News Nouvelles - Canadian Association of Physical Medicine and

CAPM&R
ACMP&R
The Canadian Association of Physical Medicine and Rehabilitation
News
Nouvelles
L’Association canadienne de médecine physique et de réadaptation
December 2008
INSIDE THIS ISSUE
SOMMAIRE
Décembre 2008
Save the Date!
“Reach for the Summit Collaborative Care” May 27-30, 2009
Rimrock Resort Hotel - Banff, AB.
From the Editor....................... 2
Le mot de la rédaction............ 2
President’s Message................ 3
Message de la présidente......... 3
Awards and Special
Recognition............................. 4
Interesting Cases..................... 5
Research Corner: Why this
article is interesting ............... 6
Rehabilitation Hallways........... 6
2008 Conference Highlights.... 7
2008 Contest Winners............. 8
2009 Annual Scientific
Meeting Preliminary
Announcement..................... 10
Call for Abstracts................... 10
Contest and Award Notices.... 11
Paralympic Update................. 13
In Memoriam......................... 14
The Rimrock Resort Hotel is a CAA/AAA Four Diamond rated property
FROM THE EDITOR
Dear Members:
Meridith is a truly dedicated medical
educator. For those of us who
have had the privilege to work with
Meridith recognize the knowledge and
professionalism she brings to our
specialty. Though distance separates
us and I now have 6 years postresidency experience under my belt, I
still find myself asking, “What would
Meridith do?” when I am presented
with a particular challenge.
W
inter has arrived early here
on the east coast with cold
weather and snow. Very much
in contrast to the beautiful weather we
had in June for our annual meeting
in Fredericton New Brunswick. It
was great to see so many colleagues
travel across Canada to visit our small
province. I would like to take this
opportunity to thank the planning
committee for an impressive meeting.
Patti Forgeron
As we enter the holiday season and
our practices get increasingly busy, a period of
reflection is often put on the back burner. As
I reflect on the year 2008, I am reminded how
fortunate I am to have my health, family and
rewarding career. We all have individuals who
have touched us in some way, either personally or
professionally and often overlook their importance
in our lives.
I am fortunate to have trained with Dr. Meridith
Marks during my residency training in Ottawa.
Meridith is going through some tough
times with her health and she has
been courageous in her relentless battle with her
illness. Her perseverance should be an inspiration
to all of us. Best wishes Meridith!
Friends and colleagues, over the holidays spend
quality time with your family and friends. Reflect
and celebrate your individual professional and
personal accomplishments.
Merry Christmas and Happy New Year.
Dr. Patti Forgeron
Editor
Le mot de la rédaction
Aux membres,
S
ur la côte Est, l’hiver a fait sentir sa
présence tôt cette année : nous avons
déjà de la neige et le temps est froid. Tout
un contraste avec la belle température du mois
de juin au moment de l’assemblée annuelle à
Fredericton au Nouveau-Brunswick. La venue de
nombreux collègues d’un peu partout au Canada
dans notre petite province m’a fait chaud au coeur.
Je profite de l’occasion pour remercier le comité de
planification de ce congrès impressionnant.
À la veille de la période des fêtes, alors que notre
charge de travail s’alourdit, nous avons peu de
temps pour réfléchir au temps qui passe. Revoyant
en pensée l’année 2008, je me rends compte à
quel point je suis chanceuse d’être en santé, d’être
entourée des membres de ma famille et de mener
une carrière gratifiante. Nous avons tous croisé
des personnes qui ont laissé une empreinte dans
notre vie, personnelle ou professionnelle, et nous
ne sommes pas toujours conscients sur le coup de
leur importance.
J’ai eu le bonheur de bénéficier des enseignements
de la Dre Meridith Marks durant ma résidence
2
à Ottawa. Meridith est la quintessence de
l’éducatrice médicale. Tous ceux qui ont eu le
privilège de travailler avec elle savent qu’elle
personnifie l’expertise et le professionnalisme.
Malgré la distance qui nous sépare et le fait que
j’ai maintenant six ans d’expérience, il y a encore
des jours où je me demande ce que ferait Meridith
dans tel ou tel cas.
Meridith traverse une période difficile, sa santé
n’est pas bonne. Elle fait preuve d’un immense
courage dans son combat contre la maladie. Sa
détermination est exemplaire. Je me croise les
doigts en espérant qu’elle remporte cette victoire.
Bonne chance Meridith!
Je vous souhaite, amis et collègues, une belle
période des fêtes en compagnie de votre famille
et de vos amis. Profitez-en pour vous remémorer
les beaux moments de votre vie, personnelle ou
professionnelle.
Joyeux Noël et bonne et heureuse année.
Dre Patti Forgeron
Rédactrice en chef
CAPM&R NEWS - NOUVELLES DE L’ACMP&R
President’s Message
such as health human resources and
an explosion in healthcare expenditures
that many provinces cannot manage.
s I am writing this short letter to
On November 14th, I attended a meeting
you, I am preparing to return to
on human resources in specialty care
Haiti where I have been helping
arranged by the Royal College. While
with the training of local healthcare
preparing for this meeting I realized
workers in rehabilitation therapy and
that we, as a national specialty, have a
practice. Haiti has been especially hard
Colleen O’Connell, lot of work to do to get a better grasp
MD, FRCPC
hit this past year, beginning with the
of our anticipated needs for Physical
food crisis and associated rioting and
Medicine & Rehabilitation in the future.
instability. This was followed by political turmoil,
The demand for our specialty is ever increasing.
two hurricanes, two tropical storms, and now
We are seeing a disproportionate increase in the
the collapse of two schools. In the midst of this
number of persons living with impairments, partly
chaos, it never ceases to amaze me how caring
due to an aging population as well as improved
and concerned our own communities are here
emergency and general medical interventions.
in Canada. I have received numerous messages
Although new residency positions have been
and offers of support from colleagues and the
added to existing programs, and new programs
public across the country simply because they
have been introduced, PM&R as a specialty
knew I “did something in Haiti”. I am often asked
must come together and critically appraise
if it seems hopeless, and whether we are making
our anticipated needs over the next decades.
any difference at all. Based on the response that
Otherwise we will be unable to advocate effectively
I have received from friends and colleagues, I
or respond with appropriate training and resource
am confident that we are making a difference.
allocation.
The fact that there is this increase in awareness
I look forward to working with you all in the
and that we are thinking outside of our borders
remaining six months of my term as President of
is testimony to the impact that we can have as
your organization. It has truly been a pleasure.
global citizens.
Have a wonderful holiday season and we’ll see you
So now back on the home front, while our
all in Banff.
own “crises” may pale in comparison to those
Colleen O’Connell, MD, FRCPC
experienced by our neighbors to the south, we
Physical Medicine & Rehabilitation
are at critical crossroads with regards to issues
Dear Members of Canadian Association
of Physical Medicine & Rehabilitation:
A
Message de la présidente
Aux membres de l’Association canadienne de
médecine physique et de réadaptation,
A
u moment d’écrire ce bref message, je me
prépare à retourner à Haïti où je participe à
la formation en réadaptation de travailleurs
de la santé. Le pays a été de nouveau durement
frappé cette année, d’abord par la crise alimentaire
et les émeutes subséquentes qui ont créé un
climat d’instabilité. Ensuite la tourmente politique,
deux ouragans, deux tempêtes tropicales et
l’effondrement de deux écoles dernièrement. Dans
tout ce chaos, la compassion et le dévouement des
gens d’ici n’ont de cesse de m’étonner. J’ai reçu
une multitude de messages et de propositions
d’aide de collègues et de personnes d’un peu
partout au pays tout simplement parce qu’ils
DECEMBER 2008 DÉCEMBRE
savent que j’ai « fait quelque chose en Haïti ». On
me demande souvent si cela est sans espoir, et
si nous pouvons vraiment aider la population. À
en juger par la réaction d’amis et de collègues, je
suis convaincue que notre présence est utile. La
sensibilisation accrue et le fait que le sort d’un
autre pays nous préoccupe illustrent l’impact que
nous pouvons avoir quand nous nous conduisons
en citoyens du monde.
Revenons à nos moutons, nos « crises » peuvent
sembler bien mineures en comparaison avec
celles qui sévissent chez nos voisins du Sud.
Nous sommes à la croisée des chemins en ce
qui concerne des questions telles les ressources
humaines en santé et la flambée des dépenses
Suite à la page 6
3
Awards and Special Recognition
‘Mr. Rehabilitation’ – Grateful War Veterans Honour
Dr. Amarjit Singh Arneja
The Indo-Canadian Telegram (July 2008)
‘
M
r. Rehabilitation’ Dr. Amarjit Singh
Arneja and his seven-member
Rehabilitation Team were presented a
plaque by the veterans of the War Amputations
of Canada Manitoba Branch. Bill Neal, Director
of the War Amputations Manitoba Branch,
wrote in a 2003 letter of recognition: “You have
provided services to veteran amputee patients,
diligently with dedication, extra care and
innovation. Your kindness, great professional
medical expertise, prompt attention, exceptional
concerns and caring attitude towards the
veterans is very much appreciated.”
CPC names prominent Toronto doctor as 2010
assistant chef de mission
Dr. Gaétan Tardif, of
Toronto, has been named
as Assistant Chef de
Mission for the Canadian
team at the Vancouver
2010 Paralympic Winter
Games. He will work
alongside 2010 Chef de
Mission Blair McIntosh. They will oversee
all aspects of Team
Canada’s preparation
for the 2010 Vancouver
Games, the premiere
winter sporting event for athletes with a physical
disability. The Vancouver 2010 Paralympic
Winter Games run March 12-21, 2010. “It’s
an honour to serve the Canadian Paralympic
Committee, Paralympic athletes and coaches. My
current involvement with the Beijing Mission has
only strengthened my desire to remain connected
to the Paralympic Movement in Canada,” said
Tardif.
He is currently also Assistant Chef de Mission
for the Canadian team heading to the Beijing
2008 Paralympic Summer Games, running
from September 6-17, 2008 in China. Tardif
has extensive experience at Paralympic Games,
having also served as Chief Medical Officer at
the 2006 Turin Paralympic Winter Games and
at the 2002 Salt Lake City Paralympic Winter
Games, and as a team doctor at the 2004 Athens
4
Paralympic Summer Games and at the 2000
Sydney Paralympic Summer Games.
“Paralympic athletes are truly phenomenal. They
are so amazing and inspiring - a joy to work
with - and that’s what brings me back again
and again,” stated Tardif, who is Vice-President
of Patient Care and Chief Medial Officer at the
Toronto Rehabilitation Institute. He is also
Academic Head of the Division of Physiatry at
the University of Toronto, Head of the Division
of Physiatry, Department of Medicine at the
University of Health Network and Toronto’s Mount
Sinai Hospital.
“I have always had an interest in leveraging the
public awareness that the Paralympic Games
create to promote the social and health benefits
of participating in physical activities regardless of
physical impairments,” says Tardif. “Hosting the
Vancouver 2010 Paralympic Games will provide
unprecedented exposure to the Paralympic
Movement and help spread the word about the
benefits of sport for Canadians with a physical
disability. It will also enable us to showcase
the incredible athletic feats of Canada’s elite
Paralympic athletes to both our hometown crowds
and internationally.”
McIntosh and Tardif’s initial key priorities will be
finalizing the budget and operational plans for
the Canadian team at the 2010 Games, selecting
key volunteer members of their team and meeting
with athletes and coaches.
CAPM&R NEWS - NOUVELLES DE L’ACMP&R
Interesting Cases
Patient with a Cauda Equina Syndrome Complicated by
Pneumococcal Meningitis and Osteomyelitis: A Case Report
S. Abbas Moosavi MD, Andrei Dokukin, MD Se Won Lee, MD
Montefiore Medical Center/Albert Einstein College Medicine, Bronx New York
P
atient presented to the ER complaining of
severe low back pain. While getting up from
a chair, she experienced 10/10 sharp, shock
– like pain radiating to the right leg accompanied
by “pins and needles” sensation and weakness.
She was obese (163 lbs, height 5’ 4”), had a heart
rate of 105 bpm and in distress. There was no local
spinal or paraspinal tenderness, but the pain was
reproducible with any movement. Bilateral SLR
was positive. Initially lower extremity strength and
sensation could not be adequately tested because
of pain. MRI of the spine revealed severe spinal
stenosis at L4-L5 level.
Immediately, she underwent transforaminal
steroid injection with lidocaine and Depomedrol
with some relief. On subsequent examination she
had 4/5 strength in bilateral lower extremities.
Sensory examination revealed “saddle” anesthesia.
Rectal tone was decreased and she did not urinate
voluntarily since admission about 1 day. Diagnosis
of cauda equina syndrome (CES) was made.
Intravenous steroid therapy was initiated, and
emergent decompression surgery was scheduled.
On the way to the OR patient became
unresponsive. She had nucal rigidity, BP was
220/120 and T° was 102. Work up revealed
Streptococcus pneumoniae meningitis and IV
antibiotics were started. Over the course of
treatment, her strength deteriorated to 3/5 in
proximally and 2/5 distally in LE. Rectal tone
became absent, and the sensory deficits worsened.
Eventually she underwent L4/L5 laminectomy,
about 3 weeks after admission.
In the rehabilitation unit, patient’s strength
improved to 4-/5 at hip flexors, 4+/5 at knee
extensors, and 2/5 ankles bilaterally. She became
independent with bed-to-chair transfers, and was
able to ambulate 150 feet with a rolling walker and
bilateral AFOs after two weeks of therapy. Patient’s
incision was not healing. Surgical pathology
showed Streptococcus pneumoniae osteomyelitis in
the excised portions of the L4-L5 vertebrae. Patient
was treated with long course of antibiotics and
discharged home.
DECEMBER 2008 DÉCEMBRE
Discussion:
CES is characterized by varying degree of bowel
and bladder dysfunction, perineal sensory loss, and
lower extremity motor deficits due to central disc
herniation in lumbar region. It is rarely reported as
a complication of spinal stenosis.(1) It is also a rare
complication of a lumbar epidural steroid injection
(LESI). Inadvertent subarachnoid injections of
intended epidural steroids have been reported to
cause CES.(2) It is possible that LESI played a role
in the development of CES in our patient. Bacterial
meningitis is a rare complication of an LESI (3), but
to our knowledge, Streptococcus pneumoniae has
never been reported as the causative organism.
Pneumococcal vertebral osteomyelitis has been
documented, and local trauma as the predisposing
factor.(4) Serial ESI may be immunosuppressive,
and a risk factor for development of osteomyelitis.
(5)
It remains unclear weather the LESI was the
cause for the infection in our patient. Significant
improvement in sensory, motor, bowel and urinary
bladder deficits occurs if the surgical decompression
is undertaken in the first 48 hours.(6) Our patient
showed significant improvements in strength despite
3 week delay in surgery. To our knowledge this is
the first case of CES complicated by streptococcal
meningitis and osteomyelitis.
References:
1. Johnsson KE, Sass M. Cauda equina syndrome in lumbar
spinal stenosis: case report and incidence in Jutland,
Denmark. J Spinal Disord Tech. 2004 Aug;17(4):334-5.
2. Bilir A, Gulec S. Cauda equina syndrome after epidural
steroid injection: a case report. J Manipulative Physiol Ther.
2006 Jul-Aug;2 z9(6):492.e1-3.
3. Cooper AB, Sharpe MD. Bacterial meningitis and cauda
equina syndrome after epidural steroid injections. Can J
Anaesth. 1996 May;43(5 Pt 1):471-4.
4. Schleiter G, Gantz NM. Vertebral osteomyelitis secondary
to Streptococcus pneumoniae: a pathophysiologic
understanding. Diagn Microbiol Infect Dis. 1986
May;5(1):77-80.
5. Simopoulos TT, Kraemer JJ, Glazer P, Bajwa ZH. Vertebral
osteomyelitis: a potentially catastrophic outcome after
lumbar epidural steroid injection. Pain Physician. 2008
Sep-Oct;11(5):693-7.5. Ahn UM, Ahn NU, Buchowski JM,
et al. Cauda equina syndrome secondary to lumbar disc
herniation: a meta-analysis of surgical outcomes. Spine
6. Ahn UM, Ahn NU, Buchowski JM, et al. Cauda equina
syndrome secondary to lumbar disc herniation: a metaanalysis of surgical outcomes. Spine. 2000;25:1515-1522.
5
Research Corner: Why this article is interesting
Finestone, Hillel M; Rabinovitch, Deborah L. “Tennis elbow no more: practical eccentric and concentric
exercises to heal the pain.” Canadian Family Physician 2008:54 (8): 1115-6.
Abstract
Lateral epicondylitis, commonly referred
to as tennis elbow, is thought to be an
overuse injury that involves the origin of
the wrist extensor muscles. It is brought on
by sports and occupational activities that
involve repetitive wrist motion or a power
grip. The overuse causes microtears near the
origin of the extensor carpi radialis brevis
at the lateral epicondyle. This leads to the
formation of fibrosis and granulation tissue.
Although treatments such as stretching and
steroid injections have been described as
successful, many cases are often difficult to
treat successfully. Eccentric training has been
described as an excellent treatment, regardless
of duration of symptoms, but its use is still
fairly limited in North America. The authors
describe a practical home-based treatment
protocol involving progressive eccentric and
concentric training of the wrist extensor
muscles. The potential physiological principles
involved in the healing process as well as
particular clinical “tips” will be presented. It
has been a very rewarding treatment.
Dr. H. Finestone has been contracted to write
a Greenwood Publishing book entitled “Pain
Detective: every symptom tells a story; How
stress and psychological hurt cause chronic
physical pain”. Estimated time of publication
is in 2009.
Rehabilitation Hallways
Are you connected to your colleagues through the Rehabilitation Hallways?
www.rehabilitationhallway.com/forum/
Suite de la page 3
en santé devant laquelle des provinces se
sentent impuissantes. Le 14 novembre dernier,
j’ai assisté à une réunion sur les ressources
humaines en médecine spécialisée organisée
par le Collège royal. En me préparant à
cette réunion, je me suis rendue compte que
nous, représentants d’une spécialité exercée
à l’échelle du pays, avions encore beaucoup
à faire pour déterminer avec précision
nos besoins en médecine physique et de
réadaptation à l’avenir. Nous constatons que la
demande dans notre spécialité est en hausse
constante. Nous sommes témoins d’une
augmentation sans précédent du nombre de
personnes aux prises avec une incapacité en
raison non seulement du vieillissement de
la population, mais également de l’efficacité
accrue des interventions médicales d’urgence
et générales. Même si de nouveaux postes de
6
résidence ont été ajoutés aux programmes de
formation et que de nouveaux programmes
ont vu le jour, la médecine physique et de
réadaptation en tant que spécialité doit
unir ses efforts pour évaluer ses besoins
dans les prochaines décennies. Si nous
manquons le coche, nous serons incapables
de véritablement défendre les intérêts de la
spécialité ou de réagir par la formation et
l’affectation des ressources appropriées.
Je me réjouis à l’idée de collaborer avec vous
tous durant les six derniers mois de mon
mandat à la présidence de votre association.
L’aventure a été captivante. Je vous souhaite
une agréable période des fêtes et je suis
impatiente de vous rencontrer à Banff.
Colleen O’Connell, médecin, FRCPC
Médecine physique et de réadaptation
CAPM&R NEWS - NOUVELLES DE L’ACMP&R
2008 Conference Highlights
2008 Conference Proceedings
You can access the 2008 Book of Abstracts on
the CAPM&R website at
www.capmr.ca/agm2008.htm.
3rd Place: Dr. Thomas A. Miller
A 30: Electrodiagnostic Outcome of Ulnar Nerve
Transposition
2008 Best Poster Presentation Awards
2008 Contest Reviewers
Best Overall: Dr. Jennifer Salter
A 27: Delayed Spinal Cord Injury Following
Electrical Trauma: A Case Study
The CAPM&R would like to thank the efforts of
those members who volunteered their time to
review the 2008 contest submissions.
Best Review: Dr. Robert Teasell
A 19: Blueprint for Improving Stroke
Rehabilitation in Canada
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Dr.
Best Experimental: Dr. John Flannery
A 16: An Innovation in Hip Fracture Care is
Helping Older Persons to Return Home: A New
Integrated Model of Care
Amarjit Arneja
Nigel Ashworth
David Berbrayer
Markus Besemann
Jeff Blackmer
Cathy Craven
Matthew Faris
Hillel Finestone
Heather Finlayson
David Flaschner
Katherine Knox
Mike Lang
Dhiren Naidu
Jaywant Patil
Jeff Pike
Mohan Radhakrishna
Lalith Satkunam
Debbie Timpson
Guy Trudel
Joy Wee
Scott Worley
These abstracts are available in the
CAPM&R 2008 Conference Proceedings:
www.capmr.ca/agm2008.htm.
Paper of the Year
Winner: Dr. Robert Teasell
Foley N, Salter K, Teasell R. Specialized Stroke
Services: A Meta-analysis Comparing Three
Models of Care. Cerebrovascular Diseases 2007;
23:194-202.
2008 Sandy Pinkerton Quaich
2008 Best Podium, Best Poster and
Paper of the Year Winners
2008 Best Podium Presentation Awards
1st Place: Dr. Guy Trudel
A 31: The Effect of Bedrest on Lower Limb Fat
Content and Muscle Atrophy
2nd Place: Dr. Douglas Priestley
A 33: Cardiovascular Morbidity and Mortality,
and Reamputation Rates Among Persons with
Lower Extremity Amputations due to Peripheral
Vascular Occlusive Disease
DECEMBER 2008 DÉCEMBRE
The 2008 Sandy Pinkerton Quaich was the
most exciting event to date. Winning the
sudden death playoff hole with a par 3 was
John Milczarek. For the full story, visit the
CAPM&R website at www.capmr.ca/sandy_
pinkerton_quaich.htm.
7
2008 Contest Winners
2008 Medical Student Essay
Contest Winner
2008 Resident Essay
Contest Winner
Considering the
Role of Quadriceps
Muscle Weakness in
Knee Osteoarthritis
How to Diagnose
Superior Labral
Anterior Posterior
(SLAP) Lesions
Michael J. Berger, MD Candidate Class of 2010
Schulich School of Medicine and Dentistry,
The University of Western Ontario, London,
Ontario, Canada
Gaurav Gupta, MD University of Ottawa, Ottawa,
Ontario, Canada.
Address all correspondence to Michael Berger
c/o Dr. Timothy J. Doherty LHSC, 339
Windermere Road, Room C7-131 London,
Ontario, N6A 5A5
Phone: (519) 685-8500 x73140
email: [email protected]
Introduction: Acute trauma and repetitive
overhead throwing can lead to pathology of the
superior labrum and associated biceps tendon,
known as superior labral anterior posterior
(SLAP) lesions. SLAP lesions are associated
with pain, and functional limitations, and do
not respond to conservative, non-operative
treatment.
Abstract
The purpose of this review is to examine
current understanding of the relationship
between quadriceps muscle strength and
osteoarthritis of the knee joint. While strength
deficits are common in healthy older adults,
they are often of greater magnitude in similarly
aged patients with OA. The mechanisms
responsible for the loss in muscle strength
in knee OA may include those previously
implicated in normal ageing processes,
such as changes to muscle and motor unit
morphology. In addition, neural mechanisms
contributing to strength loss, such as reduced
central drive (voluntary activation of the
quadriceps muscle), due to alterations in
joint architecture may occur independently of
normal ageing processes. While the relevance of
the neuromuscular system to the pathogenesis
of disease is not fully understood, the effect
of these deficits on pain and disability is well
established and has widespread implications
on the development and implementation of
rehabilitation protocols.
8
Abstract
Objective: To determine the clinical utility
of physical examination tests and imaging to
identify SLAP lesions.
Methods: A comprehensive literature review
and critical analysis of clinical tests and
imaging modalities, relevant to SLAP lesions,
was conducted.
Results: There is no pathognomonic clinical
test or combination of tests for diagnosing
SLAP lesions. However, magnetic resonance
arthrograms (MRA) have a strong ability to
identify SLAP lesions.
Conclusion: Positive clinical tests and/or
lack of response to conservative treatment
should guide referral for MRA. Patients with
positive MRA for SLAP lesions, or ongoing
symptoms despite negative clinical and imaging
tests, should be considered for diagnostic
arthroscopy (i.e. gold standard).
CAPM&R NEWS - NOUVELLES DE L’ACMP&R
2008 Resident Research
Contest Winner
Using Modified
Rankin Scores to
Evaluate Stroke
Rehabilitation:
A Functional Independence
Measure Derivation.
Scott C Wiebe, MSc, MD1, Mike Sharma, MD,
FRCPC2, Daniel A Deforge, MD, FRCPC1, Hillel M
Finestone, MD, FRCPC3
1
2
3
Division of Physical Medicine and Rehabilitation, The
Ottawa Hospital Rehabilitation Centre, University of
Ottawa, Canada;
Department of Neurology, The Ottawa Hospital,
University of Ottawa, Canada;
Department of Physical Medicine and Rehabilitation,
Sisters of Charity of Ottawa Health Services, Canada
Abstract
Objective: The modified Rankin Scale (mRS)
is commonly used as a functional outcome
measure in stroke trials, while rehabilitation
facilities typically use the Functional
Independent Measure (FIMTM), making
comparison of acute stroke and rehabilitation
interventions difficult. We propose a method of
translating the FIM into the mRS.
Methods: Discharge functional scores for 294
patients completing stroke rehabilitation were
used to develop a translation of FIM scores into
mRS scores, which was then validated against
the source dataset and an independent set of
48 patients. After applying this translation to
yield admission mRS scores, we examined the
relationship between gains on the 2 scales.
Results: There was 76.5% agreement between
the direct and derived mRS scores with
excellent correlation (Spearman’s ρ 0.92, κw
0.91, p<0.0001). Agreement was 94.2% when
dichotomized at mRS ≤ 2. Validation performed
on an independent dataset yielded similar
agreement (68.7%; Spearman’s ρ 0.86, κw
0.88, p<0.0001). Absolute FIM gains and FIM
efficiencies correlated highly with mRS gains
(ANOVA F=14-60, p<0.0001), but a measure
of relative FIM recovery best distinguished
patients who improved on the mRS from those
who did not (F=140, p<0.0001).
Conclusions: Conversion to mRS scores from
available rehabilitation FIM scores is feasible
and demonstrates excellent reliability. This will
allow direct outcome and cost comparisons
for rehab interventions within the continuum
of stroke care. Relative recovery of FIM
deficits best reflects improvement on the mRS
compared to absolute FIM changes or FIM
efficiencies.
Did you know?
The CAPM&R is an Accredited Provider and able to review programs
for Section 1 credit. The cost for review is $500 + GST.
However, CAPM&R members benefit from a discounted rate of
$300 + GST for program reviews. Please visit the CAPM&R website
at www.capmr.ca/CPD_MOC_page.htm for more information.
The CAPM&R website is www.capmr.ca.
Our old site www.capmr.medical.org has been decommissioned.
Please update your bookmarks!
DECEMBER 2008 DÉCEMBRE
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2009 Annual Scientific Meeting
2009 Preliminary Program Outline
WEDNESDAY, MAY 27
Business Meetings
All Day
1900-2100
Welcome Reception
1900-2100
Exhibit Set Up
THURSDAY, MAY 28
0700-0845
0700-0845
0900-1200
1215-1315
1330-1600
1600-1715
1715-1830
1900-
0730-0845
Special Interest Group
Meetings
Business Meetings
Rehab Update
Lunch With Exhibitors
Stroke Symposium
Special Interest Group
Meetings
Residents Career Planning
Dinner Symposium Or Awards
Reception
FRIDAY, MAY 29
Special Interest Group
Meetings
*Please
0700-0845
0845-1200
130013001900-
Business Meetings
Scientific Program
Off-Site Events
Sandy Pinkerton Quaich – Golf
tournament – Banff Springs
Evening Event /Awards
Ceremony
SATURDAY, MAY 30
CPRDF Annual General
Meeting
0800-0845
CAPM&R Annual Business
Meeting
0900-0940
Humanities Lecture – Topic
TBC
0940-1200
Neuromuscular/Peripheral
Nerve Symposium
1200 -1300
Lunch With Exhibitors
1300-1600
MSK Symposium
1600-1700
Closing Plenary
1830Annual Dinner/Dance
0730-0800
note that the evening events may be adjusted.
Canadian Association of Physical Medicine
and Rehabilitation
Annual Scientific Meeting
May 27-30, 2009
The Rimrock Resort Hotel, Banff, AB
Call for Abstracts
The next Annual Scientific Meeting will be held May 27-30, 2009
at the Rimrock Resort Hotel in Banff, AB.
The Call for Abstracts is posted on the CAPM&R website at
www.capmr.ca/abstract_page_information.htm.
The deadline for submissions is February 15, 2009.
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CAPM&R NEWS - NOUVELLES DE L’ACMP&R
Contest and Award Notices
CAPM&R Award of Merit
I
n a spirit of recognition for achievement,
contribution, and character, the
CAPM&R introduces the Award of Merit.
In past years, members with outstanding
and exemplary contributions to the field of
physiatry were recognized by an Honorary
Lecture, held during the Association’s
Annual Scientific Meeting. In 2008,
CAPM&R Executive Committee elected
to resurrect the award, renaming it the
CAPM&R Award of Merit. Our Association
members are no ordinary citizens; with
valuable contributions to both the art and
science of medicine, mentoring, advocacy,
humanitarianism, research, and education.
A permanent plaque with recipients’
names, including the past Honorary
Lecturers, will be housed on display at
the CAPM&R headquarters located in the
Royal College of Physicians and Surgeons
of Canada building. Beginning with the
2008 Annual Scientific Meeting, recipients
will be honored with their award during a
presentation ceremony.
Nominations for the Award will be accepted
until February 15, 2009. The Executive of
the CAPM&R will select the recipient.
Criteria:
1. Must be a member in good standing with the
CAPM&R (any category).
2. Must have contributed to the activities of the
CAPM&R and/or CPRDF.
3. Must not be a current member of the CAPM&R
Executive Committee.
4. Must be nominated by his/her peers, at least one
who is a CAPM&R member.
5. Has made a contribution to the field of physiatry,
through research, education, advocacy, medical
care, humanitarianism, mentorship, or the
advancement of our field.
Process:
Please complete the nominations form, attach the
nominee’s CV and outline why the nominee is an
appropriate candidate. Completed nominations should
be submitted to the CAPM&R, 774 Echo Drive, Ottawa,
ON K1S 5N8. Submissions may also be sent by e-mail
to [email protected] or by fax to 613-730-1116. A
maximum of one award will be presented annually.
Award:
The recipient will be presented a plaque during an
awards ceremony held at the Annual Scientific Meeting
of the CAPM&R, and have opportunity to address
the membership for 5-10 minutes. Up to $1,000 will
be reimbursed to the recipient for their travel to and
accommodations at the conference, and registration for
that meeting will be complimentary.
See Nomination Form on page 12
Research and Essay Contests and
Paper of the Year
The Canadian Association of Physical Medicine and Rehabilitation (CAPM&R) 57th Annual
Scientific Meeting will take place at the Rimrock Resort Hotel in Banff, Alberta, May 27-30,
2009. The annual Resident and Medical Student Essay contest, the Resident and Student
Research contest, and the Paper of the Year submission deadline is February 15, 2009.
For additional information, please visit our website at
www.capmr.ca/cprdf-e.htm#activities.
DECEMBER 2008 DÉCEMBRE
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Nomination – CAPM&R Award of Merit
Nominee Information
Name:
Contact Information:
Involved in:
CAPM&R
 Yes  No
CPRDF  Yes  No
Please describe the nominee’s involvement in the CAPM&R and/or CPRDF:
Please describe the nominee’s contribution to the field of physiatry:
CV included  Yes  No
Nominator Information
Name:
E-mail:
Why did you nominate this member of CAPM&R for the Award of Merit?
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CAPM&R NEWS - NOUVELLES DE L’ACMP&R
Dear friend,
I am very excited to announce the launch of “Feel the Rush 2008,” a Canadian Paralympic Committee
(CPC) campaign celebrating winter and summer Paralympic sports. Our goal is to increase the number of
Canadians with a disability who “feel the rush” of confidence and empowerment that comes with enjoying
sport on a daily basis, some of whom will continue on to become high performance athletes and support
Canada retaining its top medal winning position at future Paralympic Games.
“Feel the Rush 2008,” follows the success of the original Feel the Rush campaign launched in 2006. We
are once again looking for your help in spreading the word.
At the centre of the campaign is www.feeltherush.ca, a destination for persons with a disability to learn
about the sports best suited to their abilities and interests and to locate national, provincial, or local
sporting associations.
To help you spread the word, and promote sport for the 3.6 million Canadians living with a disability, the
following items are available free of charge:
A promotional video that captures the thrill of Paralympic sports.
A Feel the Rush banner for sport and leisure fairs, conferences, events and speaking engagements.
For more information on “Feel the Rush 2008,” and to order these items please visit www.feeltherush.ca.
You can also help by adding the following link and description to the links or resources section of your
own website.
www.feeltherush.ca - a Canadian Paralympic Committee website providing details of sport for persons
with a disability to learn about the sports best suited to their abilities and interests, and to locate
national, provincial, or local sporting associations.
2008 will be an exciting year for the Paralympic movement in Canada. In September we will see our
athletes compete in Beijing, and then all eyes will turn to Canada for the lead up to the 2010 Paralympic
Winter Games in Vancouver and Whistler. The CPC plans to use this opportunity to create widespread
awareness of Canada’s international Paralympic leadership, and ensure Canadians with a disability
continue to be inspired and supported to participate in sport.
Please join us.
Sincerely,
Carla Qualtrough
President
DECEMBER 2008 DÉCEMBRE
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I n M e m o r i am
Andrews, Leslie Gerald, Vancouver, British Columbia; University of London, London,
England, 1952, pediatrics. Died Feb. 5, 2008, aged 78.
Basmajian, John Varoujan, Ancaster, Ontario; University of Toronto, Toronto, Ontario,
1945, physical medicine and rehabilitation. Died Mar. 18, 2008, aged 86. The citation
appointing Dr. Basmajian as an Officer of the Order of Canada (1995) stated: “He greatly
influenced generations of physicians-in-training, invented several widely-used medial
devices and developed scientific techniques. Notable among his many accomplishments
was his pioneering work in electromyography, which had a significant impact on the
development of biofeedback techniques, used for rehabilitation following injury to the
central nervous system.” Dr. Basmajian authored more than 400 scientific articles
and was the series editor of the 22-volume Rehabilitation Medicine Library. He was the
co-founder and president of the International Society of Electromyographic Kinesiology
and president of the American Association of Anatomists. He is survived by his wife, Dora,
children, Haig, Nancy and Sally, and 4 grandchildren.
Nieto de Renteria, José in Montreal, on Sunday the 26th of October, at the age of
81. He was retired from L’Institut de Readaptation de Montreal and a recipient of the
Order of Civil Merit bestowed upon him by the King of Spain, Juan-Carlos I.
He is survived by his wife, Monique Wilhelmy, his children Charles, Frederick
(Susanna Lam), Marie-Monique (Jean-Noel Lebrec), his grandchildren, Philip, William
and Amalia, as well as his sister Julia Nieto, and several brothers and sisters in-law
and many nieces, nephews as well as friends in Canada and in Spain.
Donation in his memory may be made to the Fondation de L’Institut de Readaptation
de Montreal, 6300 Darlington, Montreal, QC H3S 2J4.
A Montréal, le 26 octobre 2008, à l’âge de 81 ans, est décédé Dr. Jose M. Nieto de
Renteria, retraité de L’Institut de Réadaptation de Montréal et décoré de l’Ordre du
Mérite Civil par le Roi d’Espagne, Juan-Carlos I.
Il laisse dans le deuil son épouse, Monique Wilhelmy, ses enfants Charles, Frederick
(Susanna Lam), Marie-Monique (Jean-Noel Lebrec), ses petits-enfants Philip, William et
Amalia, ainsi que sa soeur Julia Nieto, plusieurs beaux-frères et belles-soeurs, ainsi que
de nombreux neveux, nièces, parents et amis au Canada et en Espagne.
Des dons à la Fondation de L’Institut de Réadaptation de Montréal, 6300 Darlington,
Montréal, QC H3S 2J4 seraient appréciés.
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CAPM&R NEWS - NOUVELLES DE L’ACMP&R