Early physiatry exposure for medical students: The Johns Hopkins PM&R Expo
By Anne Kuwabara, Stanley Guillaume, Samiran Bhattacharya, and James Pendleton
On January 28th, 2017,the first annual “PM&R Expo” was held at the Johns Hopkins School of Medicine. This special event was supported by the Association of Academic Physiatrists. Medical and undergraduate students from University of Maryland, Johns Hopkins University, Howard University, and Georgetown University attended and participated in this event.
The purpose of this event was to provide exposure to the multifaceted field of PM&R and promote collaboration and partnership between the different local medical schools. Exposure to PM&R varies among medical schools, and Johns Hopkins Medicine PM&R Interest Group wanted to initiate a partnership for students to gain access to resources and become immersed into the field, regardless of the amount of exposure provided by their home institution.
The Expo consisted of 5 different stations, through which groups of students rotated. Each station was independently constructed and overseen by an attending, therapist, and a student and provided an overview lecture on the specific subject followed by opportunities for the students to engage and to practice newly learned techniques. The goal was for students to acquire a sense of the the broad topics the field encompasses and the various tools used within each.
Dr. Charles Odonkor, Anne Kuwabara, and Stanley Guillaume coordinated and facilitated the group rotations and ongoing event logistics. The stations that were part of this Expo included the following:
Dr. Cristina Sadowsky, Ms. Enjeen Woolford, and James Pendleton conducted the spinal cord injury (SCI) station. Here, students learned some of the nuances in the presentation and evaluation of patients at acute and chronic phases of SCI. The differences in approach and application between compensatory and restorative therapeutic techniques were also discussed. Furthermore, students were introduced to activity-based restorative therapies (ABRT) and functional electrical stimulation (FES) as therapeutic techniques for SCI patients during the chronic phase of recovery. Basic science and clinical research in mitigating nervous tissue damage following SCI as well as various cell-based therapies were presented.
Dr. Pablo Celnik, Ms. Sowmya Kumble, and Dr. Samiran Bhattacharya helped lead a station on neurorehabilitation. Students learned about the wide scope of neurorehabilitation, from the role of physiatry in the neurocritical care unit, to the growing scope of research in the field related to non-invasive brain stimulation. Students had the opportunity to learn about research initiatives with stroke subjects, and brain stimulation techniques such as transcranial magnetic stimulation (TMS) and transcranial direct current stimulation (tDCS).
Spasticity Management Station - Eugene Khoroshan
Dr. Sam Mayer, Mr. Eugene Khoroshan, Dr. Christina Kokorelis, and the Allergan team ran the spasticity management station. This station put emphasis on teaching students about the definition of spasticity and the importance of its management and treatment. The management and treatment of migraines were also explained. Thanks to the Allergan team, we were able to use electronic injector simulation models to allow students to learn how to do these injections. The models were crucial to this station because they also projected the muscles with which the injector tips come in contact. Therefore, not only were students learning how to inject, but they were receiving more knowledge on the anatomy of the upper and lower extremities.
Spasticity Management Station - Sam Mayer
We had two teams of animal assisted therapy (AAT) specialists; Barb Carvelius with Molly and Linda Solano with Siren, as well as therapists Catherine Scott and Kristin Stressing, run the animal assistive therapy station. AAT is combined with occupational, physical and speech therapy to work on sensory stimulation, cognitive and visual perception, tone inhibition, range of motion, balance, mobility, coordination, speech, and mental health. Patient progress is monitored over a period of time based on personal goals and objectives. AAT is not for everyone such as patients with a fear of animals, allergies, open wounds, dermatitis, and immunosuppression. Commonly used tools include brushes, tables, balls, leashes, collars, chairs, dog toys, and bubbles.
Ms. Jyo Supnekar, Ms. Dawn Kutcher, and Ms. Kathryn McGinty ran the stations on laser therapy, lymphedema, kinesiotaping, and orthoses. Lymphedema is an abnormal accumulation of protein rich fluid in the interstitium, which causes chronic inflammation, and reactive fibrosis of the affected tissues. It is treated with complete decongestive therapy, manual lymphatic drainage, compression bandaging, remedial exercises, meticulous skin and nail care. The Biolase class IV laser, PhysioTouch, LymphoTouch were provided as tools also used for lymphedema for the students to have hands-on experience. Students also had the opportunity to learn and examine different orthoses. Orthoses are used to describe a single, rigid or semi rigid device that supports a weak or deformed body part or restricts motion in an injured part of the body. Orthoses also can be used for mobilization of joints. Orthotics can be provided or fabricated by an occupational therapist or certified hand therapist who is trained in assessment, education and fabrication. A referral to occupational therapy and an order for the orthotic is required in order to have the orthotic fabricated and covered by insurance.
We hope to continue this tradition and forge collaboration between different schools and support the promotion of PM&R at the undergraduate level to increase exposure and recognition of our outstanding field.
PM&R Interest Group Leadership Board
About the authors: Anne Kuwabara, Stanley Guilaume, Samiran Bhattacharya and James Pendleton are medical students at Johns Hopkins Medicine in Baltimore, Maryland and active leaders in the school’s PM&R Interest Group.