Delta Charlottetown to Fireworks Inn at the Bay Fortune departing Tuesday May 23 at 11 AM and then departing next day on Wednesday May 24 @ 9AM to return to the Delta with Twilite Limo.

This hands-on workshop will introduce participants to the fundamentals of musculoskeletal ultrasound scanning in order to accurately identify common musculoskeletal pathologies and injection techniques. This workshop will feature six 30-minute stations for live ultrasound scanning of common musculoskeletal structures. At each ultrasound station, small group of 5-6 participants will have the opportunity to perform hands-on scanning on live models.

Stations 1-6: Live Models

The philosophy of this SIG is that no matter where we are in our journey as a physicians we are all leaders. A leader is not a position or title it is what you do.

We will use the leadership literature to guide a round table exploration the value of leadership in patient care and academic work and our hope is to have a group in favor of submitting an application to CAPMR Executive for recognition of a leadership SIG within the association.

Moderated by Colleen O'Connell

Music therapy is a discipline in which Certified Music Therapists (MTAs) use music purposefully within therapeutic relationships to support development, health, and well-being. Music therapists use music safely and ethically to address human needs within cognitive, communicative, emotional, musical, physical, social, and spiritual domains

Moderated by Monique Taillon

This presentation will review the clinical presentation and epidemiology of cerebral palsy. It will also highlight the challenges of transitioning to adult care with a childhood onset disability and some of the specific medical and psychosocial challenges experienced by adults with cerebral palsy.

Moderated by Chris Embree

Dr. Nimish Mittal -Advanced neuroablative procedures for shoulder pain and arthritis.

Dr. Paul Winston -Advanced care of the spastic hemiplegic shoulder through cryoneurolysis and nerve blocks.

Dr. Jennifer McDonald -Procedural management of capsulitis and refractory disorders

This expert team will introduce state-of-the-art interventions for advanced practice for complex shoulder presentations including osteoarthritis adhesive capsulitis and the spastic hemiplegic shoulder

Bussing is provided

Moderated by Larry Robinson

Moderated by Chantel Debert & Ricardo Viana

Purpose: Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to: (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.

Materials and methods: A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff.

Results: There was significant improvement in mood (p<0.001) and decrease in pain (p<0.05) from pre- to-post MT with 74% reporting being "very satisfied" with the session. "Benefits of MT" was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness.

Conclusions: Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required.

Keywords: music therapy, Spinal cord injury, brain injury, mood, pain, rehabilitation

Context: Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).

Objectives: To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.

Methods: Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.

Results: Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.

Conclusion: Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited.

Keywords: Amputation stumps, Botulinum toxins, Congenital limb deformities, Pain Management, Phantom limb pain

Objective: To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy procedures

Design: Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.

Results: A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.

Conclusion: Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training.

Keywords: recovery, weight-bearing, meniscus, resection, rehabilitation

Artificial intelligence (AI) refers to computational technologies that mimic human cognitive functions such as perception, learning and problem-solving. AI-based tools may be applied along the spectrum of diagnosis, prognosis and treatment, such as radiographic diagnostic aids, clinical decision support tools, predictive modelling for recovery, personalized rehabilitation and robotics. Beyond the domain of clinical care, AI tools may optimize health system management and resource utilization within rehabilitation. Limitations to AI include ethical, legal and infrastructural barriers. Validated implementation strategies specific to AI-based tools can address concerns regarding transparency and clinical integration. To leverage AI as an adjunct in clinical care, physiatrists will need to understand the fundamental concepts and process of AI, as well as their strengths and limitations.

Keywords: Artificial Intelligence

Stroke is a prevalent contributor to disability in Canada and has many biological, psychological, and social impacts on survivors. One common complication that is often a neglected component of rehabilitation post-stroke is sexual dysfunction. When assessing sexual dysfunction, it is crucial to first frame normal sexual function with a biopsychosocial lens to evaluate the convergence of influences. Stroke adds another layer of complexity as it has been well-established to have impacts across all components of the biopsychosocial model of care. The common sexual dysfunction complications to consider include caregiver burden, low libido, erectile dysfunction, vaginal dryness, difficulty with orgasm, neuromuscular changes, and dyspareunia. In addition to a literature review, I met with a Registered Nurse from the Sexual Health Clinic at the Glenrose Rehabilitation Hospital for common clinical presentations and strategies. A patient's sexual dysfunction needs to be adequately assessed with validated scales touching on all contributing components of dysfunction, counselled with evidence-based information, and treated with targeted interventions. Healthcare providers should be aware of the resources in their area to refer patients and caregivers for additional support when necessary. Normal sexual function should be a target for a holistic recovery in the patient's rehabilitation journey.

Keywords: Stroke, Sexual Dysfunction, Rehabilitation, Biopsychosocial

Highest rated abstract overall.

BACKGROUND: About 900,000 individuals suffer a traumatic spinal cord injury (SCI) every year. SCI severely impacts quality of life and increases the risk for debilitating sequelae. Heterotopic ossification (HO) is an increasingly recognized debilitating complication of SCI, which is the abnormal formation of bone in soft tissues. Due to the knowledge gap in HO pathophysiology, current treatments are non-specific and complicated by off-target effects.

OBJECTIVE: Our goal is to develop a clinically relevant murine model of SCI-associated HO to study the pathogenic mechanism and test novel therapies.

DESIGN: Ten-week-old C57BL/6J female mice were subjected to a spinal cord transection to induce a SCI, followed with a musculotendinous injury (MTI) by crushing the left quadriceps musculotendinous tissue. Mice were euthanized after 1 and 4 weeks and high-resolution micro-CT scans of mouse hindlimbs were then used for quantitative analysis of mineralized tissue. Samples were then embedded in methyl methacrylate and consecutive 5µm sections were stained with Von Kossa to show tissue mineralization, alkaline phosphatase (ALP) for osteoblast activity, and tartrate-resistant acid phosphatase (TRAP) for osteoclast activity. Histomorphometry using ImageJ was used to quantify the percent positive area.

RESULTS: Quantitative micro-CT analysis at 1 week showed significantly higher ectopic mineral volume (in 107 µm3) in SCI+MTI in comparison to the SCI alone group (6.93 ± 2.6 vs. 0.31 ± 0.02, p = 0.02214). The ectopic mineral volume kept increasing and, at 4 weeks, it is significantly higher than that of SCI alone (14.9 ± 4.87 vs. 0.222 ± 0.023, p<0.0001). Moreover, trabecular bone volume/tissue volume (BV/TV) of distal femoral metaphysis showed a significant decrease at 4 weeks in the SCI+MTI group in comparison to MTI alone (p = 0.0007) while no statistically significant difference was noted between SCI+MTI and SCI alone at 4 weeks post-injury. ALP and TRAP staining corroborated the colocalization of osteoblast and osteoclast activity at the loci of ectopic mineralization. In SCI+MTI, the percent ALP positive area at 4 weeks post-injury was significantly higher in comparison to 1-week post-injury (mean ± SE: 4.7 ± 0.59 vs. 0.15 ± 0.052, p = 0.0286). In contrast, quantification of TRAP positive staining in SCI+MTI groups did not show a statistically significant difference between 1- and 4-weeks post-injury.

CONCLUSION: Our model represents a novel preclinical model of SCI-induced HO to study its pathogenic mechanism and assess novel therapies.

Keywords: Heterotopic Ossification, Spinal Cord Trauma, Polytrauma, Translational Science, Bone Mineralization

Context: Surgically implanted intrathecal baclofen (ITB) pumps are used for the management of refractory spasticity in pediatric and adult patients with functionally impairing lower extremity tone. There is a risk of acute, life-threatening baclofen withdrawal with pump and/or catheter dysfunction. Reported signs and symptoms of acute baclofen withdrawal on ITB include pruritus, hypertonicity, labile blood pressure, hyperthermia, mental status changes, rhabdomyolysis, acute kidney injury, seizures, coma and death. There is little literature on the presentation and management of acute baclofen withdrawal.

Findings: We describe a case of a 53-year-old patient with secondary progressive Multiple Sclerosis. This patient had longstanding severe lower extremity spasticity that was managed with 800 mcg of ITB per day. She presented to ER with dehiscence and wound infection of her ITB pump site. She was admitted to the surgical service, and her pump/catheter system was removed. In anticipation of acute baclofen withdrawal, she was started on oral baclofen 20 mg four times/day. She developed a suspected generalized seizure within 24 hours of admission, with altered level of consciousness. Physiatry was consulted for management of suspected acute baclofen withdrawal. In addition to the reported seizure, the patient had complaints of severe pruritus, with increased tone and diaphoresis. She was started on diazepam 5 mg IV q6h, which was weaned to discontinuation over a week. The Infectious Disease and Plastic Surgery teams were consulted for wound management. With initiation of IV diazepam, she had no further seizures and her pruritus resolved, which remained that way after her benzodiazepines were stopped. Her mental status gradually improved. Her creatinine and creatine kinase remained stable, with no evidence of acute kidney injury or rhabdomyolysis. She was eventually transferred to tertiary rehabilitation for optimization of function in the setting of increased tone.

Clinical Relevance: Acute baclofen withdrawal is a rare life-threatening complication that can be seen with ITB pump/catheter malfunction. Our case highlights several points, including that oral baclofen may not be sufficient for management, pruritus is an important symptom to recognize for evolving withdrawal, acute withdrawal is not always immediate but can develop within 24 hours of system removal, and benzodiazepines may be a suitable treatment for acute management.

Keywords: Baclofen [D02.241.081.114.500.350.100], GABA Agonists [D27.505.519.625.240.200], gamma-Aminobutyric Acid [D02.241.081.114.500.350], Multiple Sclerosis [C20.111.258.250.500], Nervous System Diseases [C10]

Context:

Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate.

Objective:

This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.

Methods:

OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.

Results:

3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.

Conclusion:

Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting.

Keywords:

Amputation, Artificial intelligence, Diabetes Mellitus, Forecasting, Machine learning

Problem: Persons with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE); guidelines recommend VTE prophylaxis (VTEp) for 8-12 weeks or until discharge, whichever is shorter. Because persons with SCI may have prolonged hospital stays, the need for ongoing VTEp may warrant reassessment as VTEp has risks including hemorrhage, thrombocytopenia, and osteoporosis. From local baseline data from June-August 2022 inclusive, 45.5% of SCI rehabilitation inpatients received VTEp in excess of guideline recommendations by 58 days on average. Thus, this initiative aimed to decrease the proportion of patients with a new SCI admitted for rehabilitation to Parkwood Institute who receive VTEp beyond their individualized recommended treatment duration from 45.5% to 30%.

Root Cause Analysis: Fishbone framework, process map, and stakeholder interviews identified 7 key providers (4 physiatrists, 3 hospitalists, 1 pharmacist) and 3 priority root causes: unclear duration of VTEp; knowledge gap for VTEp recommendations; and no mechanism to prompt providers to reassess VTEp duration.

Interventions: A series of interventions were introduced. 7 key providers were engaged in consensus-building for criteria for 8- or 12-week VTEp duration. Key providers and other stakeholders, including leaders, nurses, trainees, and allied health team members, received education outlining the above care gap, rationale for the intervention, and the indications for 8 or 12-week duration of VTEp. Stakeholder feedback guided the development of a standardized process for recording the VTEp start date, deciding on the duration of VTEp, and setting a VTEp end date during weekly interdisciplinary team rounds for newly admitted patients.

Measurement of Improvement: Data was analyzed using interrupted time-series for consecutive patients admitted with a new SCI from June 2022 to January 2023 inclusive. The outcome measure was the proportion of patients with VTEp prescribed >7 days beyond the recommended duration. Balancing measures included the rate of VTE.

Effects of Intervention: Monthly run chart data demonstrated a downward shift in the outcome measure after the education sessions and initiation of the standardized VTEp review process. The median proportion of patients receiving prolonged VTEp decreased from 45.5% to 22.7%. No inpatients developed VTE post-intervention.

Conclusions: This initiative established provider buy-in and engaged stakeholders to reduce the proportion of persons receiving prolonged VTEp. Sustainability will be the focus of future efforts.

Funding: none

Keywords: Medication Overutilization, Neurological Rehabilitation, Quality Improvement, Spinal Cord Injury, Venous Thromboembolism

Context: The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.

Methods: The "Bare Bones Series" contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.

Results: Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled: "Introduction to the Bare Bones of Bone Health"; "Fracture 101"; "Blood Tests a Window into You"; "I See Your Skeleton"; "Vitamin D for all, Calcium for Some & Bones, Groans and Stones"; "Get Moving and Loading"; "Pills or Poisons & Atomic Habits"; "Snap and Crack" and, "Directions for Research".

Conclusions: The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality.

Keywords: Bone Health, Education, Fracture, Osteoporosis, Spinal Cord Injur

Moderated by:

This presentation is a summary of my own dissertation research that identified and developed a scale to measure the psychological state of being in conflict at work as well as other research in this field that summarizes the cost of conflict to people and organizations. Participants will learn consider how conflict can be an opportunity to shape organizational culture. That is, organizational culture is an intransigent pattern of social norms that guide behaviour and conflict can interrupt those patterns. This perspective offers people a way of shaping new norms and advancing organizational culture.

Als: Advances In Treatment And Care -Colleen O'Connell

In the last five years, significant advances in the treatment of ALS have necessitated a shift in the approach to diagnosis and care. Multiple drug therapies, genetic and pathophysiologic discoveries and outcomes of disease management fuel the need to have persons referred, evaluated and treatment started as early as possible. New criteria for diagnosis and importance of "don't delay, refer right away" have changed our approach to ALS care.

SCI Stimulation -Andre Krassioukov

Education in Physiatry - CBD & College Exams – Amra Saric & Anita Mountain

Covid Rehabilitation – Mark Bailey

IHIS is an exhibitor for the conference and are providing a 15 minute presentation as an entitlement for their participation.

This session was co-developed with Abbvie and CAPM&R and designed to achieve scientific integrity. objectivity and balance.

The event is co-developed with Pacira and CAPMR and planned to achieve scientific integrity, objectivity and balance.

Hands on demonstration and clinical rational for cryoneurolysis for treating patients with pain associated with spacticity.

Bussing is provided