AFRM eBulletin – 24 August 2018

Concussion Management: An evolving frontier in rehabilitation medicine

Current perceptions of the impact of concussion often underestimate its effect partly due to its evolving nature whereby symptoms have delayed onset and given the majority of patients’ recovery within a short period. This leads to the misconception of symptoms being short-lived or self-resolving without the need for longer term follow up. Concussion is a clinical syndrome and mild subset of traumatic brain injury caused by a direct or indirect force to the head. This results in a temporary disruption of normal brain function, evident by distinctive, neurological symptoms and signs. The figure often quoted is that in 85 per cent of patients who suffer a concussive injury, symptoms resolve within two weeks. The notion that compared to more severe TBI the management of concussion is more straight forward is far from reality. The condition is often complex and the management and prognosis peppered with 'known unknowns'. 

There has been a lot of recent focus on early concussion management in elite sport with on field protocols and the more acute management based around the tests outlined in SCAT 5. Depending on the severity of symptoms, subjects are withdrawn from the field of play for the remainder of the game and rested for a short time (one to two days) before resuming a graded return to activity.

The unknowns in acute management are the usefulness of imaging, (MRI and CT scans currently have limited benefit), whether biomarkers will be clinically valuable and what additional baseline assessment should be considered for return to contact sport beyond symptom resolution. 

The point of difference with Epworth’s Concussion Clinic is the active treatment of symptoms to promote earlier resolution and the reduction of secondary psychological sequelae as a consequence of the victim’s trauma. 

For example, ongoing vestibular and visual problems can be very distressing. Our team has a vestibular physiotherapist who teaches patients’ habituation exercises to alleviate movement induced symptoms and treats peripheral disorders, such as BPPV, that can occur as concurrent sequelae of the initial head blow. From the point of view of the visual system, patients often have difficulty with accommodation, convergence, smooth pursuit movements, saccades and the vestibulo-ocular reflex. All of these have treatment paradigms. There is also extensive testing of balance mechanisms and therapy directed at normalising balance reactions in day-to-day activities.

Persistent headache varies from an exacerbation of simple tension headaches to more complex symptoms in the migraine spectrum and requires aggressive management. Soft tissue injuries to the neck, can also contribute to headache and are quite amenable to specialist physiotherapy treatments. The cognitive and behavioural sequelae of concussion which include problems with memory and concentration as well as emotional lability, depression and anxiety are treated by the neuropsychologist. The therapists promote education in areas such as sleep hygiene, stress management and encourage a more positive attitude in patients as they return to their normal lifestyle. 

In recommending graded return to exercise, pacing strategies and parameters for exercise intensity and volume are given to the patient to minimise symptom exacerbation. With symptom resolution, the grading of exercise permits a gradual return to an individual’s previous level of physical ability which may include elite sport.

A significant unknown in the long-term outcome of individuals who have suffered multiple concussions, is the deterioration of cognitive, function and behaviour many years post injury. The term chronic traumatic encephalopathy (CTE) which is a pathological diagnosis has been applied to people with this clinical profile. The exact nature of the condition and the likelihood of an individual to develop CTE is still largely unknown. Patients continue to worry about the long-term effects of concussion as more evidence emerges, with concerns that this will decrease general participation in contact sports.

Professor John Olver AM MBBS MD (Melb) FAFRM (RACP)

A message from your President

AFRM Council Planning Day and 25th Anniversary of the AFRM

AFRM Council held its 2019-2020 Planning Day and Council Meeting on 9 and 10 August in Sydney. The Planning Day is particularly important as it helps to set and prioritise strategic activities for the next two years. The broad topics discussed included: making the AFRM value proposition and ways to raise awareness of the value of rehabilitation medicine, medical workforce issues, engaging members in activities of the Faculty and College, education and training, research and current policy and advocacy topics. We will be aiming to finish the formal strategic plan in the next month and I will provide you with some more information then.

Thank you to all AFRM Fellows and trainees who took the time to provide feedback to the recent survey regarding the AFRM Value Proposition and Narrative document.

The results of the survey were:

  • 69 Fellows or trainees provided responses
  • 74 per cent of respondents answered yes to Question 1: ‘Do you support the use of the term Rehabilitation Medicine Physician (rather than Rehabilitation Physician) as the everyday-use name to describe ourselves?’
  • 60 per cent of respondents answered yes to Question 2: ‘Do you support the use of the proposed tagline for rehabilitation medicine ‘Putting Lives Back Together’?’
  • 87 per cent of respondents answered yes to Question 3: ‘Do you agree with the value sentences proposed in the document?’
  • 91 per cent of respondents answered yes to Question 4: ‘Do you agree with the value paragraphs proposed in the document?’
  • 97 per cent of respondents answered yes to Question 5: ‘Do you support the need for the AFRM to do more work to raise the profile and promote the value of our specialty?’

Many people also provided specific and detailed comments regarding these questions and these have been very helpful in assisting us to modify and refine the value sentences and paragraphs. We will be circulating the next draft of the document soon.

2018 marks the 25th anniversary of Australasian Faculty of Rehabilitation Medicine. When I first received correspondence in early 1992 notifying me that my application to join the rehabilitation medicine training program had been successful it was from the Australasian College of Rehabilitation Medicine (ACRM). By the time I received a letter just over 12 months later telling me that I had been unsuccessful in the Part 1 Clinical Exam, it was from the Australasian Faculty of Rehabilitation Medicine (AFRM). As a specialty, we have accomplished a lot together in the last 25 years (and before) and should be very proud of reaching this milestone. AFRM Council and the College’s Communications team are exploring a number of ways that we can celebrate the anniversary, the first of those being to develop a special anniversary AFRM logo. We will keep you updated on developments.

Professor Tim Geraghty 
President, AFRM

Visual Gait Analysis

Visual Gait Analysis is a complex skill. HETI (Health Education and Training) has recently supported several two day workshops to facilitate the development of this skill amongst clinicians. The Clinical Gait Analysis Service at Monash Health in Victoria facilitated this learning event which included lectures, workshops and break-out sessions for numerous case studies, addressing a wide variety of both adult and paediatric conditions affecting gait. This two minute survey (seven questions) is aimed at assessing the level of interest of clinicians and physicians in attending a similar course (facilitated by The Kids Rehab Department at The Children's Hospital, Westmead) to assist with planning such an event.

Stephanie Robinson
Physiotherapist – Brain Injury Service 
Kids Rehab

AFRM Expression of Interest – Regional Committees

Expression of Interests are being sought for several opportunities within AFRM Regional Committees.

The AFRM Regional Committee has been established to:

  • advise the Faculty Council on matters relevant to the Faculty in their region
  • promote rehabilitation medicine in their region
  • respond to new and emerging rehabilitation medicine issues relevant to the Faculty as they arise provided the issue is approved by the Faculty President or Faculty Council prior to work commencing
  • work with other relevant appropriate College bodies and staff in relation to training and continual professional development and contributing to policy and advocacy matters
  • the activities of the Committee must be consistent with the College’s Strategic Directions document or any successor document.

For further information please visit: 
www.racp.edu.au/expressions-of-interest/afrm-nsw-regional-committee
www.racp.edu.au/expressions-of-interest/afrm-wa-regional-committee

Trainee research awards reminder

Deadlines  for abstract submissions for Trainee Research Awards events are fast approaching. 

Trainees across Australian states and territories, and New Zealand can take part.

Learn more

Have you logged into your new RACP benefits website?

Your RACP member benefits program can save you hundreds throughout the year, with discounts on a range of lifestyle, leisure and financial services. 

Including holidays and work trip essentials, discounted business management software or financial planning and insurance for professionals. 

Your member benefits program can also help you save on everyday essentials like fuel and groceries or household necessities with pre-purchased gift cards*.

Visit your RACP Member Advantage website or call 1300 853 352 for more information.

*Terms and Conditions apply.

Final call: up to $8,000 available for women's leadership development

Women currently working in the healthcare sector have a final opportunity to register their interest in a scholarship worth up to $8,000 to support participation in a leadership development program. 

Funding must be apportioned by the end of September and it is unsure when these grants will be available again. Find out more and register your interest by completing the Expression of Interest form prior to 5pm on September 21: www.wla.edu.au/health 

Apply or nominate for College and Faculty awards and prizes

Recognise an outstanding colleague or apply for a career-enriching opportunity through the different awards and prizes offered by RACP and AFRM. Nominations are now open for several prestigious College awards and prizes, including:

Applications for the Adrian Paul Prize are open to AFRM Fellows in the first year of Fellowship. The prize is awarded for the best scientific work in the field of rehabilitation medicine that is submitted as part of the AFRM training program.

Trainees are also encouraged to apply for the RACP Trainee Research Awards for Excellence. Regional awardees will be invited to attend and present at the 2019 RACP Congress in Auckland. They will also have the opportunity to have their abstract published.

Visit the RACP Foundation webpage for full details of all awards and prizes offered by your Faculty and the College. For more information about the eligibility criteria or the application process, please contact RACP Foundation at Foundation@racp.edu.au or call +61 2 9256 9639.

Participate in a questionnaire about transition of young people from children’s to adult services for Botulinum toxin A (BoNT-A) injections in NSW

Are you a clinician who works, or has recently worked in an adult or paediatric (spasticity management) BoNT-A service in NSW or ACT? If so we would be grateful if you could help improve the understanding of clinicians’ experiences of the transition of young people who need Botulinum toxin A (BoNT-A) injections by completing the questionnaire in the link below.

Botulinum Toxin-A Transition Project Questionnaire 

Alternatively, you can copy and paste the following link into your web browser:
https://redcap.sydney.edu.au/surveys/?s=H8JJ7L8KCE   

Completing the questionnaire will require approximately 15 minutes. The questionnaire is part of a project funded by the NSW Agency of Clinical Innovation to improve the experience for young people who need Botulinum toxin A injections as they transition from children’s to adult services. 
Ethics approval has been attained, approval number: HREC/18/SCHN/248).

Closing date of the questionnaire is set to 11.59pm, 30 September 2018. 

Please feel free to contact Anne de Groot (project officer) via email Anne.degroot@health.nsw.gov if you have any questions about this study. 

ASMR newsletter

The Australian Society for Medical Research's August newsletter is now available for you to read.

Child health experts and key stakeholders come together in Canberra for the RACP Inequities in Child Health Forum 

On Wednesday of last week, the Royal Australasian College of Physicians hosted our Inequities in Child Health Forum at Australian Parliament House in Canberra, where leading child health experts presented to an audience including Members of Parliament and Senators, state and territory Chief Paediatricians and heads of key medical, public health and community bodies.

Australian Federal Minister for Health and Shadow Minister for Health and Medicare spoke at the event, with the Minister for Health announcing funding for the development of a National Action Plan for Children’s Health 2020 to 2030. The Minister stated that the plan “will ensure that we give our Indigenous Australians, our rural Australians, and our younger Australians in more difficult socio-economic circumstances, the best shot at the best life to be the best person that they can otherwise ever hope to be."

Child health experts Associate Professor Susan Woolfenden, Professor Sharon Goldfeld and Professor Ngiare Brown presented on the actions and strategies needed to reduce inequities in health care access and outcomes, and the part that health practitioners and politicians can play in acting as a buffer against cycles of disadvantage. The Forum and its messages received significant media coverage across print, radio, social media and television, helping to promote discussion of an important area for child health and wellbeing.

The RACP President Associate Professor Mark Lane, President of the Paediatrics and Child Health Division Professor Paul Colditz, and senior Paediatricians also met with the Commonwealth Chief Medical Officer, and other government representatives. 

The RACP will continue its dialogue with key decision makers to ensure high quality, truly universal health care services are available to all children regardless of their postcode.

To find out more about this issue, you can read our Inequities in Child Health Position Statement or its accompanying fact sheet, and access the tools in our online advocacy kit

You can also listen to Professor Sharon Goldfeld discuss the issue of child health inequities on ABC RN Breakfast as recorded on 15 August 2018. 

Trainee events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

Go to the events list at any time to see what events are coming up.

AFRM training resources

Bi-National Training Program (BNTP) 

The AFRM conducts the BNTP on the last Wednesday of every month from February to November. These training sessions are broadcast across Australia and New Zealand. The BNTP sessions use Zoom conferencing to provide trainees with Rehabilitation Medicine knowledge and information. These sessions are not intended to prepare trainees for the AFRM Fellowship Examinations. 

View session dates

Important note: If you join the session late, the videoconference room will indicate that it is locked and will not allow you to connect. Please ensure that you turn your webcam off before you join the session. Due to the nature of the recordings if you connect to the videoconference with your webcam on you will appear on the screen. 

To join the videoconference on the day, follow this link to the Zoom Software.

Please note this is the URL embedded in the above link: https://racp.zoom.us/j/3899131497 

The meeting ID: 389 913 1497 

Email the RACP events team at events@racp.edu.au or call +61 2 8247 6240 to arrange equipment testing. Ensure you do this as soon as possible to avoid any last-minute disruptions.

NSW Saturday Lecture Series

Go to the events list at any time to see what events are coming up.

AFRM contact details 

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM Education and Training enquiries:
Name: Lanica Roventa, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Examination enquiries:
Name: Vanessa Hall, Examination Coordinator 
Phone: +61 2 9256 5422
Email: examinations@racp.edu.au  

AFRM training site accreditation enquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
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