Katharine Alter, MD; Florian Heinen, MD; Sebastian Schroeder, MD; Steffen Berweck, MD

Transcription

1 Wednesday Pre-Conference Session Options Ultrasound Symposium: Neuromuscular Ultrasound: Hands On Ultrasound Training Course for Chemodenervation Procedures Katharine Alter, MD; Florian Heinen, MD; Sebastian Schroeder, MD; Steffen Berweck, MD Target Audience: Physicians, nurse practitioners, physician assistants, therapists Course Summary: This full day course includes 90 minutes of didactic lectures including the following: Part I Ultrasound (US) Basics: the principles of ultrasound scanning/physics, the sonoacoustic properties of relevant tissues, US scanning techniques/tips. Part II, Clinical Applications of US: The use of US for procedural guidance/chemodenervation procedures including Botulinum Toxin and Phenol, The use of US in Neuromuscular Medicine. Part III, Hands on Scanning: The remainder of the course is comprised of hands on ultrasound training: Head and neck muscles, structures, upper/lower limb muscles and nerves. Part IV Procedural guidance training using phantoms or other models will also be included. 1. Be proficient in the basic physics and scanning techniques of ultrasound 2. Be proficient with the basics of US imaging 3. Identify clinical applications of US for procedural guidance and in Neuromuscular medicine 4. Identify key muscles in the neck, upper/lower limbs, parotid/submandibular glands. Identify sonoacoustic properties of relevant tissues and the benefits and limitations of incorporating US into clinical practice

2 PC 1: Early Detection and Diagnosis of High-risk of Cerebral Palsy and Cerebral Palsy: International Recommendations Iona Novak, Cathy Morgan, Annette Majnemer, Zack Boychuck, Colleen Payton, Michael Msall, Nathalie Maitre & Garey Noritz Target Audience: Neurologists, Paediatricians, Neonatologists, Physiatrists, General Practitioners, Neuro-Radiologists, Physical Therapists, Occupational Therapists, Speech Therapists, Nurses, Early Educators and Parents Course Summary: Cerebral palsy is the most common physical disability in childhood and is typically diagnosed between months of age. Advances in neuroscience have driven the field to identify strategies for accelerating early detection of high-risk infants (eg. Preterm, hypoxic ischaemic encephalopathy, neonatal stroke, congenital abnormalities, intrauterine growth restriction, multiples, neonatal intensive care graduates), to enable timely access to diagnostic-specific early intervention when the greatest neuroplastic gains are possible. IMPACT for CP, an international, multidisciplinary research network, unanimously agreed to develop an international clinical practice guideline on early detection. The guideline states that: Cerebral palsy or high-risk of cerebral palsy can be detected accurately and early using standardized tools. High quality evidence indicates that for infants less than 5-months corrected age, with identifiable high-risk for cerebral palsy, early detection using a combination of the General Movements assessment and MRI at near term age is over 95% accurate and is therefore strongly recommended. High quality evidence indicates that for infants older than 5-months corrected age, with high-risk for cerebral palsy, early detection using a combination of the Hammersmith Infant Neurological Evaluation (HINE) and early MRI is over 90% accurate and is therefore strongly recommended. The accuracy of these techniques in infants without discernable risks or lower-risks for cerebral palsy (e.g. healthy term born infants, with no apparent pregnancy and neonatal risks) are not yet known but are conditionally recommended based on best-available evidence. Accurate early detection of high-risk of cerebral palsy is possible even when early MRI and the General Movements assessment are not safe, available, feasible or affordable, using the HINE, which detects cerebral palsy with more than 90% accuracy (in Preterm, hypoxic ischaemic encephalopathy, neonatal stroke and NICU graduate populations) and also provides objective information about likely motor severity. Early detection of high-risk of cerebral palsy, followed by cerebral palsy-specific early intervention is strongly recommended and should be the standard of care to optimize infant neuroplasticity, prevent complications and enhance parent well-being. This workshop will use a structured facilitation approach, in small groups, to identify implementation barriers and solutions to facilitate rapid uptake of the clinical guideline. The interactive activities and facilitation will follow the internationally recognised knowledge translation approach, known as Knowledge to Action developed by Ian Graham.

3 At the end of the Pre-Conference Session, participants will have: 1. New knowledge of the best-available evidence on accurate early detection of cerebral palsy published in an international clinical practice guideline. The presentation will be supported with video case studies of infants and their assessment data so as to illustrate the clinical utility of the guideline; 2. Had an opportunity to critically analyse the barriers to implementation of these international guidelines in their local context; 3. New knowledge of the learning s from North American and global implementation projects in centers seeking to implement the guidelines, giving examples of successful (and unsuccessful) implementation strategies. 4. Had an opportunity to identify practical knowledge translation solutions to overcome self-identified implementation barriers that might exist in their local context.

4 PC 2: Pain in CP: Reflections on Identification, Management, and Prevention Allan Colver, MA, MB BS, MD, FRCPCH; Darcy Fehlings, MD, FRCP(C), MSc; Jon Mink, MD, PhD; Shauna Kingsnorth, PhD; David Roye, MD; Heather Shearer Target Audience: Health Professionals involved in the care of individuals with CP Course Summary: Pain is under-recognized and under-treated in individuals with cerebral palsy (CP) and impacts negatively on an individual s quality of life. This course will provide a clinical framework (ADOPt) for the assessment and management of pain in CP including a practical orientation to a recently published CP Pain Toolbox. The optimal management strategies for pain from dystonia and the prevention and management of musculoskeletal sources of pain will be highlighted. A stakeholder perspective on the impact of pain on the well-being of children with CP will be provided. At the end of the Pre-Conference Session, participants will be able to discuss 1. The importance of pain on quality of life and well-being in individuals with CP 2. A clinical framework for managing pain in CP 3. Optimized management of Dystonia in CP 4. Prevention of MSK pain in CP

5 PC 3: Neurosurgical Management of Childhood Spasticity Richard C. E. Anderson MD, Michael Partington MD, Sameer Sheth MD, Patricia Tan MD, Dean Morgan PT, Claudia Ghigliotty OT Target Audience: Physical therapists, occupational therapists, physiatrists, child neurologists, orthopedic surgeons, neurosurgeons, and pediatricians Course Summary: This course will focus on the neurosurgical management of childhood spasticity. Faculty will discuss the pathophysiology of spasticity as well as neurosurgical treatment options including selective dorsal rhizotomy, intrathecal baclofen therapy, and deep brain stimulation. The pathophysiology and management of dystonia will also be discussed briefly. In addition, considerable time will be dedicated to discussions of how to select patients for the best treatment option, with perspectives from both surgeons and therapists. The last part of the session will focus on case presentations/discussions to highlight the selection process and outcomes. Participants are encouraged to bring case presentations for discussion. 1. Discuss indications for neurosurgical treatments in children with spasticity 2. Discuss outcomes for children after selective dorsal rhizotomy and intrathecal baclofen 3. Discuss the role for deep brain stimulation in children with spasticity and dystonia 4. Discuss how to select patients for the different neurosurgical treatment options