age of reproduction.

Design: Prospective longitudinal study, repeated measures of reproductive hormone levels post-TBI.

Setting: Inpatients, brain injury rehabilitation hospital

Participants:  30 women ages 18 – 25 with TBI and 30 healthy controls matched for age and reproductive cycle

Main Outcome Measures: Serum levels of estradiol and progesterone measured by ELISA at time of admission in the ED/inpatient rehab and 3 days later; menstrual cycle history, including date of last period; tests of executive functioning.

Results:  Based on the literature, we expect to find significantly better outcomes in TBI patients with undisrupted hormonal cycle and overall higher reproductive hormone levels at time of TBI, and six-month follow up.

Conclusions: Reproductive hormones circulating at time of injury may predict outcomes after TBI.  Further investigation of the molecular mechanisms involved may provide support for targeted treatments for women and men with TBI.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe key issues in brain injury literature related to gender differences in outcomes after TBI.
  2. Describe normal fluctuations in female reproductive hormones during the menstrual cycle and life phase changes.
  3. Describe methods and outcomes of a translational study looking at impact of circulating hormones at time of TBI.

 

Population-Based Outcomes after Traumatic Brain Injury in the United States [#95]

14 November: 10:30 AM – 12:00 PM

Faculty
Jeneita Bell, MD MPH, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Chamblee, GA; John Corrigan, PhD, Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH; Jeffrey P. Cuthbert, PhD MPH MS, Research Department, Craig Hospital, Englewood, CO; John D. Corrigan, PhD, Ohio State University, Columbus, OH; Cindy Harrison-Felix, PhD, Research Department, Craig Hospital, Englewood, CO; Juliet K. Haarbauer-Krupa, PhD, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA; Flora Hammond, MD, Department of Physical Medicine and Rehabilitation, Indiana School of Medicine, Indiana University, Indianapolis, IN; Christopher Pretz, PhD, Research Department, Craig Hospital/ NDSC, Englewood, CO

Diagnosis: Brain Injury
Focus: Outcomes research/ Epidemiology

Traumatic brain injury (TBI) is a major public health concern in the United States (US). These injuries account for nearly one-third of all injury-related civilian deaths and have an estimated annual economic cost of over $76 billion.[1]  Each year, at least 1.7 million Americans will incur a TBI, of which 275,000 will be severe enough to require hospitalization.[2]  For those hospitalized with TBI, approximately 52,000 will die as result of injury,[2] and those who survive will have an elevated risk of long-term physical and neurological deficits, cognitive impairment, disability, and reduced lifespan.[3]  As a result of the substantial economic and societal costs and the large number of individuals experiencing hospitalized TBI in the US, the CDC has collaborated with partners in the field of TBI research to further understand the consequences of hospitalized TBI throughout the life course and to better understand outcomes associated with TBI rehabilitation. This presentation will provide a snapshot of the CDCs research efforts on TBI and review specific examples of the undertakings and collaborations of the CDC that resulted from these efforts. Personnel from the Traumatic Brain Injury Model Systems (TBIMS) and the TBIMS National Data and Statistical Center will provide results of several studies that have developed from collaborative efforts with the CDC, including US population estimates of factors that influence return to work within two years post injury, factors that influence functional status change within five years post injury, and risk factors associated with and rates of mortality following TBI.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Highlight areas of ongoing research involving TBI undertaken or sponsored by CDC.
  2. Establish the representativeness of the Traumatic Brain Injury Model Systems National Database.
  3. Identify factors that influence return to work within 2 years for adults admitted to inpatient rehabilitation in the United States between 2001 and 2010.
  4. Identify factors that influence functional status change within 5 years for adults admitted to inpatient rehabilitation in the United States between 2001 and 2007.
  5. Provide overall and yearly mortality rates and predictors of mortality for adults admitted to inpatient rehabilitation in the United States between 2001 and 2010.

 

Balancing Change in Health Policy and Clinical Practice in Ireland, Sweden and USA [#97]

14 November: 10:30 AM – 12:00 PM

Faculty
Barbara O’Connell, President/CEO Acquired Brain Injury Ireland, Dun Laoghaire, Dublin, Ireland; Dr. Micael Edblom, Department Head of PM&R, County Hospital Ryhov, Jonkoping, Sweden; Carolyn Zollar, Vice President for Governmental Relations and Policy Development for the American Medical Rehabilitation Providers Association, Washington DC; Chris MacDonell, CARF International, Washington DC

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke, Neurodegenerative disorder (e.g., MS, Parkinson’s disease), diagnosis-independent
Focus: Health/disability policy, ethics, advocacy

Today’s world is facing dramatic and sweeping changes due to increasing financial crises, shifting political boundaries, aging populations, technological advances and employment shifts. The field of rehabilitation potentially faces overwhelming perils when health policy changes occur or financial downturns escalate. This symposium will bring together three individuals who are active in the field of rehabilitation in Ireland, Sweden, and the United States. They will bring their unique perspectives forward to generate discussion with the audience. The emphasis is to explore methods and techniques to preserve needed services for individuals with disabilities. The entire continuum of services from inpatient to community based residential services will be addressed.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Increased awareness of how financial and political climates impact rehabilitation in different countries.
  2. Articulate the major issues of health care in different countries and how they are dealt with.
  3. Determine how countries are balancing policy and financial challenges and facilitating quality care.

 

Techniques to Improve Carry-Over of Clinical Improvements to Daily Activities [#32]

14 November: 10:30 AM – 12:00 PM

Faculty
Edward Taub, PhD, University Professor of Psychology, Director CI Therapy Research Group, University of Alabama, Birmingham, AL; Lynne Gauthier, PhD, Assistant Professor of Physical Medicine and Rehabilitation, Licensed Clinical Psychologist, Ohio State University, Columbus, OH; Elizabeth Skidmore, PhD, OTR/L, Associate Professor of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA; Gitendra Uswatte, PhD, Associate Professor of Psychology & Physical Therapy, University of Alabama, Birmingham, AL

Diagnosis: Brain Injury, Stroke, Cerebral palsy, multiple sclerosis
Focus: Cerebral palsy, multiple sclerosis, clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

A number of evidence-based treatments are now available to individuals who have experienced neurological injury. Despite demonstrated improvements in speech, motor, or cognitive function on clinic-based measures, these improvements don’t always translate to improved functioning within the home/community setting.  Several behavioral techniques have been employed to facilitate better carry-over of clinical gains to daily activities (ADLs). We will present here new research demonstrating the substantial benefit of supplementing clinic-based intervention with behavioral techniques to improve transfer of training from the clinic to the home/community setting. This symposium will feature three multidisciplinary presentations on ways in which behavioral and problem-solving techniques, used in conjunction with evidence-based approaches to care, can substantially improve patient function and engagement outside the clinical setting.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss key principles underlying behavioral techniques designed to improve transfer of skills acquired in therapy to improvements in daily living.
  2. Describe how these principles have been implemented through CI therapy using a “transfer package,” including an interdisciplinary model of care that allows for delivery and reimbursement of CI therapy.
  3. Discuss neuroscientific evidence addressing these principles, and their implementation in the context of CI therapy.
  4. Describe how these principles have been applied through guided training, a patient-centered guided problem-solving approach (compared to directed training, more traditional therapist-directed approach).

 

Effective Recognition and Management of Domestic Violence in the Disabled Population [#59]

14 November: 10:30 AM – 12:00 PM

Faculty
Ann Miller Wilson Maxwell, MD, Senior Resident, Carolinas Rehabilitation, Charlotte, NC; LaTanya D. Lofton, MD, Carolinas Rehabilitation, Charlotte, NC; Erin P. Rumble, MSW – Counselor, Domestic Violence Heath Care Project, Carolinas Healthcare System, Charlotte, NC

Diagnosis:  Diagnosis-independent or N/A
Focus:  Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Domestic violence in all of its forms is a modern day epidemic that affects an estimated 40% – 60% of disabled women; however, education on the matter remains inconsistent in training and continuing education programs. Those with disabilities have additional physical or cognitive barriers, making it difficult to leave an abusive relationship and seek out available services. Studies indicate that women and men with disabilities are often dependent on their abuser for financial, emotional, physical or medical support, and therefore remain in abusive relationships. Abuse can take on many forms in this population, including withholding necessary adaptive equipment, medications, or transportation. A recent study of 13 medical specialties in Arizona showed that Physical Medicine and Rehabilitation physicians scored the lowest when asked about the amount of previous domestic violence education, awareness of services to offer victims and perceived competency in screening (Williamson et al, 2004). Other disciplines comprising the rehabilitation team have also noted similar deficiencies in training. By reviewing relevant literature, examining current research, discussing perceptions and attitudes, and presenting effective strategies for suspecting, screening and managing disabled victims of domestic violence, this course will empower participants to confidently develop a plan of care for these vulnerable and often overlooked patients.

Learning Objectives

  1. To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:
  2. Participants will review relevant literature and research with regards to domestic violence in the disabled population, thus ensuring that they both understand the scope and significance of the issue as well as consider their own attitudes, perceptions and clinical practice characteristics when it comes to this vulnerable population.
  3. Participants will learn basic strategies for approaching and screening suspected victims of domestic violence and will acquire the tools needed to confidently develop a plan of care for these patients.
  4. Participants will learn how to create and implement screening protocols within their practices to ensure efficient identification and management of patients at risk or currently experiencing domestic violence.

 

Rehab is Over, Now What? Innovative Outpatient Programs for Spinal Cord Injury [#100]

14 November: 10:30 AM – 12:00 PM

Faculty
Kim Anderson-Erisman, PhD, Research Associate Professor, Department of Neurological Surgery, University of Miami,  and Director of Education, Miami Project to Cure Paralysis, Miami, FL; Jennifer McParland, PT, COMT, Program Director, Spinal Cord Injury-Neuro Program, Brooks Rehabilitation Hospital, Jacksonville, FL; Candy Tefertiller, PT, DPT, ATP, NCS, Director of Physical Therapy, Craig Hospital, Englewood, CO; Jennifer French, MBA, Executive Director, Neurotech Network, Tampa, FL

Diagnosis: Spinal Cord Injury focused; programs also serve other diagnoses.
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

This course will focus on the development of innovative programs for people with spinal cord injury once their ‘traditional’ rehabilitation program has ended. Technology and fitness techniques are integrated into clinical practice in unique ways in a variety of programs. The challenge is the translation to home-based programming and access to equipment. This course will introduce program models ranging from an SCI specific center to an SCI program working within a multi-programmatic rehabilitation facility; how they have formulated programs to deliver opportunities for their clients to continue exercise and promote wellness; and how the rehabilitation centers implemented them in a cost effective manner. The course will conclude with a discussion on how to implement innovative programming for spinal cord injury rehabilitation.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Introduce innovative programs that extend beyond traditional rehabilitation.
  2. Discuss how to implement these programs and make them cost effective in both a small and large facility setting.
  3. Explore ways to promote health and wellness among the spinal cord injury population.

 

Complex Regional Pain Syndrome (CRPS); Diagnosis and Treatment

14 November: 10:30 AM – 12:00 PM

Faculty
Martin Grabois, MD, Professor & Chairman, Baylor College of Medicine, Houston, TX

Diagnosis: Pain / Interdisciplinary Pain Rehabilitation
Focus:  Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

This session will present a clinical discussion of Complex Regional Pain Syndrome (CRPS). It will present CRPS from a historical prospective. It will present and discuss the new IASP criteria for the diagnosis of CRPS. It will review the the incidence, etiology, and pathophysiology of CRPS. The clinical presentation of CRPS will be reviewed with emphasis on clinical evaluation with diagnostic tests put in perspective. CRPS treatment will be presented with emphasis on pharmacology, invasive treatments, psychological interventions that will moderate pain, and increase function.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the diagnostic criteria for CRPS
  2. Understand the clinical presentation of CRPS
  3. Understand the treatment options to modify pain and increase function

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THURSDAY, 14 NOVEMBER
SPECIAL OPPORTUNITIES: 10:30 AM – 3:00 PM


ACRM ISIG, NETWORKING GROUP, TASK FORCE AND COMMITTEE MEETINGS

  • Chair Council (by invitation only)
    10:30 AM – 11:30 AM
  • Neurodegenerative Diseases Networking Group
    10:30 AM – 12:00 PM
  • BI-ISIG Annual Summit
    12:30 PM – 1:30 PM

SCI-ISIG LUNCHEON WITH SPEAKER (TICKETED EVENT)

The Role of Research in Reimbursement
14 November: 12:00 PM – 1:30 PM

Jennifer French, MBAJennifer French, MBA, the executive director for Neurotech Network, will moderate a panel of experts to discuss The Role of Research in Reimbursement, followed by open audience discussion.

Panelists include:
•    Kim Anderson-Erisman, PhD, Research Associate Professor and Director of Education, Miami Project
•    Scott Simcox, PhD Candidate, Chief Technology Officer, Restorative Therapies
•    Mary Schmidt-Read, PT, DPT, MS, SCI Program Director and Coordinator of Research, Director of NeuroRecovery Network, Magee Rehabilitation

Out of pocket costs and third party reimbursement drive access to rehabilitation services, equipment and technology for persons with spinal cord injury. Financial impact is a key consideration in the decision process. How can the research community impact clinical practice, clinical services and financial access? This panel discussion will focus on novel ways to work with third party payers to gain financial access to essential services and equipment. It will also focus on how to use current research within the reimbursement process with consumer, clinical and industry perspectives. The session will also highlight examples of how this is accomplished. Open discussion with attendees will lead into how to foster relationships between clinicians and researchers to impact future outcomes to guide reimbursement decision-making toward the spinal cord injury population.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the impact the issues and perspectives of the consumer, clinician and industry in the reimbursement process and financial access.
  2. Provide examples of how research has impacted reimbursement for clinical services or equipment with successful outcomes.
  3. Discuss novel ways of using research to gain access to essential services and equipment.
  4. Foster key relationships of how future rehabilitation research can assist with the reimbursement decision process.

 

SHELDON BERROL MEMORIAL CHAUTAUQUA LECTURE:

Brain Injury as a Chronic Condition: Policy, Payer, and Consumer Perspectives
14 November: 1:30 PM – 3:00 PM

The majority of attention and resources have been principally directed toward saving lives and the early days post-injury, yet not enough has been done to improve the long term quality of lives that we save.  We must adjust our lenses, and focus on the long term medical and psychosocial issues faced by individuals with brain injury.  We must teach about brain injury to all healthcare providers, develop clinical protocols for brain injury and navigate the realities of healthcare legislation and policy so as to best advocate for not only the individuals who have a brain injury, but for the millions who will eventually develop this problem. At the 2013 Chautauqua, we will discuss the implications of caring for brain injury within a chronic disease management framework though a moderated panel discussion.  Representatives from the diverse worlds of policy maker, insurance provider, and consumer will share their perspectives on this emerging issue of managing brain injury as a chronic condition.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand a model for the implementation and management of brain injury as a chronic condition.
  2. Understand implications of this model for consumers.
  3. Understand implications of this model for payors and funding.
  4. Understand implications of this model for policy.

flora hammond mdModerator: Flora Hammond, MD is a board certified physiatrist and Professor and Chair of the Department of Physical Medicine and Rehabilitation at Indiana School of Medicine; Chief of Medical Affairs and Brain Injury Medical Director at the Rehabilitation Hospital of Indiana; Medical Director at St. Vincent Acute Rehabilitation Unit; and Medical Director for NeuroRestorative in Indiana. She is currently Project Director of the Indiana Traumatic Brain Injury Model System. Dr. Hammond is an experienced researcher who has conducted numerous studies on the long-term issues confronting individuals with brain injury and the effectiveness of treatment strategies to improve outcomes.

PANELISTS

Tom Tatlock MDTom Tatlock, MD was an adult psychiatrist in Appleton, WI from 1978 until 2000. In 1999, he sustained a “mild” traumatic brain injury when he fell off a ladder and had to retire. He has firsthand, experiential knowledge that brain injury is a chronic condition. Because he is well known in the area as a volunteer advocate for people who have sustained a TBI, many individuals and/or their family members have contacted him to share their experiences or to ask for information. His own experiences and their stories have inspired him to make numerous presentations to physicians, other professionals, and various groups in an effort to teach them about TBI and its sequelae. Dr. Tatlock will share with us his perspectives on TBI as a chronic condition. His points of view are those of a person who has sustained a TBI, who has been a physician, and who is actively working to educate others.

John Hinton DOJohn T. Hinton DO, MPH serves as the Senior Medical Director for ADVANTAGE Health Solutions in Indianapolis, IN. In this role he manages the admission and extension requests for the Traumatic Brain Injury Program for Indiana Medicaid and supports other Medicaid and Medicare programs.  He has participated on the Policy Working Group of the Galveston Brain Injury Conference and serves on the Board of the Indiana HRSA TBI Implementation Grant. Besides his administrative roles, Dr. Hinton continues to see patients in a hospital affiliated clinic.

peter thomas 20130910 progprintPeter W. Thomas, Principal, Powers Pyles Sutter & Verville, PC. Mr. Thomas has a federal law and legislative practice in the areas of health care and disability policy, Medicare coverage and reimbursement policy, medical rehabilitation services, devices and research, appropriations, and vocational and community services and supports. He has personal experience with disability and is co-author of The Americans with Disabilities Act: A Guidebook for Management and People with Disabilities (1993).

 

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ORAL PRESENTATION OF SCIENTIFIC PAPERS

14 November: 1:00 PM – 3:00 PM
Multi-Diagnosis Topics
MODERATOR: J. Preston Harley PhD, FACRM, Neuropsychology Institute, Naperville, IL

Deborah L. Wilkerson Early Career Award Winner Presentation:
Alexithymia After Brain Injury: What is it and Why it Deserves More Attention
Award Winner: Dawn Neumann, PhD, Indiana University School of Medicine, Indianapolis, IN 
Read More>>>

Selective Tibial Neurotomy as a Treatment for Spastic Foot : A Randomized, Assessor-Blinded, Controlled Trial
Thierry Deltombe, MD, CHU UCL Mont-Godinne PMR Department, Yvoir, Namur, Belgium

Rehabilitation of Lower Limb Amputees in the VA Acute Setting: Impact of Clinical Guidelines
Linda J. Resnik, PT, PhD, Providence VA Medical Center, Brown University, Providence, RI

Older Adults With Acquired Brain Injury: Functional Independence Measures After Inpatient Rehabilitation
Vincy Chan, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada

Meeting the Reintegration Needs of Individuals With Spinal Cord Injury: Effectiveness of Community-Based Occupational Therapy
Justin Craig Fry, University of Utah, Salt Lake City, UT; Pollie Price, PhD, OTR/L, University of Utah, Salt Lake City, UT

 


THURSDAY, 14 NOVEMBER
CONCURRENT SESSIONS: 1:30 PM — 3:00 PM


Best Practices in Cross-Border Collaboration in Rehabilitation Research[#68]

14 November: 1:30 PM – 3:00 PM

Lead Presenter: Koen Putman, PhD, Lecturer in Health Services Research, Co-Chair of the Interuniversity Centre for Health Economics Research, Vrije Universiteit Brussel, Belgium

Panelists: Susan Charlifue, PhD, FACRM, Senior Principal Investigator, Craig Hospital, Englewood CO; Fofi Constantinidou, PhD, Professor of Language Disorders & Clinical Neuropsychology, Department of Psychology, Director, Center for Applied Neuroscience, University of Cyprus, Nicosia, CY; and Dr. Mohamed Sakel, FRCP, Director / Consultant Neurorehab, Medical Academic Staff Committee, BMA (UK) Hon Senior Research Fellow, Engineering, Uni of Kent Hon Senior Lecturer, Psychology, UoK East Kent University Hospital NHS Trust

Moderator: Stephanie A. Kolakowsky-Hayner, PhD, CBIST Director of Rehabilitation Research, Santa Clara Valley Medical Center, San Jose, CA

Development and implementation of international clinical trials and research collaboratives are essential in this age of globalization. Cross-border collaboration strengthens the validity and value of the science, averts duplication, achieves economies of scale, and reduces the cost of acquiring new knowledge. This panel’s featured presenter will describe the need and opportunity for cross-border collaborations in rehabilitation research. He will discuss timeliness and how these collaborative efforts differ today than in the past as well as his successful experience with international collaboration. Panelists will also describe their experiences with international collaboration, including lessons learned, advantages, disadvantages, opportunities, barriers, challenges, and best practice suggestions. Open discussion will be encouraged to develop general recommendations for cross-border collaboration as well as specific recommendations for ACRM and the International Networking Group.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the need and opportunity for a global approach to rehabilitation research across disciplines and diagnoses.
  2. Introduce and illustrate successful research collaborations already conducted or currently underway.
  3. Establish recommendations for future collaborations and a roadmap for the future.

Health Promotion and Fitness Transition from Clinical Practice to the Community for People with SCI [#133]

14 November: 1:30 PM – 3:00 PM

Faculty
James Rimmer, PhD, Professor in the School of Health Professions and Endowed Chair, Lakeshore Foundation in Health Promotion and Rehabilitation Sciences, University of Alabama at Birmingham, Birmingham, AL; Sue Ann Sisto, PT, MA, PhD, FACRM, Professor and Research Director, School of Health Technology and Management, Stony Brook University, Stony Brook, NY, President-Elect of ACRM; Karen Hutchinson, PT, PhD, DPT, Clinical Associate Professor, Boston University, Boston, MA; Twala Maresh, PT, DPT, NCS, ATP, Senior Clinical Instructor, Department of Physical Therapy, University of Central Arkansas, Conway, AK; Rachel Cowan, PhD, Research Assistant Professor, Department of Neurosurgery & Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Lois Pope Life Center, Miami, FL

Diagnosis: Spinal Cord Injury
Focus: Health/disability policy, ethics, advocacy

Healthy people 2020 addresses the needs for health and fitness for people with disabilities. Debate is centered on whether the factors responsible for the reductions in mortality would have a similar effect on morbidity. Some argue that the medical care improvements that saved lives were not accompanied by either disease prevention that would maintain healthy states or health care that would delay functional consequences of disease.  Disability adjusted life years (DALYs) differ from other measures of adjusted life years because they reflect years lost to ill-health instead of years lived with ill-health; another difference is that they link two major dimensions of health: disease and disability.  There are many challenges to the promotion of healthy DALYs.  Models of community fitness, physiological consequences of secondary conditions, challenges to transitioning from the clinic to community fitness, assistive technologies to facilitate fitness and personal examples of engagement in a fitness lifestyle will be presented and discussed.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Provide an inclusive model for transitioning people with spinal cord injury from the clinic to the community
  2. Review the physiological need for prevention of secondary conditions across the lifespan of individuals with spinal cord injury
  3. Outline facilitators and obstacles between clinicians and other exercise specialists in the implementation of a life-long plan for fitness and health
  4. Discuss options for the use of assistive technologies that can facilitate a fitness plan
  5. Describe how fitness supports reintegration; define physical activity enabling or limiting factors; and review interventions that have successfully increased physical activity among persons with SCI.

Evidence-Based Management of Spasticity in Activity-Based Restorative Therapy: Bench to Bedside Science [#69]

14 November: 1:30 PM – 3:00 PM

Faculty
Rebecca Martin, OTR/L, OTD, Manager of Clinical Education and Training, International Center for Spinal Cord Injury at Kennedy Krieger, Baltimore, MD; Cristina  Sadowsky, MD, Medical Director, International Center for Spinal Cord Injury at Kennedy Krieger, Assistant Professor Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD; John W. McDonald, MD, PhD, Executive Director, International Center for Spinal Cord Injury at Kennedy Krieger, Associate Professor of Neurology and Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD

Diagnosis: Brain Injury, Spinal Cord Injury, Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

The presence of spasticity has a major impact on an individual’s functional skills, therapeutic progress, quality of life, and perhaps regeneration and neurological recovery.  Conventional interventions involve the use of medications which can have a dampening effect on the nervous system.  While this may reduce the effects of spasticity on function, it is also likely that these medications have a negative impact on the potential for regeneration and recovery.  Drawing from current evidence and the outcomes from our research laboratories, we will demonstrate that spasticity reducing medications inhibit mechanisms for regeneration, including new cell birth, survival and maturation  We will discuss multimodal alternatives to spasticity management using an activity-based approach. ABRT involves purposeful, repetitive activation of the nervous system above and below the injury level to optimize the system’s recovery while working to offset the rapid aging and chronic complications that occur as a consequence of neurologic injury and immobility.  In addition to discussing therapeutic interventions, we will discuss the benefits of and alternatives to oral medications.  The panel will discuss clinical rationale and decision making when treating spasticity.  Finally, we will present outcomes from our clinical experience to show that patients improve with minimal medical spasticity management and that spasticity does not increase in response to ABRT interventions.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the impact of spasticity reducing medications on the damaged nervous system.
  2. Identify alternative strategies for spasticity management.
  3. Demonstrate appropriate clinical rationale for the use of spasticity reducing medications

 

Novel Concepts in the Treatment of Disabilities Associated with Chronic Conditions [#135]

14 November: 1:30 PM – 3:00 PM

Faculty
Allen W. Brown, MD, Associate Professor of Physical Medicine and Rehabilitation, Chair, Division of Brain Rehabilitation, Department of Physical Medicine and Rehabilitation Mayo Clinic, Rochester, MN; Joline E. Brandenburg, MD,  Instructor Department of Physical Medicine and Rehabilitation and Pediatrics, Mayo Clinic; Rochester MN; Andrea L. Cheville, MD, Associate Professor of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN; Carmen Militza Terzic, Mayo Clinic, Rochester, MN

Diagnosis: Brain Injury, Neurodegenerative disorder (e.g., MS, Parkinson’s disease), cancer rehabilitation, chronic diseases, cerebral palsy, spasticity
Focus: cancer rehabilitation, chronic diseases, cerebral palsy, spasticity Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Disability related to chronic disease develops and progresses insidiously. Improved functional screening, monitoring approaches and effective treatment to overcome impairment, disability and quality of life while maintaining a cost-sensitive and patient-centric model for function-oriented care delivery are needed. This symposium will provide an overview on the current research projects oriented to identify tools for better understanding, monitoring and treating disabilities in chronic diseases, with special focus in traumatic brain injury, cancer and spasticity associated with cerebral palsy.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Interpret epidemiological aspects of Traumatic Brain Injury: incidence, risk factors, survival and cost of care
  2. Cite novel spasticity management strategies in children with CP
  3. Recognize disabilities related to chronic diseases
  4. List tools for longitudinally monitoring physical function in chronically diseased populations

 

Optimizing Stroke Rehabilitation for Individuals with Cognitive Impairments[#83]

14 November: 1:30 PM – 3:00 PM

Faculty
Grace Campbell, PhD, MSW, CRRN, University of Pittsburgh School of Nursing, Allison Park, PA; Ellen Whyte, MD, Assistant Professor of Psychiatry, University of Pittsburgh School of Medicine; Pittsburgh, PA; Elizabeth Skidmore PhD, OTR/L, Associate Professor of Occupational Therapy, University of Pittsburgh School of Health and Rehabilitation Sciences, Pittsburgh, PA; Deirdre Dawson, PhD, OTR/L, Senior Scientist, Rotman Research Institute, Baycrest, and Associate Professor of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, CA

Diagnosis: Stroke
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

One-third to one-half of acute strokes result in newly acquired impairments in basic (i.e., attention, memory), and higher order cognitive functions (i.e., fluency, flexibility, inhibition). Alone, or in combination, these impairments disrupt independence with daily activities (i.e., self-care, mobility), and are associated with significant long-term disability, falls, and morbidity. Individuals with stroke-related cognitive impairments have prolonged hospitalization and often require institutionalization, accounting for a substantial portion of stroke-related health care costs. These facts beg the question, “What can we do to improve rehabilitation outcomes for individuals with stroke-related cognitive impairments?” This symposium will review theoretical models and scientific evidence designed to begin to address this question. Dr. Campbell will review the current state of the science addressing the incidence and impact of cognitive impairments after stroke, addressing subsequent disability, falls and other health-related consequences. Dr. Whyte will provide an overview selected biological mechanisms that show promise for informing potential augmentative pharmacological interventions designed to enhance rehabilitation benefits. She will present data from previous and ongoing studies examining the efficacy of these interventions, and discuss potential directions for future research in this area. Dr. Skidmore will present an overview of learning principles, and theoretical models that support promising interventions for rehabilitation tailored for individuals with cognitive impairments after stroke. Finally, Dr. Dawson will provide a brief presentation that discusses the clinical implications of the research presented, and she will lead a discussion among symposia participants.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the incidence of cognitive impairments after acute stroke, and their short-term and long-term consequences (disability, falls, morbidity and poor quality of life).
  2. Discuss the evidence surrounding innovative pharmacological augmentation of rehabilitation for individuals with cognitive impairments after acute stroke, and the implications of biobehavioral mechanisms for enhancing rehabilitation.
  3. Describe new applications of learning principles designed to improve rehabilitation outcomes for individuals with cognitive impairments after acute stroke, and the evidence supporting these new applications.
  4. Discuss the clinical implications of theoretical models and scientific evidence addressing efforts to improve rehabilitation outcomes for individuals with cognitive impairments.

 

The Importance of Measuring Clinical Outcomes for Pain Management

14 November: 1:30 PM – 3:00 PM

Faculty
Fred Neal Davis, MD, Michigan Pain Consultants, PC, ProCare Systems, Inc., Grand Rapids, MI

During this time of rapid transformation in healthcare it is of utmost importance that clinicians demonstrate the value of their work. This presentation will explore the use of an interdisciplinary multidimensional pain care management system and explain the importance of its use to help guide patient care, gather clinical outcomes and serve as a foundation for value based care.   It will also show how care management tools can not only help with clinical care but can assist practitioners and organizations strategically advocate on behalf of their patients and their practices.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Outline the components and use of an interdisciplinary pain care management system
  2. To understand how the data can be used for outcomes research and improve patient care
  3. To apply the system strategically for the practice or organization

Top of page


THURSDAY, 14 NOVEMBER
CONCURRENT SESSIONS: 3:30 PM – 5:00 PM


Children and Youth with Acquired Brain Injury: Transition Challenges and Outcomes [#76]

14 November: 3:30 PM – 5:00 PM

Faculty
Angela Colantonio, PhD, OT Reg (Ont.), FACRM, Saunderson Family Chair, Acquired Brain Injury Research, Toronto Rehabilitation Institute, University Health Network, Professor, Department of Occupational Sciences & Occupational Therapy, University of Toronto, Toronto, ON, CA; Bonnie Todis, PhD, Senior Research Associate, Centre on Brain Injury Research and Training, Principle Investigator, TBI Transition Website Development Project, University of Oregon,  Eugene, OR; Julie Haarbauer-Krupa, PhD, Principle Investigator, Readiness for Transition for Adolescents with Complex Medical Conditions and THE B.R.A.I.N Program: An Intervention Model for Teens with Acquired Brain Injury, Division of Rehabilitation Sciences, Children’s Healthcare of Atlanta, Atlanta, GA; Vincy Chan, HonBSc, MPH, PhD Candidate, Graduate Department of Rehabilitation Sciences, Faculty of Medicine, University of Toronto, Toronto Rehabilitation Institute, University Health Network, Toronto, ON, CA; Joanne Maxwell, MSc, BScOT, BSc, OT Reg (Ont.), PCS Project Manager/LIFEspan Project Coordinator, Toronto Rehabilitation Institute, UHN; Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, CA

Diagnosis: Brain Injury
Focus: Outcomes research/epidemiology

Acquired brain injury (ABI), which includes traumatic (TBI) and non-traumatic brain injury (nTBI), is a leading cause of death and disability worldwide. While the highest rates are among children and youth, there is currently a paucity of population based information on this vulnerable population and even less on their transition issues and outcomes. This symposium will begin with a presentation on data from a population based study of children and youth aged 19 years and under in a publicly insured population, which will describe their profile and trajectory across the continuum of care. Two presentations will present data from studies on transition among children and youth from Canada (LIFEspan Model) and the United States (B.R.A.I.N program and Readiness for Transition Pilot Study), which will focus on identifying barriers to transition services, challenges for children and youth with ABI, and factors that are associated with successful transfer to adulthood. This symposium will conclude with a presentation on the T-Web from the United States, a website to improve transition outcomes for children with TBI, which addresses the challenges identified by students with TBI. This multi-disciplinary and multi-institutional symposium provides evidence that current data on the epidemiology of children and youth with ABI and mixed-methods research can guide clinical practices related to transition services for this vulnerable population. It also identifies areas in need of further research.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the trajectory of care of children and youth from the emergency department and acute care with acquired brain injury from a population based perspective in a publicly insured population
  2. Report findings of (1) a study for adolescents with complex healthcare needs and outcomes from an intervention program for TBI, (2) a longitudinal study of transition outcomes for students with TBI in the Pacific Northwest, (3) a population based study on children and youth with acquired brain injury from a publicly insured population
  3. Discuss the need for training and information (1) for healthcare and vocational transition, (2) to help educators modify evidence-based transition practices to meet the needs of students with TBI
  4. Identify and describe key principles of transition service models and access evidence-based transition practices that have been shown to result in positive transition outcomes for (1) adolescents with TBI, Cerebral Palsy, other complex health conditions, (2) students with disability
  5. Describe the components of the T-Web Intervention, including separate modules for educators, parents, and students with TBI

 

Technology Based Cognitive Interventions: Current Evidence-Based Approaches to Cognitive Remediation [#102]

14 November: 3:30 PM – 5:00 PM

Faculty
Gerald T. Voelbel, Assistant Professor, Steinhard School, New York University, New York, NY, Karuna Subramaniam, Research Scientist, University of California, San Francisco; Lee Hyer, Research Psychologist, Mercer School of Medicine, Sylvain Moreno, Lead Scientist Center for Brain Fitness, Rotman Research Institute, Baycrest Hospital/University of Toronto, ON, CA; Karuna Subramaniam, UCSF, San Francisco, CA; Lee Hyer, Mercer School of Medicine and Georgia Neurosurgical Institute, Macon, GA; Sylvain Moreno, Rotman Research Institute, Baycrest, Toronto, ON, CA

Diagnosis: Brain Injury, Schizophrenia, Mild Cognitive Impairment
Focus: Outcomes research/epidemiology

Psychiatric and neurological populations suffer from numerous cognitive deficits. Advances in cognitive rehabilitation have been made with multiple clinical populations with structured technology based cognitive remediation programs. This symposium will present translational experimental studies of technology based cognitive interventions that demonstrate improvements in targeted cognitive abilities. In addition, the studies will demonstrate that these cognitive gains are generalized to other cognitive domains and everyday abilities. The first study presented will demonstrate the efficacy of remediating processing speed in a sample of adults with traumatic brain injury. The results will demonstrate improvements in auditory processing speed and its effects on verbal memory and attention. The second study presented will demonstrate a cognitive remediation technique that results in improvements in working memory in patients diagnosed with schizophrenia. In addition, this study will demonstrate the neuroplasticity of the cognitive interventions and functional changes of the left dorsolateral prefrontal cortex post-intervention. The third study will demonstrate cognitive improvements in the area of working memory and attention in adults diagnosed with mild cognitive impairment. The fourth study presented will demonstrate neuroplasticity and cognitive improvements in executive functions in preschool aged children with a technology based cognitive training program. Furthermore, this study will demonstrate that the cognitive improvements are sustained longitudinally. Together these studies will demonstrate the advances in technology based cognitive remediation translational studies that may be applied to clinical disorders with cognitive deficits.

Learning Objectives

  1. To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:
  2. Results of current technology based cognitive remediation techniques
  3. Translation of experimental clinical trials with technology based cognitive interventions.
  4. The promotion of neuroplasticity through targeted cognitive remediation techniques.

 

Neurodegenerative Effects of Epilepsy: Cognitive and Psychosocial Sequelae and Recommendations for Rehabilitation Research and Practice[#91]

14 November: 3:30 PM – 5:00 PM

Faculty
Fofi Constantinidou, PhD, CCC-SLP, Professor of Language Disorders and Clinical Neuropsychology and Director, Center for Applied Neuroscience, University of Cyprus, Nicosia, CY; Panagiotis Stavrinides, PhD, Lecturer of Developmental Psychology, University of Cyprus, Nicosia, CY; Andrea Makri, MA, School Psychologist, University of Cyprus, Nicosia, CY; Donna Langenbahn, PhD, Associate Director of Psychology, Outpatient Services Rusk Institute of Rehabilitation Medicine, NYU Langone Medical Center, New York, NY; Teresa Ashman, PhD, Associate Director of Psychology Research and Training, Director of Postdoctoral Fellowship, Rusk Rehabilitation, and Associate Professor, NYU Langone School of Medicine, New York, NY

Diagnosis: Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Epilepsy is a common neurological disorder affecting one percent of the general population. Even though it is one of the most prevalent neurological conditions, the term “epilepsy” has been associated with negative connotations and psychosocial adjustment implications. Furthermore, patients with epilepsy experience a variety of cognitive symptoms which render them vulnerable to accelerated pathological aging. The variety and severity of the psychosocial and cognitive symptoms and subsequent impact on psychosocial adjustment are related to the severity of the disorder and the ability to control the seizure activity. Despite the neurodegenerative nature of the disorder and the associated cognitive, psychosocial and quality-of-life implications, rehabilitation medicine and research has not taken an active role in the management of this population.

The international panel of presenters will present data on the effects of epilepsy on executive and memory performance and the link between cognitive performance and quality of life. Additionally, psychosocial adjustment challenges of patients with chronic epilepsy will be presented. Finally, recommendations for cognitive and neuropsychological rehabilitation will be made based on an evidence-based systematic review of the literature.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Provide evidence on the neurodegenerative nature of adult chronic epilepsy.
  2. Describe the need and opportunity for outcomes research in the rehabilitation of individuals with chronic epilepsy.
  3. Establish recommendations for cognitive and psychosocial rehabilitation.
  4. Establish recommendations for future international collaborations in epilepsy research.

 

Educate, Train, Treat, Track: Bringing State of the Art Care to Our Military with TBI [#116]

14 November: 3:30 PM – 5:00 PM

Faculty
MAJ Sarah Goldman, MOT, PhD, Army TBI Program Director, US Army, HQDA, OTSG, Falls Church, VA; Dr. Stephanie N. Maxfield-Panker, PhD, Army TBI Program Manager, Army Office of the Surgeon General, HQDA, OTSG, Falls Church, VA; LCDR Tara Cozzarelli, Education Specialist, Army Office of the Surgeon General, HQDA, OTSG, Falls Church, VA; Dr. Lynne M. Lowe, ORISE Fellow, US Army, HQDA, OTSG, Lebanaon, PA; Dr. Karen McCulloch, PhD, PT, NCS Professor and Assistant Director for Distance and Continuing Education, Division of Physical Therapy, University of North Carolina, Chapel Hill, ORISE Fellow, HQDA, OTSG, Hillsborough, NC; Mary Radomski, PhD, OTR/L, Clinical Scientist, Sister Kenny Research Center, ORISE Fellow, HQDA, OTSG,  Minneapolis, MN; Dr. Michael L. Russell, ANAM Program Director, HQ, USA MEDCOM, HQDA, OTSG, Fort Sam Houston, TX

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

An expert panel will discuss the U.S.  Army Traumatic Brain Injury (TBI) program within the context of rehabilitation clinical and research initiatives as well as programmatic outcomes.  Presenters will discuss progress from the U.S. Army TBI Task Force and delineate existing rehabilitation gaps within the system. Additional topics include rehabilitation capabilities and services in the deployed and garrison environments within the context of Department of Defense (DoD) policy for TBI care including specific algorithms for recurrent concussion. Policy discussions include the evolution of, and current, policies and clinical algorithms in the deployed and garrison environments as well as DoD clinical recommendations related to rehabilitation from TBI.  Briefly discuss the Neurocognitive Assessment Tool and role of neurocognitive assessment in return to duty decision making. Share Department of Defense TBI coding procedures and discuss challenges in analyzing coded data. Share Army TBI education and training strategies to educating a widely-dispersed population of medical providers. Present specific rehabilitation tools and resources developed to support the TBI mission to include patient education handouts, educational videos and slide decks, the TBI Rehabilitation ToolKit, and the Graded Return to Activity clinical recommendation. Share Army TBI Research initiatives related to TBI rehabilitation.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss the components of the Army TBI program, with an emphasis on the foundations of research and policy that create a framework for education and cultural change.
  2. Describe activities conducted and products developed to support education and care for patients with TBI and their families.
  3. Recognize the relevance of Army TBI programs to your professional practice.
  4. Identify and restate pilot and ongoing studies related to concussion care in the military population and how the results may be applied to other patient groups.

 

Electrical Stimulation from Basic Science to Clinical Practice: Is it Evidence-Based? [#119]

14 November: 3:30 PM – 5:00 PM

Faculty
Gail F. Forrest, PhD, Assistant Director, Human Performance and Engineering Laboratory (HPEL), Kessler Foundation Research Center, West Orange, NJ, Assistant Professor of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey, New Jersey Medical School; Pouran D. Faghri, MD, MS, FACSM, Professor of Health Promotion, Biomedical, and Community Medicine and Health Care, Director, Graduate Program in Health Promotion Sciences, Department of Allied Health Sciences, CANR, University of Connecticut, Storrs, CT; Samuel Lee PT, PhD, Assistant Professor in the Department of Physical Therapy, Biomechanics and Movement Science Program, Affiliated faculty member of the Biomedical Engineering Department, University of Delaware, Newark, DE; Sue Ann Sisto, PT, MA, PhD, FACRM, Professor of Physical Therapy, Research Director in Rehabilitation Sciences and Director of the Movement Performance Lab at Stony Brook University, Stony Brook, NY

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke, Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Neuroscience (e.g., neural regeneration/repair, motor control/learning, biomechanics)

Much of past electrical stimulation (ES) research has focused on outcomes without much consideration given to the underlying mechanisms for ES configurations such as sequencing, timing, and dosing to elicit change.  More recently there has been a paradigm shift in research to understand the basic mechanisms underlying molecular changes and to translate the findings at the cellular level to whole body neuromusculoskeletal system in response to ES mediated training.  In this presentation we will present studies that evaluated the effects of ES at the cell level including changes in genotype and phenotype as a results of ES as well as applied ES studies both from animal models to human subjects that describe the underlying mechanisms of neuromotor plasticity as well as functional recovery.

The purpose of this symposium is:

  1. To review the cellular, structural, and molecular level changes that result from single dose and multi sessions of ES. For example, changes mRNA levels for PG1-α, and Myosin Heavy Chain (MyH7, MyH2A, MyH2B, MyH2D) and myostatin.
  2. To discuss the ES translational research from the basic research to applied research including both animal and human studies and from the micro to macro changes.
  3. To review underlying muscle adaptations as related to voluntary and electrically elicited muscle contractions. The stimulation parameters that may be used for ES will be discussed in a manner to develop strategies to minimize fatigue and maximize muscle performance.
  4. To describe the evolution of clinical practice using ES including equipment, parameters and patient selection as well as the evidence supporting clinical decisions to optimize patient outcomes.
  5. To discuss the future development of technology and ES protocols such as clinical development for artificial delivery.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Explain the cellular, structural, and molecular level changes that result from electrical stimulation
  2. Identify the changes in electrical stimulation research from basic to applied research human domains
  3. Report the underlying muscle adaptations with change in electrical stimulation parameters
  4. Describe the changes in clinical delivery using electrical stimulation to optimize patient outcome
  5. Report future areas of development in electrical stimulation hardware and software.

 

Innovative Delivery of Pain Self-Management Programs

14 November: 3:30 PM – 5:00 PM

Faculty
Dawn M. Ehde, PhD, University of Washington School of Medicine, Seattle, WA; Kristin R. Archer, PhD, DPT, Department of Orthopaedic Surgery Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN; Steve T. Wegener, PhD, ABPP, Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, MD

Diagnosis: Pain
Focus: Outcomes measurement

Self-management programs that target psychosocial risk factors have proven effective for reducing pain and disability in individuals with disabilities, chronic disease, and musculoskeletal disorders.  However, studies indicate that many people with pain have inadequate access to evidence-based pain treatment due to financial constraints, geographical barriers, and mobility issues that typically render clinic-based programs impractical. This symposium will describe innovative delivery models that broaden the availability of effective pain management and behavior change strategies. This symposium will include 3 speakers actively involved in the development and implementation of telephone and web-based pain self-management programs. Each speaker will use a clinical trial to demonstrate novel application of pain treatment. The research programs represented in this session will focus on telephone and web-based pain self-management programs; implementation through non-traditional providers, such as physical therapists; and the translation of these models into clinical practice.

Speakers will be responsible for discussing rationale for the intervention and delivery model, reviewing how results of the specific trial fit with the existing evidence in that area, and delineating future research and clinical priorities.  The specific trials covered in this symposium will include adults with disabilities and chronic disease, low back pain, and postsurgical pain. By the end of the session attendees will be familiar with specific findings from each trial and the rationale and significance of each delivery model. Session attendees will also have a better understanding of the challenges of delivering self-management programs and how such programs can be applied in novel settings and through innovative implementation strategies, hopefully encouraging clinical implementation.

Our speaker panel will address the urgent need to improve access and utilization of effective pain self-management strategies. In this symposium we hope to bring together clinicians and researchers with a common interest in more effective management of pain and disability. This symposium will provide attendees with a “big picture” view of access to care and has the potential to broaden the appreciation for what is being done with telephone and internet technology to tackle this important public health issue.  This session should be appealing to a wide audience since it will be appropriate for rehabilitation researchers and clinicians. The primary practice gaps that will be addressed are to a) expand knowledge of telephone and web-based programs to improve patient use of self-management strategies and patient outcomes; b) introduce the use of non-traditional providers to broaden the availability of effective pain management and behavior change strategies; and c) provide examples where these alternative delivery models have been effectively utilized.  There is potential for other practice gaps to be addressed depending on experiences and backgrounds of the symposium attendees.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify current evidence and future priorities for self-management programs
  2. Identify current evidence and future priorities for self-management programs
  3. Describe the challenges of implementing self-management programs
  4. Describe the rationale for using alternative delivery models and non-traditional providers for self-management programs
  5. Understand how addressing pain through telephone and web-based self-management programs may result in improved patient outcomes and decreased health care utilization/expenditures

 

New Developments in the SCI-QOL/SCI-FI Measurement System [#132]

14 November: 3:30 PM – 5:00 PM

Faculty
David Tulsky, PhD, Director, Center for Rehabilitation Outcomes & Assessment Research, Director of Research, Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI; Pamela Kisala, MA, Senior Research Associate, Center for Rehabilitation Outcomes & Assessment Research, Department of Physical Medicine & Rehabilitation, University of Michigan Medical School, Ann Arbor, MI; Mary D. Slavin, PhD, PT, Director, Education and Dissemination, Health and Disability Research Institute, Boston University School of Public Health, Boston, MA; Allen Heinemann, PhD, Professor, Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University and Director, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL

Discussant:
Marcel Dijkers, PhD, Research Professor of Physical Medicine and Rehabilitation, Mount Sinai School of Medicine, New York, NY

Diagnosis: Spinal Cord Injury
Focus: Research methods (e.g., measurement, research design analytic/statistical methods)

The Spinal Cord Injury Quality of Life (SCI-QOL)/Spinal Cord Injury Functional Index (SCI-FI) measurement system is comprised of 22 item banks across the areas of Emotional Health, Physical-Medical Health, Social Participation (SCI-QOL) and Physical Function (SCI-FI) which are specifically targeted to individuals with SCI. New data on the construct validity, clinical utility, and responsiveness of the scales are now emerging. First, 240 individuals with recent traumatic SCI are completing the SCI-QOL/SCI-FI and criterion measures over multiple time points to validate the measures and assess their responsiveness to change. Second, new focus groups and item development work have resulted in the SCI-FI version 2 which will differentiate the capacity (i.e., unaided ability) and performance (i.e., ability with devices or assistance) components of physical functioning. Third, a large study is administering the SCI-QOL social participation item banks, the more generic PROMIS and Neuro-QOL social scales, criteria measures of participation, and measures of environmental barriers and facilitators. The current sample includes 305 individuals with disabilities. This symposium will describe these new advances and modifications and will provide data demonstrating the construct validity, clinical utility, and responsiveness to change of the SCI-QOL and SCI-FI instruments.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify research data which support of the construct validity of the SCI-QOL/SCI-FI instruments for use in rehabilitation outcomes research and clinical practice.
  2. Describe the responsiveness of the SCI-FI physical functioning item banks following very recent SCI (<3 months).
  3. Describe the responsiveness of the SCI-QOL psychosocial item banks following less recent SCI (between 3 months-1 year).
  4. Describe revisions to the SCI-FI physical functioning item banks which will now facilitate assessment of capacity and performance components of physical functioning.
  5. Examine the convergent validity of the SCI-QOL Social Participation banks with criteria participation measures and measures of environmental factors.

 

ORAL PRESENTATION OF SCIENTIFIC PAPERS

14 November: 3:30 PM – 5:00 PM
Stoke Topics
MODERATOR: Pamela Roberts, PhD, OTR/L, SCFES, FAOTA, CPHQ, Cedars-Sinai Medical Center, Los Angeles, CA

A Prospective Comparison Study of Functional Outcomes After Traumatic and Atraumatic Spinal Cord Lesions (SCL)
Shiv Yadav, MD, DNB, MNAMS, All India Institute of Medical Sciences, New Delhi, Delhi, India

Computer-Adaptive Balance Testing Improves Discrimination Between Community-Dwelling Elderly Fallers and Non-fallers
Poonam Pardasaney, DPT, MS, ScD, Health & Disability Research Institute, School of Public Health, Boston University, Boston, MA

Limitations of a Rehabilitation Efficiency Measure for the Quality Reporting Program
Anne Deutsch, RN, PhD, Rehabilitation Institute of Chicago, Chicago, IL; Holly DeMark Neumann, MPPA, Rehabilitation Institute of Chicago, Chicago, IL

Examining Outcomes of the I-PASS (Improving Participation After Stroke Self Management Program): A Pilot Study
Joy Hammel, PhD, OTR, University of Illinois at Chicago, Chicago, IL

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THURSDAY, 14 NOVEMBER
SPECIAL OPPORTUNITIES: 3:30 PM – 7:00 PM


EXHIBITORS WELCOME RECEPTION & SCIENTIFIC POSTER VIEWING

14 November: 5:00 PM – 7:00 PM (with poster authors)

With Outstanding Scientific Poster Award Presentations


CORE CONFERENCE – DAY 2
FRIDAY, 15 NOVEMBER
SPECIAL OPPORTUNITIES: 7:00 AM – 10:00 AM


ACRM ISIG, NETWORKING GROUP, TASK FORCE & COMMITTEE MEETINGS

  • Health Policy Networking Group
    7:00 AM – 8:00 AM
  • BI-ISIG Disorders of Consciousness Task Force: Minimal Competency Guidelines for Acute Rehabilitation
    7:15 AM – 8:15 AM
  • International Networking Group Business Meeting
    8:30 AM – 10:00 AM

ORAL PRESENTATION OF SCIENTIFIC PAPERS

15 November: 8:30 AM – 10:00 AM
TBI Topics
MODERATOR: Gerard Ribbers, MD, PhD, Rotterdam Neurorehabilitation Research (RoNeRes), Rotterdam, Netherlands

The Impact of a Drama-Based Intervention on the Emotion Work of Neurorehabilitation Staff
Pia Kontos, PhD, University of Toronto, Toronto, ON, Canada

Reducing the Need for Seclusion and Restraint in an Inpatient Neurobehavioral Unit
Matthew Lee Macey, RN-CBIS, Brookhaven Hospital, Tulsa, OK

Treatment of Persistent Post-Concussive Symptoms Utilizing Prismatic Eyeglass Lenses
Mark Rosner, MD, St. Joseph Mercy Hospital, Ypsilanti, MI; Debby Feinberg, OD, Vision Specialists of Michigan, Bloomfield Hills, MI; Jennifer Doble, St. Joseph Mercy Hospital, Ypsilanti, MI

Temporal Patterns of Neural Network Synchronization in Veterans With and Without Mild TBI and PTSD
Malene Abell, BS, Indiana University, Bloomington, IN


FRIDAY, 15 NOVEMBER
CONCURRENT SESSIONS: 7:15 AM – 8:15 AM


Rehabilitation of Individuals with Traumatic Brain Injury: Impact and Response to a Fragmented System [#105]

15 November: 7:15 AM – 8:15 AM

Faculty
Eileen Elias, Adjunct Professor, Boston University, Sargent College, Health Sciences Department, Director of Disability Service Center, JBS International, Inc.

Diagnosis: Brain Injury
Focus: Other or N/A

Recovery from and support for living with traumatic brain injury (TBI) is a lifelong process requiring individuals with TBI (IWTBI) to have knowledge of and access to effective and continuous rehabilitation services to maximize biopsychosocial functioning. However, the rehabilitation continuum of care is fragmented, creating barriers for individuals to access rehabilitation services essential for each stage along the continuum and specific to needs. Thus, information regarding what services are available, where services can be found, what funding sources are available to pay for needed services, and which services are evidence-based and accredited is difficult to obtain. The goal of the lecture is to provide an overview of the current state of the post-acute rehabilitation service delivery system for IWTBI across the age span and to present financial, structural, personal, and attitudinal barriers IWTBI face in accessing needed services. The lecture will include a demonstration on the use of a web-based tool for overcoming such barriers. The tool, accessible to IWTBI, caregivers and health providers, supports IWTBI in having a full community life and supports continuous quality improvement and resulting evaluation of data rather than anecdotal evidence. In addition, the lecture will include information on guiding practices and future research to improve the effective delivery of rehabilitation services. This symposium provides the opportunity for a multidimensional conversation – discussing current situations and solutions to improve the rehabilitation continuum of care and reduce the burden and costs of TBI to individuals, caregivers, providers and society through solutions, such as this web-based tool.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe barriers individuals with TBI face in accessing needed rehabilitation services.
  2. Explain the use of a comprehensive web-based tool for eliminating barriers in the service delivery system.
  3. Provide information on this tool’s ability to provide data on rehabilitation service gaps rather than current use of anecdotal evidence.
  4. Identify guiding practices and future research for improving the effective delivery of rehabilitation services for individuals with TBI.

The Dutch ParkinsonNet: Promoting International Neurorehabilitation Research Collaboration and Exchange [#134]

15 November: 7:15 AM – 8:15 AM

Faculty
Mark A. Hirsch, PhD, Research Scientist, Carolinas Rehabilitation, Carolinas Health Care System, Department of Physical Medicine and Rehabilitation, Charlotte, NC

Diagnosis: Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Background and Significance: Individuals with Parkinson’s disease (PD) are less physically active at diagnosis than healthy controls and inactivity increases with disease progression (van Nimwegen et al., 2011). Several factors work against this patient population receiving guidance toward increased physical activity they urgently need including fragmented care, delivered by clinicians lacking expertise, and lack of early referral into physiotherapy or exercise (Dahodwala et al., 2009). Recently the national Dutch ParkinsonNetwork cluster randomized controlled trials (RCTs) found improved quality of care with cost containment (Munneke et al., 2010; Nijkrake et al., 2010; Speelman et al., in press).

Objectives: Review the RCTs and scientific studies conducted on the efficacy of the Dutch ParkinsonNet to promote international research collaboration, foster opportunities for international exchange and ipromotion of evidence-based best practices in Parkinson’s disease neurorehabilitation.

Settings: Outpatient, community-based.

Method and Participants:  The Dutch ParkinsonNet (Keus et al., 2012) has trained nationally in The Netherlands over 2000 healthcare professionals and conducted two large (N=700) cluster randomized controlled trials on physical activity promotion in Parkinson’s disease demonstrating improvements in the quality and access to PD care while containing the costs.

Results: Key elements of the Dutch ParkinsonNet include (1) distribution of the Royal Dutch evidence-based guidelines on physiotherapy (Keus et al., 2004) and best-practices exercise prescription for PD.  Workshop participation to improve expertise in PD care, (2) streamlining the referral process, and (3) improve transparency, (4) continuous education to improve expertise, collaboration and communication.

Conclusions: The author suggests strategies for Parkinson’s international research collaborations.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. List the potential benefits of exercise on non-motor symptoms of human Parkinson’s disease supported by randomized controlled trials
  2. Summarize the evidence-based literature of animal models of exercise and Parkinson’s disease on neuroprotection
  3. Review the RCTs and other scientific studies conducted on the efficacy of the Dutch ParkinsonNet
  4. Describe key steps in promoting international collaboration and exchange with the Dutch ParkinsonNet

 

Neurotrophic Growth Markers as an Index of Brain Function in the CNS[#103]

15 November: 7:15 AM – 8:15 AM

Faculty
Patricia Cristine Heyn, PhD, Assistant Professor, Department of Physical Medicine and Rehabilitation Research Center Coordinator, Assistive Technology Partners (ATP), Education Director, Colorado Intellectual & Developmental Disabilities Research Center (IDDRC), School of Medicine, University of Colorado Denver Anschutz Medical Campus, Denver, CO

Diagnosis: Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Neuroscience (e.g., neural regeneration/repair, motor control/learning, biomechanics)

This presentation will discuss the current literature supporting potential neurotrophic growth factor markers for early diagnosis and treatment of common adult neurodevelopmental and neurodegenerative disorders. Although the discussed evidence will have a special focus to the applications of Brain Derived Neurotrophic Factor (BDNF) in humans, the insulin-like growth factor II (IGF-II), a neurotrophic growth factor, has recently been shown to significantly enhance memory retention and prevent forgetting in rats as well as being a regulator of neural stem cell proliferation in the dentate gyrus. IGF-II is expressed in the brain during development and adulthood, with the highest relative expression being in the hippocampus, the key structural component of the short-term memory brain circuitry. This presentation will explore the potential of neurotrophic growth factors such as BDNF, a protein associated to physical activity and muscle metabolism, to be used as a clinical marker for neurodegenerative process associate to brain injury and aging.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Gain knowledge of the current literature, animal and human model, supporting the adoption of neurotrophic growth markers for early diagnosis of Alzheimer’s disease and related neurodegenerative disorders
  2. Identify the clinical significance of BDNF as a marker of neurodegeneration.
  3. Understand how to measure neurotrophic growth markers in response to exercise treatments for the intervention of neurodegenerative disorders.

 

Updated Clinical Practice Guidelines for Mild Traumatic Brain Injury and Persistent Symptoms [#115]

15 November: 7:15 AM – 8:15 AM

Faculty
Shawn Marshall, MD, MSc, FRCPC, University of Ottawa, Ottawa, ON, CA; Diana Velikonja, PhD, CPsych, McMaster University, Hamilton, ON, CA; Mark Bayley, MD, FRCPC, University of Toronto, Toronto, ON, CA; Scott McCullagh, MD, FRCPC, University of Toronto, Toronto, ON, CA; Lindsay Berrigan, PhD, Dalhousie University, Halifax, NS; Donna Ouchterlony, MD, CCFP, University of Toronto, Toronto, ON, CA; Kelly Weegar, BA (Hons), Ottawa Hospital Research Institute, Ottawa, ON, CA

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

This symposium will discuss a clinical practice guideline update that was undertaken to aid health care professionals in implementing evidence-based, best-practice care for the challenging population of individuals who experience PPCS following MTBI.

Quality of evidence, The Guidelines for MTBI and Persistent Symptoms, were published in March 2011. More recently, a search for new clinical practice guidelines addressing MTBI and a systematic review of the literature evaluating treatment of PPCS were conducted. Health care professionals representing a range of disciplines from across Canada, the United States and abroad were brought together at an expert consensus conference to review the existing guidelines and new evidence to revise the original Guideline. Evaluation of the guidelines by sport medicine and military physicians has also provided key feedback that has informed revisions for the next edition.

A modified Delphi process was used to create more than 70 recommendations that address the diagnosis and management of MTBI and PPCS, including Post-traumatic Headache, Sleep Disturbances, Mental Health Difficulties, Cognitive Difficulties, Balance Disorders, Fatigue, and Return to Work/School. In addition, numerous resources, tools and treatment algorithms are included in the guideline to aid in the implementation of the recommendations.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify patients who are at-risk for persistent postconcussive symptoms.
  2. Discuss evidence-based treatment of individuals who manifest persistent symptoms following mild traumatic brain injury.
  3. Improve patient care by reviewing a framework that can be implemented by health care professionals effectively.

 

The Value of Mixed Methods: Lessons Learned Through Intervention Research in Individuals with Chronic Stroke [#137]

15 November: 7:15 AM – 8:15 AM

Faculty
Angela Merlo, PT, DPT, PhD, Assistant Professor, Northern Arizona University – Phoenix Biomedical Campus, Physical Therapy Program, Phoenix, AZ; Stacy L. Fritz, PT, PhD,  Program Director and Assistant Professor, University of South Carolina, Physical Therapy Program, Columbia, SC

Diagnosis: Stroke
Focus: Research methods (e.g., measurement, research design analytic/statistical methods)

The National Institutes of Health have recognized the need to develop new methodologies to improve the quality and scientific power of research. Although randomized controlled trials continue to be the gold standard to identify causality, this method is not suited for every type of question or outcome.  For this reason, mixed method designs are becoming increasingly more common.  Researchers are beginning to incorporate qualitative methods such as interviews and observations to help comprehend individual experiences and perceptions of interventions.

During 2008-2012 a randomized controlled trial (RCT) funded by the American Heart Association was conducted to assess the efficacy of intensive therapy on gait, balance and mobility in individuals with chronic stroke. Concurrently, a separate study was conducted assessing participants’ perspectives of the benefits associated with participation in the RCT. Although a mixed method design was not established for the above studies, a retrospective look at the methodology and data revealed the value of such a design.

The overall purpose of this symposium is to highlight lessons learned from a randomized controlled trial on intensive therapy in individuals with chronic stroke and a concurrent qualitative study on a subset of participants. Specifically, the speakers will expose the value of a mixed method design for use in intervention studies by: introducing qualitative and quantitative data collected from a randomized controlled trial, highlighting the parallelisms and discrepancies between the two data sets, and discussing how mixed methods may support the pilot process and direct future research.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Communicate knowledge of mixed methods and its value in intervention research
  2. Identify the advantage of using a mixed methods design
  3. Identify how qualitative data can be used to enhance quantitative data
  4. Discuss how mixed methods may help guide future intervention research

 

Development of a Functional Status Quality Metric [#138]

15 November: 7:15 AM – 8:15 AM

Faculty
Anne Deutsch, RN, PhD, Clinical Research Scientist, Rehabilitation Institute of Chicago and Senior Research Public Health Analyst, RTI International, Washington, DC; Tara McMullen, MPH, PhD(c), Health Analyst, Centers for Medicare and Medicaid Services, Quality Measurement & Health Assessment Group; Trudy Mallinson, PhD, OTR/L, NZROT, FAOTA, Marianjoy Rehabilitation Hospital, Wheaton, IL

Diagnosis: Diagnosis-independent
Focus: RTI International

Functional status is an important outcome for post-acute care (PAC) providers, including inpatient rehabilitation facilities (IRFs), long-term care hospitals (LTCHs), skilled nursing facilities (SNFs), and home health agencies (HHAs).  The Centers for Medicare and Medicaid Services collected standardized patient assessment data, including admission and discharge functional status data and other clinical data for factors affecting functional outcomes in 206 acute care and PAC providers. In this panel presentation we describe our work to develop functional status quality metrics using the standardized patients assessment data collected.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Participants will be able to describe Medicare’s post-acute care quality reporting programs
  2. Participants will be able describe reliability and validity of the CARE functional status items
  3. Participants will be able to describe 3 analytic issues related to functional status quality metric development

 

The Role of Health Promotion in the Aging SCI Population [#96]

15 November: 7:15 AM – 8:15 AM

Faculty
Candice McCooey, DPT, Spaulding Rehabilitation Hospital, Boston, MA

Diagnosis: Spinal Cord Injury
Focus: Other or N/A

Many individuals with SCI are now living an average of 30 to 40 years post injury and experiencing the multidimensional process of aging. Understanding the impact of aging and of changes in perceived health status across the lifespan is essential to the design and implementation of future, more responsive health-promotion programs. In order to design more effective health promotion programs for the SCI population, we must first understand the impact of aging.
Due to the fragmented nature of the US healthcare system, primary care physicians may not have familiarity or comfort regarding the needs of individuals with SCI. Physiatrists more often have knowledge of their needs, but may lack primary care expertise. Lack of a coordinated approach to the complex care required for individuals aging with SCI likely contributes to the continued development of the physical and psychosocial health conditions that negatively affect health and quality of life.  Recent research has demonstrated the impact of aging in the SCI population; therefore, it is imperative that healthcare providers promote life adjustments through proactive preventative approaches.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Participants will be able to identify the primary health conditions associated with aging in the SCI population.
  2. Participants will be able to explain the relationship between age-related changes and quality of life in the SCI population.
  3. Participants will be able to apply the concept of health promotion and prevention to their clinical practice with aging individuals in the SCI population.

 

Medical Home: A team Approach to Supporting Health and Independence for Individuals with Disabilities [#143]

15 November: 7:15 AM – 8:15 AM

Faculty
Nancy A. Flinn, OTR/L, PhD, Director of Outcomes and Research, Courage Center, Minneapolis, MN

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke, Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Outcomes research/epidemiology

Adults with physical disabilities have complex medical and social needs. They are four times more likely than the general population to have been hospitalized in the last year (NCHS, 2011). Due to limited access to routine management of chronic conditions and frequent use of expensive forms of care, they contribute to the 5 percent of the US population that account for 47.5 percent of all health care spending (NIHCM, 2011). Patient-centered medical homes can significantly reduce health care costs for the most medically complex patients (Flottemesch, 2012), and can be used to address the social and medical needs for this group. Courage Center Medical Home’s mission is to achieve the triple aim of improved health, improved client experience, and decreased cost of care for medically complex patients with disabilities. As a community-based rehabilitation and resource center, Courage Center’s primary care and community-based service providers work together to provide comprehensive care. Through a recent CMS Innovation award, medical home patients have access to in-home support to help with transportation, housing, and food. Patients can also participate in educational workshops, such as the Stanford-developed Chronic Disease Self-Management Program (Holman, 1996). Through expanded primary care and community support, in the last three years the Medical Home has achieved a 67 percent reduction in hospital days, a main cost-driver in this group, and improved health-related quality of life and client engagement. Because of these strong outcomes, Courage Center has been successful in negotiating improved payment systems that move away from fee-for-service and towards value based reimbursement.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Audience will recognize the high medical and social needs of the population with disabilities.
  2. Audience will describe the importance that individuals with disabilities receive disability knowledgeable medical and community-based services.
  3. Audience will recognize the value of an integrative approach to health care that coordinates both medical and community-based services for this population.

 

Pain Management and Rehabilitation: The Great Divide

15 November: 7:15 AM – 8:15 AM

Faculty
Andrea L. Cheville, MD, MSCE, Associate Professor and Research Chair of Physical Medicine, and Rehabilitation, Mayo Clinic, Rochester, MN

Diagnosis: Pain
Focus: Clinical practice

Pain and function are intimately related at many levels. Yet, pain is seldom systematically addressed during the delivery of rehabilitation services, despite the growing participation of rehabilitation clinicians in pain management practices. Instead of a healthy integration characterized by a prioritization of function during pain management and of pain control during rehabilitation, the pain management and rehabilitation communities operate, for the most part, in isolation from one another. This presentation will provide a brief overview of the current state-of-the-knowledge in pain management as it applies to patients’ with disabilities, and outline the empirical basis that broadly links pain to functional outcomes. Opportunities to forge clinical and research alliances between the rehabilitation and pain management communities will be highlighted.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Engage more effectively with pain management specialists to ensure that their patients receive the current standard of care.
  2. Integrate the evidence linking pain and rehabilitation outcomes in clinical and research practices
  3. Leverage the unique properties of analgesics to optimize pain control during functional activities

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 FRIDAY, 15 NOVEMBER
CONCURRENT SESSIONS: 8:30 AM – 10:00 AM


Occupational Traumatic Brain Injury: Gender, Health and the Workplace[#131]

15 November: 8:30 AM – 10:00 AM

Faculty
Angela Colantonio, PhD, OT Reg (Ont.), FACRM, Saunderson Family Chair in Acquired Brain Injury Research and senior scientist, and a CIHR Research Chair in Gender, Work and Health, Toronto Rehabilitation Institute, UHN, Professor, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, CA; Elizabeth Mansfield, PhD, MSc, qualitative researcher in occupational health and safety, Toronto Rehabilitation Institute, Toronto, ON, CA; Tatyana Mollayeva, MD, PhD (C), University of Toronto, Graduate Department of Rehabilitation Science and Collaborative Program in Neuroscience, Toronto, ON, CA; Mary Stergiou-Kita, PhD, scientist, Toronto Rehabilitation Institute, Assistant Professor, Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, CA; Jo-Ann McInnis, Brain Injury Association of Canada, Charlottetown, Prince Edward Island, CA

Diagnosis: Brain Injury
Focus: Health/disability policy, ethics, advocacy

Traumatic brain injury occurring at the workplace (wrTBI) is a leading cause of death and disability. While workplace morbidity/mortality is higher in males in every age group, current research shows that more than 40 percent of work-related brain injuries are sustained by women. To date, there is a paucity of research which investigates incidents and outcomes through a sex and gender lens. In addition, while many personal, occupational and environmental factors have been associated with work re-integration and secondary injury prevention, our team is focusing on less frequently investigated issues such as psychosocial status, chronic pain and sleep, and the provision of workplace supports and accommodations.

This interdisciplinary symposium will bring together scientists with expertise in occupational and rehabilitation science, sociology, occupational health and safety, and sleep medicine. We will begin with an introduction to wrTBI from a population-based perspective. The second presentation will focus on sex and gender differences in return to work following wrTBI. The third presentation will review the available evidence concerning sleep dysfunction post-wrTBI, incidence of which is reported to be up to 80 percent. We will conclude with a discussion of workplace accommodations for individuals with cognitive and psychosocial challenges following brain and electrical injuries.
This symposium will provide clinicians with strategies to assist individuals with wrTBI, researchers with methods for conducting sex and gender-based analyses, and policy makers with suggestions on best practices for workplace accommodations. This session may also be relevant to employers, unions and worker advocates in enhancing their understanding of injured workers’ experiences.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the multifactorial risk factors and burden of occupational TBI and its epidemiological distribution within Canada and USA.
  2. Recognize the role of sex/gender differences in TBI epidemiology and work-related outcomes post-injury.
  3. Identify multifactorial nature of sleep dysfunction post-TBI, its correlations and relationship with disability, gender and work.
  4. Discuss the relevance of accommodations to successful return to work following a brain injury
  5. Identify a strategy that can be employed within clinical practices to facilitate  work re-integration

 

Co-Morbidities Associated with Lifetime Exposure to Traumatic Brain Injury (TBI) [#85]

15 November: 8:30 AM – 10:00 AM

Faculty
Jennifer Bogner, PhD, ABPP, FACRM, Associate Professor, Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH; John D. Corrigan, PhD, ABPP, FACRM, Professor, Department of Physical Medicine and Rehabilitation, Ohio State University, Columbus, OH; Jeff Cuthbert, PhD, MPH, MS, OT, Researcher, Craig Hospital, Englewood, CO; Kristen Dams-O’Conner, PhD, Assistant Professor, Department of Rehabilitation Medicine, Ichan School of Medicine at Mount Sinai, New York, NY; Gale Whiteneck, Craig Hospital, Englewood, CO; Tessa Hart, Moss Rehabilitation Research Institute, Elkins Park, PA; Tamara Bushnik, PhD, FACRM, Rusk Institute for Rehabilitation Medicine, NYULMC, New York, NY; Flora Hammond, Indiana University, Indianapolis, IN; Stephanie A. Kolakowsky-Hayner, Santa Clara Valley Medical Center, Rehabilitation Research Center, San Jose, CA; Kristen Dams-O’Connor, Mount Sinai School of Medicine, New York, NY; Dave Mellick, Craig Hospital, Englewood, CO

Diagnosis: Brain Injury
Focus: Outcomes research/epidemiology

Four studies using standardized methodology for detecting lifetime exposure to TBI in a range of populations provide evidence of associations between indicators of lifetime history (e.g., worst injury, number of TBIs, age at first TBI), comorbidities, and disabilities. The findings have implications for clinical assessments of risks for poorer outcomes, as well as for research on disorders for which lifetime indicators of TBI may be important covariates.

Two studies were population-based. A Colorado study of adults contacted via random-digit dialing provided population-weighted estimates of the prevalence of disability based on indicators of lifetime TBI exposure. A study on prisoners identified clusters based on different aspects of lifetime history of TBI; cluster membership was associated with current functioning. The findings reinforced the importance of injury severity, as well as developmental stage at first TBI.

Two other studies evaluated exposure to TBI prior to an Index injury (the injury that brought the person to the attention of the clinician or researcher). A prospective study of persons presenting with mild TBI to four emergency departments found that prior TBI was associated with worse functional outcomes, more post-concussive symptoms, and lower life satisfaction. Inter-injury interval and age at injury on recovery were important aspects of lifetime history. A TBI Model Systems study of persons with moderate-severe Index injuries found that behavioral issues were strongly associated with younger age of first TBI and more severe prior injuries. Unexpectedly, prior TBI was associated with less severe Index injuries and better functioning upon admission to rehabilitation.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify important indicators of lifetime exposure to traumatic brain injury
  2. Cite the prevalence rates of lifetime history of TBI in population-based samples.
  3. Describe the relationships between indicators of lifetime TBI history, co-morbidities, and disabilities.

 

Regenerative Medicine: New Frontier in Rehabilitation Medicine [#130]

15 November: 8:30 AM – 10:00 AM

Faculty
Nathan K. LeBrasseur, PhD, Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN; Isobel A. Scarisbrick, PhD, Associate Professor, Department of Physical Medicine and Rehabilitation and Physiology, Mayo Clinic, Rochester, MN; Carmen M. Terzic, MD, PhD, Associate Professor, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN

Diagnosis: spinal cord injury, sarcopenia, ischemic cardiac disease, avascular necrosis
Focus: Other or N/A

Regenerative Medicine is poised to transform healthcare by providing the prospect of definitive solutions that address the unmet needs of patients. The decisive goal of regenerative rehabilitation medicine is to advance care from palliation to on-demand repair, to restore function and independence; to improve quality of life and to reintegrate individual to their society. Regenerative Medicine will be a vital component of medical and surgical practice in the coming years as it will create new models of health care and transform medicine and surgery. Therefore, it is important to educate the next generation of clinicians and scientists in the latest regenerative medicine applications. This symposium will provide to the audience an update on promising pharmacological therapies and stem cell technology aimed to repair, regenerate, recovery and restore organs and tissues such as skeletal muscle, spinal cord, heart, joints.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Recognize novel therapies to restore skeletal muscle mass in the face of aging and disease
  2. Identify novel targets for therapies to promote repair and regeneration of spinal cord
  3. Discuss the use of stem cell technologies for regenerative medicine

 

Implications of Hospital-to-Inpatient Rehabilitation Continuity [#125]

15 November: 8:30 AM – 10:00 AM

Faculty
James E. Graham, PhD, DC, University of Texas Medical Branch, Galveston, TX; Janet Prvu Bettger, ScD, FAHA, Duke University, Durham, NC; Kenneth J. Ottenbacher, PhD, OTR, University of Texas Medical Branch, Galveston, TX

Diagnosis: Diagnosis-independent or NA
Focus: Outcomes research/epidemiology

Several provisions within the Affordable Care Act extend inpatient providers accountability for patient wellbeing beyond the services provided and outcomes achieved during the isolated stay in their facility. The net effects of initiatives such as accountable care organizations, bundled payments, value-based purchasing and others, are that both upstream and downstream providers are motivated to 1) improve their performance rankings relative to others at the same level of care, and 2) align themselves with top performing providers at other levels of the care continuum. Thus, acute hospitals now have a direct, vested interest in the effectiveness and efficiency of post-acute providers.
Older adults who require intensive post-acute care are most in need of well-coordinated care to manage their prolonged recovery, but they are also most vulnerable to disruptions in their care plan or care team as they transition from setting to setting and ultimately back to the community. Inpatient rehabilitation facilities (IRFs) provide the most intensive post-acute rehabilitative care. The assumption underlying many of the healthcare reform initiatives listed above is that shared accountability and resultant increased continuity lead to better patient experiences and improved outcomes. During this symposium we will (a) present the results from our analyses testing this assumption using the 100 percent Medicare hospital claims and IRF assessment files, and (b) discuss potential implications of the observed hospital-IRF referral patterns from both the patient and provider (facility) perspectives.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Explain how hospital-IRF referral patterns can affect patient options and care transitions.
  2. Identify the effects of facility-level continuity on both patient outcomes and facility quality performance scores.
  3. Recognize the motivation for and implications of acute/post-acute networks moving forward.

 

An Intensive, Interprofessional, Community-Based Intervention Program for Persons Post-Stroke [#113]

15 November: 8:30 AM – 10:00 AM

Faculty
Elizabeth Hoover, MS, CCC-SLP, BC-ANCDS(A), Clinical Assistant Professor, Department of Speech and Hearing Sciences, and Clinical Director, Aphasia Resource Center, Boston University, Boston, MA; Sue Berger, PhD, OTR/L, BCG, FAOTA, Clinical Associate Professor, Department of Occupational Therapy, Boston University, Boston, MA; Tamara R. DeAngelis, PT, DPT, GCS, Senior Physical Therapist, Center for Neurorehabilitation, Boston University; Stacey Zawacki, DrPH, MS, RD, Director of the Sargent Choice Nutrition Center and Clinical Assistant Professor, Department of Health Sciences at Boston University, Boston, MA; Terry Ellis, Boston University, Boston, MA; Anne Carney, Boston University, Sargent College, Boston, MA

Diagnosis: Stroke
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Evidence clearly demonstrates that individuals who have had a stroke benefit from rehabilitation in the chronic stages (Gauthier et al., 2008; Peurala et al., 2011) and from an interprofessional approach to care (Johansen, Lindbaek, Stanghelle, & Brekke, 2011). Intensity of treatment has also been shown to influence outcomes related to in both communication and motor deficits (Barzel et al., 2009; Basso, 2005; Bhogal, Teasell, & Speechley, 2003; Smania et al., 2012). This panel presentation will describe the development of an intensive, interprofessional, community-based program situated in an academic environment for clients living post-stroke. Results from three years of program implementation will be presented.The client-centered structure of this program includes extensive peer support among program participants, often leading to increased self-efficacy and social participation. This program is an exciting and novel approach for improving the community participation of individuals living post- stroke.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the development and structure of a one month intensive, interprofessional, community-based stroke program.
  2. Explain discipline-specific outcome measures conducted at baseline and discharge and analyzed for program evaluation.
  3. Discuss the key elements of intervention across all four professions (i.e., Speech-Language Pathology; Nutrition; Occupational Therapy; Physical Therapy) .
  4. Describe results from three years of program implementation.

 

Lifestyle Redesign® for Pressure Ulcer Prevention in Spinal Cord Injury[#155]

15 November: 8:30 AM – 10:00 AM

Faculty
Florence Clark, PhD, OTR/L, FAOTA, Professor and Associate Dean, Division of Occupational Science and Occupational Therapy, University of Southern California (USC), Los Angeles, CA, President, American Occupational Therapy Association; Erna Imperatore Blanche, PhD, OTR/L, FAOTA, Associate Professor, Clinical Practice. Division of Occupational Science and Occupational Therapy, University of Southern California (USC), Los Angeles, CA; Trudy R. Mallinson, PhD, OTR/L, NZROT, Visiting Associate Professor, School of Medicine & Health Sciences, The George Washington University; Jeanine Blanchard, PhD, OTR/L, Project Manager, NIH-funded Pressure Ulcer Prevention Study (PUPS), Division of Occupational Science and Occupational Therapy, University of Southern California (USC), Los Angeles, CA; Jesus Diaz, OTD, OTR/L, Research Assistant Professor, Occupational Therapy, Division of Occupational Science and Occupational Therapy, University of Southern California (USC), Los Angeles, CA; Alison Cogan, MA, OTR/L, Doctoral Student, Division of Occupational Science and Occupational Therapy, University of Southern California (USC), Los Angeles, CA

Diagnosis: Spinal Cord Injury
Focus: Other or N/A

In this symposium we will present preliminary findings from the Pressure Ulcer Prevention Study (PUPS) randomized controlled trial. The purpose of this trial is to test the efficacy of a community-based intervention, administered by occupational therapists and nurses, that is designed to enable adults with spinal cord injury (SCI) to reduce their risk for medically serious (Stage III or IV) pressure ulcers (PrU) by  enacting daily lifestyle choices that foster successful prevention.

In this study, 170 individuals with SCI have been recruited at Rancho Los Amigos National Rehabilitation Center and randomized to either a 12-month LR intervention condition or to a standard care control group. Research participants are predominantly members of racial/ethnic minority groups from impoverished communities. Several methods are being undertaken to measure the occurrence of PrUs, including full skin evaluations (at post-intervention and 12-month follow-up, with the Bates-Jensen Wound Assessment Tool administered when an ulcer is present), medical chart review, and phone interviews. In addition to examining PrU outcomes, various secondary analyses will be performed to document the intervention’s effects on surgeries and overall medical costs, quality of life, and specific prevention practices that potentially mediate any positive intervention effects.

Beyond reporting on preliminary study results, we will discuss our response to emergent methodological issues, including challenges that were encountered in areas such as recruitment and retention, intervention delivery, and outcome assessment. Finally, we will provide suggestions for translating the obtained findings into clinical practice.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Explain the importance of conducting pressure ulcer prevention randomized controlled trials on the efficacy and cost effectiveness of interventions designed to reduce the incidence of medically serious pressure ulcers in low income, ethnically diverse, community-based populations with SCI.
  2. Describe the design and key preliminary findings of the PUPS trial.
  3. Describe the manualized components of the PUPS intervention and the ways in which they were tailored to be responsive to participant characteristics and life circumstances
  4. Describe recruitment and retention strategies utilized to obtain the required sample of ethnically diverse adults with SCI from disadvantaged populations.

 

Update on Spinal Cord Injury Pain

15 November: 8:30 AM – 10:00 AM

Faculty
J. Scott Richards, PhD, OC, PT, Professor, Laval University, Birmingham, AL; Marcel Dijkers, PhD, FACRM, Professor, Mount Sinai School of Medicine, New York, NY; Thomas N. Bryce, MD, Associate Professor, Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY

Pain following spinal cord injury (SCI) is an often debilitating secondary condition which can negatively impact quality of life and limit participation.  In this symposium, we will describe current findings on the incidence/prevalence and impact of pain in this group of individuals.  We will also review the history and current thinking on SCI pain classification, and review the current proposed international consensus classification scheme, the International SCI Pain Classification (ISCIP).  We will review a recently published standard dataset proposed for adoption internationally for clinical and research work on SCI pain.  Evidence will be presented on the efficacy of medications and physical interventions for neuropathic and non-neuropathic SCI pain.  Finally, data describing the efficacy of behavioral interventions will be presented, including cognitive-behavioral approaches,  hypnosis and virtual reality.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify the main subtypes of SCI pain as described in the ISCIP Classification scheme.
  2. Describe current knowledge of the prevalence of SCI pain and the timing of development of pain types.
  3. Describe the purpose of the SCI Basic Pain Dataset.
  4. Identify at least two medical and or physical interventions for SCI pain with demonstrated efficacy.
  5. Describe two behavioral approaches to SCI pain with demonstrated efficacy.

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PLENARY SESSION:

Symposium in Honor of Robert C. Wagenaar, PhD: 1957-2013 [#219]

15 November: 10:30 AM — 12:00 PM

Faculty
Douglas I. Katz, MD; Gert Kwakkel, PT, PhD; Alan M. Jette, PhD; Daniel K. White, PT, ScD

The rehabilitation community lost a talented and much-beloved colleague with the passing of Dr. Robert C. Wagenaar on 13 February 2013. Dr. Wagenaar was a well-respected scientist, thoughtful mentor, and a cherished friend to many of his colleagues. A skilled scientist, highly regarded for his work in dynamical systems theory, he studied gait patterns in patients with stroke and Parkinson’s disease, and investigated rehabilitation interventions to modify abnormal movement patterns. He was the essence of a translational research scientist, transforming theory to clinical practice in rehabilitation. Dr. Wagenaar was also a devoted educator and mentor to many graduate students, post-doctoral students, and junior colleagues. His mentees have emerged as leaders in their own areas of work. At ACRM, Dr. Wagenaar served as co-chair of the Program Committee from 2010 until his death and was instrumental in dramatically improving the caliber of scientific presentations at the annual meeting. This symposium is presented in his honor in recognition of the many contributions he made to our lives and work. >>> Learn more . . .


FRIDAY, 15 NOVEMBER
SPECIAL OPPORTUNITY: 12:00 PM – 1:30 PM


BRUCKER MEMORIAL INTERNATIONAL LUNCHEON (TICKETED EVENT)

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Presented by the International Networking Group in memory of Bernard S. Brucker, PhD, ABPP

International Partnering in Research

Kathryn McPhersonFeatured Speaker: Kathryn M. McPherson, RN, RM, Dip HV, BA (Hons), PhD, professor of rehabilitation and Laura Fergusson Chair for the School of Rehabilitation and Occupation Studies and the director of the Person Centred Rehabilitation Centre in the Health and Rehabilitation Research Centre (HRRC) at AUT University in Auckland, New Zealand.

International partnering in research offers a wide ranging set of opportunities and challenges in applying for funding, doing the work, and translating findings. This presentation will examine these issues through the eyes of one researcher (and one research team), based in New Zealand. Despite successful international collaborative funding applications in Europe, Asia, UK, North America and Australasia, not all have been straightforward, and robust structures to manage the complexity are clearly vital.  Establishing good relationships, truly respecting the knowledge, expertise and cultural perspectives of others doesn’t just happen. But when it does – it can be exciting and transformative.

 

ACRM ISIG, NETWORKING GROUP, TASK FORCE, AND COMMITTEE MEETINGS

  • Policy & Legislation Committee (by invitation only)
    12:00 PM – 1:00 PM
  • Communications Committee
    Interested in joining this committee? Plan to attend!
    12:00 PM – 1:00 PM
  • BI-ISIG Long-Term Issues Task Force
    12:00 PM – 1:00 PM
  • Stroke-ISIG Vision Task Force
    12:00 PM – 1:00 PM
    Off-site lunch meeting. Location TBD. Members will meet at the registration desk.
  • BI-ISIG Community-Based Rehabilitation Task Force
    12:00 PM – 1:15 PM
  • BI-ISIG Cognitive Rehabilitation Task Force
    12:00 PM – 1:15 PM

  • BI-ISIG Mild TBI Task Force
    12:00 PM – 1:30 PM
  • Stroke-ISIG Task Force Chairs (by invitation only)
    12:15 PM – 1:30 PM
  • Stroke-ISIG Business Meeting
    1:30 PM – 3:00 PM

ORAL PRESENTATION OF SCIENTIFIC PAPERS

15 November: 1:30 PM – 3:00
TBI Topics
MODERATOR: Virginia Mills, MS, PT, CCM, Lic NHA, FACRM, Neurological Rehabilitation Assoicates, Wellesley, MA

Recovery of Cognitive Functioning and Independence After Prolonged Disorders of Consciousness Following Brain Injury: 1-8 Year Follow-up
Douglas I. Katz, MD, Braintree Rehab Hospital, Braintree, MA

Treatment Effect Versus Pretreatment Recovery in Persons With Traumatic Brain Injury: Effectiveness of Postacute Rehabilitation
Richard M. Capriotti, PhD, Pate Rehabilitation, Anna, TX

A Randomized, Double-Blinded, Placebo-Controlled Trial to Improve Attention in Persons with TBI Receiving Acute Rehabilitation
Ronald Seel, Shepherd Center, Atlanta, GA

Impacts of Exercise and Affirmations on Cognition and Mood for Individuals with Traumatic Brain Injury
Yuen Shan Christine Lee, NYU Langone Medical Center, New York, NY


FRIDAY, 15 NOVEMBER
CONCURRENT SESSIONS: 1:30 PM – 3:00 PM


Trends in Traumatic Brain Injury in the United States [#79]

15 November: 1:30 PM – 3:00 PM

Juliet Haarbauer-Krupa, PhD, Health Scientist, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (CDC), Atlanta, GA; Mark Faul, PhD, MA, Senior Health Scientist, National Injury Prevention and Control Center, CDC; Victor G. Coronado, CDC; Tadesse Haileyesus, CDC; Julie Gilchrist, CDC; Tabitha A.Herzog, BS, UCLA medical student, CDC; Jeneita M.Bell, MD, MPH, CDC; Christopher A. Taylor, PhD, CDC; Michael R. Lionbarger, MPH, CDC; Lisa C.McGuire, PhD, CDC; Likang Xu, CDC; Brian Amour, CDC; William S. Pearson, PhD, Office of Prevention through Healthcare; Elizabeth Courtney-Long, MA, CDC; Vincent A. Campbell, CDC

Diagnosis: Brain Injury
Focus: Outcomes research/epidemiology

A traumatic brain injury (TBI) is an injury that disrupts the normal function of the brain and is caused by a bump, blow or jolt to the head or a penetrating head injury. It was recently estimated that, in 2009, approximately 3.5 million patients with a TBI listed as primary or secondary diagnosis were hospitalized and discharged alive (N=300,667) or were treated and released from emergency departments (EDs; N=2,077,350), outpatient departments (ODs; N=83,857), and office-based physicians’ offices (OB-P; N=1,079,338) (Coronado et al., 2012). However, these statistics are potential underestimates because they do not include active duty military service members and those who did not seek medical care; therefore, the true incidence of TBI in the US remains unknown. Because the health effects of TBI can be permanent with varying outcomes for those who survive, it is crucial to understand the epidemiology of TBI and potential risk and burden for TBI survivors. This presentation will describe national data on trends in sports and recreation TBI, emergency department visits, hospitalizations, and rehabilitation. Trends will be described by age group, gender, payment type, discharge disposition, and care following hospitalization.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify incidence of TBI in the United States
  2. Describe trends in emergency department visits, hospitalizations and post-acute care for TBI
  3. Describe trends for TBI in sports and recreational injuries

 

Outcome Prediction in Post-Traumatic Disorders of Consciousness: Is it Time to Revisit Prognostic Guidelines [#109]

15 November: 1:30 PM – 3:00 PM

Faculty
Joseph T. Giacino, PhD, Director of Rehabilitation Neuropsychology, Spaulding Rehabilitation Hospital, Neuropsychology Consultant, Department of Psychiatry, Massachusetts General Hospital, Associate Professor, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Brian Edlow, MD, Neurocritical Care Fellow, Massachusetts General Hospital and Brigham and Women’s Hospital, Boston, MA; Yelena Guller, PhD, Spaulding Rehabilitation Hospital, Boston, MA

Diagnosis: Brain Injury
Focus: Outcomes research/epidemiology

Individuals who sustain severe acquired brain injury often experience disorders of consciousness (DoC), including the vegetative (VS) and minimally conscious states (MCS). These conditions may be transient or permanent. Among those who experience prolonged (i.e., > 2 weeks) DoC, it is difficult to predict who will subsequently recover, and the extent of functional recovery that will eventually be attained. In 1995, the American Academy of Neurology published prognostic guidelines for the vegetative state (VS). In 2002, the Aspen Workgroup followed up with recommendations for  clinical management of the minimally conscious state (MCS). Both postition statements suggested that these conditions could be considered permanent by 12 months post-injury. Over the course of the last 8 years, a series of long-term outcome studies have been published which consistently show that approximately 20% of patients in VS and MCS for one year (combined) continue to improved significantly after this point. In addition, data indicate that a substantial minority go on to regain functional independence. Part I of this course will review the recent evidence that challenges existing prognostic guidelines. In Part II, we will discuss potential prognostic applications of advanced structural and functional neuroimaging techniques, including susceptibility weighted imaging, diffusion tensor imaging and tractography, resting state fMRI and stimulus-related fMRI activation paradigms. Part III will discuss the emerging role of multimodal assessment approaches in evaluating brain connectivity for diagnostic, prognostic and treatment planning purposes. The course will close with an open discussion of the clinical practice implications of the material reviewed.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Outline current prognostic guidelines for the vegetative state (VS) and minimally conscious states (MCS)
  2. Discuss recent long-term outcome studies
  3. Describe the use of advanced imaging tools in prognostic assessment
  4. Identify strategies for integrating transcranial magnetic stimulation and functional MRI for diagnostic and treatment purposes

 

A Clinical Practice Guideline to Enhance Outcomes in People with Neurologic Injury: Gait Recovery [#153]

15 November: 1:30 PM – 3:00 PM

Faculty
Anne H. Chan, PT, DPT, MBA, NCS, Director of Business Development, Sheltering Arms Physical Rehabilitation Centers, Richmond, VA; Amber Devers, PT, DPT, NCS, Physical Therapist, Sheltering Arms Rehabilitation Hospital, Richmond, VA; Deborah Backus, PT, PhD, Shepherd Center, Atlanta, GA

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

The science of recovery from neurologic injury has changed in the past 30 years. The knowledge of plasticity in the central nervous system combined with principles of motor control and motor learning have changed the state of rehabilitation. In addition, technologic advances allow for the implementation of this new knowledge in the clinic when translated in a valuable way for clinicians and patients. The proposed session will review the current science that should be matched to current neurologic practice for gait recovery. A clinical practice guideline that utilizes technology for recovery across a continuum of care will be presented as a method of knowledge translation. The guideline uses a unique assessment of people with neurologic injury to place them into severity categories which guides intervention. Selected technologies discussed will be body weight support, robotics, exoskeletons, and functional electric stimulation. Video case studies, with an emphasis on stroke and spinal cord injury, will be utilized to show the transfer of knowledge to action.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Upon completion of this section, the participant will be able to, in the context of people with neurological injury or disease, such as stroke or SCI: Define the principles of neuroplasticity, motor control, and motor learning for lower limb function
  2. Synthesize current evidence for neuroplasticity in recovery of gait.
  3. Discuss the steps to create a clinical practice guideline (CPG) and become aware of how a CPG can be used across a continuum of care.
  4. Describe how the use advanced technologies can facilitate motor learning and activity-based interventions for gait recovery.

 

Novel Approaches to Clinical Practice Improvement [#156]

15 November: 1:30 PM – 3:00 PM

Faculty
Allen W. Heinemann, PhD, FACRM, Director, Center for Rehabilitation Outcomes Research and Associate Director of Research, Rehabilitation Institute of Chicago, professor, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University; Linda Ehrlich-Jones, PhD, RN, Clinical Research Scientist, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Research Assistant Professor, Department of Physical Medicine & Rehabilitation at the Feinberg School of Medicine, Northwestern University; Jason Raad, MS, PhD (C), Project Manager, Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago. List of Participants and Their Roles in the Abstract

Diagnosis: Spinal Cord Injury, Neurodegenerative disorder (e.g., MS, Parkinson’s disease), amputation
Focus: Outcomes research/epidemiology

Evidence-based practice (EBP) provides the best means to incorporate research into rehabilitation care. One obstacle to EBP is clinicians’ uncertainty regarding the optimal instruments to monitor patients’ outcomes. This symposium will describe three EBP projects that engaged clinicians in a rehabilitation hospital, prosthetics clinics, and a professional association to promote outcome measurement.
In a 24-bed inpatient rehabilitation unit, we worked with clinicians to implement as part of routine care the administration of patient-reported outcomes as computer adaptive tests. Clinicians selected the Patient-Reported Outcome Measurement Information System depression, fatigue, sleep disruption, pain interference, and positive and negative psychosocial illness impact instruments. We used the NIH Assessment Center to administer these computer adaptive tests. We will describe the respondent burden on patients and the staffing requirements.

In prosthetics clinics, many facilities assess patient satisfaction to fulfill accreditation requirements of the American Board of Prosthetic, Orthotics and Pedorthics. We worked with six prosthetic clinics to incorporate the Orthotics Prosthetics User Survey into routine practice, then consulted with them to develop quality improvement projects to address issues related to functional status and satisfaction.
Finally, we will describe a collaborative project with a professional association to provide outcome instrument summaries that therapists use to monitor patients’ rehabilitation progress. Association members have written more than 100 instruments for the Rehabilitation Measures Database, an online database of outcome instruments.

These projects illustrate novel methods to help clinicians incorporate outcome measures into routine practice. We will highlight the facilitators and barriers encountered by clinicians in using outcome measures.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe approaches to engage clinicians in utilizing outcome measures in their clinical practice.
  2. Discuss facilitators and barriers encountered by clinicians with using outcome measures in their clinical practice.
  3. Identify effective collaborations to assist clinicians with utilizing outcome measures.

 

Safe Patient Handling Programs in Rehabilitation [#13]

15 November: 1:30 PM – 3:00 PM

Faculty
Marc Campo, PT, PhD, Professor, School of Health and Natural Sciences, Mercy College, Dobbs Ferry, NY; Amy Darragh, OTR/L, PhD, Assistant Professor of Occupational Therapy, School of Health and Rehabilitation Sciences, Wexner Medical Center, Ohio State University, Columbus, OH

Diagnosis: Brain Injury, Spinal Cord Injury, Stroke, Neurodegenerative disorder (e.g., MS, Parkinson’s disease) The presentation is relevant to all rehabilitation diagnoses but we will discuss the effect of several specific diagnoses such as stroke or total joint replacement.
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Safe patient handling and movement (SPH) programs have been implemented widely in rehabilitation settings across the United States. The goal of SPH programs is to reduce or eliminate manual handling of patients through a combination of advanced patient handling technologies and policies that determine their use.  They protect rehabilitation staff from work-related injuries, as well as protect patients from falls during transfers and lifts.  However, these programs also change rehabilitation care practices profoundly.  They can enable earlier and more aggressive patient mobilization, as well as provide more rehabilitation options for patients who were previously too heavy to be mobilized. In recent years policies, initiatives and laws have increased the number and scope of SPH programs dramatically. Examples include the Veteran’s Administration’s (VA) 200 million dollar initiative to implement SPH in all VA inpatient facilities. Another example is the American Nurses Association “Handle with Care” campaign to eliminate manual handling of patients in nursing. The purpose of this symposium is to provide a detailed, evidence-based review of SPH, with particular focus on the implications for rehabilitation. The presentation will provide an extensive overview of SPH, describe the use of SPH in rehabilitation and examine the effect of SPH on patient outcomes.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the use of safe patient handling programs in rehabilitation.
  2. Identify the most commonly used safe patient handling technologies in rehabilitation.
  3. Discuss the advantages and disadvantages of specific patient handling technologies for rehabilitation care.
  4. Analyze the effect of safe patient handling programs on patient rehabilitation outcomes.

 

Interprofessional Pain Education for Collaborative Patient-Centered Care

15 November: 1:30 PM – 3:00 PM

Faculty
Judith Hunter, BSc(PT), MSc, PhD, Assistant Professor, Department of Physical Therapy and Curriculum Director, Certificate in Pain Management, University of Alberta, Edmonton, AB, CA

Diagnosis: Pain
Focus: Clinical Practice

Acute and/or persistent pain continue to be major health problems for many individuals and roadblocks to rehabilitation, yet pain education for health professional trainees and clinicians remains inadequate.  Despite the substantial evidence base for pain management, and a health care climate attentive to the use of this evidence in practice, gaps in health care professionals’ pain knowledge and problematic beliefs persist.  In addition, best practices for chronic pain management requires multidimensional approach and interprofessional collaboration.  However most pre- and post-professional pain focuses primarily on biological approach and/or uni-professional training.  Interprofessional education (IPE) is becoming a popular notion in university contexts, but, what does this mean and is there evidence of benefit?  In the past several years innovative interprofessional pain curricula for pre-licensure as well as practicing clinicians have been developed to address these gaps. This presentation  will outline the concept of IPE in the context of pain; describe the evidence base for IPE pain programs targeting health care providers and trainees; and discuss current examples of development implementation and evaluation IPE  focused pain programs for students, trainees, and health care providers.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss the breadth and depth of the meaning of interprofesssional education (IPE) and interprofessional care(IPC).
  2. Describe the evidence base for IPE pain programs targeting a) trainees (undergraduate and graduate) and b) health care providers.
  3. Describe the recommended steps in the development, implementation, and evaluation of pain education programs.
  4. Discuss the outcomes of IPE including the goals we want to accomplish.
  5. Discuss some applied examples and lessons learned.

 

NeuroControl; Exploitation of Neuroplasticity

Invited Symposium from the Netherlands Neuroscience Society
15 November: 1:30 PM – 3:00 PM

Faculty
Ruud W. Selles, PhD, Department of Rehabilitation Medicine & Department of Plastic and Reconstructive Surgery, Erasmus MC – University Medical Center Rotterdam, The Netherlands; Carel G.M. Meskers, MD, PhD, Department of Rehabilitation Medicine, Leiden University Medical Center, Leiden, The Netherlands; Prof. dr. Frans C.T. van der Helm, Delft University of Technology, Faculty of Mechanical Engineering, BioMechanical Engineering, Delft, The Netherlands; Edwin van Asseldonk, PhD, Biomechanical Engineering, University of Twente, Enschede, The Netherlands

Diagnosis: Pain
Focus: Technology; neurorehabilitation

The exploitation of neuroplasticity may be the key to break through current recovery patterns of patients with neurological disorders in improving primary recovery of function (“restitution”) instead of compensation. In this symposium, we will discuss ways to design new assessment and treatment paradigms focusing on the exploitation of neuroplasticity in patients with sensorimotor disorders. The session will bring together researchers from clinical, engineering and neuroscience perspectives.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Obtain insight into how neurocontrol of patients can be described and quantified using system identification and parameter estimation
  2. Learn how these tools can be applied for diagnosis and assessment in neurological rehabilitation
  3. Obtain insight in the basic science of robot assisted training and how this knowledge can be translated into new robot-assisted trainers.

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FRIDAY, 15 NOVEMBER
CONCURRENT SESSIONS: 3:30 PM – 5:00 PM


Systems of Care for ABI in a Universal Healthcare System [#28]

15 November: 3:30 PM – 5:00 PM

Faculty
Nora Cullen, MD, Toronto Rehabilitation Institute, University Health Network, West Park Healthcare Centre,Toronto, ON, CA; Bonne Swaine, PhD, Psysiotherapy Program, École de réadaptation, Faculté de médecine, Université de Montréal, Montreal, QC, CA; Isabelle Gagnon, PT, PhD, School of Physical & Occupational Therapy, McGill University, Montreal, QC, CA; Michelle Keightley, C. Psych, Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, ON, CA; Philippe Fait, PhD, Department of Physical Activity, Université du Québec à Trois-Rivières, QC, CA; Michelle McKerral, PhD, Department of Psychology, Universite de Montreal, Montreal, QC, CA; Carol DeMatteo, PT, OT, School of Rehabilitation Science, McMaster University, Hamilton, ON, CA; Brad McFadyen, PhD, Department of Physical Therapy, Université Laval, Quebec, QC, CA; Deirdre Dawson, PhD, Rotman Research Institute, Baycrest, University of Toronto, Toronto, ON, CA; Carolina Bottari, MSc, OT, PhD, École de réadaptation, Université de Montréal, Montreal, QC, CA; Guylaine Le Dorze, MSc, PhD, Speech-Language Pathology, Faculty of Medicine, Université de Montréal, Montreal, QC, CA; Marcel Dijkers, Icahn School of Medicine at Mount Sinai, New York, NY

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Acquired brain injury (ABI) is a leading cause of disability in North America. In Canada, national standards of care or best-practice guidelines for service delivery to ABI patients across the continuum of care do not exist. The Head Injury Partnership Endeavor (HIPE) team, launched in 2007, is a multidisciplinary team composed of Ontario- and Québec-based researchers which conducts collaborative research focusing on optimizing head injury service delivery in Canada.

This symposium, through research presentation and panel discussion, will highlight current work by researchers within the partnership on ABI service delivery across the continuum of care in the context of a publicly-funded healthcare system. Presentations will focus on Canadian research occurring within three major settings across the system of care: acute care, rehabilitation, and return to community. Regional variations in transfer and admission practices will be discussed, and results of a survey on clinical stakeholders’ perceptions on existing policies will be presented. The community piece will explore evidence-based clinical decision-making for return to activities after mild TBI, emphasizing guideline development, measures of readiness, and interventions to facilitate return to activities. Lastly, we will address the use of therapist communication behaviours to enhance effective goal attainment across the continuum of care for patients with cognitive deficits after ABI.

Via panel discussion, current concepts surrounding ABI management and research will be identified and discussed through the lens of a publicly-funded model of care. This system of care will be presented as a contrast to the American healthcare model.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe current Canadian research studies by the HIPE team
  2. Discuss ABI service delivery across the continuum of care in a publicly-funded healthcare system
  3. Recognize the benefits and challenges of ABI service delivery in a universal healthcare system

 

Mild TBI: New Neuropsychiatric Perspectives [#98]

15 November: 3:30 PM – 5:00 PM

Faculty
Jonathan M. Silver, MD, New York University School of Medicine, New York, NY; David B. Arciniegas, MD, Baylor College of Medicine/TIRR Memorial Hermann, Baylor College of Medicine, Thomas W. McAllister, MD, Dartmouth University, Houston, TX

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Approximately 1.5 million Americans experience traumatic brain injury each year, the vast majority of which are mild. In the moments following a TBI, postconcussive symptoms are nearly universal. These include alterations of consciousness, disturbances of attention, slow processing speed, impaired declarative memory, and executive dysfunction, and frequently are accompanied by emotional and behavioral disturbances as well as sensory and motor problems. Over the days to weeks after mild TBI, recovery usually proceeds rapidly and typically is complete. When early symptoms are unrecognized, misunderstood, and/or inadequately addressed, early postconcussive symptoms may become chronic and engender secondary psychological health and psychosocial consequences. Pre-injury health and psychosocial factors also influence the short- and long-term effects of TBI. Understanding and improving outcomes after TBI therefore requires consideration not only of the effects of external physical forces on the brain but also the person sustaining that injury and the events preceding and following it.

This session will provide participants with new and emerging perspectives on mild TBI. A heuristic with which to understand the influences of pre-injury, injury-related, and post-injury factors on postconcussive symptoms will be presented. The roles of context and process in the genesis of attention and memory impairments after TBI will be considered, and the long-term effects of repetitive subconcussive impacts will be described. Finally, factors that influence effort and symptom reporting after TBI are identified and their implications for clinical and forensic practice are discussed.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify pre-injury, injury-related, and post-injury factors that influence the development and persistence of postconcussive symptoms.
  2. Recognize the contributions of context and process to cognitive dysfunction following mild traumatic brain injury.
  3. Identify the effects of repetitive subconcussive impacts on short- and long-term cognitive performance.
  4. Recognize factors that influence effort and symptom reporting in the late period after mild traumatic brain injury.
  5. Recognize the contributions of context and process to cognitive dysfunction following mild traumatic brain injury.
  6. identify the effects of repetitive subconcussive impacts on short- and long-term cognitive performance.
  7. Recognize factors that influence effort and symptom reporting in the late period after mild traumatic brain injury.

 

Integrating Physical Wellness Approaches into the Lives of People with Neurodegenerative Diseases [#144]

15 November: 3:30 PM – 5:00 PM

Faculty
Deborah Backus, PT, PhD is Director of Multiple Sclerosis Research, The Eula C. and Andrew C. Carlos MS Rehabilitation and Wellness Program, Crawford Research Institute, Shepherd Center, Atlanta, GA; Lisa M. Muratori, PT, EdD, Clinical Associate Professor, Stony Brook University, Department of Physical Therapy, School of Health Technology & Management, Research and Development Park, Rehabilitation Research and Movement Performance (RRAMP) Laboratory, Stony Brook, NY; Vanina Dal Bello-Haas, PT, PhD, Associate Professor, Assistant Dean, Physiotherapy Program School of Rehabilitation Science, McMaster University, Hamilton, ON, CA; Becky G. Farley, PhD, MS, PT, Physiology Research Associate, University of Arizona and the CEO/Founder of the nonprofit Parkinson Wellness Recovery, Tucson, AZ; Eduard Gappmaier, PT, PhD, Associate Professor, University of Utah, Salt Lake City, UT, Director of the Clinical Neuromuscular Research Laboratory, University of Utah Multiple Sclerosis Rehabilitation and Wellness Program; Christine Manella, PT, LMT, MCMT, Therapy Manager, Multiple Sclerosis Institute * Medical -Surgical * Pain Institute, Shepherd Center, Atlanta, GA; Jacqueline Montes, PT, EDd, NCS, Physical Therapist, SMA Clinical Research Center, Columbia University, New York, NY

Diagnosis: Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Other or N/A

Emerging evidence suggests that people with neurodegenerative diseases (NDD), such as Parkinson’s Disease (PD), Multiple Sclerosis (MS) or Amyotrophic Lateral Sclerosis (ALS) can benefit from rehabilitation and exercise interventions to improve health and wellbeing, as well as to manage the signs and symptoms of these NDD. Although the underlying mechanisms of NDD may vary amongst themselves as well as other neurological diseases and injury, there are some guiding principles and opportunities that can be used to provide safe and effective methods for exercise. In order to promote greater health and to prevent secondary conditions that result from the immobility imposed by NDD, it is imperative that the barriers to exercise be identified and overcome.

This session will utilize didactic sessions combined with group activity and open discussion to promote opportunities for greater health and wellness in people with PD, MS, or ALS.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Identify key issues related to the health and wellness barriers unique to people with neurodegenerative diseases (NDD)
  2. Define exercise approaches to improving health in people with NDD
  3. Identify approaches to exercise that are appropriate across diagnostic groups in people with NDD
  4. Provide options for incorporating physical wellness approaches into a variety of settings for people with NDD, including the clinic, community and home
  5. Understand the use of technology and telehealth systems to improve access to health and wellness programs for people with NDD.

 

Understanding On-Road Safety in Elderly Drivers: Different Perspectives [#106]

15 November: 3:30 PM – 5:00 PM

Faculty
Barbara Mazer, PhD, Assistant Professor, School of Physical and Occupational Therapy, McGill University & CRIR-Jewish Rehabilitation Hospital, Montreal, QC, CA; Isabelle Gelinas, PhD, Associate Professor, School of Physical and Occupational Therapy, McGill University, Montreal, QC, CA; Brenda Vrkljan, PhD, Associate Professor of Occupational Therapy, School of Rehabilitation Science, McMaster University, Hamilton, ON, CA; Sjaan Koppel, PhD, Senior Research Fellow, Behavioural Safety Science Team, Monash University Accident Research Centre (MUARC), Melbourne, AU; Judith Charlton, PhD, Associate Director of Behavioural Safety Science Research, Monash University Accident Research Centre (MUARC) & Coordinator of Postgraduate Studies, Monash Injury Research Institute (MIRI), Melbourne, AU; Shawn Marshall, MD, Physical Medicine and Rehabilitation Specialist, Associate Professor of Medicine, University of Ottawa and Clinical Investigator, Ottawa Hospital Research Institute, Ottawa, ON

Diagnosis: Seniors
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Given our aging population, the number of seniors who drive is increasing. Although most seniors are safe drivers, this age group experiences one of the highest crash rates per mile driven, due to the increasing prevalence of medical conditions. The high morbidity and mortality associated with crashes involving older drivers creates a serious hazard to themselves and others. Consequently, the accurate identification of at-risk drivers has become a public health priority. While there are several approaches to examining driving safety in seniors, there is no consensus regarding the most informative and accurate way to guide health care professionals and decision makers in their approach.

This seminar will review the different approaches used to judge safety in older drivers.  These include: on-road evaluation, naturalistic driving observation, driving exposure using in-vehicle technology, driving simulator and crash data. The evidence supporting each approach as well as their advantages, limitations and application will be presented.  This will be followed by a discussion on the best approaches to use in clinical practice, research activities and policy development.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand the different approaches to collecting information about seniors’ driving abilities
  2. Describe  the advantages, limitations and application of each of these approaches
  3. Develop consensus regarding the best method(s) of determining safe driving performance in older drivers in different circumstances

 

Inducing and Guiding Plasticity in Sensorimotor Systems to Enhance Neurorehabilitation after Spinal Cord Injury [#112]

15 November: 3:30 PM – 5:00 PM

Faculty
Monica A. Perez, PT, PhD, Assistant Professor, Department of Physical Medicine and Rehabilitation, Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA; Jonathan R. Wolpaw, MD, Chief, Laboratory of Neural Injury and Repair, Wadsworth Center, New York State Department of Health and State University of New York, Albany, NY; Monica A. Gorassini, PhD, Professor, Department of Biomedical Engineering, Centre for Neuroscience, University of Alberta, Edmonton, Alberta, CA; Peter H. Ellaway, PhD, Emeritus Professor of Physiology, Division of Brain Sciences, Imperial College London, UK

Diagnosis: Spinal Cord Injury, Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Neuroscience (e.g., neural regeneration/repair, motor control/learning, biomechanics)

Activity-dependent plasticity is one of the central mechanisms contributing to the recovery of sensory and motor function after spinal cord injury (SCI). In this symposium we will discuss evidence for plasticity at multiple sites in the central nervous system after injury and the current approaches that are being used to enhance plasticity and promote recovery of sensorimotor function after SCI.

Human and animal studies have demonstrated that the adult spinal cord has a remarkable capacity for reorganization to individual experience and this has been recognized as activity-dependent plasticity. Anatomical and physiological changes in the injured spinal cord have been elicited by inputs from the periphery and the brain. Motor training, pharmacological agents, and selective activation of sensory inputs have provided a framework to support the role of activity-dependent spinal cord plasticity in the recovery of movements in humans with SCI. Together these approaches are providing important new methods for neurorehabilitation.

In both animals and humans with incomplete SCI, noninvasive operant conditioning protocols are being used to modify specific spinal reflex pathways so as to improve motor function. These protocols can target specific reflex pathways and can thereby an individual’s specific deficits. In addition, noninvasive stimulation approaches can target the primary motor cortex and synapses between corticospinal cells and spinal motoneurons to promote plasticity after SCI. Repeated transcranial magnetic stimulation and peripheral nerve electrical stimulation, alone or in combination, are being used to enhance aspects of sensorimotor function in paralyzed limbs and to elicit spike-timing dependent plasticity at residual corticospinal synaptic connections. Furthermore, pharmacological approaches can target serotonergic receptors to modulate motoneuron excitability and sensory transmission in reflex pathways and thereby mitigate spasticity after SCI.

Overall, new methods for inducing and guiding plasticity in spinal and supraspinal pathways open novel possibilities for significantly improving neurorehabilitation after SCI, and thus enhancing functional recovery.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Learn about anatomical and physiological evidence for activity-dependent spinal cord plasticity after SCI.
  2. Learn about strategies that elicit plasticity in the spinal cord after SCI. Advantages and limitations of the use of motor training, functional electrical stimulation, and pharmacology in humans with SCI will be discussed.
  3. Learn about noninvasive protocols that target motor cortex, corticospinal connections, or spinal reflex pathways to enhance sensorimotor function after SCI.

 

Pressure Ulcer Prevention in Acute Spinal Cord Injury: Current Findings and Recommendations for the Future [#101]

15 November: 3:30 PM – 5:00 PM

Faculty
David M. Brienza, PhD, Professor, Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Gerben DeJong, PhD, FACRM, Senior Fellow and Director of the Center for Post-Acute Innovation and Research, MedStar National Rehabilitation Hospital and MedStar Health Research Institute, Professor, Department of Rehabilitation Medicine, Georgetown University School of Medicine, Washington, DC; Ching-Hui “Jean” Hsieh, PhD, Senior Research Associate, Center for Post-Acute Innovation and Research, MedStar National Rehabilitation Hospital and MedStar Health Research Institute, Washington, DC; Jeanne M. Zanca, PhD, MPT, Senior Research Scientist, Spinal Cord Injury Laboratory, Kessler Foundation, West Orange, NJ

Diagnosis: Spinal Cord Injury
Focus: Outcomes research/epidemiology

Pressure ulcers (PU) remain one of the most vexing secondary complications for individuals with spinal cord injury (SCI), and PU acquisition has recently become a quality indicator in post-acute care, with significant reimbursement implications. Our understanding of anatomic, physiologic, psychological, and environmental risks for PU has improved, but our knowledge remains incomplete. Two recent investigations by the University of Pittsburgh (RERC-PU study) and National Rehabilitation Hospital (SKIN study), conducted independently of one another, have examined PU risk factors and preventive strategies in the acute phase of SCI. The RERC-PU Study followed individuals with acute SCI from acute care to acute rehabilitation. The study collected plasma and urine samples for 105 participants (3x/week in acute care and 1x/week in acute rehab) to screen for 25 inflammatory cytokines along with NO2-/NO3. Analyses aimed to explore the associations between participant characteristics, inflammatory response and various clinical outcomes, including PU incidence, pain, respiratory complications, urinary tract infections and depression. The SKIN study aimed to identify patient risk factors, including comorbidity, select biomarkers, and behaviors, and clinical interventions most strongly associated with risk for developing a PU during acute rehabilitation. This symposium will report findings from both studies on PU incidence rates, factors and preventive strategies that relate to PU onset, and proposed risk models. The presentations will provide recommendations for the application of their findings in clinical practice and for the design of future research. This symposium will benefit consumers, clinicians, and researchers with an interest in SCI and the prevention of secondary complications.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Report pressure ulcer incidence rates observed in acute care and inpatient rehabilitation for spinal cord injury
  2. Identify risk factors for pressure ulcer development during acute care and inpatient rehabilitation
  3. Discuss how the findings from current research can inform health care policy and guide clinical practice
  4. Identify challenges in examining pressure ulcer prevention and discuss lessons learned and recommendations for future research

 

A Grand Unifying Theory of Chronic Pain: Etiology, Perpetuation, and Recovery

15 November: 3:30 PM – 5:00 PM

Faculty
Jessica Pullins, PhD, Functional Restoration Programs Director, Bay Area Pain and Wellness Center, Los Gatos, CA/Prospira PainCare, Mountain View, CA

Diagnosis: Chronic pain
Focus: Clinical practice

Weaving together historical perspectives, recent research, clinical observation and best treatment practices, this course will introduce a novel and comprehensive theory of chronic pain. The discussion will highlight mechanisms underlying the development of chronic pain, the biopsychosocial characteristics associated with chronic pain, and a framework for managing it. The course will also provide a discussion of likely subtypes of chronic pain sufferers as well as implications for diagnosis, research and treatment.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe a potential core process which leads to the development and perpetuation of chronic pain.
  2. Identify indicators of this core process in clinical settings, and explain the underlying process to patients.
  3. Describe the treatment approaches which will permit management of the chronic pain process.

 

STROKE-ISIG SPECIAL TOPICS SESSION:

Translating Research into Clinical Practice: Rehabilitation Robotics after Stroke

15 November: 3:30 PM – 5:00 PM

Moderator: Elizabeth Skidmore, PhD, OT(R), University of Pittsburgh, Pittsburgh, PA

Panelists
Joel Stein, MD, Columbia University, Weill Cornell Medical College. New York, NY; Susan Fasoli, ScD, OTR/L, Providence Veterans Administration Medical Center, Brown University, Providence, RI; Carolynn Patten, PT, PhD, University of Florida, Gainesville, FL; Lorie Richards, PhD, OTR/L, University of Utah, Salt Lake City, UT

Diagnosis: Stroke
Focus: Clinical practice, technology

This Stroke-ISIG sponsored symposium will examine the current state-of-the-science examining the integration of robotic devices in clinical rehabilitation after stroke. The multidisciplinary panel of experts will present findings from clinical studies detailing the evidence surrounding several robotic devices, and discuss barriers and facilitators to implementing robotic devices in the clinical rehabilitation setting. In addition, the panel will provide recommendations for the consideration of scientists, practitioners, and administrators to guide future efforts addressing the role of robotic devices in stroke rehabilitation. A discussant will facilitate panel and participant discussion and debate.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the current state-of-the-science addressing the application of robotic devices in for a variety of purposes in stroke rehabilitation.
  2. Discuss the opportunities and challenges that robotic devices provide when integrating them into stroke rehabilitation
  3. Discuss potential future directions for stroke rehabilitation robotics in science and clinical practice.

ACRM ISIG, NETWORKING GROUP, TASK FORCE & COMMITTEE MEETINGS

  • Outcomes Measurement Networking Group
    3:30 PM — 5:00 PM


FRIDAY, 15 NOVEMBER
SPECIAL OPPORTUNITIES: 5:00 PM – 11:00 PM


ACRM MEMBERSHIP MEETING

15 November: 5:00 PM – 6:30 PM

Open to all attendees, the ACRM Membership Meeting is a great place to learn about the current activities of ACRM and upcoming opportunities. Witness the passing of the presidential necklace from current president, Tamara Bushnik, PhD, FACRM (2010 – 2013) to president-elect, Sue Ann Sisto, PT, PhD, FACRM (2013 – 2015) and hear Dr. Sisto’s membership address.

HENRY B. BETTS AWARDS GALA (TICKETED EVENT)

15 November: 7:00 PM – 11:00 PM

Join colleagues for an evening of celebration! Explore international buffets and chefs’ stations for a culinary sampling from across the globe, paired with wines from more than a dozen countries. Then, raise a toast to the 2013 ACRM Fellows and winners of seven prestigious ACRM awards for excellence, including:

  • Gold Key Award: Ralph M. Nitkin, PhD
  • Distinguished Member Award: Elliot J. Roth, MD Claire Kalpakjian, PhD
  • John Stanley Coulter Award: Allen Heinemann, PhD
  • Deborah L. Wilkerson Early Career Award: Dawn Neumann, PhD
  • Mitchell Rosenthal Mid-Career Award: Joshua Cantor, PhD, ABPP (deceased)
  • Elizabeth and Sidney Licht Award: Lisa Ottomanelli, PhD
  • Edward Lowman Award: Elliot Roth, MD


2013 ACRM Fellows:

Leighton Chan, MD, MPH, FACRM
Flora Hammond, MD, FACRM
Cindy Harrison-Felix, PhD, FACRM
Mike Jones, PhD, FACRM
Virginia “Ginna” Mills, MS, PT, CCM, LicNHA, FACRM
Ronald T. Seel, PhD, FACRM
Lance Trexler, PhD, FACRM
AFTER GALA PARTY (TICKETED EVENT)

15 November: 8:30 PM – 11:00 PM

Skip the dinner if you must, but don’t miss the celebration!

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CORE CONFERENCE – DAY 3
SATURDAY, 16 NOVEMBER


ACRM ISIG, NETWORKING GROUP, TASK FORCE AND COMMITTEE MEETINGS

  • BI-ISIG Prognosis after TBI Task Force
    7:30 AM – 8:30 AM
  • BI-ISIG Disorders of Consciousness Task Force Acute Confusion Case Definition Project
    7:30 AM – 8:30 AM
  • BI-ISIG Pediatric & Adolescent Task Force
    7:30 AM – 8:30 AM
  • Program Committee Meeting (by invitation only)
    7:30 AM – 8:30 AM
  • Stroke-ISIG Living Life after Young Stroke Task Force
    7:30 AM – 8:30 AM
  • Geriatric Rehabilitation Group
    7:30 AM – 8:30 AM

COFFEE WITH ARCHIVES OF PHYSICAL MEDICINE & REHABILITATION EDITORS

16 November: 7:30 AM — 8:30 AM

Meet chief co-editors and members of the editorial board for the Archives of Physical Medicine and Rehabilitation over coffee and a pastry. This is an informal opportunity to discuss your questions regarding manuscript topics appropriate for submission, types of submissions, manuscript preparation, the peer review process, and resubmissions.

NIDRR-SPONSORED ARRT YOUNG INVESTIGATORS PANEL

16 November: 8:00 AM – 10:00 AM

1) NIDRR: Disparity in Access to Healthcare among Individuals with Physical Disabilities: 2001-2010
8:00 AM – 8:15 AM

NIDRR AART Fellow: Elham Mahmoudi, PhD, University of Michigan, Ann Arbor, MI

Diagnosis:
 Other or N/A
Focus: Health/disability policy, ethics, advocacy

Objective: This study examines disability-related disparities in access to healthcare and investigates the factors associated with reporting no access to care.

Results: We analyzed a total of 138,670 adults (with mild to severe physical disabilities=27,276; without any physical disability=111,404). Our analysis indicated the odds of reporting not getting medical care, dental care, and prescription drugs are 39% (p < 0.001), 51% (p < 0.001), and 38% (p < 0.001) higher for individuals with physical disabilities, respectively. Furthermore, in comparison with Whites with disabilities, our data showed that Hispanics with physical disabilities have an additional 37% (p < 0.015) higher odd of reporting inability to get prescription drugs. Our models of access indicated that being poor (p <0.001), lacking health insurance coverage (p < 0.001), being a smoker (P < 0.001), residing in South (P < 0.007), and being female (p < 0.001) also significantly increase the odds of reporting no access to care.

Conclusion: There are large and significant disparities in access to healthcare between adults with and without physical disabilities.
2) NIDRR: Biopsychosocial Determinants of Patient-Reported Improvement in Chronic Diseases for Adults over 50 Years of Age
8:15 AM – 8:30 AM

NIDRR ARRT Fellow: Chia-Chiang Wang, PhD, CRC, Northwestern University, Chicago, IL

Diagnosis: Arthritis, cancer, diabetes, heart conditions, and lung diseases
Focus: Outcomes research/epidemiology

Objectives: To examine and compare disease-specific biopsychosocial determinants that predict two-year follow-up of patient-reported improvements in chronic diseases for adults age 50 to 80 years.

Results: The five chronic disease groups shared some common predictors, but also had disease-specific biological or psychosocial predictors of chronic disease improvement. Age, race/ethnicity, and self-rated health were the common predictors of patient-reported improvement across some groups. African Americans and Latinos were more likely to report improvements in diabetes, arthritis, lung diseases (only African American participants), and heart conditions (only Latino participants) as compared to Caucasian participants. In addition, male gender (cancer), body mass index, smoking (lung diseases), binge drinking (arthritis), number of hospitalization days (heart conditions and arthritis), perceived control in health, and life satisfaction (cancer) were disease-specific predictors.

Conclusions: Disease-specific biopsychosocial predictors of patient-reported improvement in chronic diseases could direct the development of interventions for aging populations to prevent their future functional limitations and long-term disabilities.
3) NIDRR: Development and Evaluation of a Smart Cueing Kitchen for Individuals with Cognitive Impairments Brain Injury
8:30 AM – 8:45 AM

NIDRR ARRT Fellow: Harshal Mahajan, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA

Diagnosis: Alzheimer’s Disease
Focus: Technology

Objective: To develop smart sensing and prompting technologies that will provide automatic context aware guidance to individuals with cognitive impairments while completing their everyday kitchen tasks and to evaluate usability and user preferences towards system components.

Results: Design of the Smart Cueing Kitchen (SCK) was motivated by user needs such as: Assistance in remembering locations of recipe ingredients and keeping track of their progress while preparing a recipe; users need to be guided before they realize they have failed and feel frustrated; guidance should be minimally distracting; users should be able to perceive their kitchen as a stress reducer rather than a stress producer. The context aware prompter software uses the information from a portable network of sensors in the kitchen for automatic recognition of user’s activities and adaptively guides users to complete the task at hand using various prompting strategies. The safety monitoring software ensures user’s safety during and after the use of kitchen appliances. For example, appliances such as the stove, oven, and water faucets are continuously monitored and can be automatically switched off by the kitchen software or remotely by the user or family member using a cell phone application.

The projected picture prompts were the most preferred. Participants were also most efficient at item retrieval when picture prompts were used and least efficient when guided by computer generated verbal instructions alone. Participants preferred multi modal cues and had strong personal inclinations towards colors of the visual cues and types of computer voices. A second round of ethnographic interviews that is currently being conducted will add further insights and be used to validate earlier findings. Another clinical protocol is currently being developed to evaluate the usability, reliability, and effectiveness of the automated guidance system in contrast to similar commercially available alternatives such as recipe apps on cell phones. This protocol is also aimed at evaluating the clinical utility of the SCK in improving task efficiency and independence.

Conclusions: SCK was built as a cognitive orthosis for people with cognitive impairments to provide support for kitchen activities and take remedial actions to ensure user safety. The SCK software provides multiple customization options to fit the needs and personal preferences of individuals with cognitive impairments. In addition to being an automated cooking assistant and safety monitor the SCK system has promising future applications as a training tool during rehabilitation process. By keeping people with cognitive impairments active and safe in their home environments and hence away from nursing homes and hospitals, smart kitchen technologies may contribute towards reducing healthcare cost in the long term.
4) NIDRR: Time Course of Kinematic Improvements in Survivors of Stroke during Upper-Extremity Robotic Rehabilitation
8:45 AM – 9:00 AM

NIDRR ARRT Fellow: Crystal Massie, PhD, OTR, University of Maryland School of Medicine, Baltimore, MD

Diagnosis: 
Stroke
Focus: Neuroscience

Objective: Determine when improvements in unassisted reaching occur during robotic rehabilitation for chronic survivors of stroke.

Results: No group differences were observed. Improvement in percentage of targets hit was related to baseline FM scores (FM scores 15-20 had greatest gains). The number of targets hit significantly increased and was retained after the 3rd visit on; movement time and peak velocity significantly improved and were retained after the 6th visit.

Conclusions: Results inform intervention planning in that additional daily time on robot did not improve unassisted reaching kinematics and most gains were achieved within two weeks. Further, response to planar robot therapy may depend on initial FM scores.
5) NIDRR: Employment Outcomes for People with Disabilities across Age and Disability Groups
9:00 AM – 9:15 AM

NIDRR ARRT Fellow: Valentina Lukyanova, University of Illinois at Chicago, Chicago, IL

Diagnosis: Other or N/A
Focus: Outcomes research/epidemiology

Objective:  In general, older workers (50+) struggle to recover from job loss, as they may be perceived as having certain characteristics that may impact negatively the likelihood of obtaining employment, including poor health, resistance to change, or low trainability. Little is known how age is associated with employment outcomes for people with disabilities receiving Vocational Rehabilitation (VR) services. This abstract’s specific goals are to (1) compare employment outcomes of VR consumers with different types of disability as they age, and (2) identify the VR services that are predictors of successful employment in these groups.

Results: Results indicate that older [51 to 65] and middle-age consumers [36 to 50] were more likely to be employed compared to younger consumers [18 to 35]. The regression analysis found age-related variations in employment outcome by type of disability. Older and middle-age VR recipients who reported learning or sensory disability were significantly more likely to find jobs than younger recipients. Older consumers with chronic disability, however, were significantly less likely to be placed in jobs. There were no age differences in employment outcomes for consumers with mental or physical illness.

Conclusions: The findings suggest that people with less severe impairments had a better chance of finding jobs with age. We interpret these results in the context of the current job market that favors the skilled workers with more job experience.
6) NIDRR: Pulmonary Function Characteristics of Boys with Duchenne Muscular Dystrophy: One-Year Data from CINRG
9:15 AM – 9:30 AM

NIDRR ARRT Fellow: Bethany Lipa, MD, UC Davis Medical Center/Shriners Hospital for Children, Sacramento, CA

Diagnosis:
 Neuromuscular Disorder
Focus: Outcomes research/epidemiology

Objective: The lack of well-characterized outcome measures in both ambulatory and non-ambulatory individuals with DMD limits the ability to show effectiveness during therapeutic clinical trials. The objective of this study is to determine whether changes in pulmonary function over a one-year period would have adequate sensitivity to be used as an endpoint for clinical trials in patients with DMD.

Results: Over a 1-year period, there were significant increases in the FVC, FEV1, and PEFR in each age group for children.

Conclusions: Pulmonary function testing reflects growth-associated increases in the absolute pulmonary capacity of younger boys with DMD as well as changes in the relative PFT performance when normalized using percent-predicted equations over a one-year period. These data suggest that percent predicted FVCs have the capacity to show change over time and will be useful outcome measures for clinical trials with DMD.
function tests (PFTs) were performed as part of a CINRG longitudinal study that included 287 individuals with confirmed DMD (ages 6 -28 years) in 20 centers from 10 countries. PFTs included forced vital capacity (FVC) and percent-predicted FVC (%FVC), forced expiratory volume in 1 second (FEV1) and %FEV1, peak expiratory flow rate (PEFR) and %PEFR, maximum inspiratory pressure (MIP) and %MIP, maximum expiratory pressure (MEP) and %MEP, peak cough flow (PCF) and %PCF. Significance was accepted at p < 0.05. Analysis was based on 3 age groups: 7-12, 13-18, and >19.

7) NIDRR: The Impact of Medicaid Managed Care on Patient Outcomes and Satisfaction
9:30 AM – 9:45 AM

NIDRR ARRT Fellow: Randall Owen, University of Illinois, Chicago, IL

Diagnosis: N/A
Focus: Health/disability policy, ethics, advocacy

Objectives: Managed care is becoming a common form of Medicaid service delivery in the United States. However, little is known about the experiences of people receiving Medicaid through an MCO, their perspectives on outcomes/health. Research questions include, (1) What impact has Medicaid Managed Care had on the health and function of Medicaid recipients and their access to services? (2) What impact has Medicaid Managed Care had on the satisfaction of Medicaid recipients with their healthcare?

Results: The results of the survey did not show any significant differences in patient health function, levels of activities of daily living or instrumental activities of daily living, frequency of obtaining immediate care, or receipt of preventive services, medical services, specialty services, or medical equipment. In general, satisfaction with healthcare decreased. The question that asked about satisfaction with the overall healthcare was not quite significant (p=.089), although more specific questions did show a reduction. Satisfaction with primary care physicians (p=.003) and satisfaction with specialist services (p=.001) both showed a significant decrease in satisfaction from the baseline to the first year of the managed care program. However, the survey did not show significant changes in other measures related to the primary care physician: travel times, wait times, ease of making an appointment, and whether the PCP to the patient’s wishes into account all did not change. The same is true for measures related to specialist, except that travel times to specialists did significantly increase from the baseline to the first year of the program (p=.016). When asked whether a recipient could see the same doctors after the change to managed care, 35% said they could still see all of them, 33% said they could still see some of them and 32% said they see completely new doctors.

Conclusions: The findings show a complex relationship between satisfaction and healthcare services. While services did not show any changes from the baseline through the first year of the program, satisfaction did decrease on a number of measures. Patients do not always equate good medical practice with satisfaction. This implies the need for a more nuanced understanding of managed care in terms of process alongside outcomes. As the survey showed, 32% had to seeing new doctors, which may have led to some of the dissatisfaction. In addition, many respondents wrote in comments indicating not understanding MCO procedures. Better understanding of these issues will allow us to create and implement better policies that meet the needs of Medicaid recipients.


SATURDAY, 16 NOVEMBER
CONCURRENT SESSIONS: 8:30 AM – 10:00 AM


Development of Clinical Recommendations for Service Members’ Graded Return to Activity after Concussion [#57]

16 November: 8:30 AM – 10:00 AM

Faculty
Mary Vining Radomski, PhD, OTR/L, Clinical scientist, Sister Kenny Research Center, ORISE Fellow, Army Office of Surgeon General, Minneapolis, MN; MAJ Sarah Goldman, PhD, OTR/L, CHT, Army TBI Program Director, Rehabilitation & Reintegration Division of the Army, Office of the Surgeon General, Falls Church, VA; Karen McCulloch, PT, PhD, Professor and Assistant Director, Distance and Continuing Education Division of Physical Therapy, University of North Carolina, Chapel Hill, ORISE Fellow, Army Office of the Surgeon General, Hillsborough, NC; Grant Iverson, PhD, Director, Neuropsychology Outcome Assessment Laboratory, Professor, Department of Psychiatry, University of British Columbia, Vancouver, BC, CA

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Many service members (SM) in both deployed and non-deployed settings sustain mild traumatic brain injury/concussion in the course of combat, training, or recreation. The Department of Defense (DoD) and Veterans Affairs developed protocols for concussion screening and acute medical management, in part based on expert guidance from the civilian sector related to injured athletes. However, to date existing published guidelines regarding optimal progression of activities postconcussion lack specificity and relevance for a military population. The Army Office of the Surgeon General and the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury charged a military-civilian expert work group to review the existing literature and consult with other experts to propose Clinical Recommendations to specify an activity progression that bridges the gap between rest and full return to duty. The military-civilian, multidisciplinary expert work group met via teleconference for 3 months to review and discuss existing research literature, which resulted in a draft activity progression. A consensus conference of additional military and civilian subject matter experts and stakeholders from the medical, rehabilitation, and sports medicine fields was convened to review and further specify the standardized graded return to activity protocol for SM with mild traumatic brain injury. In this symposium, we present the evidence related to rest and concussion, describe the DoD graded return to activity protocol and its rationale, and compare the resulting Department of Defense Clinical Recommendation to related recommendations from 4th International Consensus Conference on Concussion in Sport (Zurich 2012).

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Summarize current literature and dilemmas related to return to activity after concussion
  2. Describe an example of the Department of Defense’s proposed protocol for graded exercise and activities for Service Members with concussion
  3. Discuss relevant definitions and recommendations from the 4th International Consensus Conference on Concussion in Sport (Zurich 2012)

 

Measuring Morpheus: An Introductory Guide to Studying Sleep after Brain Injury [#65]

16 November: 8:30 AM – 10:00 AM

Faculty
Dan Schwartz, MD, Assistant Professor of Medicine, Division of Pulmonary Diseases and Critical Care Medicine, University of South Florida, Staff Physician, Pulmonary Disease Section, Department of Internal Medicine, James A. Haley Veterans Hospital, Tampa, FL; Ross Zafonte, DO, Earle P. and Ida S. Charlton Professor and Chair, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Vice President of Medical Affairs, Research and Education, Spaulding Rehabilitation Network, Chief, Physical Medicine and Rehabilitation, Massachusetts General Hospital, Boston, MA; Joshua B. Cantor, PhD, ABPP, Co-Director, Brain Injury Research Center, Associate Professor , Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai, New York, NY; William Lu, PhD, Fellow, Department of Rehabilitation Medicine , Icahn School of Medicine at Mount Sinai, New York, NY; Risa Nakase-Richardson, PhD, Assistant Professor, Department of Pulmonary and Sleep Medicine, University of South Florida, Clinical Neuropsychologist, Polytrauma/Psychology, James A. Haley Veterans Hospital, Tampa, FL

Diagnosis: Brain Injury, Sleep
Focus: Sleep Technology (e.g., prosthetics/orthotics, robotics, assistive technology)

Sleep disruption varies from 25 to 75 percent in TBI cross-sectional samples. Sleep is critical for neural repair in early stages of recovery and disordered sleep may play a role in early cognitive decline after TBI. Despite the prevalence and negative consequences associated with poor sleep, there is a paucity of research in the area of sleep and TBI. Current studies suffer from inadequate methodologies, cross-sectional designs, and small sample sizes. The purpose of this symposium is to provide a general overview of sleep medicine as it applies to TBI and methodologies for studying sleep highlighted across studies presented. The first presentation will provide an abbreviated review of sleep, broad categories of disorders, and assessment methodologies to facilitate an appreciation for cross-disciplinary perspectives of sleep research. The relative merits and shortcomings of different assessment technologies (e.g., polysomnography and actigraphy) in different clinical settings will be discussed in the context of three studies. The application of the gold-standard polysomongraphy will be highlighted along with other indirect measures of wearable technology (i.e., actigraphy, wearable electrodes), laboratory biomarkers, and subjective report. The feasibility of different metrics will be discussed in the context of acute recovery and post-acute stages. Advantages and disadvantages will be discussed for each study with recommendations for future research. Course objectives are to improve participants’ (1) understanding of sleep phenomenology and its measurement, (2) understanding of post-TBI sleep/wake/fatigue issues across the continuum of care, (3) understanding of key problems in TBI-related sleep/wake/fatigue research and practice.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Improve participants’ understanding of sleep phenomenology and sleep measurement.
  2. Improve participants’ understanding of post-TBI sleep/wake/fatigue issues across the continuum of care.
  3. Improve participants’ understanding of key problems in TBI-related sleep/wake/fatigue research and practice.

 

Cognitive Impairment in People with MS:  Evaluation and Impact on Balance and Mobility [#146]

16 November: 8:30 AM – 10:00 AM

Faculty
Joanne Wagner, PT, PhD, Assistant Professor, Program in Physical Therapy, Saint Louis University, Saint Louis, MO; Deborah Backus, PT, PhD, Director of Multiple Sclerosis Research, Shepherd Center, Atlanta, GA; Joanne Wagner, PT, PhD, Saint Louis University, Saint Louis, MO; Robert Godsall, PhD, Neuropsychologist, Shepherd Center, Atlanta, GA; Jacob Sosnoff, PhD, Associate Professor, Department of Kinesiology and Community Health, College of Applied Health Sciences, University of Illinois at Urbaba-Champaign, Urbaba, IL; Robin Howard, PT, DPT, NCS, University of Southern California, Los Angeles, CA;

Diagnosis: Neurodegenerative disorder (e.g., MS, Parkinson’s disease)
Focus: Other or N/A

Approximately 50 percent of all people with MS will develop problems with cognition, ranging from difficulties with only one or two areas of cognitive functioning to several. Deficits may occur in memory, attention, information processing, executive function, visuospatial function and verbal fluency. Changes in these areas of cognitive function can dramatically alter a person’s function and quality of life, and therefore require early recognition, assessment, and treatment. Cognitive deficits can also greatly impact rehabilitation of the person with MS, making it more difficult for them to attend to tasks and to retain. Additionally, there is emerging evidence that some people with MS exhibit greater cognitive-motor dual tasks deficits during balance and gait activities when compared to persons without disability.

Understanding cognitive dysfunction in people with MS, and having strategies to assess and address this dysfunction during rehabilitation may improve the rehabilitation process and outcomes for people with MS.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the minimal recommended cognitive assessment in people with MS
  2. Discuss the impact of cognitive deficits on mobility and balance in people with MS
  3. Describe dual task deficits related to gait and balance in people with MS
  4. Describe assessment methods used to assess dual-task performance during balance and gait
  5. Identify strategies to address cognitive deficits and dual task deficits in people with MS

 

Irritability and Aggression after Traumatic Brain Injury (TBI):  New Findings and Clinical Implications [#71]

16 November: 8:30 AM – 10:00 AM

Faculty
Jacob Kean, PhD, Research Scientist, Assistant Professor, Center of Excellence on Implementing Evidence-Based Practice, Richard L. Roudebush VA Medical Center, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine; Rehabilitation Hospital of Indiana; Regenstrief Center for Health Services Research, Regenstrief Institute, Indianapolis, IN; Dawn Neumann, PhD, Assistant Professor, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine; Rehabilitation Hospital of Indiana, Indianapolis, IN; Flora M. Hammond, MD, Chair and Professor, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN; James F. Malec, PhD, Professor and Research Director, Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Rehabilitation Hospital of Indiana, Indianapolis, IN

Diagnosis: Brain Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Feelings and behaviors identified as “irritability” or “aggression” are frequently reported (27%-73% prevalence) as problematic after traumatic brain injury (TBI). However, there is no well-accepted operational definition, evaluation procedures, or treatment for these conditions. The goal of this symposium is to describe the state-of-the-science in the assessment and treatment of post-TBI irritability and aggression. Jacob Kean, PhD will describe current assessment procedures, the relationship of irritability and aggression, and implications for an operational definition. Flora Hammond, MD, will review her qualitative research with 50 individuals with TBI, close others, and rehabilitation professionals. These interviews suggest that the impact of irritability and/or aggression on activities and participation is of most concern to those directly affected by these disorders and that 6 life domains are primarily affected: marriage and family, other relationships, domestic activities, work and education, driving and transportation, and public activities. Dawn Neumann, PhD, will review the effects of negative attributions, alexithymia, and empathy on irritability and aggression. Her studies suggest that these psychological and underlying neurologic mechanisms are associated with irritability and aggression. James Malec, PhD, will synthesize findings and summarize the implications for assessment, treatment, and future research. Our ongoing research suggests that the assessment of irritability and aggression should be from multiple perspectives (patient, significant other, professional) and include ratings of severity, frequency, and impact. Research to clearly delineate psychological and neurological mechanisms are necessary to develop targeted treatments which are likely to involve both pharmacology and cognitive-behavior therapy.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the concept of post-TBI irritabilty and aggresssion and critical elements for evaluation
  2. Describe the impact and nature of post-TBI irritabilty and aggression as seen from the perspectives of those most directly affected by these behaviors
  3. Identify neurologic, psychologic, and social factors which may contribute to post-TBI irritability and aggression
  4. Describe current best practices in the evaluation and treatment of post-TBI irritability and aggression

 

Integration of Reconstructive Therapies to Improve Upper Limb Function[#147]

16 November: 8:30 AM – 10:00 AM

Faculty
Deborah Backus, PT, PhD, Director of Multiple Sclerosis Research, Director SCI Upper Limb Research and Translation Lab, Shepherd Center, Atlanta, GA; Andrew Elkwood, MD, FACS, Plastic and Reconstructive Surgeon, Director of the Center for Treatment of Paralysis and Reconstructive Nerve Surgery, elected Best Doctors in America® from 2005 to 2006 and 2009 to 2012, featured on CNN, Good Morning America, the Oprah Winfrey Show, 20/20 and others; Neil Holland, MD, listed as a top doc in the New York Metropolitan area by Castle Connelly and New Jersey Monthly Magazine, Associate Professor, Department of Neurology at Drexel University College of Medicine,  Philadelphia, PA. Dr. Holland is Chief of Neurology and Medical Director of the Neuroscience Institute and Stroke Program at Monmouth Medical Center, West Long Branch, NJ; Amy Bohn, CPAM, OTR/L, Occupational Therapist, Childrens Healthcare of Atlanta, GA and has worked in SCI rehabilitation as well as coached wheelchair sports for the past 15 years. She has experience treating across the continuum of care including ICU, inpatient rehabilitation, day program, outpatient, and home health. These experiences have allowed her to develop an innovative and aggressive treatments for promoting maximal functional return in the upper extremity of individuals with neurological and musculoskeletal deficits.

Diagnosis: Spinal Cord Injury
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Although there are numerous cutting edge research efforts to cure tetraplegia, presently there is no means to reverse central nervous system injury. There are, however, numerous surgical interventions to help improve function (e.g., nerve transplantation, neurotization and tendon transfer). This symposium is aimed at the rehab community, and is an effort to introduce and discuss a reconstructive approach to tetraplegic patients and to help coordinate a multidisciplinary approach to their care. Isolated treatment from the standpoint of individual specialties leads to suboptimal care and outcomes.

This 90-minute symposium will be delivered in four sections. The first section will be an overview of standard and cutting edge surgical approaches to tetraplegia. The goal is to present a reconstructive surgical mindset to improving patient function. The second section presents EMG concerns regarding preoperative planning. Preoperative EMG is significantly different from the usual diagnostic testing, and requires very specific communication between specialties. The third section discusses PT/OT considerations in the post-reanimation surgical patient. Finally, the fourth section puts the first three lectures together and presents numerous cases for preoperative discussion.

Learning Objectives:
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Discuss the role and value of reconstructive approaches in the upper limb (UL) of people with tetraplegia
  2. Describe examination, including EMG assessment, for preoperative planning for reconstructive surgery for people with tetraplegia
  3. Discuss rehabilitation considerations after reconstructive intervention
  4. Apply knowledge attained to discuss specific case examples of reconstructive and rehabilitative interventions in people with tetraplegia

 

Locomotor Training in Pediatric SCI: Special Considerations for Training and Outcomes Measurement [#108]

16 November: 8:30 AM – 10:00 AM

Faculty
Therese E. Johnston, PT, PhD, MBA, Associate Professor, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA; MJ Mulcahey, PhD, OTR/L, Professor, Jefferson School of Health Professions, Thomas Jefferson University, Philadelphia, PA; Andrea L. Behrman, PhD, PT, FAPTA, Professor, University of Louisville, Kentucky Spinal Cord Injury Research Center, Louisville, KY; Shelley Trimble, PT, Pediatric Rehabilitation and Research PT, Frazier Rehabilitation Institute, Louisville, KY

Diagnosis: Spinal Cord Injury
Focus: Other or N/A

Locomotor training has become a more widely implemented technique in the rehabilitation of people with incomplete spinal cord injury in order to enhance neuroplasticity and improve functional walking ability. As the majority of people who sustain an SCI are adults at the time of injury, this intervention has primarily been delivered in adult rehabilitation settings. However, children with SCI may also benefit from locomotor training, as evidenced by two case studies that have shown benefits for children. In order to deliver this intervention and evaluate the outcomes for children with SCI, additional considerations are warranted. Adaptations to equipment are necessary to accommodate the small size and different body dimensions of children as well as allow for growth for longer duration intervention programs. Children with SCI are also at risk for unique medical and musculoskeletal conditions, including neuromuscular scoliosis and hip subluxation that require monitoring, especially during an intervention program such as locomotor training. With any intervention program, the ability to accurately assess outcomes is important, and instruments that are used following locomotor training for adults with SCI may not be reliable or valid in children with SCI. The choice of outcome measurement techniques thus needs careful consideration, and pediatric specific measures or adapted versions of adult measures may be required. Due to these differences, development and implementation of a program of pediatric locomotor training requires unique considerations to ensure safety and appropriately determine the outcomes on functional mobility.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Define locomotor training and describe its physiological basis.
  2. Discuss the issues unique to locomotor training in pediatric SCI.
  3. Identify training and equipment adaptations that are important in pediatric SCI.
  4. Describe the medical and musculoskeletal conditions seen in children with SCI and discuss (a) the potential  impact on locomotor training in pediatric SCI and (b) the potential impact of locomotor training on development of musculoskeletal conditions.
  5. Describe the current and emerging outcomes instruments that are applicable post-locomotor training in pediatric SCI.

Interdisciplinary Outpatient and Inpatient Pain Rehabilitation

16 November: 8:30 AM – 10:00 AM

Faculty
Virgil Wittmer, PhD, Brooks Rehabilitation, Jacksonville, FL

Diagnosis: Chronic pain
Focus: Clinical practice (assessment, diagnosis, treatment, knowledge translation/EBP)

Chronic pain is one of the most expensive medical problems in the United States. Unfortunately, the traditional medical model has been less than effective regarding long-term outcomes with regard to pain reduction, mood, and function. Additionally, there is increasing evidence that long-term use of opioid medications may result in a paradoxical increase of pain (opioid induced hyperalgesia). This, combined with the significant increase in accidental deaths due to opioids over the past 10 years, suggests a need for alternative strategies and treatment for chronic pain. There is need for a “reawakening” of the importance of interdisciplinary pain rehabilitation for treatment of chronic pain, given evidence-based research and current guidelines. The rehabilitation model, which is effective for treatment of TBI, SCI, and amputation, also has excellent short-term and long-term outcomes for patients who suffer from chronic pain.

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Understand why interdisciplinary pain rehabilitation (IPR) is the most effective treatment for chronic pain, i.e., review evidence-based research outcomes.
  2. Present research strongly suggesting that catastrophizing and fear-avoidance behaviors (especially regarding increased pain) within the first few weeks after injury are significant predictors of chronic disability, depression, and physical disuse (i.e., development of a chronic pain syndrome).
  3. Understand the basic components and treatment strategies (medical, psychological, physical/occupational therapy, and biofeedback) of interdisciplinary pain rehabilitation.
  4. Understand opioid induced hyperalgesia, and the importance of including opioid weaning as an additional treatment goal of IPR.

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John Stanley Coulter Award Lecture:

Measuring, Managing, and Predicting Rehabilitation Outcomes: Reflections on Nearly 30 Years of ACRM Membership and a Research Agenda

16 November: 10:30 AM – 11:30 AM

Allen Heinemann - imageAward Recipient:
Allen Heinemann, PhD, ABPP (RP), FACRM, Feinberg School of Medicine, Northwestern University and Rehabilitation Institute of Chicago, Chicago, IL

ACRM members have demonstrated a keen interest in measuring and monitoring rehabilitation outcomes since the organization’s inception, and their research products have influenced healthcare practice and policy. By way of example, ACRM was a co-applicant for the grant award from the National Institute on Disability and Rehabilitation Research (NIDRR) that developed the Functional Independence Measure (FIM). Subsequently, the Centers for Medicare and Medicaid Services adopted the FIM as the basis of its Prospective Payment System for Inpatient Rehabilitation Facilities. NIDRR’s Long Range Plan for 2013-2017 emphasizes research that determines “the features of possible interventions that are most significant in achieving desired outcomes and the measures that would be required to illustrate those outcomes.” This priority is consonant with Gale Whiteneck’s 1994 Coulter lecture, titled “Measuring What Matters: Key Rehabilitation Outcomes.”
In the intervening 20 years, we have benefitted from the development of detailed taxonomies of health and disability; models of healthcare structure, process, and outcome; and efforts to define healthcare quality measures. Needed now are sustained efforts to evaluate promising interventions with carefully targeted endpoints operationalized by instruments that are reflective of and sensitive to clinical investigators’ goals.
This lecture will review the history of rehabilitation outcome measurement, identify sentinel events in the development of rehabilitation outcome measures, and describe opportunities to improve rehabilitation services through the routine collection, reporting and aggregating of details about rehabilitation services, processes, and outcomes. In so doing, I illustrate ways in which ACRM can pursue its mission to “improve lives through interdisciplinary rehabilitation research.”

Learning Objectives
To support the attainment of knowledge, competence, and performance, the learner should be able to achieve the following objectives:

  1. Describe the history of rehabilitation outcome measurement
  2. Identify sentinel events in the development of rehabilitation outcome measures
  3. Describe opportunities to improve rehabilitation services through the routine collection, reporting and aggregating of details about rehabilitation services, processes and outcomes
  4. 2013 award winner is Allen Heinemann, PhD, ABPP (RP), FACRM.

POST-CONFERENCE
SATURDAY, 16 NOVEMBER


ACRM MEETINGS

16 November

  • Early Career Networking Group Business Meeting
    11:30 AM – 1:00 PM
  • Archives Editorial Board Meeting
    11:30 AM – 2:00 PM

POST-CONFERENCE EVENTS
SATURDAY, 16 NOVEMBER
INSTRUCTIONAL COURSES: 11:30 AM – 3:30 PM


Five MORE Instructional Courses to help you dig deep into special interest areas and pile on the Continuing Education credits.

>>> Learn more! Read Complete Course Descriptions HERE

12) Cognitive Rehabilitation for Children: Past and Present [#44] 13)  Medical Rehabilitation Research NIH Infrastructure Network [#45] 14)  Brain Injury Coping Skills (BICS) Workshop: An Intervention for Survivors of Brain Injury and Caregivers [#63] 15)  Using Rehabilitation Measures to Generate Medicare G-Codes and Guide Clinical Interventions [#78] 16) Diagnosis, Serial Tracking, and Prognosis of the Severely Brain Injured Patient: A Skill Building Course [#34]

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