Jeudi 8h-10h: Wearable Technology Meets Physical Therapy

Elizabeth Ennis, PT, EdD, PCS, ATP
George Fulk, PT, PhD
Robert Latz, PT, DPT, CHCIO
Mary Rodgers, PT, PhD,FAPTA, FASB

Wearable mobile health technologies have exploded over the past 5 years. With improvements in technology these devices have become smaller, more affordable and are more consumer friendly. Wearable mobile health sensors provide the ability to accurately and precisely monitor and measure steps taken, calories burned, transitions, time spent doing certain activities, and other health parameters while patients go about their everyday activities in their home and community. In addition, there are FDA approved monitors for tracking Parkinson’s changes, Glucose, vital signs, and more. Information from these devices can help inform physical therapy practice and can even be used as part of a behavioral intervention to motivate clients to improve their health. In this educational session, we will provide an overview of wearable technologies related to Physical Therapy. We will review how some clinicians are currently (or in the near future) using these technologies in clinical practice. In short, this course will improve awareness of the opportunities, benefits, and precautions in using wearable mobile health technologies in Physical Therapy.

Learning Objectives:
1. Describe the various types of wearable technologies relevant to Physical Therapy.
2. Compare the clinical utility of different wearable technologies that are currently available on the market
3. Argue the Pro’s and Con’s of mobile wearable technology now and in the near future.
4. Discuss the opportunities, benefits, and precautions of using wearable mobile technologies in Physical Therapy

Jeudi 11h-13h: Walking Recovery After SCI: Translating Lessons From the Lab Into Clinical Practice

Jeffrey Kleim, Ph.D
Candy Tefertiller, PT, DPT, ATP, NCS

There have been an increasing number of studies published in recent years focusing on walking recovery after spinal cord injury (SCI) in both basic and translational science models. Basic science literature may provide novel insights into the advancement of clinical care after spinal cord injury with the goal of recovering walking. However, because basic scientists and frontline clinicians don’t always "speak the same language," these findings may be underutilized in the development of interventions focused on walking recovery after SCI. This session will provide the audience with an overview of pertinent literature from both basic and translational science focused on motor learning to improve walking recovery after spinal cord injury. The presenters will discuss clinical interventions for improving motor learning after spinal cord injury, along with suggestions regarding timing, dosage, and feedback.

Learning Objectives:
1 . Discuss specific neural and behavioral signals that drive plasticity and recovery after central nervous system injury.
2. Review basic and translational science literature focused on promoting recovery of walking after spinal cord injury.
3. Discuss opportunities for translating motor learning principles focused on walking recovery after spinal cord injury from the lab to the clinical setting.
4. Review practical application of motor learning principles to improve walking recovery in the clinical setting after spinal cord injury through case study illustrations.

Jeudi 15h-17h: It’s All About That Base: Gluteal Function and Activation After Stroke

Walter Weiss, PT, MPT, NCS, KEMG

Adequate hip extensor and abductor function is essential for successful walking. The gluteal muscles play a vital role in maintaining pelvic stability. Hip extensor and abductor weakness has been associated with increased falls, abnormal gait patterns, and an inability to increase walking speed. Recent advances in clinical research have highlighted key concepts to facilitate neuroplasticity and recovery after stroke. Clinicians treating the stroke population frequently miss the impact of hip muscle weakness towards specific gait deviations and often forgo individual muscle strength testing. This session will highlight the penalties of hip extensor and abductor weakness for individuals with hemiparesis from stroke. The presenter will review the supine hip extensor manual muscle test. The presenter will also demonstrate treatment concepts to facilitate neuroplasticity including functional, high-challenge, motor learning-based exercises for maximal recruitment.

Learning Objectives:
1 . Identify the torque demands and resultant timing of EMG activity for the primary hip extensors and abductors during walking for healthy individuals as well as individuals poststroke.
2. Recognize the different walking patterns individuals employ after stroke.
3. Become familiar with the supine hip extensor manual muscle test and recognize the penalties of hip muscle weakness for individuals with hemiparesis from stroke.
4. Review and practice select exercises and activities that infuse the principles of motor learning and neuroplasticity.

Vendredi 8h-10h: Optimizing Exercise Effects on Neuroplasticity to Promote Motor Rehabilitation

Lara Boyd, PT, PhD
Cameron Mang, BPE, MSc, Phd (Cand)

Stroke rehabilitation research has focused on developing strategies that facilitate neuroplasticity to maximize functional outcomes. Brain-derived neurotrophic factor (BDNF) has emerged as a key molecular signaling pathway mediating central nervous system plasticity. Thus, rehabilitation strategies that optimize BDNF effects on neuroplasticity may be especially effective for improving motor function post stroke. The purpose of this session is to describe the evidence linking aerobic exercise, BDNF, cortical plasticity, and motor learning in humans and to discuss potential strategies by which aerobic exercise, when paired with motor learning-based interventions, may improve motor rehabilitation outcomes post stroke.

Learning Objectives:
1 . Describe the role of BDNF in neuroplasticity in healthy people and after stroke.
2. Present evidence for genetic and epigenetic sources of variability in the expression of BDNF.
3. Discuss evidence for the role of aerobic exercise in enhancing brain function through modulations in cortical plasticity and BDNF production.
4. Consider how the effects of aerobic exercise might be harnessed to improve motor rehabilitation post stroke.

Vendredi 11h-13h: Return to Running in Patients With Acquired Brain Injury

Jaime Cepeda, PT, DPT
Estelle Gallo, PT, DPT, NCS
Michael Post, PT, DPT, CSCS, CKTP
Katie Ann Sheeran, PT, DPT

Running is a fundamental skill and one of our motor milestones. High-level mobility (HLM) is important for leisure, sporting, social, and work-related activities. Research showed that the ability to run short distances was a strong predictor of returning to work for young stroke survivor. However, this tends to be overlooked in the rehabilitation of those with acquired brain injury (ABI). This session will explain the running biomechanics in the healthy and ABI populations. The speakers will present how to examine and quantify HLM using the HiMAT and objective criteria to determine when a patient is ready to initiate training, and will review the components of HLM intervention, highlighting specific impairments and skill acquisition required for running. A case study will illustrate the application of the recommendation in the clinic.

Learning Objectives:
1 . Describe the normal biomechanics of running.
2. Describe running abnormalities after acquired brain injury.
3. Apply the recommended examination techniques and outcome measures for HLM.
4. Identify objective criteria to guide initiation of HLM training.

Vendredi 15h-17h: Is There a Role for Manual Therapy in My Neuro Patient? Lumbar Spine and Lower Extremity Impairments in Patients With Neurological Disorders

Lindsay Conn, PT, DPT, NCS
Mary Beth Geiser, PT, DPT, OCS, FAAOMPT
Jeevan Pandya, PT, MHS, OCS, COMT, FAAOMPT

The research demonstrates the effectiveness of manual therapy in the management of patients with orthopedic complications. However, there is a paucity of literature examining the impact of treating orthopedic impairments in patients with primary neurological disorders. More important, the role of manual therapy in the management of this patient population is rarely discussed or considered. The proposed effects of manual therapy have considerably changed over the past few years. Physical therapists treating patients with neurological disorders should be aware of the potential benefits of manual therapy for this patient population. The goal of this session is to provide evidence-based information relative to the most commonly used manual therapy techniques for lumbar spine and lower extremity impairments in patients with neurological disorders. The primary diagnoses covered during this presentation will be stroke and Parkinson disease.

Learning Objectives:
1 . Recognize common lumbar spine and lower extremity orthopedic impairments in patients with primary neurological patient disorders.
2. Explain the mechanical and neurophysiological changes associated with manual therapy interventions.
3. Identify the appropriate patient with neurological disorder who will benefit from manual therapy.
4. Apply commonly used orthopedic manual physical therapy techniques in the management of lumbar spine, pelvis, hip, knee, ankle, and foot.

Samedi 8h-10h: Predicting Recovery of Upper Limb Function After Stroke

Winston Byblow, Ph.D.
Steven Cramer, M.D., Ph.D.
Cathy Stinear, Ph.D.
Steven Wolf, Ph.D., PT, FAPTA, FAHA

The ability to live independently after stroke depends on the reduction of motor impairment and recovery of motor function. Accurate prognosis of motor recovery assists rehabilitation planning and supports realistic goal setting by patients and clinicians. While greater initial impairment generally predicts poorer recovery of function, accurate prognosis for individual patients remains difficult. In this session, the presenters will describe a new approach to predicting upper limb motor outcomes for individual patients based on objective measures of the brain. The speakers will describe how these predictions can be used to tailor rehabilitation goals and present preliminary evidence of the potential benefits of this approach. Participants will gain an appreciation of the value of accurate prognoses and the tools to make more accurate prognoses in their own practice.

Learning Objectives:
1 . Describe the basic neurobiological processes that occur during the first 6 months of recovery after stroke.
2. Identify the main factors that affect independence in daily activities after stroke.
3. Evaluate the use of clinical measures and experience for predicting the recovery of upper limb function.
4. Use objective measures of the brain to improve the accuracy of predictions of upper extremity recovery for individual patients.

Samedi 11h-13h: Making Real-World Arm Use Measurement a Clinical Reality in Stroke

Janice Eng, BSc(PT/OT), PhD
Kathryn Hayward, PT, PhD
Catherine Lang, PT, PhD

The ultimate goal of arm rehabilitation after stroke is to promote use of the arm in everyday activities. Although a stroke survivor’s real-world arm use can be collected through self-report questionnaires, these measures are unlikely to be reliable in people who have cognitive deficits such as memory, recall, and attention. There is a need to be able to gain an objective indicator of arm use. One tool available is accelerometers, which are relatively cheap and simple to use. This session will show how accelerometers determine the amount of use; how to determine their reliability, validity, and sensitivity; how the accelerometer signal can be turned into clinically meaningful data; and how to identify possible facilitators and barriers to clinical deployment. The presenters will apply this information to clinical scenarios and provide guidance on practicalities of application, duration of wear, and patient compliance.

Learning Objectives:
1 . Discuss the rationale for measuring real-world arm use after stroke.
2. Describe how accelerometers measure movement; their reliability, validity, and sensitivity to change; and challenges in collating completed research.
3. Explain how the accelerometer signal can be turned into clinically meaningful information.
4. Discuss the facilitators and barriers to deployment of accelerometers in the clinical environment.

Samedi 15h-17h: Creative Evidence-Based Use of Electrical Stimulation in Acquired Brain Injury Rehabilitation

Amy Berryman, OTR, MSHSA
Denise O’Dell, PT, DSc

This session is designed to inspire new and creative uses of functional electrical stimulation (FES) in acquired brain injury rehabilitation. The presenters will review the basic applications and literature related to the use of FES with clients with acquired brain injury. This session will show participants how to use photo and video case presentations of creative applications using the functional electrical stimulation (FES) foundational knowledge in the areas of muscle activation/inhibition, ataxia, sensory awareness, and robotic technologies. Participants will utilize movement analysis and clinical decision-making skills in final cases to identify additional intervention strategies.

Learning Objectives:
1. Discuss purpose and parameters for use of FES for neuromuscular rehabilitation.
2. Summarize current literature for use of FES for management of impairments.
3. Review clinical cases and videos for creative treatment application of FES.