Friday, November 20, 2020 - CASEM Co-developed Sports Medicine Lectures
1205-1230 - Hip Pain: The Millennial And Middle Aged Hip
Margaret Burghardt, BSc. MD. CCFP (SEM). Dip. Sport & Exercise Medicine (CASEM), Primary Care Staff Physician Lead, Rebound PT and Sport Medicine Clinic
Hip pain is common in the Millennial and Middle Aged patient. Femoroacetabular impingement (FAI), Labral tears and early OA contribute to hip pain in these age groups. This presentation will aim to outline current diagnostic tools, treatment options and outcomes for these conditions. Factors affecting surgical candidacy for hip arthroscopy will be discussed as will current and future research in this area.
At the end of the session participants will be able to:
- Diagnose and understand the Treatment Options and Outcomes for Femoroacetabular Impingement (FAI), Labral tears and Early Osteoarthritis of the Hip
- Know the indications for and against Hip Arthroscopy as a treatment option
- Understand evolving research in this area
CanMEDS Roles: Medical Expert (the integrating role), Health Advocate, Professional
Target Audience: Physiatrists, Residents,
Medical Students, Sport and Exercise Medicine Physician, Family Physicians
Declaration of Conflicts of Interest:
- None
Margaret Burghardt:
- Primary Care Sport Medicine Physician in Barrie and Orillia, ON.
- MSK Preceptor, U or T Family Medicine Residency Program.
- Current President, Canadian Academy of Sport and Exercise Medicine (CASEM) 2020-2021
- Chair, CASEM Publications Cmte 2012-2020
- Team Physician, Swimming Canada 2018-
1245-1310 - Management Of Sport Related Concussion In The Adaptive Athlete
Richard Goudie, BSc MD CCFP (SEM) Dip Sport Med CAPM AAPM, Emergency Department at RVH
Concussions are now understandably well recognized in the athletic environment. Much education has taken place over the last years to assure injured (concussed) athletes are recognized and managed safely. Not much research and knowledge exists for the adaptive athletes where many of the tests and evaluation methods for the able bodied athletes are inadequate.
At the end of the session participants will be able to:
- Recognize the signs and symptoms of a concussion
- Record a detailed history from an athlete who sustained a concussion
- Perform a focused examination of the concussed athlete
- Adapt their evaluation to the adaptive athlete
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional
Target Audience: Physiatrists
Declaration of Conflicts of Interest:
- None
Richard Goudie:
I live in Barrie where I split my work between the Emergency Department at RVH, Primary Care Sport Medicine practice and Chronic Pain Management.
Obtained my Medical degree from the University of Ottawa in 1991, completed a Rotating Internship at Lion's Gate Hospital in North Vancouver in 1992, received my Canadian Family Practice College (CFPC) Diploma in 1993 and completed a Fellowship in Sports Medicine at the University of Western Ontario in 1997. Member of the Canadian Academy of Sports and Exercise Medicine (CASEM) since 1996. It coincided with the year I obtained my Diploma of Sports and Exercise Medicine. I have sat on CASEM's Sport Safety Committee, Education Committee and presently Chair the Selection Committee. I was a Director on the CASEM Board (2010 - 2013), Secretary-Treasurer (2013 - 2014) and was the Academy's President in 2015-2016.
Over the years I have been part of Team Canada's Health Care Team at multiple major games including Canada Games, Pan American Games, World University Games, Commonwealth Games and Olympic Games. I was the Canadian Team's Chief Medical Officer for the Para Pan American Games in Guadalajara (2011) and Toronto (2015); for the Paralympic Games in Beijing (2008), London (2012) and the Assistant Chief Medical Officer in Rio (2016). I held the position of Team Physician for the Women's National Wheelchair Basketball Team from 2010 to 2016.
1325-1345 - Relative Energy Deficiency In Sport (red-s): A Clinical Guide To Diagnosis And Treatment
Margo Mountjoy, MD, PhD, CCFP(SEM), FCFP, FACSM, Dip Sport Med., Dean/ Associate Clinical Professor, McMaster University
Athletes are driven by heavy pressure to perform. One form of this pressure is often tied to being extremely lean. This creates a dynamic where athletes do not consume sufficient energy to replace what is being used, resulting in ongoing caloric deficits. This is what scientists refer to as Relative Energy Deficiency in Sport (RED-S). If the nutritional restrictions become chronic, athletes may be pushed to the brink of physical and mental breakdown. This collapse results in a slew of negative health consequences, decreased performance over time, and results in long term negative effects during and after an athletes career. This symposium will review the underpinning science, health and performance outcomes, diagnosis, treatment and prevention.
At the end of the session participants will be able to:
- Describe the pathophysiology of RED-S under the health and performance presentations of Low Energy Availability
- Identify and work up p atients with RED-S appropriately
- Clinically manage patients with RED-S
- Develop a prevention strategy for RED-S
CanMEDS Roles: Medical Expert (the integrating role), Collaborator, Health Advocate, Scholar
Target Audience: Physiatrists, Residents, Medical Students
Declaration of Conflicts of Interest:
- Jamaican Sport Medicine; Description of relationship(s) : Honoraria for key note
- FIFA; Description of relationship(s) : Scientific Advisory Board
- CFPC; Description of relationship(s) : Research Grant evaluating impact of Certificates of Added Competency
Margo Mountjoy is a former international level artistic swimmer, and is now a member of the FINA (aquatics)Executive Board, with the portfolio of sport medicine. She is a clinician scientist with research interest in elite athlete well-being.
Margo is the Chair of the ASOIF Medical and Scientific Group; a member of the IOC Medical Commission Games Group; and the WADA Health Medicine and Research Committee. She also volunteers for World Rugby and FIFA.
Margo is the RA Dean at the Michael G. DeGroote School of Medicine, McMaster University (WRC). She is also the Clinical and Academic Lead of the Health and Performance Centre at the University of Guelph where she focusses her clinical practice on elite athlete health care.
Previous Events
Friday November 6
1205-1225 - Cervical Spine Update
Jeff Wilson, Neurosurgeon Scientist at St Michael's Hospital and University of Toronto.
At the end of the session participants will be able to:
- Expand knowledge on surgical indications for cervical spine pathology
CanMEDS Roles: Medical Expert (the integrating role)
Target Audience: Physiatrists
Declaration of Conflicts of Interest:
- Dr. Wilson receives direct financial payments including receipt of honoraria from Stryker Canada; relationship : Consultant
- Dr. Wilson receives Funded grants from CIHR
Dr. Jeff Wilson entered the neurosurgery program at University of Toronto after completing his MD at the University of Saskatchewan in 2007. During residency he earned a PhD through IMS and the Surgeon Scientist Program under the mentorship of Michael Fehlings and Abhaya Kulkarni with his research focused on the epidemiology and clinical epidemiology of traumatic spinal cord injury. Dr. Wilson's research has been funded by multiple grants from the Christopher and Dana Reeve Foundation, Cervical Spine Research Society and the Ontario Neurotrauma Foundation; further, he has been the recipient of numerous prestigious awards including: the K.G. McKenzie Prize from the Canadian Federation of Neurological Sciences, the Synthes Spinal Cord Injury Award from the American Association of Neurological Surgeon and the Shafie S. Fazel Outstanding Resident Surgeon and Investigator Award from the U of T Department of Surgery. After obtaining his FRCSC in neurosurgery in 2015, Dr. Wilson undertook a combined neurosurgery orthopedic fellowship in complex spine surgery at Thomas Jefferson University in Philadelphia, PA under the mentorship of James Harrop and Alex Vaccaro. Dr. Wilson returns to Toronto as a surgeon scientist at St. Michael's Hospital with clinical focus on the full spectrum of spinal disorders. From a research perspective, he is primarily interested in topics related to the epidemiology and clinical epidemiology of spinal trauma and spinal cord injury. Currently he serves as the deputy editor of the journal Clinical Spine Surgery.
1225-1245 - Thoracic Spine
Howard Ginsberg
Howard Ginsberg, neurosurgeon and biomedical engineer, St. Michael's Hospital and the University of Toronto.
A 20 minute discussion of common and less common conditions affecting the thoracic spine which are diagnosed in a delayed fashion.
At the end of the session participants will be able to:
- Diagnose common conditions affecting the thoracic spine
- List uncommon conditions affecting the thoracic spine
- Describe the urgency and treatment of thoracic spine conditions
- Expand knowledge on surgical indications for cervical spine pathology
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Collaborator, Health Advocate, Scholar, Professional
Target Audience: Physiatrists
Declaration of Conflicts of Interest:
- None
Howard Ginsberg is a neurosurgeon and biomedical engineer at St. Michael's Hospital and the University of Toronto specializing in complex spinal surgery. He has a degree in Engineering Science from the University of Toronto as well as a PhD in Biomedical Engineering and currently holds the position of Assistant Professor in the Department of Surgery and the Institute of Biomaterials and Biomedical Engineering. Howard’s research focuses on engineering applications to neurosurgical procedures with the goal of improving safety and outcome for patients. His current projects include: Mass Spectrometry Imaging, Diagnosis and Guidance in Surgery; Spinal Implants; Intraoperative Surgical Navigation; Therapeutic and Diagnostic Ultrasound.
1300-1320 - Disorders Of The Lumbar Spine: A Best Evidence Approach To Treatment
Joel Finkelstein, Chief of the Division of Spinal Surgery, Sunnybrook Health Sciences Centre, Associate Professor of Surgery, University of Toronto.
The investigation and treatment of low back pain has become an industry unto itself. The presentation will discuss the treatments that have developed for back pain and specifically discuss the main indications for surgery in degenerative spinal disorders.
At the end of the session participants will be able to:
- Recognize pain patterns in degenerative lumbar spine disorders
- Recognize the lack of specificity in identifying pain generators
- Describe the evidence gap in treatment of low back pain
- Define surgical vs non surgical indications
Target Audience: Physiatrists
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Scholar
Dr. Finkelstein completed his orthopaedic residency at the University of Toronto. He obtained specialized training in spinal surgery as a fellow at Sunnybrook Health Sciences Centre and at the University of Washington. His interests involve spinal trauma, metastatic disease and degenerative disorders.
He is the Chief of the Division of Spinal Surgery at Sunnybrook Health Sciences Centre and is Associate Professor of Surgery at the University of Toronto.
Speaker Declaration of Conflicts of Interest:
- Dr. Finkelstein receives direct financial payments including receipt of honoraria from Stryker Spine Canada; Relationship(s) : Consultant
- Dr. Finkelstein has the potential to influence the content of the educational activity as he receives Institutional Educational Support from Zimmer Biomet, Stryker Spine Canada
1320-1330 - Role of Physiatrist in Spine Care
Dr. Hossein Amani, Physical Medicine and Rehabilitation
University of Toronto
At the end of this presentation participants will:
- Reflect on use of clinical exam and imaging or other testing in diagnosis of the spine patient
- Appreciate the role of physiatrist in the overall management of the spine patient
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Collaborator, Health Advocate, Scholar, Professional
Target Audience: Physiatrists
Declaration of Conflicts of Interest:
- None
Dr. Hossein Amani has been a faculty member at the University of Toronto PM&R Division since 2003 and involved in mentoring and teaching PM&R residents since then. He has served on the University of Toronto PM&R Residency Selection Committee on multiple occasions. Dr. Amani has PM&R specialty certifications in Canada (FRCPC)and the United States (FABPMR). He also has subspecialty certifications in Pain Medicine, Sports Medicine, Neuromuscular Medicine, and Brain Injury Medicine. He is certified by and has served as an EMG oral board examiner for the American Board of Electrodiagnostic Medicine. He is past Vice-Chair of the Ontario Medical Association PM&R Section Executive Committee and was Chair of the OMA PM&R Section Annual Scientific Meetings from 2012 until 2017.In early 2016, Dr. Amani approached Dr. Robinson to co-chair and create an annual University of Toronto PM&R conference, now known as the Toronto PM&R Conference or “TPMRC.” The guiding principle behind this conference is the famous quote by Carl Friedrich Gauss, “pauca sed matura,” meaning “few but ripe.” The goal of this conference is to bring together superb experts to give high impact interactive lectures and to disseminate cutting-edge information on topics pertinent to the field of PM&R.
1330-1340 - Back Pain and Rehabilitation
Dr. David Berbrayer, Physical Medicine and Rehabilitation
University of Toronto
At the end of this presentation on back pain and rehabilitation participants will:
- Reflect on use and prescription of exercise as a treatment modality of low back pain
- Appreciate the types of braces available and consider use of braces in treatment of back pain
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Collaborator, Health Advocate, Scholar, Professional
Target Audience: Physiatrists
Declaration of Conflicts of Interest:
- None
Dr. David Berbrayer is a specialist in Physical Medicine and Rehabilitation certified by the Royal College of Physicians and Surgeons of Canada and the American Board of Medical Specialties. Dr. Berbrayer is a member of the educational committee of AAP (Association Academic Physiatrists), Member of the Transitional committee & Educational committee of ACPDM (American Academy of Cerebral Palsy and Developmental Medicine) and Evidence based committee – performance metrics of AAPM&R.Dr. David Berbrayer is past Education Chair and past CPD chair of CAPM&R (Canadian Association of Physical Medicine and Rehabilitation) and current Pediatric Section Chair of the CAPM&R. Dr. Berbrayer is the Medical Director, Physical Medicine and Rehabilitation, Sunnybrook Health Sciences Centre University of Toronto. Dr. Berbrayer is past Vice President and Chief of Staff Lyndhurst Hospital. He is a founding member of Toronto Rehabilitation Institute. Dr. Berbrayer is a consultant at Holland Bloorview Kids Rehab the largest pediatric facility in Toronto and consultant at Hospital for Sick Children. Dr. Berbrayer is Associate Professor, Department of Medicine, University of Toronto.
Friday November 13
Improving Function in Patients with Complex Nerve and Spinal Cord Injuries through Interdisciplinary Surgical and PM&R Clinics
Overall Objectives:
At the end the activity, participants will be able to:
- Distinguish which patients would be good candidates for surgical interventions
- Recognize surgical options to improve function in our patients
- Develop EMG skills required of complex clinics
1205-1225 - Peripheral Nerve Transfers
Paul Binhammer, MD, MSc, FRCS, Division Head, Sunnybrook Health Sciences Centre.
Peripheral Nerve Transfers are a surgical technique to improve patient outcomes. This presentation describes the concepts and provides a clinical example of peripheral nerve transfers.
At the end of the session participants will be able to:
- Describe the concept of nerve transfers
- Describe a clinical example of peripheral nerve transfer
CanMEDS Roles: Medical Expert (the integrating role), Collaborator, Health Advocate
Target Audience: Physiatrists,
Residents,
Medical Students
Declaration of Conflicts of Interest:
- Dr. Binhammer receives direct financial payments including receipt of honoraria from AO North America; relationship : Speaker and content creator for Education Not-for-Profit
- Dr. Binhammer sit on an advisory board for AO North America; relationship : Speaker and content creator for Education Not-for-Profit
Paul Binhammer completed fellowships in hand surgery in Strasbourg and Salt Lake City. He has been at the University for Toronto for the past 25 years, 17 as Division head at Sunnybrook. His academic focus has been on clinical research and international hand education.
1225-1245 - Nerve transfers for Brachial Plexus Injury
Heather Baltzer, MD MSc FRCSC FACS, Director, Toronto Western Hand Program, University of Toronto.
This presentation will describe the algorithm for considering nerve grafts vs nerve transfers for brachial plexus injuries.
At the end of the session participants will be able to:
- Describe the appropriate nerve transfers for brachial plexus injuries
CanMEDS Roles: Medical Expert (the integrating role), Collaborator
Target Audience: Physiatrists, Residents
Declaration of Conflicts of Interest:
- None
Dr Heather Baltzer is the Director of the Toronto Western Hand Program. She is a hand and peripheral nerve surgeon. Her medical school and residency were completed at the University of Toronto and her fellowship at Mayo Clinic in Rochester MN. She has completed an MSc at the Institute for Health Policy management and Evaluation. Her clinical focus is on Nerve Injuries and recovery. Her research focus is on population health studies of hand and upper limb trauma.
1300-1320 - Peripheral Nerve Transfers
Jana Dengler, MD, MASc, FRCSC, Hand and Peripheral Nerve Surgeon, Sunnybrook Health Sciences Centre, University of Toronto.
Individuals with cervical spinal cord injury have identified improvement in upper limb function as a top priority. Surgical options such as tendon transfers and novel nerve transfers can improve elbow, wrist and hand function. This presentation will discuss nerve transfer options in persons with cervical level spinal cord injury to improve upper limb function.
At the end of the session participants will be able to:
- Identify individuals with SCI that may be candidates for nerve transfer
- Describe why nerve transfer surgery may be time-sensitive in people with SCI
CanMEDS Roles: Medical Expert (the integrating role), Communicator, Collaborator, Health Advocate
Target Audience: Physiatrists,
Residents,
Medical Students
Declaration of Conflicts of Interest:
- None
Dr. Dengler graduated from the University of Toronto Faculty of Medicine in 2013, and subsequently completed her residency training in Plastic and Reconstructive Surgery at the University of Toronto in 2018. Prior to this, she completed undergraduate and graduate degrees in biomedical engineering. After residency, Dr. Dengler pursued fellowship training in hand, peripheral nerve, and microsurgery at the Washington University of St. Louis, under the direction of Drs. Susan Mackinnon and Amy Moore. Dr. Dengler joined Sunnybrook Health Sciences Centre and the University of Toronto in 2019, where her clinical focus is in adult hand, peripheral nerve, and microsurgery. She has a special interest in improving upper extremity function in people living with cervical spinal cord injury. Her research program currently focuses on improving access to care, processes of care, and outcomes in peripheral nerve injuries and cervical-level spinal cord injury. Dr. Dengler is currently completing a Master's degree in Translational Science, and strives to bring modern treatment paradigms for nerve injuries to healthcare providers and affected patients globally. Dr. Dengler has been the recipient of numerous awards for her academic and research work, and is the author of several peer-reviewed publications.
1320-1340 - Role of EMG in Nerve Injury and Surgical Planning
Larry Robinson, Professor and Division Director for Physical Medicine and Rehabilitation at the University of Toronto and holds the John and Sally Eaton Chair in Rehabilitation Sciences.
At the end of the session participants will be able to:
- Summarize methods for measuring severity of nerve injury.
- Contrast EMG methods in conventional clinics with those used for surgical decision making
- Review electrodiagnostic methods for tracking nerve recovery
CanMEDS Roles: Medical Expert (the integrating role), Collaborator, Health Advocate
Target Audience: Physiatrists
Medical Students, Residents
Declaration of Conflicts of Interest:
- None
Dr. Larry Robinson is Professor and Division Director for Physical Medicine and Rehabilitation at the University of Toronto and holds the John and Sally Eaton Chair in Rehabilitation Sciences. He comes to us from the University of Washington where he served as Chair of the Department of Rehabilitation Medicine and later as Vice Dean for Clinical Affairs and Post Graduate Medical Education. Dr. Robinson has published extensively on electrodiagnosis with 120 publications in the peer-reviewed literature, and has published a number of articles on traumatic neuropathy and using EMG for prognosis.