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Poster 158: Availability of Teaching Skills Improvement Programs in U.S. Physical Medicine and Rehabilitation Academic Programs
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ACADEMY ANNUAL ASSEMBLY ABSTRACTS
lower-extremity weakness. Case Description: On presentation, a lumbar puncture was performed that showed pleocytosis with lymphocytic predominance and elevated protein concentration. After progression of his symptoms to acute flaccid paralysis and onset of urinary retention, magnetic resonance imaging of the thoracic and lumbar spine were obtained that found contrast enhancement around the conus, with increased central cord signal on T2 imaging, suggesting an inflammatory or infectious process. Electromyography was suggestive of a lumbosacral motor neuropathy or polyradiculopathy. Viral culture of the cerebrospinal fluid was positive for West Nile virus (WNV) and the patient was diagnosed with WNV myelitis. Assessment/Results: Given the patient’s symptoms and decreased mobility, physiatry was consulted and he was admitted to the acute rehabilitation floor. On admission, the patient was at a moderate-to-maximum assistance level for transfers and bed mobility. The patient increased his overall strength and on completion of the rehabilitation program he was independent in activities of daily living, ambulating with a right knee-ankle-foot orthotic and a left ankle-foot orthotic and a rolling walker up to 45m (150ft), and was able to negotiate stairs at a supervised level. Conclusions: Encephalitis and meningitis are more common manifestations of the WNV infections than the acute flaccid paralysis syndrome. The acute flaccid paralysis syndrome is preceded by encephalitis, a rash, and typically produces an asymmetric myelitis with long-term functional outcomes demonstrating that most will have incomplete recovery of limb strength resulting in profound residual deficits. As WNV infections in the United States rise, comprehensive rehabilitation should be considered for those with this condition to provide the best opportunity to improve functional mobility and quality of life. Key Words: Myelitis, Paralysis; Rehabilitation; West Nile virus.
Poster 158 Availability of Teaching Skills Improvement Programs in U.S. Physical Medicine and Rehabilitation Academic Programs. AnnMarie Thomas, MD (Spaulding Rehab/Harvard Med, Boston, MA); Stacy Bishop, DO. Disclosure: A. Thomas, None; S. Bishop, None. Objective: To determine the prevalence and characteristics of teaching skills improvement programs (TSIPs) in academic PM&R programs. Design: A 23-item questionnaire was emailed and faxed to the 65 PM&R residency program directors in October 2004 and again in March 2005. Information requested included demographics, whether or not there was a TSIP, and the characteristics of any TSIP. Setting: U.S. PM&R residency programs. Participants: Residency program directors. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: 63% (n⫽41) completed the survey of which 17% (n⫽7) had a TSIP. The TSIPs were offered 1 to 2 times per year, with 1 to 2 hours of instruction per offering; 57% of the TSIPs were during working hours. 86% of the TSIPs had mandatory attendance and 50% included other specialties. The department chair or other teaching staff provided the instruction in 50% of the TSIPs. The most common topic covered was evaluation and feedback and the most frequent instructional method was group discussion. 50% provided post-program assessments and 57% offered later reinforcement of teaching skills. Resident evaluation of faculty teaching skills occurred in 92.7% of the residency programs that responded. Conclusions: Few TSIPs exist in academic PM&R programs. Further evaluation is needed to determine the most effective characteristics of TSIPs. Key Words: Rehabilitation; Teaching. Arch Phys Med Rehabil Vol 88, September 2007
Poster 159 Cognitive Demand Affects Functional Mobility in Multiple Sclerosis. Seema R. Khurana, DO (University of Miami, Miami, FL); George H. Kraft, MD; Melissa J. Cline, BS; Alyssa M. DiGiacomo, MPH; Rohini V. Wadhwani, BS; James D. Bowen, MD. Disclosure: S.R. Khurana, None; G.H. Kraft, None; M.J. Cline, None; A.M. DiGiacomo, None; R.V. Wadhwani, None; J.D. Bowen, None. Objective: To analyze the affects of cognitive distractions on ambulation in people with multiple sclerosis (MS). Design: Prospective case-control study. Setting: MS clinic. Participants: 100 ambulatory (Expanded Disability Status Scale score ⬍6.0) community-dwelling adults (53 with MS, 57 age- and sex-matched controls) were enrolled. Interventions: 2 ambulation measures were used: the Timed Up & Go (TUG) test and a 100-foot walking test. These measures were performed under 3 conditions: no cognitive task; a simple cognitive task: reciting the alphabet; and a more difficult cognitive task: counting backward by 3. In addition, subjects counted backward by 3 while seated and completed the Paced Auditory Serial Addition Test. Main Outcome Measures: The time taken to complete each of the tests and the subjects’ accuracy. Results: In MS subjects and controls, both simple and complex cognitive tasks adversely affect motor performance. MS subjects showed trends toward greater differences in speed between the TUG alone and the TUG with the alphabet (P⫽.04). The MS group performed 81% to 92% worse, respectively, when performing a cognitive task along with the motor task than with the motor task alone. Conclusions: Cognitive challenge does impair speed of motor behavior in MS. The complexity of the cognitive task may not matter, but more importantly, the 2 tasks are being performed simultaneously. This study is relevant to MS because it addresses the interplay between 2 areas that are commonly affected by MS: cognition and motor function. The results allow us to better understand the impact of distraction on common motor functions. Key Words: Cognition; Multiple sclerosis; Rehabilitation; Walking. Poster 160 Lumbar Diskogenic Pain: A Review of Minimal Invasive Treatment Modality. Hany R. Nosir, MD (Advanced Pain Management, Milwaukee, WI). Disclosure: H.R. Nosir, None. Objective: To understand the role of minimal invasive treatment in lumbar diskogenic pain, including thermal collagen modification treatment, biologic photodynamic-photochemical disk repair, and disk cell transplantation. Data Sources: Systematic review of the medical and surgical literature regarding minimal invasive therapy in lumbar diskogenic pain. 40 research and clinical reports published between 2000 and 2006 were reviewed for lumbar degenerative disk disease, minimal invasive therapy, and treatment outcomes. Study Selection: A systematic review of all available studies based on Cochrane Collaboration evidence review criteria and meta-analysis of minimal invasive interventions in lumbar diskogenic pain. Case series, cost-effectiveness analysis, randomized trials, and prospective studies were reviewed. Data Extraction: The literature on the minimal invasive therapy in disk disease is limited to short clinical follow-ups. The success rates reported in different studies vary from 65% to 70% of excellent or good results. Data Synthesis: Minimal invasive intradiskal treatment has shown promising results with regard to pain relief, increased level of functioning, and improved quality of life. Conclusions: Minimal invasive disk modalities provide an alternative for lumbar diskogenic pain, with fewer long-term side effects. However, more clinical studies and basic science research are necessary to improve the clinical efficacy of these techniques. Key Words: Intervertebral disk; Rehabiliation.
ACADEMY ANNUAL ASSEMBLY ABSTRACTS
lower-extremity weakness. Case Description: On presentation, a lumbar puncture was performed that showed pleocytosis with lymphocytic predominance and elevated protein concentration. After progression of his symptoms to acute flaccid paralysis and onset of urinary retention, magnetic resonance imaging of the thoracic and lumbar spine were obtained that found contrast enhancement around the conus, with increased central cord signal on T2 imaging, suggesting an inflammatory or infectious process. Electromyography was suggestive of a lumbosacral motor neuropathy or polyradiculopathy. Viral culture of the cerebrospinal fluid was positive for West Nile virus (WNV) and the patient was diagnosed with WNV myelitis. Assessment/Results: Given the patient’s symptoms and decreased mobility, physiatry was consulted and he was admitted to the acute rehabilitation floor. On admission, the patient was at a moderate-to-maximum assistance level for transfers and bed mobility. The patient increased his overall strength and on completion of the rehabilitation program he was independent in activities of daily living, ambulating with a right knee-ankle-foot orthotic and a left ankle-foot orthotic and a rolling walker up to 45m (150ft), and was able to negotiate stairs at a supervised level. Conclusions: Encephalitis and meningitis are more common manifestations of the WNV infections than the acute flaccid paralysis syndrome. The acute flaccid paralysis syndrome is preceded by encephalitis, a rash, and typically produces an asymmetric myelitis with long-term functional outcomes demonstrating that most will have incomplete recovery of limb strength resulting in profound residual deficits. As WNV infections in the United States rise, comprehensive rehabilitation should be considered for those with this condition to provide the best opportunity to improve functional mobility and quality of life. Key Words: Myelitis, Paralysis; Rehabilitation; West Nile virus.
Poster 158 Availability of Teaching Skills Improvement Programs in U.S. Physical Medicine and Rehabilitation Academic Programs. AnnMarie Thomas, MD (Spaulding Rehab/Harvard Med, Boston, MA); Stacy Bishop, DO. Disclosure: A. Thomas, None; S. Bishop, None. Objective: To determine the prevalence and characteristics of teaching skills improvement programs (TSIPs) in academic PM&R programs. Design: A 23-item questionnaire was emailed and faxed to the 65 PM&R residency program directors in October 2004 and again in March 2005. Information requested included demographics, whether or not there was a TSIP, and the characteristics of any TSIP. Setting: U.S. PM&R residency programs. Participants: Residency program directors. Interventions: Not applicable. Main Outcome Measures: Not applicable. Results: 63% (n⫽41) completed the survey of which 17% (n⫽7) had a TSIP. The TSIPs were offered 1 to 2 times per year, with 1 to 2 hours of instruction per offering; 57% of the TSIPs were during working hours. 86% of the TSIPs had mandatory attendance and 50% included other specialties. The department chair or other teaching staff provided the instruction in 50% of the TSIPs. The most common topic covered was evaluation and feedback and the most frequent instructional method was group discussion. 50% provided post-program assessments and 57% offered later reinforcement of teaching skills. Resident evaluation of faculty teaching skills occurred in 92.7% of the residency programs that responded. Conclusions: Few TSIPs exist in academic PM&R programs. Further evaluation is needed to determine the most effective characteristics of TSIPs. Key Words: Rehabilitation; Teaching. Arch Phys Med Rehabil Vol 88, September 2007
Poster 159 Cognitive Demand Affects Functional Mobility in Multiple Sclerosis. Seema R. Khurana, DO (University of Miami, Miami, FL); George H. Kraft, MD; Melissa J. Cline, BS; Alyssa M. DiGiacomo, MPH; Rohini V. Wadhwani, BS; James D. Bowen, MD. Disclosure: S.R. Khurana, None; G.H. Kraft, None; M.J. Cline, None; A.M. DiGiacomo, None; R.V. Wadhwani, None; J.D. Bowen, None. Objective: To analyze the affects of cognitive distractions on ambulation in people with multiple sclerosis (MS). Design: Prospective case-control study. Setting: MS clinic. Participants: 100 ambulatory (Expanded Disability Status Scale score ⬍6.0) community-dwelling adults (53 with MS, 57 age- and sex-matched controls) were enrolled. Interventions: 2 ambulation measures were used: the Timed Up & Go (TUG) test and a 100-foot walking test. These measures were performed under 3 conditions: no cognitive task; a simple cognitive task: reciting the alphabet; and a more difficult cognitive task: counting backward by 3. In addition, subjects counted backward by 3 while seated and completed the Paced Auditory Serial Addition Test. Main Outcome Measures: The time taken to complete each of the tests and the subjects’ accuracy. Results: In MS subjects and controls, both simple and complex cognitive tasks adversely affect motor performance. MS subjects showed trends toward greater differences in speed between the TUG alone and the TUG with the alphabet (P⫽.04). The MS group performed 81% to 92% worse, respectively, when performing a cognitive task along with the motor task than with the motor task alone. Conclusions: Cognitive challenge does impair speed of motor behavior in MS. The complexity of the cognitive task may not matter, but more importantly, the 2 tasks are being performed simultaneously. This study is relevant to MS because it addresses the interplay between 2 areas that are commonly affected by MS: cognition and motor function. The results allow us to better understand the impact of distraction on common motor functions. Key Words: Cognition; Multiple sclerosis; Rehabilitation; Walking. Poster 160 Lumbar Diskogenic Pain: A Review of Minimal Invasive Treatment Modality. Hany R. Nosir, MD (Advanced Pain Management, Milwaukee, WI). Disclosure: H.R. Nosir, None. Objective: To understand the role of minimal invasive treatment in lumbar diskogenic pain, including thermal collagen modification treatment, biologic photodynamic-photochemical disk repair, and disk cell transplantation. Data Sources: Systematic review of the medical and surgical literature regarding minimal invasive therapy in lumbar diskogenic pain. 40 research and clinical reports published between 2000 and 2006 were reviewed for lumbar degenerative disk disease, minimal invasive therapy, and treatment outcomes. Study Selection: A systematic review of all available studies based on Cochrane Collaboration evidence review criteria and meta-analysis of minimal invasive interventions in lumbar diskogenic pain. Case series, cost-effectiveness analysis, randomized trials, and prospective studies were reviewed. Data Extraction: The literature on the minimal invasive therapy in disk disease is limited to short clinical follow-ups. The success rates reported in different studies vary from 65% to 70% of excellent or good results. Data Synthesis: Minimal invasive intradiskal treatment has shown promising results with regard to pain relief, increased level of functioning, and improved quality of life. Conclusions: Minimal invasive disk modalities provide an alternative for lumbar diskogenic pain, with fewer long-term side effects. However, more clinical studies and basic science research are necessary to improve the clinical efficacy of these techniques. Key Words: Intervertebral disk; Rehabiliation.