- Email: [email protected]
Knee pain relief with genicular nerve blockage in a brain injured patient with heterotopic ossification
Abstracts / Annals of Physical and Rehabilitation Medicine 57S (2014) e422–e424 and in terms of health insurance and social insurance. To analyse the critical areas of financing, especially areas with the greatest potential impact on the budget of patients and their families, this work uses stratification according to degree of disability (in terms of Czech law), activity and participation, age at the time of brain damage, expected percentage representation in population.
e423
the General Councils can obtain reimbursement thereof. A drift is beginning to emerge which consists in reversing the roles and asking National Solidarity to replace the insurers without however the insurers reimbursing to the General Councils the amounts they have paid. http://dx.doi.org/10.1016/j.rehab.2014.03.1538
http://dx.doi.org/10.1016/j.rehab.2014.03.1536 CO95-005-e
Posters
Commercial insurance coverage for outpatient cardiac rehabilitation in patients with chronic heart failure Thirapatarapong a,∗ ,
Thomas b ,
Pack b ,
W. R. Q. S. Sharma b , R. Squires b a Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok b Cardiovascular Health and Rehabilitation Program, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation ∗ Corresponding author. Keywords: Cardiac rehabilitation; Heart failure; Healthcare insurance Background.– Although cardiac rehabilitation improves outcomes in patients with heart failure, it is not currently a Medicare covered indication. Furthermore, coverage policies by private insurance companies vary widely. Purpose.– To determine the percentage of large commercial health insurance companies that provides coverage for outpatient cardiac rehabilitation (CR) for patients with heart failure (HF). Methods.– We identified a sample of the largest commercial healthcare providers and analyzed their CR coverage policies for patients with HF. We reviewed company websites and, when unclear, contacted companies by email or telephone. We excluded insurance clearinghouses because they did not directly provide healthcare insurance. Results.– Out of 44 eligible insurance companies, 29 (66%) reported that they provide coverage for outpatient CR in patients with HF. The majority of companies (83%) covered CR for patients with any type of HF. A minority (10%) did not cover CR for patients with HF if it was considered a pre-existing condition. Conclusion.– A significant percentage of commercial healthcare insurance companies in the United States report that they currently cover outpatient CR for patients with HF. Because health insurance coverage is associated with patient participation in CR, efforts should be made to expand insurance coverage for CR in HF patient. http://dx.doi.org/10.1016/j.rehab.2014.03.1537 CO95-006-e
Pivotal point between ordinary general rules of law relating to indemnification for persons with a handicap and the National Solidarity Fund M.E. Afonso Avocat à la Cour d’Appel de Paris, Paris, France Keywords: National solidarity fund; Insurer; Social welfare bodies; Indemnification; Benefits In France, a person with a handicap may combine the benefits financed by the National Solidarity Fund with the indemnification paid by an insurer. The insurer must reimburse to the social welfare bodies (organismes sociaux) the benefits in kind and in cash that they have paid to the victim. The law of 1985 contained a list of the social welfare bodies benefiting from recourse but to date General Councils (Conseils Généraux) are not on this list. Since the Social Security finance law of 2006, compensation under ordinary general rules of law is administered on an “itemized” basis, which leads insurers to claim the deduction of the benefits paid under National Solidarity. In a decision of May 2013, the Court of Cassation ruled that the “PCH” (handicap-compensating benefit) was an indemnification, which henceforth allows insurers to claim the deduction thereof from the indemnification owed to the victim, without this meaning that
P501-e
Role of rehabilitation teamwork on well being and quality of life of patients with chronic degenerative disease T. Vander Loewenstein Rehabilitation Hospital, Raanana Keywords: Degenerative disease; Multidiscipline rehabilitation team Introduction.– Patients suffer from chronic neurological disease often received only medical treatment by neurologist and sometimes never consulted with rehabilitation medicine specialist. Methods.– We present a young patient suffers from longstanding Parkinson disease and diabetes mellitus with severe Charcot foot deformities which cause functional decline. He was admitted to our rehabilitation center due to general deterioration after acute illness. He was bed ridden, unable to stand and walk, with severe resting tremor and rigidity. His foots had typical Charcot deformities. Neurologic and orthopaedic rehabilitation teamwork reveal to dramatic improvement of general status, safety of patient gait and quality of life. Results.– We discuss about the role of rehabilitation approach to patients with chronic degenerative diseases, like Parkinson disease, multisystem atrophy, multiple sclerosis, Alzheimer disease and importance of motor and cognitive training along with strong drug administration in rehabilitation setting. Discussion.– Accurate multidiscipline rehabilitation team treatment and follow up cause stabile functional status of patients suffer from chronic disease and improved their quality of life. http://dx.doi.org/10.1016/j.rehab.2014.03.1539 P502-e
Knee pain relief with genicular nerve blockage in a brain injured patient with heterotopic ossification
E. Adiguzel ∗ , A. Uran , S. Kesikburun , E. Yasar Gulhane Military Medical Academy, Department of PMR, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey ∗ Corresponding author. Keywords: Heterotopic ossification; Genicular nerve blockage Introduction.– Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. Here we aimed to present a patient with knee pain due to neurogenic HO. Observations.– A 14-year-old traumatic brain injured patient was admitted to our hospital with bilateral knee pain and limited range of motion (ROM). Her medical history revealed that she had a motor vehicle accident 1.5 years ago. She had knee pain for two months especially while walking and standing exercises. Visual Analog Score (VAS) of knee pain was 80 mm. On physical examination, there was ROM limitation of both knee joints. There was no redness and effusion. X-ray examination revealed calcification, which was diagnosed as HO. After 15 sessions physical therapy, she did not have pain relief. We performed ultrasonography (US) guided genicular nerve blockage to both knees with 2 mL lidocaine and 1 mL bethamethasone. Two weeks after the injection, VAS of pain was decreased to 30 mm, walking distance increased. No adverse effect was seen. At six-month follow-up VAS of pain was still 20 mm. Discussion.– US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain
e424
Abstracts / Annals of Physical and Rehabilitation Medicine 57S (2014) e422–e424
relief in patients with neurogenic knee HO to increase patient’s compliance. http://dx.doi.org/10.1016/j.rehab.2014.03.1540
Further reading Levit KR et al. (1995), “State Health Expenditure Accounts: Building Blocks for State Health” EDF brings disability in the horizon (2020). http://dx.doi.org/10.1016/j.rehab.2014.03.1542
P503-e
Census study of the students with disabilities and of the compensations implemented by the Handicap Mission within the Aix-Marseille University M. Prats a,∗ , B. Delorge b , M. Kerzoncuf a , L. Bensoussan a , J.M. Viton a , A. Delarque a a CHU La Timone, Service de Médecine Physique Réadaptation, Marseille, France b Responsable de la Vie étudiante et handicap de l’université d’Aix Marseille, Marseille, France ∗ Corresponding author. Introduction.– Access to the college cycle for the students with disabilities (SWD) and their employability have become a priority for universities. The Handicap Mission manages it within the Aix-Marseille University (AMU). Few studies focus on the SWD’s insertion/integration within the universities and on the compensations. The objective is to analyse within the AMU the SWD’s census and characteristics, and the Handicap Mission’s operating. Methods.– Census is conducted with a Handi-need card (university curriculum, deficiencies, technical and social helps, adjustments appealed for at the university). The SWD is addressed to the Preventive Medicine Department, which carries out an adjustment certificate, addressed to the Handicap Mission. Results.– The Handicap Mission improves SWD’s insertion, defines necessary adjustments and promotes research on disability. In total, 551 SWD are identified, 304 in law and human sciences, 141 encountered deficiencies related to language disorders, among which 105 were not defined by the students (“Other” in the questionnaire). Five hundred and nineteen SWD benefited from the third time, 40 got support for taking notes. Discussion.– Compensations and Handicap Mission improve the monitoring and the link between high school and university for the SWD, promote their exam success and give them support in the working life. http://dx.doi.org/10.1016/j.rehab.2014.03.1541 P504-e
International classification of health committee (South Africa) B. Dodi Family World Vision, Durban, South Africa Keywords: European Disability Forum; South African Federal Council on Disability; National Inter-Sectoral Disability Prevention Strategy The department of health and the South African Federal Council on Disability facilitates the development of a National Inter-Sectoral Disability Prevention Strategy that sets National norms and minimum standards for the prevention of disabilities. Health care is one of the largest industries and complex in terms of job creation and innovations. It calls for a core set of financial data provided by the National Health Accounts as well as by International comparisons of health care spending. Research disability matters should be grounded in a human rights perspective promoting participation and access of disabled in order to produce useful data. European Disability Forum 2020 encourages 100% funding for organisations of persons with disabilities participating in research projects. Public awareness through office of the deputy president in consultation with (SAHRC) and (SAFCD) should develop a medium and long term disability awareness strategy, inclusion of disability as a priority in the National Health plan for universal access to primary health care. In conclusion the South African constitution brought equal rights for all including the disabled.
P505-e
Agressive behaviour after traumatic brain injury
S. Domingues ∗ , C. Galvão , G. Pires , C. Afonso , L. Gonc¸alves , J. Jacinto Centro de Medicina de Reabilita¸cão de Alcoitão, Alcabideche ∗ Corresponding author. Keywords: Traumatic brain injury; Agitation; Treatment Introduction.– Traumatic brain injury (TBI) is one of the major causes of disability worldwide. It often results in multifocal lesions and diffuse brain damage, with a variety of physical, cognitive and neurobehavioral impairments, that are unique to each person and rise additional obstacles to rehabilitation programs and future integration. Agitation is a common finding in the acute phase of recovery from TBI aggression, generating anxiety and fear among family and health care providers. In a rehabilitation department, it assumes a greater relevance interfering with the rehabilitation process and often preventing successful outcomes. Methods.– A research on PubMed with the words “traumatic brain injury” AND “agitation” AND “treatment” and abstract evaluation was carried out. Results.– Pharmacologic treatment for agitation might be beneficial, however, unlike other psychiatric and neurologic conditions, the use of pharmaceuticals is still not evidence based for those patients. Discussion.– An adequate program for providing positive and removing negative stimuli is needed, with the use of medication and non-pharmacologic methods to promote the desired long-term outcomes. Further reading Sandel ME et al. The agitated brain injured patient. Definitions, differential diagnosis, and assessment. Arch Phys Med Rehabil 1996.77:617–23. http://dx.doi.org/10.1016/j.rehab.2014.03.1543 P506-e
Impacts of financial crisis on rehabilitation I.A. Tzanos ∗ , M. Papastefanou , E. Stefas , A. Patrelis , K. Tziotzou , N. Groumas National Rehabilitation Centre, Athens, Ilion, Greece ∗ Corresponding author.
Introduction.– The purpose of this study was to ascertain if financial crisis has impacts on rehabilitation. Methods.– Between Jan 2011–Aug 2013 in our department there were hospitalized 518 patients (299 strokes, 102 paraplegias and tetraplegias, 24 amputations, 93 other pathologies). Respectively, 3940 outpatients with similar problems were examined. Patients were recorded in case they (a) needed orthotics or prostheses (b) needed rehabilitation continuance after hospitalization or physiotherapy for outpatients (c) had problems with special drug administration. Results.– Thirty percent of the 899 stroke inpatients and outpatients who needed orthotics had economic insufficiency to buy them. Twenty percent of those who needed amputation could not be provided with it for economical reasons. The percentage rises to 100% for those without any medical insurance. Also 40% of patients who needed special drug administration for spasticity (botulinum toxin) or baclofen pump could not have access to them because of the complicated and difficult procedure. Concerning to outpatients with musculoskeletal problems who needed physiotherapy or inpatients who needed to continue their rehabilitation program after hospitalization, 20% of them could not afford it and 30–50% did not complete the therapy process. Discussion.– Economic difficulties during the last years have significant impact on patients’ full term rehabilitation. http://dx.doi.org/10.1016/j.rehab.2014.03.1544
e423
the General Councils can obtain reimbursement thereof. A drift is beginning to emerge which consists in reversing the roles and asking National Solidarity to replace the insurers without however the insurers reimbursing to the General Councils the amounts they have paid. http://dx.doi.org/10.1016/j.rehab.2014.03.1538
http://dx.doi.org/10.1016/j.rehab.2014.03.1536 CO95-005-e
Posters
Commercial insurance coverage for outpatient cardiac rehabilitation in patients with chronic heart failure Thirapatarapong a,∗ ,
Thomas b ,
Pack b ,
W. R. Q. S. Sharma b , R. Squires b a Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok b Cardiovascular Health and Rehabilitation Program, Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation ∗ Corresponding author. Keywords: Cardiac rehabilitation; Heart failure; Healthcare insurance Background.– Although cardiac rehabilitation improves outcomes in patients with heart failure, it is not currently a Medicare covered indication. Furthermore, coverage policies by private insurance companies vary widely. Purpose.– To determine the percentage of large commercial health insurance companies that provides coverage for outpatient cardiac rehabilitation (CR) for patients with heart failure (HF). Methods.– We identified a sample of the largest commercial healthcare providers and analyzed their CR coverage policies for patients with HF. We reviewed company websites and, when unclear, contacted companies by email or telephone. We excluded insurance clearinghouses because they did not directly provide healthcare insurance. Results.– Out of 44 eligible insurance companies, 29 (66%) reported that they provide coverage for outpatient CR in patients with HF. The majority of companies (83%) covered CR for patients with any type of HF. A minority (10%) did not cover CR for patients with HF if it was considered a pre-existing condition. Conclusion.– A significant percentage of commercial healthcare insurance companies in the United States report that they currently cover outpatient CR for patients with HF. Because health insurance coverage is associated with patient participation in CR, efforts should be made to expand insurance coverage for CR in HF patient. http://dx.doi.org/10.1016/j.rehab.2014.03.1537 CO95-006-e
Pivotal point between ordinary general rules of law relating to indemnification for persons with a handicap and the National Solidarity Fund M.E. Afonso Avocat à la Cour d’Appel de Paris, Paris, France Keywords: National solidarity fund; Insurer; Social welfare bodies; Indemnification; Benefits In France, a person with a handicap may combine the benefits financed by the National Solidarity Fund with the indemnification paid by an insurer. The insurer must reimburse to the social welfare bodies (organismes sociaux) the benefits in kind and in cash that they have paid to the victim. The law of 1985 contained a list of the social welfare bodies benefiting from recourse but to date General Councils (Conseils Généraux) are not on this list. Since the Social Security finance law of 2006, compensation under ordinary general rules of law is administered on an “itemized” basis, which leads insurers to claim the deduction of the benefits paid under National Solidarity. In a decision of May 2013, the Court of Cassation ruled that the “PCH” (handicap-compensating benefit) was an indemnification, which henceforth allows insurers to claim the deduction thereof from the indemnification owed to the victim, without this meaning that
P501-e
Role of rehabilitation teamwork on well being and quality of life of patients with chronic degenerative disease T. Vander Loewenstein Rehabilitation Hospital, Raanana Keywords: Degenerative disease; Multidiscipline rehabilitation team Introduction.– Patients suffer from chronic neurological disease often received only medical treatment by neurologist and sometimes never consulted with rehabilitation medicine specialist. Methods.– We present a young patient suffers from longstanding Parkinson disease and diabetes mellitus with severe Charcot foot deformities which cause functional decline. He was admitted to our rehabilitation center due to general deterioration after acute illness. He was bed ridden, unable to stand and walk, with severe resting tremor and rigidity. His foots had typical Charcot deformities. Neurologic and orthopaedic rehabilitation teamwork reveal to dramatic improvement of general status, safety of patient gait and quality of life. Results.– We discuss about the role of rehabilitation approach to patients with chronic degenerative diseases, like Parkinson disease, multisystem atrophy, multiple sclerosis, Alzheimer disease and importance of motor and cognitive training along with strong drug administration in rehabilitation setting. Discussion.– Accurate multidiscipline rehabilitation team treatment and follow up cause stabile functional status of patients suffer from chronic disease and improved their quality of life. http://dx.doi.org/10.1016/j.rehab.2014.03.1539 P502-e
Knee pain relief with genicular nerve blockage in a brain injured patient with heterotopic ossification
E. Adiguzel ∗ , A. Uran , S. Kesikburun , E. Yasar Gulhane Military Medical Academy, Department of PMR, Turkish Armed Forces Rehabilitation Center, Ankara, Turkey ∗ Corresponding author. Keywords: Heterotopic ossification; Genicular nerve blockage Introduction.– Heterotopic ossification (HO) is the ectopic bone formation in non-osseous tissues. Here we aimed to present a patient with knee pain due to neurogenic HO. Observations.– A 14-year-old traumatic brain injured patient was admitted to our hospital with bilateral knee pain and limited range of motion (ROM). Her medical history revealed that she had a motor vehicle accident 1.5 years ago. She had knee pain for two months especially while walking and standing exercises. Visual Analog Score (VAS) of knee pain was 80 mm. On physical examination, there was ROM limitation of both knee joints. There was no redness and effusion. X-ray examination revealed calcification, which was diagnosed as HO. After 15 sessions physical therapy, she did not have pain relief. We performed ultrasonography (US) guided genicular nerve blockage to both knees with 2 mL lidocaine and 1 mL bethamethasone. Two weeks after the injection, VAS of pain was decreased to 30 mm, walking distance increased. No adverse effect was seen. At six-month follow-up VAS of pain was still 20 mm. Discussion.– US guided genicular nerve blockage can provide pain relief in HO and this technique may be effective and alternative for pain
e424
Abstracts / Annals of Physical and Rehabilitation Medicine 57S (2014) e422–e424
relief in patients with neurogenic knee HO to increase patient’s compliance. http://dx.doi.org/10.1016/j.rehab.2014.03.1540
Further reading Levit KR et al. (1995), “State Health Expenditure Accounts: Building Blocks for State Health” EDF brings disability in the horizon (2020). http://dx.doi.org/10.1016/j.rehab.2014.03.1542
P503-e
Census study of the students with disabilities and of the compensations implemented by the Handicap Mission within the Aix-Marseille University M. Prats a,∗ , B. Delorge b , M. Kerzoncuf a , L. Bensoussan a , J.M. Viton a , A. Delarque a a CHU La Timone, Service de Médecine Physique Réadaptation, Marseille, France b Responsable de la Vie étudiante et handicap de l’université d’Aix Marseille, Marseille, France ∗ Corresponding author. Introduction.– Access to the college cycle for the students with disabilities (SWD) and their employability have become a priority for universities. The Handicap Mission manages it within the Aix-Marseille University (AMU). Few studies focus on the SWD’s insertion/integration within the universities and on the compensations. The objective is to analyse within the AMU the SWD’s census and characteristics, and the Handicap Mission’s operating. Methods.– Census is conducted with a Handi-need card (university curriculum, deficiencies, technical and social helps, adjustments appealed for at the university). The SWD is addressed to the Preventive Medicine Department, which carries out an adjustment certificate, addressed to the Handicap Mission. Results.– The Handicap Mission improves SWD’s insertion, defines necessary adjustments and promotes research on disability. In total, 551 SWD are identified, 304 in law and human sciences, 141 encountered deficiencies related to language disorders, among which 105 were not defined by the students (“Other” in the questionnaire). Five hundred and nineteen SWD benefited from the third time, 40 got support for taking notes. Discussion.– Compensations and Handicap Mission improve the monitoring and the link between high school and university for the SWD, promote their exam success and give them support in the working life. http://dx.doi.org/10.1016/j.rehab.2014.03.1541 P504-e
International classification of health committee (South Africa) B. Dodi Family World Vision, Durban, South Africa Keywords: European Disability Forum; South African Federal Council on Disability; National Inter-Sectoral Disability Prevention Strategy The department of health and the South African Federal Council on Disability facilitates the development of a National Inter-Sectoral Disability Prevention Strategy that sets National norms and minimum standards for the prevention of disabilities. Health care is one of the largest industries and complex in terms of job creation and innovations. It calls for a core set of financial data provided by the National Health Accounts as well as by International comparisons of health care spending. Research disability matters should be grounded in a human rights perspective promoting participation and access of disabled in order to produce useful data. European Disability Forum 2020 encourages 100% funding for organisations of persons with disabilities participating in research projects. Public awareness through office of the deputy president in consultation with (SAHRC) and (SAFCD) should develop a medium and long term disability awareness strategy, inclusion of disability as a priority in the National Health plan for universal access to primary health care. In conclusion the South African constitution brought equal rights for all including the disabled.
P505-e
Agressive behaviour after traumatic brain injury
S. Domingues ∗ , C. Galvão , G. Pires , C. Afonso , L. Gonc¸alves , J. Jacinto Centro de Medicina de Reabilita¸cão de Alcoitão, Alcabideche ∗ Corresponding author. Keywords: Traumatic brain injury; Agitation; Treatment Introduction.– Traumatic brain injury (TBI) is one of the major causes of disability worldwide. It often results in multifocal lesions and diffuse brain damage, with a variety of physical, cognitive and neurobehavioral impairments, that are unique to each person and rise additional obstacles to rehabilitation programs and future integration. Agitation is a common finding in the acute phase of recovery from TBI aggression, generating anxiety and fear among family and health care providers. In a rehabilitation department, it assumes a greater relevance interfering with the rehabilitation process and often preventing successful outcomes. Methods.– A research on PubMed with the words “traumatic brain injury” AND “agitation” AND “treatment” and abstract evaluation was carried out. Results.– Pharmacologic treatment for agitation might be beneficial, however, unlike other psychiatric and neurologic conditions, the use of pharmaceuticals is still not evidence based for those patients. Discussion.– An adequate program for providing positive and removing negative stimuli is needed, with the use of medication and non-pharmacologic methods to promote the desired long-term outcomes. Further reading Sandel ME et al. The agitated brain injured patient. Definitions, differential diagnosis, and assessment. Arch Phys Med Rehabil 1996.77:617–23. http://dx.doi.org/10.1016/j.rehab.2014.03.1543 P506-e
Impacts of financial crisis on rehabilitation I.A. Tzanos ∗ , M. Papastefanou , E. Stefas , A. Patrelis , K. Tziotzou , N. Groumas National Rehabilitation Centre, Athens, Ilion, Greece ∗ Corresponding author.
Introduction.– The purpose of this study was to ascertain if financial crisis has impacts on rehabilitation. Methods.– Between Jan 2011–Aug 2013 in our department there were hospitalized 518 patients (299 strokes, 102 paraplegias and tetraplegias, 24 amputations, 93 other pathologies). Respectively, 3940 outpatients with similar problems were examined. Patients were recorded in case they (a) needed orthotics or prostheses (b) needed rehabilitation continuance after hospitalization or physiotherapy for outpatients (c) had problems with special drug administration. Results.– Thirty percent of the 899 stroke inpatients and outpatients who needed orthotics had economic insufficiency to buy them. Twenty percent of those who needed amputation could not be provided with it for economical reasons. The percentage rises to 100% for those without any medical insurance. Also 40% of patients who needed special drug administration for spasticity (botulinum toxin) or baclofen pump could not have access to them because of the complicated and difficult procedure. Concerning to outpatients with musculoskeletal problems who needed physiotherapy or inpatients who needed to continue their rehabilitation program after hospitalization, 20% of them could not afford it and 30–50% did not complete the therapy process. Discussion.– Economic difficulties during the last years have significant impact on patients’ full term rehabilitation. http://dx.doi.org/10.1016/j.rehab.2014.03.1544