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Bringing It All Together In Rehabilitation

From the initial accident to the hospital room, to the rehabilitation clinic, to the courtroom and beyond, the healing process is a journey.

When you suffer an injury, you want to be sure the professionals you encounter at every step along the way have the best information available to help you recover.

On June 6, Bergeron Clifford welcomed 40 medical and rehabilitation professionals from across Kingston to a conference aimed at sharing information about their profession. During a half-day conference, staff from hospitals and clinics across the city heard from leading experts in neuropsychiatry, physiotherapy, surgery, and injury assessment.

“We see ourselves as all part of the same team,” says Chris Clifford, partner at Bergeron Clifford. “We are all working together towards the same goal of helping victims of accidents recover. By bringing in speakers and hosting events like this, we are providing the local medical community an opportunity to improve their knowledge and clinical skills.

Dr. Elvina Chu of Queen’s University’s Department of Psychiatry opened the conference, speaking about neuropsychiatry and the consequences of brain injury on patient recovery.

One in every 200 Canadians have a reported brain injury, and the cases are disproportionately found among young and otherwise healthy people. It is important to know when trying to treat someone with a fresh or pre-existing brain injury, how the condition of the patient’s brain might affect their treatment.

“Your brain is like a gelatinous mass and it moves around inside a rigid structure,” Dr. Chu explains. “When the brain is rattled about and bumped up against the skull, that is when the damage occurs. The skull doesn’t give way if there is swelling from bleeding inside and this pre-disposes people to suffering a worse brain injury.”

Dr. Chu notes a patient with a brain injury could be physically recovering but their brain can be losing function at the same time. This decreased function has longer-term consequences – when the patient attempts to return to work once they have completed rehabilitation, for example, some of them find they can no longer cope or succeed in that environment due to the physical or mental changes they have undergone. They may be physically healed, but mentally they are not the same as they were before.

Next up was Dr. Milos Popovic of the Toronto Rehabilitation Institute, speaking about an invention he has been working on to help victims of central nervous system injuries such as strokes and spinal cord injuries. The MyndMove provides electrical stimulation to the muscle to help retrain the body and rebuild fine motor control in the arms. Previous devices focused just on stimulating the muscles – bypassing the brain rather than working with it.

“Rather than fire all the muscles – which previous devices did – our device works the way the brain works,” says Dr. Popovic. “And, eventually, after 40 hours with an occupational therapist, the patient can do it all on their own without the assistive device.”

Much like other therapies, progress can be slow at first – taking minutes in the early days to accomplish simple tasks. And Dr. Popovic stresses that it is important to have the device, the therapist, and also the patient’s active support and participation in order for the therapy to be successful.

A participant asked Dr. Popovic about the cost of the MyndMove device, and he replied that clients pay an ongoing fee for the device along with support and upgrades. This ensures the patient always has the most up-to-date technology. Dr. Popovic also said he constantly works to try and make the technology cheaper.

Dr. Aaron Campbell, an orthopedic surgeon at Kingston Health Sciences Centre, took over behind the podium next. The focus of his presentation was on the types of ligament and soft tissue injuries and how to recover from them. He stressed the importance of therapy in healing from many of these injuries particularly for older patients with degenerative conditions such as arthritis.

“If I have a pet peeve, it’s that ACL injuries are lumped in together when they are all quite different, with different outcomes and responses,” he says. “There are a lot of variables and you can’t always use the same ‘recipe’ to address the injury.”

Dr. Campbell noted that young females, in particular, tend to need follow up after these types of injuries, likely due to looser ligaments and smaller ACLs.

Closing out the conference was Dr. Darrin Milne, a chiropractor and clinical coordinator with Makos Health Associates. The goal of his presentation, leveraging his 20 years of experience as an independent medical evaluator, was to help rehabilitation practitioners understand catastrophic injury designations.

The number of these catastrophic designations has been on the rise in recent years, and Dr. Milne has evaluated cases that range in the hundreds of pages to one which featured 17,000 pages. Part of Dr. Milne’s work is to summarize these cases for insurers, employers, and lawyers.

Dr. Milne reviewed a number of changes and refinements to the definition of what it means to be catastrophically impaired over recent years. For instance, the definition of whether someone is a paraplegic or tetraplegic is now based on a set of criteria and tests instead of a short and subjective evaluation.

“It is important to answer the question as it is posed by the Statutory Accident Benefits Schedule (SABS) – if you cannot use your arm, for example, it is important to say “total” not “substantial”,” he says.

Dr. Milne says cases involving children can be the most difficult. Following an accident, the children can demonstrate a change in their behaviour or performance at school. Dr. Milne says, when he is evaluating cases, he asks for school records to help assess the child before and after – to help ascertain whether the mood or behaviour changes are related to the accident.

His key takeaway to the room was that the SABS updates have led to an increase in catastrophic impairment applications and have also made that status harder to attain due to the tight time window and the increasing requirement for tests and validation of a patient’s condition.

At the conclusion, attendees were provided with a certificate to acknowledge their participation for professional development purposes.

Thanks to Drs. Chu, Popovic, Campbell, and Milne for their thought-provoking presentations!



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