20th European Congress of Physical and Rehabilitation Medicine

The 20^th European Congress of Physical and Rehabilitation Medicine (PMR) was held in Estoril congress centre in Estoril, Portuguese Riviera near Lisbon from 23-28^th April 2016. Its focus was on (ICD) International Classification of Diseases, body functions and activities, environmental and personal factors and quality of life, (ICF) International Classification of Functioning, health interventions and PRM health accounts (ICHA) with the main topics as below:

Topics of general interest in PRM
PRM and disorders of Nervous System
PRM and orthopaedic and musculoskeletal disorders
PRM in other specific disabling conditions
Interactive and clinical rehabilitation sciences

The congress started officially on the evening of Sunday 24^th April with a very attractive opening ceremony including two local guitarists playing Portuguese guitar followed by a group of young dancers with some disabilities who impressed all the audience in the main auditorium.

The first two days before the official opening (23^rd and 24^th April) included mainly workshops and courses in muscle ultrasound (MUSCULUS), Mesotherapy (a procedure in which multiple tiny injections of pharmaceuticals, vitamins, etc. are delivered into the mesodermal layer of tissue under the skin, to promote the loss of fat or cellulite), clinical examination in PRM, and manual medicine. The European school of Marseille also had two presentations on the first day and there were also a few different meetings for individual members, executive committee and general assembly.

There was an international teaching programme in Botulinum Toxin and musculoskeletal disorders. Speakers mainly from France shared their experience in treating chronic exertional compartment syndrome and functional popliteal artery pain entrapment with Botulinum Toxin to reduce pain in these conditions. They also claimed it can be used in reducing pain in osteoarthritis, femoral patellar syndrome and pririformis muscle syndrome. The rationale behind these experiences were reducing nociception and anti-inflammation via reducing P substance and glutamate, cleavage of neuronal SNARES and preventing release of neurotransmitters and modifiying expression of inflammatory markers. They believed Botulinum Toxin also has some roles in improvement of chondroprotection and can help with muscle imbalance around the osteoarthritic joint.

Stroke was the main topic of the auditorium in the morning of 25^th April followed by a spasticity presentation in the afternoon. Acquired brain injury was the main topic of the second day in the auditorium followed by chronic pain and complex regional pain syndrome. The satellite symposium on this day was “A comprehensive patient-oriented approach in the treatment of spastic paresis” chaired by Professor Wissel from Germany with focus on the following topics:

Listening to patient’s needs and expectations
Managing spasticity in a way that matters to patients
Upper limb spasticity: from a double-blind, randomised controlled trial, to clinical practice
Engaging and supporting patients through a guided-self rehabilitation contract

In the evening of the second day, I got a chance to participate in the shock wave therapy in physical and rehabilitation medicine workshop presented by two speakers from Bulgaria and Greece, Professor Ilieva and Dr Kouloulas and sponsored by one of the exhibitors. Shockwave therapy is used in pain treatment, improving healing fractured bones, helping in reduction of calcified tissues and treatment for tendonitis, heel spurs and renal stones. There was also discussion around targeted radiofrequency therapy as a new era in tissue hyperthermy, high intensity laser in therapeutic laser technology and continuous passive motion therapy (CPMOTION) for improvement of range of muscles and joints movements.

Perhaps the most interesting exhibition to my view was EKSO GT, an exoskeleton device used in stroke, spinal injury rehabilitation and gait training. The manufacturer claimed that it has a unique programme called Variable Assist which adapts the amount of power provided by the device to the specific needs of the patients which allows patients with any remaining motor function in their legs to contribute their own activity when walking.

Another interesting exhibition was ultrasound-guided myofascial release injection as a type of treatment that focuses on the nerve structures in the fascia and in the interfascial space itself. In addition to reducing nerve pain, the injection is believed to improve the flexibility of interfascial movement by reducing fascial adhesion. Local anaesthetics are generally used although normal saline has been reported to be equally effective. A randomised controlled trial conducted on trigger point injections for the treatment of myofascial pain in the neck, shoulder, or back revealed that normal saline has equivalent efficacy to mepivacaine. However, there is currently insufficient evidence that normal saline is as effective as local anaesthetics for myofascial release injection. One of the areas for myofascial release injection is Kager’s fat pad (between the Achilles tendon and flexor hallucis longus muscle) to treat Achillodynia.

Overall, it was a very useful congress in Physical and Rehabilitation Medicine which encompassed most of the topics on both fields and was worth it to attend.

The next European PRM congress will take place in Vilnius, Lithuania in May 2018.