Johns Hopkins at AAPM&R Annual Assembly
Explore the latest in research and clinical care case studies from the Johns Hopkins physical medicine and rehabilitation faculty and trainees, as presented at the American Academy of Physical Medicine and Rehabilitation (AAPM&R) 2024 Annual Assembly.
On this page:
Hear from our Experts
Weight Bearing Protocol Rehabilitation after Lower Limb Osseointegration in a Patient: A Case Report
Anterior Scalene Block Alleviates Dyspnea: A Case Report
Improved Motor Activation of C7 Myotome In Previous Incomplete Cervical Spinal Injury Via Spinal Cord Stimulation
Psilocybin and Chronic Neuropathic Pain: A Systematic Review
Abstracts
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Date: Wednesday, November 6, 2024 @ 12:00 p.m. P.S.T
Location: OnlineCo-Authors:
- Harman Chopra, M.D., Resident, Johns Hopkins University PM&R Program
- Tanya Juneja, M.D., Resident, Johns Hopkins University PM&R Program
- Michael Suarez, D.O., Resident, Nazareth Hospital
Case Diagnosis: Improved motor activation of the C7 myotome by spinal cord stimulation in a patient with a previous incomplete cervical spinal cord injury.
Case Description or Program Description: In the United States, there are approximately 17,730 new cases of spinal cord injury (SCI) each year. 1SCI lacks a cure, with current treatment focusing on compensation strategies for long-term complications. 2 Recent research highlights spinal cord stimulation (SCS) as a promising avenue for functional recovery in chronic SCI patients. 2 Intensive motor training often complements SCS, and it's proposed to enhance spinal circuitry, especially in cases of incomplete SCI.2 We describe mild cervical gain of function as a result of SCS in a case of incomplete cervical SCI.
Setting: Inpatient Rehabilitation, Spinal Cord Injury Center
Assessment/Results: After multiple attempts of programming to find adequate settings for pain coverage and improvement of spasticity, patient was also able to achieve Right Upper Extremity (RUE) extensor motor function with the settings of 2Hz frequency, pulse width of 550 ms, and 5 amps, a function lost after SCI.
Discussion (relevance): We describe a case of incomplete SCI resulting in loss of extensor function of RUE (AISA D) that had gain of function after spinal cord stimulation (SCS).
Conclusions: Spinal cord stimulation can lead to gain of function of certain myotomes in patients with incomplete spinal cord injury.
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Date: Wednesday, November 6, 2024 @ 12:00 p.m. P.S.T.
Location: OnlinePrimary Authors:
- David S. Jevotovsky, M.B.A., M.D., New York University Grossman School of Medicine PM&R Program
Co-Authors:
- Harman Chopra, M.D., Resident, Johns Hopkins University
- Caroline Silver, Medical Student, NYU Grossman School of Medicine
- Tanya Juneja, M.D., Resident, Johns Hopkins University
- Braden Weissman, Student, University of Michigan
- Mustafa Broachwala, D.O., Resident, Johns Hopkins University PM&R Program
- Drew Lestersmith, D.O., Resident, Johns Hopkins University PM&R Program
- Tariq Alfarra, D.O., Icahn School of Medicine at Mount Sinai
- Joel P. Castellanos, M.D., Associate Professor, Department of Anesthesiology, University of California San Diego
Background and/or Objectives: This systematic review aims to summarize the existing literature on psilocybin's use for chronic neuropathic pain treatment in humans.
Design: A search was conducted following PRISMA guidelines. Studies were evaluated for quality, and data on study characteristics, patient demographics, dosing protocols, and outcomes were extracted.
Setting: Literature review.
Participants: Adults with chronic neuropathic pain.
Interventions: Synthetic and/or organic psilocybin.
Main Outcome Measures: 11-point numeric rating scale (NRS), headache frequency, duration, and self-reported pain relief.
Results: The initial search of five databases yielded 1221 citations, with 767 remaining after deduplication. After thorough review, 21 studies were selected for a detailed quality and outcome assessment, with three classified as moderate quality, two as low quality, and 16 as very low quality. Most studies were cross-sectional surveys, structured discussions, case series, reports, or published conference abstracts. Psilocybin therapy was described in these studies for 697 patients with chronic neuropathic pain, with common conditions being chronic migraines, cluster headaches, and chronic pain of varied etiology. The studies demonstrated decreased headache frequency and NRS pain outcomes, though statistical significance was not always achieved. Seven clinical trial summaries from Cochrane’s Central Register of Controlled Trials were included, with completed studies investigating psilocybin treatment for headache conditions at specific doses and experimental sessions.
Conclusions: Psilocybin shows promise as a novel approach to managing chronic neuropathic pain with studies suggesting improvements in pain symptoms, possibly related to its serotonergic effects. The evolving legal landscape, with decriminalization efforts and potential legalization of psilocybin, necessitates guidelines for responsible and safe use. However, there are limitations in the current body of research, including study heterogeneity, lack of standardized methodologies, high risk of bias and poor-quality research. Further research is needed to establish its safety and efficacy, particularly regarding long-term use with standardized dosing, appropriate control groups, and blinding.
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Date: Thursday, November 7, 2024 @ 12:45 – 2:15 p.m. P.S.T.
Location: Case Report TheaterCo-Authors:
- Harman Chopra, M.D., Resident, Johns Hopkins University PM&R Program
- Tanya Juneja, M.D., Resident, Johns Hopkins University PM&R Program
- Mustafa Broachwala, D.O., Resident, Johns Hopkins University PM&R Program
Case Diagnosis: We present an unusual case of a patient with suspected neurogenic thoracic outlet syndrome (nTOS) with associated dyspnea whose symptoms were completely alleviated after local anesthetic block of the left anterior scalene muscle (AScm). To our knowledge, this is the first known case in the literature of dyspnea as a symptom of nTOS treated with local anesthetic injection of the AScm.
Case Description or Program Description: A 69-year-old female with a past medical history of PSVT and OSA presented with left upper chest, clavicular, and neck pain with associated numbness and tingling down the left arm and shortness of breath. On physical exam, the elevated arm stress test provoked chest pain and dyspnea at 21 seconds. Palpation of both the left scalene region and supraclavicular region lead to dyspnea without pain. She underwent a diagnostic left AScm injection with .5cc of 0.25% bupivacaine under CT-guidance on 2/13/2023. An hour after the procedure, the patient experienced 100% relief of pain in the left arm and 95% relief of dyspnea for 24 hours.
Setting: General community, musculoskeletal clinical
Assessment/Results: The patient received relief from dyspnea from injection of local anesthetic to the anterior scalene muscle.
Discussion (relevance): Few case reports have reported tachycardia or dyspnea as a symptom of nTOS (1, 2). Kaymak et al. demonstrated improvement of tachycardia after scalenectomy and proposed that the postganglionic efferent sympathetic fibers were compressed by the AScm. This is consistent with the sympathetic trunk lying anteromedially to the AScm, and literature showing activation of the left stellate ganglion leading to transient tachycardia (5). Here we propose a temporary sympathectomy with injection of local anesthetic to the AScm leading to potential improvement in the patient’s PSVT(6). Vagal dysfunction can lead to increased mucus secretion and bronchial smooth muscle contraction leading to dyspnea (10). Lastly, the phrenic nerve compression may cause diaphragmatic weakness leading to dyspnea if compressed (11).
Conclusions: We present one of the first cases in the literature of dyspnea as a symptom of nTOS with relief of dyspnea from injection of local anesthetic to the anterior scalene muscle. Anesthetic blockade and subsequent Botox injection may be considered in these patients as a treatment option.
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Date: Thursday, November 7, 2024 @ 12:45 – 2:15 p.m. P.S.T.
Location: Kiosk 1Primary Authors:
- Amaan Sheikh, D.O., Resident, Johns Hopkins University PM&R Program
Co-Authors:
- Marlis Gonzalez-Fernandez, M.D., Ph.D, Interim Chair and Associate Professor, Johns Hopkins Department of PM&R
Case Diagnosis: 50-year-old-female with severe bilateral lower extremity acrocyanosis s/p bilateral transfemoral amputations (TFA)
Case Description or Program Description: Patient was evaluated for rehabilitation after a rare vascular disease led to left transtibial amputation (TTA). Due to continued residual limb pain and poor wound healing, the patient was unable to tolerate standard prostheses and pursued alternative options. After failed amputation revision surgery, the patient was treated with TFA with osseointegration (OI) two years after initial TTA. Months after this procedure, the patient continued to have right lower limb vascular complications eventually requiring right TFA with OI. She was admitted to acute inpatient rehabilitation and progressed to outpatient rehabilitation completing a modified “half-speed” weight bearing protocol (as indicated for OI patients) using the pre-established physical therapy protocol after each TFA.
Setting: Tertiary Care Hospital
Assessment/Results: Due to the complexity of the patient’s condition and procedure, rehabilitation had to be modified to support successful rehabilitation thus lasting approximately twice as long for each limb. The patient had better pain control and tolerance of therapy with the OI interface when compared to previous attempts.
Discussion (relevance): This case indicates that patients who have complex vascular issues (even in the absence of a typical diagnosis) limiting their ability to participate in traditional rehabilitation with a usual prosthesis may benefit from OI.
Conclusions: OI is an FDA approved alternative to traditional prostheses that may offer better quality of life and improved function/mobility in well-selected patients. In this case it improved prosthesis daily wear, proximal joint range of motion, K-level, energy conservation, and satisfaction with the overall limb loss rehabilitation process.
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Date: Friday, November 8, 2024 @ 12:00 – 1:45 p.m. P.S.T
Location: Case Report TheaterCo-Authors:
- Michael Suarez, D.O., Resident , Nazareth Hospital
- David S. Jevotovsky, M.B.A., M.D., Resident , New York University Grossman School of Medicine PM&R Program
- Harman Chopra, M.D., Resident , Johns Hopkins University PM&R Program
- Joel P. Castellanos, M.D., Associate Professor, Department of Anesthesiology, University of California San Diego
Case Diagnosis: A sixty-year-old patient with a C5 AIS grade D spinal cord injury.
Case Description or Program Description: A 60-year-old patient with a history of traumatic spinal cord injury (SCI) with C5 ASIA Impairment Scale (AIS) grade D presented to the clinic with chronic right upper extremity pain, numbness, and spasticity. The patient had tried and failed extensive conservative measures for neuropathic pain and spasticity, including botulinum toxin injections and chemodenervation. On physical exam, the patient had significant right-sided upper extremity flexor tone with limited extension of the elbow. After a review of the treatment options, the patient elected to trial a spinal cord stimulator (SCS). The SCS 8-contact leads were placed in the cervical region covering C3-C5 and the thoracic region covering T9-T11. The minimally invasive SCS trial provided a 70% reduction in the patient’s neuropathic pain, leading to permanent implantation of the neurostimulation device.
Setting: Tertiary care academic medical center
Assessment/Results: At two weeks post-op, the patient reported a 100% improvement in the right upper extremity pain and an additional 60% improvement in right arm spasticity. After multiple programming adjustments, the patient regained significant function of the right elbow extensor mechanism, improving their overall function and quality of life.
Discussion (relevance): Pain and spasticity are often chronic and debilitating conditions for patients following spinal cord injury that can significantly hinder their quality of life. Neuromodulation is showing growing and promising utility in spinal cord injury rehabilitation. In this case, we present a promising use of spinal cord stimulation to improve pain, spasticity, and motor function.
Conclusions: Spinal cord stimulation is a promising treatment modality that can improve spasticity and motor function after spinal cord injury.
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Date: Friday, November 8, 2024 @ 8:00 – 9:15 a.m. P.S.T.
Location: Kiosk 3Co-Authors:
- Daniel Khokhar, D.O., PGY-1 , Lakeland Regional Health TY / Johns Hopkins PM&R
- Azmeer Khamisani, M.D., PGY-2, USA Sports Medicine
- Gayan Poovendran, M.D., Poovendran Regenerative Orthopedic Institute
Case Diagnosis: Complex Bucket Handle Tear of the Right Meniscus
Case Description or Program Description: Bucket handle meniscus tears (BHMT) result in significant dysfunction in those affected. With varying recovery time and complications, function is not always completely regained. After conservative measures, the next step is typically surgery. With advancements in regenerative therapy, bone marrow aspirate collection (BMAC) and platelet-rich plasma (PRP) have emerged as possible treatment options. With demonstrated effectiveness in osteoarthritis and ligamentous injuries, BMAC and PRP may allow for another therapeutic option for patients with meniscus injuries. This case describes a patient who presented to the outpatient clinic with the desire to avoid surgery for his BHMT. With little to no literature describing the use of BMAC/PRP in meniscus tears, the patient agreed on the novel treatment of his condition with the injection combination. The patient underwent treatment along with recommended physical therapy and supportive treatment.
Within 6.5 months of the initial visit, the patient’s BHMT was healed with evidence on MRI. The patient endorsed restoration of function and improvement of symptoms related to the injury. This case demonstrates the use of BMAC/PRP injection therapy as an alternative treatment for BHMTs.Setting: Outpatient
Assessment/Results: Complete repair of the bucket handle meniscus tear
Discussion (relevance): The use of BMAC has been shown to be moderately effective in the treatment of osteoarthritis, but there is limited literature on bucket handle meniscus tears. The ideal number of treatments, volume, and timing of the BMAC injections have yet to be well characterized. There have been case reports of single-use BMAC injections with improvement for focal chondral defects; however, these studies had a variable number of treatments and limited follow-up. Additionally, PRP has been shown to augment BMAC effectiveness, as highlighted in our case [3,6].
Conclusions: Patients with complex BHMT with failure of conservative management can consider BMAC with PRP injection. Our case demonstrates the efficacy of the procedure with a limited side effect profile for our patient in conjunction with physical therapy. Further studies are needed to determine efficacy in the different types of meniscus tears and long-term side effects of the treatment, as well as how it compares to other treatments.
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Date: Friday, November 8, 2024 @ 12:00 a.m. – 1:30 p.m. P.S.T.
Location: Kiosk 9Co-Authors:
- Ozlenen Eylul Ince Hocaoglu, M.D., Resident, Cleveland Clinic Foundation PM&R Program
- Margaret French, Ph.D., P.T., Assistant Professor, University of Utah
- Preeti Raghavan, M.D., Associate Professor, Johns Hopkins University School of Medicine
Background and/or Objectives: The 9-hole peg test (9HPT), part of the Multiple Sclerosis Functional Composite (MSFC), evaluates upper limb dysfunction in multiple sclerosis (MS) patients. The 9HPT measures the time taken to insert pegs into holes but does not evaluate impairments that may impede the task such as sensory and/or motor deficits. We used an instrumented precision grasp device to quantify hand function and correlated the measures with sensory and motor impairments.
Design: Cross sectional, observational study
Setting: Clinical research laboratory
Participants: Ten right-handed participants with MS
Interventions: Participants grasped and lifted an instrumented precision grasp device with exchangeable weights, engaging each hand independently. Their sensory and motor impairments were also assessed separately. Nonparametric Spearman’s rank correlation coefficients (p < 0.05) were used to examine the relationship between sensorimotor impairments and precision grasp measures.
Main Outcome Measures: Sensory assessments included the finger joint proprioception, modified Moberg test, monofilament test, and two-point discrimination; motor assessments included grip and pinch strength, and the 9HPT. The precision grasp instrument assessed the rate of change of grip and load forces, time taken to coordinate the grip and load forces and the efficiency of grip forces at lift off.
Results: Significant correlations were found between the rate of change of load force and finger joint proprioception (r=0.74), the time taken to generate load forces and the 9HPT (r=0.68), and the efficiency of grip forces at lift off and pinch strength (r=0.73).
Conclusions: Quantitative assessment of precision grasp with an instrumented device can capture sensory and/or motor impairments that lead to hand dysfunction in individuals with multiple sclerosis. Monitoring precision grasp parameters may be an efficient and precise approach to inform therapeutic strategies and gauge treatment efficacy.
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Date: Saturday, November 9, 2024 @ 12:00 – 1:30 p.m. P.S.T.
Location: Kiosk 7Co-Authors:
- Komal Luthra, M.D., Resident, Johns Hopkins University PM&R Program
- Yousef Darwish, M.D., Resident, Johns Hopkins University PM&R Program
- Pranamya Suri, M.D., Denver, Colorado
- Akhil Chhatre, M.D., Johns Hopkins Physical Medicine and Rehabilitation
Case Diagnosis: A 30-year-old female with achondroplasia presented with chronic neuropathic pain in her right lower extremity after right total knee arthroplasty.
Case Description or Program Description: The patient had a complex medical history and inadequate pain control from standard pharmacotherapy. Additionally, the patient had previously underwent a right proximal peroneal nerve pulsed radiofrequency procedure, which initially yielded moderate relief. Regrettably, this relief proved to be of short duration, prompting the patient to undergo the procedure two additional times over the course of a year. Given the recurrent nature of her symptoms, it was deemed that the patient might derive potential benefits from a peripheral nerve stimulation (PNS) device targeting the right common peroneal nerve. Following a successful trial, the patient successfully underwent the procedure. However, the case necessitated an innovative PNS strategy, entailing a modified implantation technique to adjust to her short limb stature and limited space for the internal stimulator.
Setting: Ambulatory surgical center
Assessment/Results: The patient was followed closely for about 2 months after the operation. She experienced significant pain relief and successfully reduced her reliance on opioid medications. Importantly, no issues related to transmission problems or device failure have been reported, underscoring the effectiveness of our placement.
Discussion (relevance): This case emphasizes the need for individualized pain management strategies and presents PNS as a versatile tool in treating neuropathic pain in patients with rare anatomical challenges. It adds to the understanding of PNS applications in atypical patient populations and highlights the potential for technique modification to achieve pain control.
Conclusions: This case demonstrates that PNS can be successfully adapted for pain management in patients with achondroplasia and other unique anatomical considerations. It opens avenues for personalized approaches in PNS lead placement, potentially improving the quality of life for patients with complex pain syndromes.
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Date: Saturday, November 9, 2024 @ 8:00 – 9:15 a.m. P.S.T.
Location: Kiosk 8Authors:
- Tracy Friedlander, M.D., Assistant Professor, Residency Program Director, Johns Hopkins University SOM, Dept PM&R
- Samuel Mayer, M.D., Associate Professor, Johns Hopkins University School of Medicine
Background and/or Objectives: Interprofessional education is a foundation for current medical practice across disciplines. The field of physical medicine and rehabilitation (PM&R) is uniquely equipped to apply the transdisciplinary approach to optimize training and clinical care. The PM&R Transdisciplinary Education Program at Johns Hopkins aims to engage post-graduate trainees, including medical residents; rehabilitation psychology/neuropsychology fellows; and physical therapy, occupational therapy, and speech-language pathology residents/fellows in a longitudinal curriculum that improves knowledge and skill in transdisciplinary approach and healthcare professions core competencies.
Design: Post graduate trainees in physician (22), psychology (8), physical therapy, occupational therapy and speech therapy programs (19) in the Department of Physical Medicine and Rehabilitation at Johns Hopkins participated in monthly learning sessions from October 2022 through June 2023 to focus on core competencies for health care professionals emphasizing transdisciplinary teamwork skills and collaboration. Pre and post survey data and qualitative data of free response survey questions, online discussion questions, and post program interviews were analyzed.
Setting: Department of Physical Medicine and Rehabilitation at Johns Hopkins, Residency and Fellowship Training Programs
Participants: Post graduate trainees in physician (22), psychology (8), physical therapy, occupational therapy and speech therapy programs (19)
Interventions: Transdisciplinary educational program consisting of monthly learning sessions from October 2022 through June 2023
Main Outcome Measures: Pre and post survey data and qualitative data of free response survey questions, online discussion questions, and post program interviews were analyzed.
Results: Results demonstrated high confidence and values for interprofessional competency constructs of diversity and ethics, patient-centeredness, community-centeredness, roles and responsibilities.
Conclusions: This program offers a framework for interprofessional healthcare education curriculum development in post-graduate training environments.
Sessions and Presentations
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Date: Thursday, November 7, 2024 @ 9:30 – 10:45 a.m. P.S.T.
Location: 8, Upper LevelSession Director:
- Hanna Hunter, M.D., Medical Director of Cancer Rehabilitation, Rehabilitation Medicine, Fred Hutch · Assistant Professor, University of Washington
Faculty:
- Ishan Roy, M.D., Ph.D., Physician Scientist/Assistant Professor, Shirley Ryan AbilityLab
- Jessica P. Engle, D.O., Assistant Professor of Physical Medicine and Rehabilitation and Oncology, Johns Hopkins School of Medicine
- Philip Chang, D.O., Assistant Professor, Cedars-Sinai Medical Center
- Neal Rakesh, M.D., M.S., Assistant Professor, Memorial Sloan Kettering Cancer Center
Session Description: Supportive care services are an integral part of maintaining and improving the quality of life of patients undergoing cancer treatment, and in survivorship. Comprehensive cancer rehabilitation requires both interdisciplinary and coordinated care with other supportive care services to optimize patient function and manage side effects of cancer. Emerging evidence has described how supportive care can improve morbidity and mortality, as well as play a key role in secondary cancer prevention.
This session will include an overview of updated guidelines in cancer pain, palliative care, exercise and symptom management that are relevant to cancer rehabilitation. Guidelines and recommendations from NCCN, ASCO, ESMO, COC will be highlighted. Panelists will then share novel clinical trials in these supportive care fields. Emerging evidence for management of common cancer-related side effects that span multiple supportive care domains will be discussed. With ongoing and growing research in supportive care oncology, this panel will highlight how “supportive care” may seem like a misnomer given its essential role in improving quality of life throughout the cancer care continuum.
Learning Objectives:
- Describe updated cancer-specific guidelines in pain management, exercise counseling, palliative care and rehabilitation services
- Identify key timepoints in clinical cancer care to collaborate with palliative care and pain management
- Interpret results of novel clinical trials in oncology supportive care, and predict potential impacts and practical applications in cancer rehabilitation
- Examine emerging clinical practice trends in the management of cancer-related nausea, fatigue, pain, and deconditioning
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Date: Thursday, November 7, 2024 @ 5:00 – 6:30 p.m. P.S.T.
Location: Halls A-B, Ground Level, Pod 4Directors:
- Mohammed Emam, M.D., Assistant Professor, Johns Hopkins University
Faculty:
- Altamash Raja, D.O., RMSK, CSCS Assistant Professor, Rowan-Virtua School of Osteopathic Medicine
- Frank Nguyen, D.O., Attending Physician, Maimonides Bone & Joint Center
- Derek Ho, D.O., Assistant Professor, Montefiore Medical Center
- Alexis Coslick, D.O., Assistant Professor, Johns Hopkins University School of Medicine
Description: High resolution ultrasonography (US) facilitates visualization of peripheral nerves including individual nerve fascicles in cases of peripheral entrapment syndromes. US has become a valuable tool for diagnosis and management of these patients as it helps depicting changes in the nerve's shape and echo-texture, and may reveal causes of nerve compression when structural abnormalities or space-occupying lesions are present.
In this hands-on session, participants will learn about sonographic evaluation of common upper extremity nerve entrapment syndromes. This includes anatomic nerve locations, common entrapment sites, and common morphological changes of entrapment neuropathies. Participants will also learn about ultrasound guided interventional techniques that maybe helpful in management of these conditions
Learning Objectives:
- Recognize normal sonoanatomy of the median, radial and ulnar nerve and branches from the upper arm to the wrist and hand.
- Recognize common entrapment sites of the upper extremity nerves through sonographic evaluation and clinical presentation
- Describe common morphological changes of common entrapment neuropathies in the upper extremity.
- Recognize set-up, patient positioning, and techniques for interventional ultrasound guided procedures in common entrapment neuropathies in the upper extremity.
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Date: Friday, November 8, 2024 @ 1:30 – 4:30 p.m. P.S.T.
Location: 16B, Mezzanine LevelDirectors
- Christopher Alessia, DO, Attending Physician, University of Miami
Faculty:
- Robert Irwin, M.D., Professor, University of Miami Miller School of Medicine
- Laura Y. Huang, M.D., Physiatrist, Mount Vernon Rehabilitation
- Se Won Lee, M.D., Program Director, HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
- Mohammed Emam, M.D., Assistant Professor, Johns Hopkins University
- Timothy K. Tiu, M.D., Assistant Professor, University of Miami Miller School of Medicine
While mononeuropathies may be straightforward diagnoses, further evaluation is advised to maximize efficacy of management. Static and dynamic evaluation of nerves using electrodiagnostics and ultrasonography allow for thorough structural and functional assessment. Additionally, there are a multitude of treatment options available including hydrodissection, prolotherapy, ligament fenestration, and percutaneous release. This session will be allow participants to review the relevant anatomy and pathophysiology, gain proficiency in the sonographic evaluation of neuropathy, revise electrodiagnostic skills, and learn about interventional options.
Learning Objectives:
- Describe the relevant pathophysiology for common mononeuropathies, as well as the clinical presentation and physical examination findings
- Perform static and dynamic evaluation of mononeuropathies using both electrodiagnostics and ultrasonography
- Compare and contrast between different interventional management options of neuropathies
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Date: Saturday, November 9, 2024 @ 8:00 – 9:15 a.m. P.S.T.
Location: Halls A-B, Ground Level, Pod 2Directors:
- Se Won Lee, M.D., Program Director, HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
Faculty:
- Mohammed Emam, M.D., Assistant Professor, Johns Hopkins University
- Kevin Machino, D.O., PM&R Sports Medicine Physician, Intermountain Health
- Timothy K. Tiu, M.D., Assistant Professor, University of Miami Miller School of Medicine
- Shane Drakes, M.D., Sports Medicine Fellowship Director, Montefiore Medical Center
Description: This hands-on demonstration and practice session aims to optimize foot and ankle ultrasonography (US) use in outpatient physiatry clinics. This session will cover surface anatomy, differential diagnosis based on surface anatomy, and US scanning to confirm differential diagnoses using case examples followed by hands-on practice. Musculoskeletal US is increasingly utilized in the physiatry clinic; however, the proficiency of diagnostic US of foot and ankle pathologies among residents and fellows needs to improve. PM&R residents and fellows are enthusiastic about learning diagnostic US skills in foot and ankle pathologies. Still, there is a limited opportunity to apply US skills in evaluating foot and ankle pathologies.
This session will be valuable for residents and fellows who want to acquire up-to-date knowledge in clinical applications of the musculoskeletal US, hands-on skills and tips in diagnosis and interventions, and limitations/practical tips of US applications in the foot and ankle pathologies commonly encountered at the outpatient clinic.
Learning Objectives:
- As a result of attending this session, participants will be able to improve the diagnostic ultrasound skills for common foot and ankle pathologies.
- As a result of attending this session, participants will be able to recognize the typical ultrasonographic findings of common foot and ankle pathologies.
- As a result of attending this session, participants will be able to recognize different pain generators from various anatomic structures based on history, clinical, and US examination.
- As a result of attending this session, participants will be able to learn common US-guided injection approaches based on the surface anatomy.
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Date: Saturday, November 9, 2024 @ 12:00 – 1:30 p.m. P.S.T.
Location: Halls A-B, Ground Level, Pod 2Director:
- Timothy K. Tiu, M.D., Assistant Professor, University of Miami Miller School of Medicine
Faculty:
- Mohammed Emam, M.D., Assistant Professor, Johns Hopkins University
- Scott E. Klass, M.D., Assistant professor of Orthopedics, Dartmouth Health/Dartmouth College
- Se Won Lee, M.D., Program Director, HCA Healthcare Sunrise Health Graduate Medical Education PM&R Program
- Tracey C. Isidro, M.D., Assistant Professor, Columbia University Medical Center and Weill Cornell Medicine
- Samuel T. Dona, Jr., M.D., Assistant Professor, Department of Orthopaedics, University of Maryland School of Medicine
- Eugene Palatulan, M.D., Attending Physician, Montefiore Health Systems/Albert Einstein College of Medicine
- Tricia Prince, D.O., Assistant Professor, Associate Program Director
- Manoj Poudel, M.D., Johns Hopkins University School of Medicine
Description: This lab will consist of Sports Medicine board-certified faculty, and will cover the evidence-based evaluation and management of both common and rare (but essential to know) sports-related injuries. The session will start with a brief presentation followed by a breakout session. Participants will be divided into small groups and rotate between stations that include spine boarding, concussion evaluation and management, e-FAST ultrasound protocol training, fracture and dislocation management, pneumothorax management, finish line conditions.
Learning Objectives:
- Describe the role of a team physician as it pertains to sideline coverage, including the responsibilities of ensuring safe participation in sport and protection of the athlete's privacy.
- Identify potential catastrophic injuries and initiate appropriate initial management, such as for cervical spine injury and tension pneumothorax.
- Evaluate an athlete for a concussion through a multimodal approach including the Sport Concussion Assessment Tool and Vestibular/Oculomotor Motor Screening.
- Perform and interpret the Extended Focused Assessment with Sonography for Trauma protocol.
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Date: Sunday, November 10, 2024 @ 8:30 – 10:00 a.m. P.S.T.
Location: Ballroom 6AB, Upper LevelFaculty:
- Max Hurwitz, D.O., Assistant Professor, University of Pittsburgh
- Oranicha Jumreornvong, M.D., Resident, Icahn School of Medicine At Mount Sinai PM&R Program
- Samuel Mayer, M.D., Associate Professor, Johns Hopkins University School of Medicine
- Amy M. West, M.D., Assistant Professor, Zucker School of Medicine at Hofstra University - Northwell
- Amy H. Ng, M.D., M.P.H., Associate Professor, University of Texas MD Anderson Cancer Center
- Marcos R. Henriquez, M.D., PGY-3, Rush University in Chicago
The top submissions from our Call for PhyzTalks will present their stories live in a fun, real-time competition where the winner will be chosen by the audience. PhyzTalks are TED™-style talks, which feature stories that are compelling and impactful to physiatrists. Come to watch your PM&R peers and enjoy breakfast on us! Breakfast will begin at 8 am and PhyzTalk presentations at 8:30 am.
Past Events
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Research and presentation topics included:
- Pain, Functional, and Structural Improvements in Lumbosacral Radiculopathy Due to Disc Herniation After Epidural Platelet-rich-plasma Injection
- 8% Topical Capsaicin Patch Placement to Treat post-covid-19 Neuropathic Pain: A Case Report
- Spasticity Practice Guidelines for Physiatrists: The Latest in Assessing, Diagnosis, and Treating Spasticity in Adults and Children
- Diagnostic and Interventional ultrasonography for common entrapment neuropathies of the upper extremity
- A Cross-sectional Survey of Cancer Rehabilitation Physiatrists Across the United States Regarding Outcome Measure Collection
- Essential Updates in the Physiatric Management of Post COVID Conditions: Fatigue, Cardiovascular, Pulmonary & Pain Disorders
- Essential Updates in the Physiatric Management of Post COVID Conditions: Autonomic, Neurologic, Cognitive and Pediatric Disorders
- Stroke Recovery and Rehabilitation: Debating the Controversies
- Making Sense of Muscle Wasting
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- ALS Following COVID-19 Infection: A Case Report
- Equivalence of In-person and Telehealth Administration of the Physical and Neurological Examination of Subtle Signs Timed Motor Subscale in Youth Recovered from Concussion and Healthy Controls
- Service Utilization and Unmet Needs of Children and Young Adults with a History of Disorder of Consciousness After Brain Injury
- Update: Swallowing Disorders Research at Johns Hopkins Rehabilitation Network