Rhaïa December 2017

To wear and what to wear – that is the question

Guest editor – Alfredo Martinez-Coll PhD, General  Manager, Stakeholder Engagement, MTPConnect

Wearable devices, initially focused on consumer products targeting fitness and wellbeing via activity tracking, are quickly finding their way to medical practice. These devices have become very advanced, with a wide variety of sensors and algorithms providing sophisticated biomedical monitoring for telehealth and remote applications or cloud-based servers/connectivity. The use of wearable devices in rehabilitation is significant in stroke, neurodegenerative diseases, as well as post-injury.

The development of these and other technologies for medical applications usually arises from multidisciplinary teams addressing unmet needs – the idea that there has to be a better way of doing things. Early prototypes are crude and bulky but provide the opportunity for proof of principle, optimisation, and validation. However, the move away from consumer products to regulated devices is a big leap. In order to market a device with 'therapeutic' or clinical benefits claims, it must go through a rigorous trials and regulatory processes.

The three articles in this newsletter cover not only the topic of wearable devices with a focus on rehabilitation, but also offer a snapshot of their unique product development journeys. I became aware of the Exoflex many years ago when my wife suffered a serious finger injury and I was looking for alternatives for her rehabilitation. At that time it was an early laboratory prototype, part of a PhD project.  Since then, the technology has been spun off into a company, has attracted the usual rounds of grant and government funding, gone through private capital raising, and continued its product development. It is now a sophisticated product undergoing device trials for regulatory approval. 

MyGolgi is a much newer technology taking advantage of strain-gauge type 'tape' using clever software algorithms to determine correct posture, using those results to prevent and treat back pain. The young inventors behind the technology are early into the device commercialisation, but are already thinking of new indications/applications for their product beyond rehabilitation.  

The other article on the internet of things (IoT) brings them all together and highlights one of the most important issues in healthcare, the digitisation of medicine. New wearable devices can now truly claim that they are 'smart' technology – they are connected to other devices, to the internet, the cloud, to healthcare providers (rehabilitation technicians, General Practitioners, specialists in multiple sites across the country and across the world), can take advantage of information in the Personalised Electronic Medical Record, adjust to the individual user, monitor 24/7, and through artificial intelligence (AI), can quickly pull this wealth of information together and provide personalised/tailored outcomes for the wearer. 

Smart wearable devices are an attractive proposition to remote communities and people in developing economies (where mobile telecommunications have experienced significant increases in reach and adoption), playing a key role in the telehealth infrastructure. Their use allows wearers to access the care they need at home, surrounded by family and friends, and most importantly unloading the healthcare system. Innovation in rehabilitation medicine, just as in other specialties, will come from the integration and focus on megatrends such as precision healthcare, integrated models of care, digital evolution, chronic disease burden, consumer control, developing markets, and global biosecurity.

Medical device and drug development are expensive, risky endevours. Support in this area is available through the Industry Growth Centre for MedTech and Pharmaceuticals (MTPConnect), part of the Australian Federal Government’s $250 million Growth Centre Initiative of the National Innovation Science Agenda. MTPConnect has been established to drive innovation, productivity and global
competitiveness, with the ultimate goal of creating sustainable employment, growth and wealth
for Australia through research, product development and a strong clinical trials sub-sector.

A new way to rehabilitate hands: the Exoflex

Dr Peter Puya Abolfathi is a biomedical engineer.
A normal working hand is one of the most important features for independence in an individual's life. Hand function can sometimes be greatly compromised following injury, pathology or surgery and timely and proper intervention is crucially important in the recovery process. By bringing back hand function, a great degree of independence and self-reliance can be returned to individuals with injuries or disabilities affecting their lives. This is particularly true for patients with tetraplegia, who can move their arms but cannot achieve hold of everyday items. It is also of great relevance to patients recovering from stroke and other neurological impairments causing partial paralysis to the upper extremities.

When it comes to the rehabilitation of the hand, current best practice is to provide manual therapist intervention for both therapy and assessment. When technology is used to assist rehabilitation, it is typically bulky and clumsy in the form of Continuous Passive Motion (CPM) devices that attach to the tip of the fingers and move them therapeutically for long durations. While CPM treatments have been shown to be effective for people recovering from hand trauma, they are often not used because they are difficult to use properly and not easy to customise. CPM treatments are not effective in bringing hand function back in patients suffering from paralysis in the hand.

With its beginnings at the Quadriplegic Hand Research Unit of the Royal North Shore Hospital, Sydney, Exoflex was developed as a tool to provide therapy to injured and neuropathic hands, assessment of hand condition, and function for paralysed hands. Exoflex is a patented revolutionary device that can magnetically ‘snap on’ to an individual’s hand allowing easy donning and doffing of the device. The portable device is controlled by a web-enabled master control unit that can be accessed remotely. 
The ability to access the device remotely has huge potential in allowing remote interaction in patient-care including assessment and an outcomes-based approach to therapy and rehabilitation. The same electromechanical innovation can eventually be applied to any joint in the body. This would have a great impact in future development in the area of exoskeletal robotics and rehabilitation robotics. One of the most interesting features of the Exoflex technology is its ability to carefully impart movement to each of hand joints individually allowing it to be highly customisable.

Since the device remembers the patients, it can provide dedicated targeted therapy for each user as required. The data for each patient is kept on the device and is viewable by the therapist as trend data which can be compared with the therapist’s own traditional assessment notes.

The Exoflex device is currently tooled for production. However, until the regulatory compliance certificates are obtained, it will not be able to be sold and used commercially for therapy. However it is available for use as a research tool for laboratories interested in using its unique biomechanical properties in suitable investigations.

While the initial version of the Exoflex technology targets the hand therapy market, it is anticipated that in time, additional benefits and uses of the technology will be presented by innovative healthcare providers and scientists.

Wearing the treatment for back pain

Mr Mitch Finlayson is a biomedical and computer systems engineer.
Wearable technology for back pain sufferers has the potential to improve patients' posture, while also providing health professionals with valuable data.

Eighty-four per cent of the world's population suffer from back pain at one point in their life. Back pain is a global health priority, with increasing prevalence of back pain over the past 20 years as the population worldwide ages. In 1990 lower back and neck pain ranked twelfth in disability-adjusted life years, by 2015 it ranked fourth1.

Treatment for back pain costs the Australian economy approximately AU $1 billion annually, with indirect costs totaling AU$8 billion annually2.

Research shows that sustained postures for more than two hours per day, in particular forward flexion combined with lateral flexion, creates the highest risk of back pain3. There is a clear need for better understanding and awareness of body positioning throughout daily life to prevent back pain and assist with rehabilitation from injury.

There are several new wearable technologies that aim to address rehabilitation for back pain sufferers by providing feedback to the user or to the health professional. However, of the devices on the market, none are able to simultaneously provide feedback to the user and the health professional for long periods of time. 

A number of wearable devices are in development across the globe including Australia. MyGolgi is a wearable device designed to provide live feedback and alerts enabling users to monitor their posture throughout daily life and correct their poor posture in real time. 

For rehabilitation medicine specialists, these advancements in technology and data collection are exciting opportunities to help patients achieve their goals.
1Hiadong Wang et al, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015
2BF Walker et al., Low Back pain in Australian Adults: The Economic Burden, Asia Pac J Public Health 2003; 15; 79
3Ramond-Roquin et al. (2015). Biomechanical constraints remain major risk factors for low back pain. The Spine Journal, 15(4), 559

The 'Internet of Things' – important questions to ask

Dr Ross Clark is a National Health and Medical Research Council R.D. Wright Biomedical Fellow based at the University of the Sunshine Coast and Honorary Fellow at the Murdoch Childrens Research Institute in Melbourne. His research focuses on working with clinicians to improve the way they assess and treat their patients by creating hardware and software systems that are usable in clinical settings.

The 'Internet of Things (IoT)' is a phrase that has received a great amount of hype recently, and for good reason. Accessing data from sensors remotely has enormous potential for improving many aspects of clinical practice, and rehabilitation technology companies are increasingly taking advantage of these capabilities. Obvious applications include installing low cost sensors with internet connectivity for telerehabilitation and monitoring purposes in remote locations. Everything from blood glucose and heart rate through to muscle weakness and standing balance impairments can be assessed, sent to the cloud, stored in a database and reported to the clinician simply and at very low cost.
 
As someone who creates IoT enabled devices it surprises people when I am often quick to disparage them. Security and data privacy are obvious issues that have received significant attention, however the implications are often overblown. A commonly raised concern is that a “mysterious entity” could steal data and use it for blackmail. This cuts to the heart of healthcare professionals, as patient privacy is sacrosanct. Hacking and interpreting an individual sensor requires immense effort, therefore data theft and extortion are more likely to be targeted at the website or server that collects and stores the information. However, in the majority of cases the data stored on a single server/database would likely have limited use to an anonymous hacker. For most IoT devices unless they are sending data to a single online database that contains in-depth patient records, the data they provide is likely to be quarantined. Furthermore, a simple step of using patient codes that are irreversible without an offline encoding system for the most part overcomes the issue of individual patient identification.
    
Issue are more likely to arise from the business practices of the service provider. Issues that can arise include:

  • The company increasing prices
    An IoT platform recently increased the minimum annual cost by six-fold in just one year. If you are bound to a company doing something similar there may be little opportunity for recourse, as often there is an upfront cost to purchase the hardware and significant time and effort is invested by the user to integrate the system into their clinical practice.
  • The company on-sells your data
    This is a serious contractual issue, and it is not always clear who owns the data that is uploaded to a server computer for analysis. In a world of ​'big data' and the impacts it can have, a large cohort of clinical outcome data could be of great financial benefit to a company if they have the rights to sell it. 
  • The company collapsing
    This will likely mean that you have no ability to continue using the system you purchased as the cost to the company of running an analysis server can be quite high. This contrasts with a program installed on a local computer, which can continue being used irrespective of the company’s success.

Another issue with the IoT is that it often ends up being a series of individual devices instead of a web of interconnected systems. This often causes great inefficiency, as each assessment tool must be connected to its own software platform and the data uploaded, processed and downloaded. This allows the company to charge subscription fees in the form of time (e.g. annual fees) or usage (e.g. charging per assessment), as it is much easier for them to stop the service on their server compared to if it is installed on your own computer/smartphone – which is likely to be more powerful and better suited to the task.

When considering purchasing a system that must be connected to the cloud you should ask a simple question – why? What are the benefits to yourself as the end user of requiring it to be cloud connected? Can they be trusted to not on-sell your data or significantly increase the cost of using their analysis servers? Unless you have a great amount of faith in the company it is worthwhile broaching these issues with them prior to investing (and continuing to invest) not just your money but your patients details with them. 

Vale Dr Garry Pearce (1950–2017)

We were all saddened to hear of the death of AFRM Past-President Dr Garry Pearce on Friday, 18 August. Those who have worked with Garry in clinical settings and in the Faculty over more than twenty years agree that he was a great man in the community and our professional network, a mentor and personal friend to many, and tower of strength in his own family. Here two colleagues have written about their experiences with, and the tremendous support of Dr Pearce.

Garry Pearce was that rare combination of intelligence, heart and humility. An early supporter of the Mind SIG, he generously gave his time and support during its foundation, and continued to offer his insight, experience and counsel as it grew.

A firm believer in work/life balance, he regaled us with his stories of motorcycling through the country with his beloved wife Toni, and spoke regularly of his pride in his cherished children and grandchildren.

He was a true believer in collegial, collaborative leadership and team work and his commitment to his many interdisciplinary professional and administrative colleagues and patients saw him regarded as an esteemed and valued colleague and friend in all of the many hospitals and clinics in which he worked.

We loved hearing of the latest instalments in his incredible career – from the Australasian Rehabilitation Outcomes Centre (AROC), to Hobart, to his recent game changing PhD. He achieved more than many do in half the time. But of course, for Garry it was less about the achievement than the process, which was always one characterised by kindness, intellect, humour, humility and wisdom. We will miss his him more than words can say. 

Dr Jane Malone 
 
Always generous with his time, consideration and heart, Dr Pearce was a bit of a mentor guardian angel for me. I met him through a peer who suggested I work for him as we seemed similar in our holistic values and approach to both rehabilitation and our own lives in general. I am so incredibly grateful that I did work with him during those six months at Greenwich.  

Before I had even met him he offered to help make a job-sharing position work and even found a job sharer for me. Once at work, he ensured I had as much study leave as I requested to support me through the Fellowship exam process and I attribute much of my success to this support.

Like an ideal supervisor, his method of supervision was comforting, nurturing and respectful. He prioritised teaching opportunities but also times for a relaxed chat in his office over a coffee. I liked the fact that he had a yoga mat in his room, that he played classical music and that one time with a sense of humility he shared the observation: "I don’t know anything; I just fumble my way through things.”

It was rare to meet someone of such acclaim and experience with so little ego or need to compete with others. By example he showed how to lead, teach and heal. I learnt a great deal from this human being. But it was this one chat we had where he told me straight that I lacked faith and needed to find a little faith in myself. That really stuck with me. 

Once the term was over we loosely kept in contact. He kindly offered to continue as a mentor figure.  Not long afterwards I was in a very trying situation. Burnt out, confused and very down about my training, I connected again with Dr Pearce. He was my support person, a voice of calm reason, and together we got through it. I sent him flowers to say thanks but never had a chance to catch up in person for a coffee. There was no rush, I thought; plenty of time and opportunity for that, I assumed. To me this man was now not only a mentor to me but a friend forever.

Dr Susannah Ward
 

President's report

Associate Professor Andrew Cole
President, AFRM

It was very good to catch up with so many friends and colleagues at the recent Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) Annual Scientific Meeting in Canberra – the venue, speakers and program were all excellent, and we had very good attendance at the Annual Members' Meeting of our Faculty on 18 September.

One major achievement acknowledged during that meeting was the successful completion and implementation of the AFRM-RMSANZ Model of Collaboration (MoC), with Dr Alex Ganora’s last act before stepping down as RMSANZ President being to join me in singing the fly-sheet to that MoC.

It was a very fitting conclusion to the journey commenced at our AFRM ASM in Adelaide four years ago, when Dr Ganora stood up, to propose the development of a Rehabilitation Society, linked with the AFRM and College, in the same way that other physician craft groups have their own societies. During that time, the College has developed the MoC model to describe the scope of the relationship between the College and each specialty society. In a recent report to the College Board, it is pleasing to see that our AFRM-RMSANZ MoC is one of two College MoC documents that have achieved finally agreed and signed-off status – the Rehabilitation Faculty leads the way again!
 
Within the College, changes to the governance structure of College’s educational and other activities will occur at the end of the term of the current College Board – it is presently convened as a representative Board of the College’s Divisions and Faculties, and is thus a very large group, in comparison to most other skills-based Boards today.

The next College Board will be considerably smaller, reflecting amendments to the College’s Constitution approved by RACP Members in May 2016 to establish a smaller, skills-based Board in place of the current representational model. The College Council is growing into the role of being the group that represents of all the individual training schemes and craft groups within the College, and I am most grateful to Dr Jenny Mann for having been our Faculty’s representative on College Council for the first two years of its life.  As immediate Faculty Past-President, Dr Steve de Graaff is now our Faculty’s representative on College Council, maintaining the close link between Faculty and College governance bodies through the approaching period of change.

Another very important activity with which the AFRM is linked is the Australian Rehabilitation Outcomes Centre (AROC). Frances Simmonds presented briefly upon AROC’s activities at the Canberra ASM, and it is perhaps easy to take for granted that we have an excellent data collection and analysis system, that many other craft groups in medicine do not share. ‘If you cannot measure it, you cannot improve it’ is perhaps one of the most famous (though apocryphal) quotes in modern management theory, and it is good to be able to measure and validate some important aspects of what we are doing with the patients that come to us, for restoration of their lives.

The Faculty Research Committee, chaired by Professor Michael Pollack, is facilitating the opportunity for an increasing number of trainees to use AROC data to inform high-quality research projects undertaken during their training. We look forward to Michael presenting a thoughtfully ‘disruptive’ George Burniston Oration at College Congress in Sydney in May 2018!

Of all matters likely to be most (helpfully) disruptive in the practice of Rehabilitation Medicine in the years to come, enhanced technologies are right up there, with system change. I trust you will enjoy reading this edition of Rhaïa, from that point of view.

Faculty Education Committee (FEC) Report – October 2017

Dr Gregory Bowring
Chair, Faculty Education Committee

The AFRM Faculty Education Committee (FEC) had their last meeting on 1 September 2017. The next meeting will be held on Friday, 17 November 2017.

New Committee or Sub-Committee Members

The Faculty Training Committee had three vacancies for membership and an EOI was published on the RACP website. 

An EOI was also published for new members on the Faculty Paediatric Training Committee (FPTC) in Rehabilitation Medicine as the new Terms of Reference now allows up to ten members and several other members will also reach their maximum terms in 2018.

Training Program Development and Implementation

2019–20 Program Requirements

The proposed program requirements for the 2019–20 Handbooks were sent to all AFRM trainees and Fellows for consultation. The final proposed program requirements were considered by the College Education Committee in October 2017.

Curriculum Review​

The AFRM Council previously discussed the issues associated with the current Module 1 and 2 examinations and proposed forming a working group to discuss these issues. The Curriculum Unit has advised that the College’s curriculum model has changed and that the review of the AFRM Curricula will therefore involve more than a refresh of the current syllabus. There is currently no set timeframe, however this is being developed by the Curricula Advisory Group with the goal to send out more information to all training committees by the end of the year. The FEC has therefore been advised that committees hold off on forming curricula working groups before this process is finalised in order to allow for more support from the Curriculum Unit and to avoid committees having to redo curricula work in the future.

AFRM 'Basic Training' Review 

The AFRM Council previously discussed setting up a committee to write a brief to the College Education Committee to inform them of our plans around AFRM 'Basic Training' i.e. that part of training which our trainees undertake culminating in successful passage through Module 1 and 2. 

In the consultations undertaken by Dr Shari Parker in producing the 'Trainee of the Future' document, certain Fellows expressed some disquiet at the variable experience and expertise of trainees who commenced Advanced Training in Rehabilitation Medicine. This led to serious consideration about whether adoption of the FRACP Part 1 Pathway would assist or alleviate some of these concerns.

  • The issue was thoroughly addressed in a series of consultations over two years culminating in the meeting at the RMSANZ ASM in Canberra in 2016 at which it was decided that AFRM Fellows were not prepared to adopt the FRACP Part 1 Pathway, but rather agreed that a review of the current AFRM 'Basic Training' was more appropriate – this would entail inter alia, curriculum review, resource identification and assessment review.
  • The consultations have highlighted the need to build on the three key areas of focus – curriculum, teaching and assessment. It is envisaged that a review will be undertaken, with support from the College, who are currently conducting an internal review of the general training curriculum.

Australian Rehabilitation Outcomes Centre (AROC) Research Initiative

Associate Professor Michael Pollack and the Research Committee and Ms Frances Simmonds, on behalf of AROC, have established a process to support the use of AROC data by trainees in research projects.

  • A pool of committed Fellows with research credentials willing to mentor trainees in research projects utilising AROC data has been established.
  • Stage 1 will seek project ideas utilising AROC data from current trainees. Five projects will be selected for support under the pilot program. Mentors will be assigned from the pool. AROC will be represented on the committee to select the five winning project proposals.
  • Stage 2 will see research projects by Fellows utilising AROC data similarly sought and supported.

Updates from Committees

Faculty Training Committee

As of September 2017, there are 215 general and 11 paediatric trainees of the AFRM.​

Accreditation Sub-committee (ASC)

There are currently 124 Accredited Training Sites for Advanced Training in Rehabilitation Medicine (general and paediatric combined).

The ASC is on track to complete the required assessments for 2017.  

Faculty Assessment Committee

In 2017 the following exams were conducted:

  • AFRM Written Assessment Module 1 – 2 May 2017 and 10 October 2017
  • AFRM Clinical Assessment Module 2 – 26 June 2017
  • AFRM Fellowship Written Examination (Adult) – 6 June 2017
  • AFRM Fellowship Clinical Examination (Adult) – 7 September 2017
  • AFRM Fellowship Written Examination (Paeds) – 6 June 2017
  • AFRM Fellowship Clinical Examination (Paeds) – 13 October 2017.

My sincere thanks to the Chairs and members of the subcommittees whose hard work supports Education, a core function of the Faculty. I’d also like to acknowledge Janet Barnes and Kathleen Walker from the College Education Directorate, who support our many subcommittees in this work.


Faculty Policy and Advocacy Committee (FPAC) Report – ​September 2017

Professor Tim Geraghty
Chair, Faculty Policy and Advocacy Committee

Committee Members

It has been another busy year for FPAC with a number of projects running concurrently and I would like to thank all members for their contribution to the effective running of the Committee.

My Committee colleagues are:

  • Dr Louis Baggio (Rural and Remote representative)
  • Dr Cynthia Bennett (New Zealand)
  • Associate Professor Andrew Cole
  • Dr Luca D'Orsogna (Western Australlia)
  • Dr Harry Eemon
  • Dr Monika Hasnat (Paediatric representative)
  • Dr Maria Paul (South Australia)
  • Dr Elisabeth Sherry (Victoria/Tasmania)
  • Dr Tai-Tak Wan (New South Wales)
  • Dr Angela Wills (Trainee representative).

The Queensland representative position is vacant.

Current work updates

1. Evolve

The Evolve Rehabilitation Medicine top five list ​was launched in September. I would like to thank all members of FPAC and AFRM Council for their assistance in undertaking this activity which has been a significant project for both groups over the past 18 months.

2. Policy documents

The RACP Landmines and Cluster Munition Policy has been reviewed, updated and signed by AFRM Council.

3. Integrated Care Working Party and Rehabilitation Medicine Integrated Care document

The draft Rehabilitation Medicine and Integrated Care paper titled 'Rehabilitation medicine physicians delivering integrated care in the community: Early Supported Discharge programs in stroke rehabilitation – an example of integrated care' has progressed well throughout the year.

It is hoped that the paper will be completed and published by early 2018. I would like to thank the FPAC sub-group working on this paper (Associate Professor Andrew Cole, Dr Tai-Tak Wan, Dr Louis Baggio and Dr Cynthia Bennett) and all FPAC members for their assistance with this task.

4. Review of the Rehabilitation Medicine Inpatient Standards document 
The review of this document is also progressing with three teleconferences held to discuss it. The working group includes myself, Dr Pesi Katrak, Dr John Estell, Dr Angela Wills, Dr Maria Paul, and Dr Cynthia Bennett. The plan is undertake a minor rather than an extensive review of the document on this occasion.    
5. AFRM Special Interest Groups (SIG) Reinvigoration Project
This project has also continued throughout the year with available SIG Chairs meeting via teleconference on a three-monthly basis to consider ways of reinvigorating the SIGs. Activities included:
  • developing meeting documentation templates
  • assisting SIGs to develop a Statement of Purpose and Induction Packs for new members
  • commencing a review on SIG website content and looking at ways to raise the profile of the SIGs including asking them to contribute brief stories to the AFRM e-bulletin.

A number of SIGs have now transferred across to governance under the Rehabilitation Medicine Society of Australia and New Zealand.

Other matters

The FPAC has also contributed significantly to a number of recent College matters including:

  • submission to the NSW Upper House Committee Inquiry into the provision of education to students with a disability or special needs in government and non-government schools in New South Wales – November 2016
  • submission to the NSW Law Reform Commission Review of the Guardianship Act 1987 – Question Paper 2 – Decision making models – February 2017
  • submission to the Victorian Government Discussion Paper on a Voluntary Assisted Dying Bill – March 2017
  • submission in response to the Voluntary Assisted Dying Bill (NSW) 2017 – July 2017
  • submission to the National Disability Insurance Scheme (NDIS) costs, Productivity Commission Paper – July 2017
  • RACP and AFRM endorsements of the Stroke Foundation Clinical Guidelines for Stroke Management 2017 

Finally, I would particularly like to thank Claire Celia and Jason Soon, Senior Policy Officers supporting FPAC – without their assistance much of the work of FPAC over the past 12 months would never have happened and also Phillipa Warnes and Stacey Barabash from the Faculties Office.

 

Mind Special Interest Group (SIG) update

Dr Jane Malone
Chair, Mind SIG 

The Mind SIG had a great time in Canberra at the RMSANZ Annual Scientific Meeting. The conference was brilliantly organised and featured some exceptionally informative and inspiring presentations.

The increasing body of evidence for mindfulness training across the spectra presents the challenge of how to further incorporate mindfulness training amongst our community and patients. Professor Craig Hassed’s workshop on mindfulness was well attended and provided participants with practical and evidence-based tools for incorporating mindfulness into their practice and lives.

Professor Lorimer Moseley’s workshop and presentation on pain illuminated current trends in pain management, peppered with incredible insights on neuroplasticity and the role of the mind in relapse and recovery.

The Mind SIG welcomed quite a few new members at our Annual General Meeting. Emerging themes for further exploration were ‘the doctor as patient’, book club, mindfulness training and insights from life after medicine. A survey was circulated prior to the meeting to seek member input and direction for Mind SIG activities next year, and the results will be calculated and shared at our next teleconference at 5.30pm Wednesday, 22 November. All are welcome to attend this teleconference.

Dr Barbara Hannon is stepping down as Mind SIG secretary after making an invaluable contribution for the last three years, and we thank her for her commitment, leadership, generosity and good humour, and look forward to her ongoing involvement on the Mind SIG Executive. 

Wishing all a safe and happy holiday period. And leaving with you this quote shared at the ASM by Professor Michael Nielson:

"Man is unique not because he does science, and is unique not because he does art, but because science and art equally are expressions of his marvellous plasticity of mind"
Jacob Bronowski


Paediatric Rehabilitation Special Interest Group (SIG) update

Dr Simon Paget
Chair, Paediatric Rehabilitation SIG

Members of the Paediatric Rehabilitation SIG were pleased to meet up at the recent RMSANZ Annual Scientific Meeting in Canberra.

The program for the conference was interesting and varied, with strong focus on neuroplasticity and pain, pertinent across age groups and diagnoses. We were very pleased to have paediatric rehabilitation well represented in the conference schedule, with excellent plenary sessions given by Professor Nadia Badawi, Dr Simon Mosalski, Associate Professor Adam Scheinberg, and Associate Professor Barry Rawicki and team about adults with childhood-onset disability. Dr Cathy Morgan and Dr Mark MacKay spoke about neuroplasticity from a paediatric perspective.

There were also free papers given on various topics including about the Australian Paediatric Rehabilitation Outcomes Centre (APROC), inpatient rehabilitation, botulinum toxin services, sedation and adverse events and improving hospital journies for adults with intellectual disability.

The group also held our second meeting of the year during the conference. Issues discussed at the meeting included working towards agreed practice for dosing for botulinum toxin A injections in children, feedback about the RACP submission to the Senate enquiry on NDIS Early Childhood Early Intervention and feedback about progress on the development of APROC.

As always, the paediatric rehabilitation SIG is keen to attract new members and provide an effective forum to discuss matters with colleagues. Please do not hesitate to contact me if you would like more information. Our next planned meeting will be at the Australasian Academy of Cerebral Palsy and Developmental Medicine (AusACPDM) conference in Auckland in March 2018. 

Rehabilitation and Older People Special Interest Group (SIG) update​

Professor Ian Cameron 
Chair, Rehabilitation and Older People SIG

The SIG Executive Group met at the recent RMSANZ meeting in Canberra. The following priorities were identified: update the training curriculum with reference to rehabilitation and older people; and develop sessions for the next meeting of RMSANZ and Asia-Oceanian Society of Physical and Rehabilitation Medicine (AO​SPRM).

The SIG is keen to encourage further involvement from Fellows and trainees. In particular, we encourage involvement from New Zealand and Australian states and territories not currently represented in the executive group (Australian Capital Territory, Northern Territory, Tasmania, Western Australia).

Spinal Cord Damage Special Interest Group (SIG) update

Associate Professor Peter New
Interim Chair, Spinal Cord Damage SIG

Dr Emma-Leigh Synnott
Interim Secretary, Spinal Cord Damage SIG

The Spinal Cord Damage (SCD) ​Special Interest Group (SIG) wants to reactivate after ‘being in hibernation’ for a few years. 

The focus of the SCD SIG is on rehabilitation of people with both traumatic spinal cord injury and non-traumatic spinal cord dysfunction. This includes both paediatric and adult rehabilitation, and the important issue of transition between these services.

The SIG acts as a forum for trainees and Fellows to share knowledge, discuss issues, and contribute to the College or Faculty in matters regarding SCD. As with all SIGs, there is no joining fee – membership ‘costs’ simply entailing participation and contribution to the activities of the SIG.

Potential activities include teleconference discussion around events and conferences related to SCD, opportunity to discuss interesting journal articles, and a space to discuss challenging cases. Other potential projects include the development of an online space for sharing articles and resources, and perhaps allowing online discussion as an adjuvant to teleconferences.  There may an opportunity to review the AFRM training program curriculum to ensure it remains relevant and focused to spinal specific rehabilitation concerns.

We ask anyone interested in joining the SCD SIG to email Dr Emma-Leigh and raise their hand to be involved. The intention is to then survey those who have expressed an interest to assess availability for a teleconference early in 2018, at which time we aim to discuss ideas regarding the activities and focus of the SCD SIG over the coming year. 

Anyone with expertise or interest in spinal cord rehabilitation medicine is welcome – we want you; come and join the club.
 

​Rehabilitation Medicine Society of Australia and New Zealand (RMSANZ) update 

Dr Lee Laycock
President, RMSANZ

It was with a great sense of honour that I accepted the role of President of RMSANZ during our Annual General Meeting in Canberra on Monday, 18 September 2017. Dr Alex Ganora has handed the baton on to me with the Society in a very healthy position and with a good ability to deal with the challenges that lie ahead for our specialty. The support of the RMSANZ Board is critical for the Society, and for me, to carry out our work. I am very grateful for the dedication and commitment from my fellow Board members. Dr Ganora will kindly remain as a Board member in his capacity as Immediate Past-President, to ensure that we do not lose momentum. 

RMSANZ is nearing its third anniversary as a legal entity, having been established on 22 February 2015. RMSANZ is a non-profit company limited by guarantee in Australia and New Zealand, governed by a Board of Directors and a Constitution. The Society now supports regional branches and some special interest groups, which have direct input to the Board through an Advisory Council. 

The Society has a membership driven organisational structure and philosophy, with 420 currently registered members. Membership is open to AFRM Fellows and trainees, as well as retired AFRM Fellows. Recently other registered healthcare professionals practicing in the field of rehabilitation medicine, or associated fields of medicine or healthcare have been able to apply for Associate Membership.

The Advisory Council allows direct representation from the different groups, including trainee members, within the Society to the Board and helps prevent the Board from operating in isolation of the sentiments and needs of the membership. It will also allow links to be formed with the outside community and other professional bodies. The Advisory Council is chaired by the Society Vice President and had its first meeting in May 2017.

Branches are vital structural elements of the Society which represent the interests of members at a local level. Branches in New South Wales / Australian Capital Territory (NSW/ACT), Victoria / Tasmania (Vic/Tas), South Australia / Northern Territory and Queensland have been formed and a New Zealand Branch will hopefully be formed soon. The Branches have already achieved a positive cash flow in their operations and are actively planning collegiate activities, such as the NSW/ACT Branch Continuing Medical Education (CME) dinners with guest speakers, held in June and November, and the Vic/Tas Branch CME evenings held in May and October this year. Some CME weekends in regional areas are being planned for 2018.

Four Special Interest Groups (SIGs) have now been established. The Private Practice SIG is currently interested in the interface between rehabilitation medicine practice in private hospitals and health insurance funding issues for rehabilitation services. The dinner in Canberra on 18 September with guest speaker Associate Professor Justine Naylor speaking about How to stop ortho rehab from disappearing – making hospitals and insurers understand, was very well attended. The Pain SIG has conducted an online survey of members' areas of interest in educational workshops and Continuing Professional Development activities and, based on the feedback, future workshops, presentations and meetings are being planned, including a weekend workshop in early December this year designed to enable the trainees to get hands on experience in basic MSK examination techniques. A NeuroRehab SIG and a Disaster Rehabilitation SIG have also been established. Each SIG facilitates meetings and the pursuit of advocacy on behalf of members in the hope that momentum, and influence, will build eventually leading to Associate Membership of the Society by interested medical, nursing and allied health professionals in Australia and New Zealand.

One of the objectives of RMSANZ is to advance and promote research, education and training relevant to the practice of rehabilitation medicine, rehabilitation, disability and related areas; to liaise with AFRM/RACP, government, educational and research institutions and to oversee the planning and content of Annual Scientific Meetings (ASM). This is implemented by an active Scientific Committee which meets regularly and is represented on ASM Organising Committees for each event. The first RMSANZ ASM was held in Melbourne in October 2016 and was attended by over 400 delegates. The second RMSANZ ASM was held in Canberra from 17 to 20 September 2017 and was themed 'The Leading Edge: Innovations in Rehabilitation Medicine'. There was a focus on pain and MSK, neuroplasticity and rehabilitation, and spinal rehabilitation and technology. The Society is now responsible for all future ASMs in rehabilitation medicine and plans are already underway for 2018 in Auckland as a Conjoint International Asia-Oceania Society of Physical and Rehabilitation Medicine (AOSPRM) meeting, and in 2019 in Adelaide. In addition to the ASM each year, there will be another Rehabilitation Snapshots Workshop to be held in June 2018 in Melbourne.
 
Another major role for the Society is to serve as a medium for advocacy on behalf of rehabilitation physicians in Australia and New Zealand to improve health, function and quality of life of people living with disabilities, with a dedicated and clear focus that is independent and unconstrained by competing interests. The Society has already prepared several submissions and published two position statements. The position statements on the Therapeutic Use of Botulinum Toxin in Rehabilitation Medicine for spasticity and dystonia and on the Role of the Rehabilitation Physician in the provision of Rehabilitation Medicine Services can be seen on the Society’s website

All AFRM Fellows and trainees are encouraged to join the RMSANZ, which is dedicated to its active membership and is driven by the needs of its members. We have a singular and independent focus on rehabilitation medicine. The growth of our specialty is reflected in the growth of the Society. Please help us to grow with your membership and participation in our different activities. 

Visit our website www.rmsanz.net to learn more.

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