The annual scientific meeting of the British Society of Physical and Rehabilitation Medicine (BSPRM) was held virtually on October 12th, 2022, under its new name. The meeting covered a wide range of intriguing rehabilitation-related topics delivered by eminent speakers.
Long Covid Rehabilitation
The conference began with Dr Manoj Sivan, President Elect of BSPRM, providing a brief overview of the long-term multisystem symptom problem that necessitates the expertise input of a specialist rehabilitation physician in Long Covid services. Dr Joanna Corrado, Clinical Research Fellow in Leeds, then expanded on the features of the long-term multisystem symptom problem, taking a more focused approach into dysautonomia, its prevalence and also discussed the HEARTLOC (heart rate variability biofeedback in Long Covid) research study, which used real-time heart rate variability (HRV) biofeedback and diaphragmatic breathing technique intervention being used in the study. Following this, Dr Anton Pick, Clinical Director of the Oxford Centre for Enablement, discussed our current understanding of pathophysiology in Long Covid, with particular reference to post-exertional malaise, and limiting factors for physical activity. He then discussed interesting research into the physiology of exercise and tolerance in patients using cardiopulmonary tests with conflicting results. Emma Tucker, a Specialist Respiratory Physiotherapist at Oxford Health NHS foundation trust, continued the discussion by discussing the practicalities of getting back into physical activity in Long Covid.
Trauma and Amputee Rehabilitation
Dr Moheb Gaid chaired the following session on trauma rehabilitation. Dr Sarah Platt, Clinical Lead for Neuro Trauma ICU at Royal Victoria Infirmary, described the major trauma services and an overview of their role as anaesthetists in trauma ICU. Dr Emily Johnston, a Consultant in Rehabilitation Medicine from the Newcastle Major Trauma Centre, continued the discussion by highlighting the value of rehabilitation prescriptions for a holistic approach. Mr Jim Ashworth Beaumont, RNOH Stanmore, a Prosthetist and Orthotist, shared his personal story of recovery from polytrauma caused by a road traffic accident that led to a transhumeral amputation during the pandemic. He described the difficulties encountered along the trauma pathway, including lack of early access to a coordinator and the paucity of programmes, but later offered in the rehab prescription that met his requirements. It was fascinating to hear about his experiences with myoelectric or body-powered upper limb prosthetics depending on his functional needs, as well as his thoughts on osseointegration techniques that are presently not offered by the NHS.
Senior Prosthetist at Glasgow’s Queen Elizabeth University Hospital, Mr Vincent MacEachern, spoke about the Scottish model for upper limb prosthetics. This paradigm is put into practice, and services like satellite clinics and first trials performed before prescriptions are supplied for upper limb prosthetics as well as other services. Dr Simon Shaw, Consultant Rehabilitation Physician, Guys and St. Thomas NHS Foundation Trust, provided additional information on prosthetics and the MDT approach with a detailed assessment, equally to address expectations for a prosthetic or non-prosthetic user before prosthetic prescription, and explained the current shortcomings in service as we are still lagging behind other countries in terms of advancing technology hand programme functions.
Community and Cancer Rehabilitation
Soon after the lunch break (with poster viewing), Dr Rohit Bhide, Rehabilitation Medicine Consultant at Sheffield Teaching Hospital, chaired the next session. Professor Diane Playford, Professor of Neurological Rehabilitation, University of Warwick, talked about the burden of community rehabilitation, with overlapping services and systematic gaps that are in need of action and delivered an insightful talk on Best Practice Guidelines in Community Rehabilitation. Also discussed were problems with how rehabilitation is currently delivered, such as a lack of collaboration among services, overlaps, or gaps in services, and how it might be possible to improve commissioning and deliver high-quality services by identifying gaps and filling them to address a variety of community conditions.
Dr Eugene Chang, Assistant Professor, Division of PM&R, University of Toronto discussed cancer rehabilitation before and after COVID-19 and provided an account of their journey to become one of the top cancer rehabilitation centres. He described the stratification model with the triage system depending on the complexity of cases in cancer survivors and explained how rehabilitation support was given during the pandemic.
Driving after brain injury
Dr Inigo Perez-Celerio, DVLA doctor Driving and Vehicle Licensing Agency, spoke later about the physician’s duties in advising on return to driving, with a focus on cases involving traumatic brain injury. He discussed how the fitness advice to drive differs depending on the cases’ levels of PTA and whether seizures were provoked or unprovoked. If physicians are unsure, they can consult with the DVLA team for additional guidance. Cases can be individually examined and advised, and in some cases, challenges may be made.
The chair of the PDOC Special Interest Group, Dr Judith Allanson, Rehabilitation Medicine Consultant in Putney, presented the session on the pharmacological treatment of people with a prolonged disorder of consciousness (PDOC). Dr Andrew Hanrahan, Consultant at Royal Hospital in Putney, introduced the speaker. The presentation briefly discussed neurochemical mechanisms and outlined the difficulties associated with PDOC research studies. It was encouraging to learn about the SIG’s future plans to standardise data collection and prescribing practices.
Overall, this conference was packed with information, had variety and was helpful for trainees to learn more about the specialty of Rehabilitation Medicine, the various services in the country, novel research studies, and other initiatives being made to improve the quality of life of those living with long term conditions and disability.