Archive: CSM 2013: Clinical Electrophysiology and Wound Management Programming

  • This is archived programming for CSM 2013. See current programming.

    Browse Clinical Electrophysiology and Wound Management sessions by day. Return to the main topic menu 

    Monday, January 21 | Tuesday, January 22 | Wednesday, January 23 | Thursday, January 24 

    * Should you choose to preselect regular (not preconference) Tuesday-Thursday sessions during the registration process, please be advised that preselection is not a guarantee of a seat. Attendees are asked to preselect to better determine room size and all efforts will be made to accommodate sessions in the largest rooms possible. All attendees are encouraged to show up to sessions early. Attendees are also encouraged to select alternative sessions in the event their first choice is full. 

    Monday, January 21 (Preconference)

    Wound Debridement Skills

    Location: Hilton Bayfront | Cobalt 520

    Time: 8:00 am - 5:30 pm (See Program for Room)

    Speakers: Karen W. Albaugh, PT, DPT, MPH, CWS; Harriett B. Loehne, PT, DPT, CWS, FACCWS; Luther Kloth, PT, MS, FAPTA, CWS, FACCWS

    Level: Intermediate

    CEUs: 0.8 (8.0 contact hours/CCUs)

    Preconference Pricing: Standard Plus (1B)

    This preconference session features an emphasis on clinical debridement skills through experiential lab activities, including sharp debridement using porcine models, pulsed lavage with suction, and low frequency ultrasound devices. The speakers will discuss the various means to achieve wound bed preparation, with 3+ hours of actual hands-on skills application. This session will culminate with an interactive case study session, where attendees will select an appropriate debridement method for the presented scenarios. The speakers will review an update on coding, billing, and documentation associated with debridement procedures. Attendees who successfully demonstrate the ability to use sharp instruments for debridement in a lab setting using porcine models will receive a competency certificate upon completion of the course.

    Upon completion of this course, you'll be able to:

    • State the significance of debridement in wound bed preparation.
    • Demonstrate competence in sharp debridement of a porcine model.
    • Select an appropriate means of debridement for a variety of clinical presentations of necrotic tissue.

    Tuesday, January 22

    Rehabilitating the Patient With Wounds: Approaches for the Non-wound Care Physical Therapy

    Joint Program: Acute Care

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Stephanie L. Woelfel, PT, MPT, CWS, FACCWS

    Level: Intermediate

    Physical therapists play an important role in acute and chronic wound management, and an increasing number of therapists are specializing in this area. But what about physical therapists who are not involved in the active wound management process? The knowledge of physiology, anatomy, exercise prescription, and positioning that all PTs possess can be invaluable in caring for a patient with wounds. This session will explore these strengths and demonstrate how all physical therapists are valuable wound care team members.

    Upon completion of this course, you'll be able to:

    • Describe effective therapeutic interventions for treating wounds of various etiologies.
    • Apply compensatory strategies that may be utilized by patients with wounds involving muscle and deeper tissues.
    • Describe and implement therapeutic interventions specific to patients with surgical wounds.
    • Implement effective physical therapist involvement on a facility wound team.

    Teaching Therapeutic Technologies in a DPT Curriculum: Incorporating FES in Rehabilitation

    Joint Program: Education

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Gad Alon, PT, PhD; Christine Conroy, PT

    Level: Intermediate

    One of the most challenging tasks facing all medical and physical therapy clinicians is how to select the most effective and, if possible, efficient interventions. This is particularly true in the past 10-15 years, as we have seen enormous increase of treatment options, predominantly in therapeutic technologies. Among these technologies, functional electrical stimulation (FES) has become the most advanced. Yet, many physical therapy academic institutions and continuing education programs continue to promote legacy yet outdated approaches that undermine the current forward-looking concept termed personalized medicine. This patient-centered paradigm is most suitable for physical rehabilitation because it focuses on individual patients' concurrent impairments and functional deficits. Moreover, personalized rehabilitation is particularly appropriate in the utilization of FES because of the well-known research and clinical experience that the response to electrical stimulation vary considerably among patients and diagnoses.

    This presentation was designed to establish a 21st century, advanced infrastructure for teaching and practicing therapeutic technologies in general and clinical electrical stimulation in particular. The program will highlight critical technological, pertinent electrophysiological mechanisms (modes of action) and the most relevant clinical determinants that PT students and practicing clinicians should be able to manage. The presenters will provide templates for clinical decisions regarding screening, testing, establishing outcome measures, and implementing the most effective treatment plans in the management of selected diagnoses in the field of physical rehabilitation. Specific case presentations of FES utilization in managing patients presenting to the clinic with diagnoses including low back syndrome, degenerative knee joint disease, COPD, congestive heart failure, peripheral vascular disease, and brachial plexus injury.

    Upon completion of this course, you'll be able to:

    • State critical technological advancements in current FES systems including advantages and shortcomings.
    • List the clinical determinants that justify utilization of FES in the management of patients in need for physical rehabilitation.
    • Follow and share with colleagues the templates of the most effective treatment plans in the management of selected diagnoses presented during the course.
    • Explain why FES is not yet considered standard of care by the physical therapy profession.

    Dressings: From Basics to Biologicals

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Rose Hamm, PT, DPT; Karen W. Albaugh, PT, DPT, MPH, CWS

    Level: Intermediate

    During the last 2 decades, dressings have progressed from wet to dry gauze, to an occlusive or semi-occlusive material, to an interactive dressing providing biological components essential for wound healing. This presentation will review the development of advanced dressings to compare the composition of different dressing categories and select appropriate dressings for various wound etiologies. An interactive activity will encourage attendees to brainstorm and discuss the selection, rationale, and methods of application for a variety of wound types.

    Upon completion of this course, you'll be able to:

    • Describe the development of dressings now considered standard of care.
    • Identify the effect of different dressing compositions on wound healing.
    • Explain the role of biological dressings in wound closure.
    • Select the appropriate dressing for a variety of case examples.
    • Demonstrate application of dressings on problematic wounds.

    Kinesiological Electromyography for the Non-laboratory Therapist

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Sherry I. Backus, PT, DPT, MA; Mark W. Lenhoff; Smita Rao, PT, PhD

    Level: Multiple Level

    Do you still have questions about kinesiologic electromyography (EMG) in the clinical reports you receive from the gait lab and the research articles you read? Do you remember why the Nyquist theorem is important or why one researcher normalizes EMG to isometrics and one to the functional task? This course will discuss what we can learn from kinesiologic electromyography and how anatomy and physiology affects the signal; the choices in technology, electrodes, sampling, and filtering that are available to researchers and clinical gait labs; and why the choices matter to you, the therapist. Topics will include current technical considerations (hardware, software, filtering, choice of electrodes, sampling rates), processing (RMS, wavelets, choices of normalization techniques), and practical issues of kinesiologic EMG in both the research and clinical settings. Research articles that use EMG as outcome measures will be presented with an emphasis on how to better understand and evaluate the methods. Clinical cases with examples of EMG will be presented and results will be interpreted. A discussion of the limitations of interpretations of EMG reports will be reviewed.

    Upon completion of this course, you'll be able to:

    • Demonstrate an understanding of the kinesiologic EMG signal: what influences the signal and what information can be derived from the signal.
    • Demonstrate an understanding of technology used for kinesiologic EMG recordings. This includes identifying the benefits and limitations associated with the choices of: electrodes, sampling and filtering, and normalization techniques.
    • Examine the practical considerations of the collection of kinesiological EMG.
    • Discuss the methods employed in research articles that use kinesiological EMG and explain how the choice in EMG methods affects the results and conclusion.
    • Interpret the kinesiologic EMG section of a clinical gait analysis.

    Lymphedema and Wound Care

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Suzie Ehmann, PT, DPT

    Level: Intermediate

    There is a considerable lack of attention in the wound healing medical community with regards to use of multi-layer lymphedema bandages as a treatment modality. Often medical providers reserve referral to a lymphedema therapist only those patients whose limbs are hugely misshapen or for whom more traditional compression systems (ie, profore, unna boot, etc) have failed to produce the desired effect. This would suggest a lack of appreciation for the well-documented impairments of the dermal lymphatics in patients with both chronic non-healing ulcers as well as those with classic elephantiasis appearance. A closer examination of the anatomy and physiology of the lymphatic system demonstrates that pathologies of venous system can impair lymphatic function. Impairment of the lymphatic system can present not only as edema, but also may display significant trophic changes, delayed wound healing, and chronic infections that may significantly decrease a patient’s functional mobility and quality of life.

    The purpose of this presentation is to highlight and provide instruction with the application of the specific components of the multi-layer inelastic lymphedema bandage system typically used by a certified lymphedema therapist and how the use of this type of bandage addresses not only the venous and lymphatic insufficiency but also dermal changes. Specific case studies will be presented to demonstrate the benefit of multi-layer lymphedema bandages for both wound healing and trophic changes. Attendees will view pictures and graphs outlining findings before and after treatment to support the success of a treatment approach.

    Upon completion of this course, you'll be able to:

    • Recognize clinical signs and symptoms of lymphedema.
    • Explain anatomy and physiology of the lymphatic system as it relates to chronic edema formation and delayed wound healing.
    • Understand how to apply the components of complete decongestive therapy for patients with chronic edema presentations and chronic non-healing wounds.
    • Describe appropriate modalities and adjunctive therapy to manage wounds associated with lymphatic dysfunction.

    Wednesday, January 23

    Dissecting the Chronic Wound: What's Really Going On in There?

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Marcy A. Turkos, PT, DPT, CWS

    Level: Advanced

    This evidence-based presentation will define the chronic wound, discuss statistics of all types of nonhealing wounds and then focus on why wounds become "chronic." The presenter will review the literature that examines the impact of wound bed pH, cytokines, growth factors, protease activity, and oxidative stress, and how these factors play a role in wound healing. The clinical applications of modern wound care dressings impacting these factors will be discussed to help the clinician advance the healing process using novel technologies.

    Upon completion of this course, you’ll be able to:

    • Define chronic wound.
    • Explain how prolonged inflammation affects wound healing.
    • List wound exudate components that are not in balance contributing to the chroncity of the wound
    • Discuss wound dressings that balance harmful components of chronic wound exudates.

    Teaching, Learning, and Practicing Electrotherapy

    Joint Program: Education

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: David M. Selkowitz, PT, PhD>

    Level: Multiple Level

    Electrotherapy is considered one of the most challenging subject areas in physical therapy to learn and teach. The content area is often not well understood and is feared by both learners and instructors. This course will assist both instructors and learners in demystifying and understanding important concepts necessary for making appropriate and necessary clinical decisions regarding the use of electrotherapy, including manipulation of parameters and choosing devices.

    Upon completion of this course, you’ll be able to:

    • Use the literature on neurophysiology and electrotherapy to explain concepts in electrotherapy and justify parameter choices to students.
    • Use simple mathematical relationships to explain concepts in electrotherapy and justify electrotherapy parameter choices to students.
    • Use different presentation methods to engage students and facilitate learning.
    • Follow a logical and practical format for teaching and learning clinical decision-making, including parameter choices and device choices, in electrotherapy.

    Strategies in Learning: How to Best Describe Neurologic Changes in NCV

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Michael C. Lescallette, PT, DPT, ECS, Roger M. Nelson, PT, PhD, FAPTA, John Lugo, PT, ECS, MS

    Level: Multiple Level

    Conduction blockade of action potentials due to myelin deformation can manifest as weakness and paresthesias. Recognition of conduction blockade during an electrophysiologic evaluation is important in determining patient prognosis and treatment options. Novice electomyographers need to be able to recognize true conduction block versus temporal dispersion versus Wallerian degeneration based on nerve conduction and EMG studies. A multi-faceted approach to teaching conduction block is needed. A triangulation approach through neurophysiology lecture, visual simulation of action potential kinematics, and actual case study review will provide the best strategy for the electromyographer. The use of evoked motor potential waveform characteristics such as negative area and negative duration will be employed along with an algorithm that will aid in interpretation.

    Upon completion of this course, you’ll be able to:

    • Explain the electrophysiologic basis for electrical NCS testing.
    • Discuss the generation and propagation of nerve and muscle action potentials.
    • Discuss physiologic and anatomic factors affecting myelin/axons and their effect on nerve conduction characteristics.
    • Discuss various pathological conditions and their effect on myelin/axons of peripheral nerves.
    • Discuss knowledge and application of instrumentation used for monitoring, recording, and measuring electrophysiologic properties of nerve.
    • Recognize normal and abnormal NCV findings and explain their significance.
    • Identify abnormalities and conduction block.
    • Discuss modifications to NCS data charts to identify true conduction block.
    • Identify the applications and limitations of EMG/NCV.
    • List the information EMG/NCS testing can provide and what it cannot provide.
    • Discuss the recognition of pathology through electrophysiologic testing and its effects on patient outcome and physical therapy treatment.

    To Stim or Not to Stim: The Role of Electrical Stimulation in the Treatment of Muscle Denervation

    Joint Program: Hand Rehabilitation

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Christine Conroy, PT; Meryl R. Gersh, PT, PhD; David M. Selkowitz, PT, PhD

    Level: Multiple Level

    During the past 10 years, new evidence has emerged regarding the role of electrical stimulation in the rehabilitation of patients with muscle denervation. Clinicians strive to synthesize recent research with foundational knowledge of electrical currents and advances in technology, and apply these concepts in a clinical decision making model. The purpose of this presentation is to consider recent evidence regarding electrical stimulation of denervated muscle within the context of the foundational science of electrical currents and to apply these considerations to contemporary practice using a patient-centered approach.

    Upon completion of this course, you'll be able to:

    • Evaluate the current evidence base for the application of electrical stimulation to denervated muscle across species.
    • Determine the anticipated goals and outcomes associated with the application of electrical stimulation to denervated muscle.
    • Interpret the findings of electrophysiologic testing in muscle denervation states (nerve conduction velocity and S-D testing) as these relate to the decision to incorporate electrical stimulation in a rehabilitation program for a client with muscle denervation.
    • Describe the electrical stimulus parameters required to evoke muscle contraction and function in denervated muscle.
    • Describe the integration of electrical stimulation of denervated muscle into a comprehensive plan of care.

    Wound Care Reimbursement 101: A Guide to Success

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Melissa K. Johnson, PT, DPT, CWS

    Level: Intermediate

    This course will review and explain terms related to coding, billing, and reimbursement related to wound management procedures performed by physical therapists. These terms include local coverage decisions, national coverage decisions, ICD-9 codes, CPT coding, correct coding initiatives, and documentation. The presenter will review the most recent changes for 2013 related to coding, billing, and reimbursement regarding physical therapy wound management procedures. Resources and scenarios will be discussed to provide tools to physical therapists for successful reimbursement.

    Upon completion of this course, you’ll be able to:

    • Define and explain terms related to billing and coding for physical therapists performing wound management.
    • Identify resources to improve billing, coding, and reimbursement for physical therapists who perform wound management procedures in various settings.
    • Review 2013 coding, payment, and coverage changes for wound management physical therapy.

    Thursday, January 24

    Surface Spinal Cord Stimulation and Recording Multisegmental Motor Responses in Limbs

    Time: 8:00 am–10:00 am (See Program for Room)

    Speakers: Mohamed A. Sabbahi, PT, PhD, ECS; Fikriye Ovak, MD

    Level: Intermediate

    Using EMG, surface electrical stimulation of C7/T11- T12 vertebral segment elicits motor responses in upper- and lower-limb muscles. These procedures test direct ascending and descending spinal pathways. Data from healthy subjects will be presented and compared to data from patients with spinal cord injuries at different spinal levels and different American Spinal Injury Association categories. A proposed method of data analysis revealed a new approach to testing ascending and descending spinal pathways.

    Upon completion of this course, you'll be able to:

    • Explain the new methods of surface electrical stimulation of spinal cord segments while recording upper- and lower-limb motor responses.
    • Discuss data of healthy subjects tested for the multisegmental motor responses (MMR) of upper and lower limbs using EMG.
    • Discuss data of patients with spinal cord injuries at different vertebral levels and ASIA categories.
    • Define a new proposed method for testing ascending and descending spinal pathways for upper and lower limbs of the right- and left-limb side.
    • Identify possible new categories of spinal cord injuries based on electrophysiological testing of spinal circuitries using surface EMG.

    Pressure Ulcers: Diagnosis, Staging, and Treatment

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Stephanie L. Woelfel, PT, MPT, CWS, FACCWS; Rose Hamm, PT, DPT

    Level: Intermediate

    Physical therapists have a vital role in treating patients with pressure ulcers, from prevention through positioning and mobilization to diagnosing and treating the wounds. This course focuses on the pathophysiology, prevention, diagnosis, and treatment of pressure ulcers, with pertinent updates from the National Pressure Ulcer Advisory Panel. The speakers will review current staging criteria with an interactive component allowing participants to stage both simple and complex pressure ulcers.

    Upon completion of this course, you'll be able to:

    • Identify the contributing factors to pressure ulcer formation.
    • Explain the sequelae of events involved in pressure ulcer formation.
    • Determine the stage of a pressure ulcer based on tissue involvement.
    • Develop a comprehensive plan of care for a patient with a pressure ulcer, based on stage and comorbidities.
    • Select the most appropriate strategy for pressure redistribution.

    Using H-reflex Studies for Back Pain: Saving Patients From Surgeries

    Time: 11:00 am–1:00 pm (See Program for Room)

    Speakers: Mohamed A. Sabbahi, PT, PhD, ECS

    Level: Intermediate

    Testing of the lumbosacral and cervical spine through Soleus, VMO, and FCR H-reflex—coupled with direction sensitive exercise therapy—could decompress spinal nerve roots. Evidence-based directional exercises may save patients with disc pathology from spinal surgeries. This session will include the results and experiences of more than 2,000 patients.

    Upon completion of this course, you'll be able to:

    • Test and evaluate nerve root impingement using H-reflexes of upper and lower limbs in patients with radiculopathy.
    • Develop protocol for evaluation of the effect of loading (standing), unloading (lying), and various dynamic trunk postures to H-reflex amplitude.
    • Explain the relationship of H-reflex amplitude (facilitation of decompression) on nerve root function/ pathology.
    • Develop an effective treatment protocol using H-reflex data to treat patients with spinal pain and radiculopathy.

    Electrophysical Agents for Management of Diabetic Neuropathy-Associated Conditions

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Speakers: Lynn Freeman, PT, PhD, DPT, GCS, CWS; Mark Besch, PT; Sara Shapiro, PT, MPH

    Level: Intermediate

    According to the Center for Disease Control, conditions associated with diabetes, specifically diabetic neuropathy, are the leading cause of physical disability in the United States. The impairments associated with diabetic peripheral neuropathy include diminished or altered sensation; compromised integument; and neuropathic pain, which can lead to activity limitations such as sleep disturbance, impaired mobility, and falls. Electrophysical agents (EPA) are frequently prescribed for musculoskeletal pain, primarily because of the volume of supportive evidence and the well-established mechanisms of action (eg, gate control and endorphin release theories). However, the pathophysiology of peripheral nerve damage and neuropathic pain is more complex than musculoskeletal pain, and is only recently becoming better understood. Further, EPAs are prescribed less frequently to manage the other deleterious impairments and activity restrictions associated with diabetic neuropathy, such as parasthesia, wounds, and falls.

    In this session, the speakers will explain how integration of therapeutically dosed electrophysical agents—such as electrical stimulation, therapeutic ultrasound, and electromagnetic therapy—maximize clinical outcomes in managing conditions associated with diabetic neuropathy. In addition, the session will include a review of literature related to use of these interventions will be presented and clinical outcomes of actual patient/client cases.

    Upon completion of this course, you'll be able to:

    • Describe the benefits that therapeutically dosed electrophysical agents have on conditions associated with diabetic neuropathy.
    • Translate research findings related to electrophysical agents for diabetic neuropathy into clinical practice.
    • Appropriately select and prescribe electrophysical agents to manage conditions associated with diabetic neuropathy.
    • Describe 4 or more enhanced clinical outcomes related to the use of electrophysical agents for diabetic neuropathy.

    Functional Electrical Stimulation: Health and Fitness Benefits for People With Spinal Cord Injury

    Time: 3:00 pm–5:00 pm (See Program for Room)

    Level: Intermediate

    This is a joint program. See full description at Neurology programming.

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