Official newsletter of the International Society of Physical and Rehabilitation Medicine
A SUCCESSFUL AND DIVERSE MEETING OF THE ASSOCIATION OF ACADEMIC PHYSIATRISTS
by Professor Gerard Francisco
With nearly 1,300 participants, the 2019 Annual Meeting of the Association of Academic Physiatrists (AAP) had its largest gathering since the society’s inception 52 years ago. The scientific program featured courses, sessions and posters on topics ranging from physiatric education, neurorehabiltiaiton, sports and musculoskeletal disorders, and research, including a session entitled, “Synergies Between the AAP & Cochrane Rehabilitation: Education, Research, Knowledge Translation.” A Spanish-language track consisting of lectures on a variety of subjects catered to its international participants.
Among the notable plenary speakers were Fabrisia Ambrosio, PhD, MPT, Director of Rehabilitation at UPMC International, who presented the state of the science in Regenerative Rehabilitation: Physical Medicine and Rehabilitation Meets Stem Cell Therapeutics. In her well-received speech, Dr. Ambrosio, who will also be a keynote speaker at this year’s 2019 ISPRM Congress in Kobe, discussed the emerging role of klotho protein in brain and muscle dysfunction. Linda Rosenstock, MD, MPH, Dean Emeritus of University of California at Los Angeles (UCLA) Fielding School of Public Health, presented Work-Related Musculoskeletal Disorders: From Science to Policy. Also presenting was ISPRM member John Chae, MD, PhD, who concluded his two-year term as AAP President with an address entitled “To Mentor, Discover and Lead.” Dr. Chae described how leaders in the field of PM&R mentored him as he cultivated his 25-year academic career, which led him to become an influential mentor to many future leaders in academic physiatry.
The meeting, which was held from February 21-23, 2019 at the Puerto Rico Convention Center, was preceded by two days of pre-conference workshops and meetings. These included evidence-based management of spasticity, musculoskeletal ultrasound, and developing self-directed quality and performance improvement projects. The Annual Meeting also serves as an opportunity for the various AAP committees (education, research, leadership development and recognition, public policy, among others) and task forces (global academic physiatry, advancing women in academic physiatry, and industry research) to meet face-to-face to discuss and plan the many future activities and initiatives of the society. At the General Business Meeting on the last day of the conference, Adam Stein, MD of New York assumed the presidency of the AAP. Dr. Stein also serves as the Chair of the ISPRM Congress in 2020. Awards were also given to best papers published in the American Journal of Physical Medicine and Rehabilitation, the AAP’s official journal.
The AAP, which bills itself as the “academic home for physiatry,” is the U.S.-based national society organizing the ISPRM Congress in Orlando, Florida, USA, to be held on March 4-9, 2020. For more details about the society, visit https://www.physiatry.org.
Did you register for ISPRM 2019? The Early Bird Deadline is approaching!
UPDATE FROM GUATEMALA
One of the key missions of ISPRM is to support development of rehabilitation training programs and rehabilitation services. We are excited to report updates from Guatemala as an example of such development.
For more than 20 years, Guatemala had 1 hospital with recognized physiatry training program, it has now grown to 2 hospitals with 5 spots. Adding to the excitement, Guatemala will be welcoming Dr. Kenneth Craig from New Zealand for scholarly exchange and workshop. In 2018, The Guatemalan Association of Physical Medicine and Rehabilitation renewed their membership in AMLAR and became part of ISPRM!
THE ROLE OF ELECTRONEUROMYOGRAPHY (ENMG) IN THE CLINICAL PRACTICE AND EDUCATION OF PRM PHYSICIANS: A BRIEF REPORT FROM THE COUNTRIES
Gulseren Akyuz 1, Ozge Kenis-Coskun2, Ilker Yagci1, Marco Franceschini3, Walter Frontera4, Jorge Lains5
Professor, M.D., Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, TURKEY
Assoc. Professor, M.D., Marmara University School of Medicine, Department of Physical Medicine and Rehabilitation, Istanbul, TURKEY
Professor, M.D., San Raffaele University Department of Physical Medicine and Rehabilitation and Research Director of Neuro-Rehabilitation Department, Rome, Italy, and Chair of the Clinical Sciences and Research Committee of ISPRM
Professor, M.D., University of Puerto Rico School of Medicine, Department of Physical Medicine, Rehabilitation, and Sports Medicine, San Juan, PR, and President of ISPRM
Professor, M.D., Rehabilitation Department – Centro de Medicina de Reabilitação Região Centro - Rovisco Pais Catholic University – Centro Regional Viseu, Coimbra, Portugal, and Past-President of ISPRM
Electroneuromyography (ENMG) is an essential diagnostic tool in the daily practice of a PRM physician. It is also crucial and frequently used in determining prognosis in rehabilitation settings. PRM physicians are unique in this aspect because they are the specialists that cover various neuro-musculoskeletal pathologies. However, the electrodiagnostic training and clinical applications among PRM physicians vary considerably throughout the world. A standard didactic and clinical program must be established to define what a PRM physician must know and how they should be trained.
Within ISPMR, we aimed to identify the status of ENMG in Physical Medicine and Rehabilitation practice and training in member countries. We contacted the representatives of 70 countries and received replies from 32 of them (45.7%). The number of PRM physicians that answered is given in in Figure 1.
The type of Physical Medicine and Rehabilitation training institutions are: Education and research hospitals, universities, rehabilitation centers, private practices and affiliated centers. When we questioned the PRM physician’s ability to evaluate and perform ENMG we have seen that the majority of the participants replied that all PRM physicians could evaluate ENMG while some can perform it (Figure 2). The three countries excluded from figure 2 present some specificities.
In Morocco, the ENMG certificates are given by a separate university that excludes PRM physicians. In Finland, performing ENMG is a different residency, and therefore only evaluation is taught to the physical medicine and rehabilitation (PMR) residents. In Portugal, PRM physicians must attend a fellowship program to perform ENMG and get reimbursed. In 24 of the countries, ENMG is a part of residency training while it is not included in Australia, New Zealand, Mongolia, Russia, Tunisia, Bosnia and Herzegovina, Morocco and Paraguay. The physiology of nerve injury and re-innervation, the basics of nerve conduction studies, instrumentation, needle ENMG, nerve-entrapment syndromes, plexopathies and radiculopathies, neuropathies, myopathies, diseases of the neuromuscular junction, diseases of the anterior horn cells are all a part of the ENMG training in the countries that include ENMG during the residency. Twenty-one of the ISPMR members stated that they would gladly welcome any help and support about ENMG training from ISPMR. Most interest was given to online educational programs about ENMG. Residency exchange programs, annual workshops and publications are also suggested as a part of this ENMG training support (Figure 3).
The results of this short survey have identified the need for a program for ENMG training among PRM physicians and Physical Medicine and Rehabilitation (PM&R) residents under the ISPRM umbrella. To the best of our knowledge, a similar survey had never been undertaken before. ENMG training is not only a diagnostic procedure but also a gateway to better understand the neuromuscular system and its pathologies in the follow-up period. Therefore, we believe it is crucial to include ENMG training in residency programs throughout the members of ISPMR. Due to the differences in medical practice worldwide, residency training in PRM is not a standard among ISPMR members. Defining the basics is an essential step in standardizing PMR training throughout the world. Standardization of residency programs is essential to improve our international collaborations, providing a common language and improving patient care. .
As ISPMR, we are ready to support our members in ENMG training in every way we can. The result of this survey showed that we should plan lectures as an online program in the near future. Since ENMG requires hands-on training as well, we are considering the possibility of organizing global workshops that will last a few weeks, not only during the World Congresses but also in National and Regional meetings. As the program will develop and evolve, with communication among members, we believe that we will efficiently answer the needs of our members. In the future, we are aiming to publish an ENMG guideline for PRM physicians to further standardize training and research within our members.
We would like to thank all the representatives of the countries that have contributed to this investigation. Names of the representatives are listed alphabetically: Abdelhafid Meliani and Abderrazak Hajjioui (Morocco), Akhtar Waheed and Waseem Icqbal (Pakistan), Andrew Cole (Australia), Arseniy Trukhanov (Russia), Catarina Aguiar Branco and Jorge Caldas (Portugal), Christoph Gutenbrunner (Germany), Farzaneh Torkan and Mansoor Rageyani (Iran), Gordana Stefanovski (Republic of Srpska, Bosnia & Hercegovina), Iuly Treger (Israel), Juan Manuel Guzman (Mexico), Kazuhisa Domen (Japan), Luh Karunia Wahyuni (Indonesia), Lydia Abdul Latif (Malaysia), Maher Saad Al-Jadid (Saudi Arabia), Maria Lourdes Fretes de Ratti (Paraguay), Mikhail Saltychev (Finland), Milica Lazovic (Serbia), Nicolas Christodoulou (Cyprus), Paolo Boldrini (Italy), Peter Lim (Singapore), Sara Laxe (Spain), Simon Fuk Tan Tang (Taiwan R.O.C.), Tarek Shafshak (Egypt), Taslim Uddin (Bangladesh), Thierry Lejeune (Belgium), Xanthi Michail (Greece), Yuen Ka Hong and Teresa Kim Yam (Yuhong), Zeljana Škarić-Karanikić (Montenegro), Zohra Ben Salah (Tunisia) , Zolzaya Batdavaajav (Mongolia).