One of the nice things about my job is that I learn new things. In late June, I was able to attend the 35th Annual Interdisciplinary Spinal Cord Course at the renowned Rehabilitation Institute of Chicago. It was just my second time in Chicago (the first over a decade ago for my cousins wedding), but both the city and the course turned out to be fantastic.
The course spanned three days and consisted of 12 hour long lectures related to evidence based treatment (best practice) of SCI and 3 afternoon lab sessions which focused on more experiential learning. The topics of the lectures I enjoyed the most were the Biomechanics of the Weight-Bearing Shoulder after Spinal Cord Injury: Implications for Clinical Practice by Sara Mulroy, PhD, PT. which emphasized strengthening the rotator cuff muscles to decrease shoulder pain from overuse due to chronic wheel-chair mobility.
The four exercises she recommends are performed with either dynabands or free weights: external rotation (infraspinatus) with the elbow at 90 degrees (8x), shoulder retraction with elbow 90 degrees (15x), thumb up lateral arm raises to shoulder height (supraspinatus, 15x with weights under 7#’s) and diagonal pull downs with straight arms (8x). All exercises can be performed w/c level or standing.
Another course called “Exposing the Skeletons in the closet of SCI Rehab” by W. Brent Edwards, PH.D, emphasized the importance of building bone density to prevent fractures in SCI due to rapid bone density loss: after 2 years 25% in hip and 50% in knees. An alarming 40% of SCI pt’s experience fractures in their lifetime the most common causes being transfers and falls from W/C’s or rolling over in bed. The two methods of reducing bone loss are with acute rehabilitation and pharmacology. Rehabilitation activities include weight-bearing exercises, Functional Electrical Stimulation (FES) and Vibration Stimulation.
Another of my favorite speakers, Jeri Morris, PhD, is a psychologist who emphasized the importance of teamwork to develop a relationship of trust with the patient in Facilitating Adjustment to Spinal Cord Injury: The Power of the Team. She believes that therapists must operate from a “position of benevolence” and understand (and deal with) why patients can be difficult and angry and above all learn to provide reality without taking away hope.
Lastly, I snuck half way through, into a lecture/lab given by Annie O’Connor, PT, OCS, Certified MDT called A Collaborative Approach to Seating: Importance of a Mechanical Therapy Approach. Basically, she specialized is pain (she says she loves it), and gets individuals whom are WC bound and in chronic, intractable, at the end of their rope pain, out of pain through careful analysis, evaluation, treatment and WC modification. It was thrilling to watch her work, a Dr. House of pain.