Review: American Congress of Rehabilitation Medicine (ACRM) annual conference 2018

We have both just completed a rewarding 4 days at ACRM 2018 in Dallas, where we attended a variety of seminars, exhibitions and networking groups with a view to horizon-scanning the latest rehabilitation innovations and their potential applications for defence of serious injury claims.

The agenda featured literally hundreds of different rehabilitation themes on a cross-disciplinary basis including conventional market sectors such as brain and spinal cord injury, and pain management, alongside modern developments such as technology and alternative therapies and medicines.

Looking back over the entire event, it is possible to pick out some recurring topics that collectively offer compensators an interesting insight into the conference’s headline theme of ‘Progress in Rehabilitation Research’. In our view, the main trends can be summarised as follows:

• The US military has a well-funded rehabilitation programme and is dealing with significant volumes of injured service personnel. For example, one session estimated around 383,000 traumatic brain injuries since 2000. As a consequence, the military is showing meaningful leadership to the civilian sector across a range of therapy disciplines.
• Clinicians are increasingly now practising positive gender discrimination for more personalised therapy delivery. Conference sessions explored differences in female brain injury and spinal cord injury, covering issues such as pregnancy, parenting, dating, sexuality and fashion.
• There is rapidly expanding technological entrepreneurship and innovation. In many therapy disciplines, breakthroughs such as virtual reality and wearable sensors offer wide possibilities and the main practical challenge for the healthcare sector is working out what to actually do with them. At least one speaker described the ongoing experimentation as ‘a solution without a problem’.
• New testing protocols are being developed to detect signs and symptoms of brain injury in the early stages following trauma. For example, one company has created a program designed to detect cognitive and neuropsychological deficits following head trauma long before these deficits are noticed by the patient.
• The biggest technological advances have probably been achieved by harnessing smartphone capabilities for therapy, especially in the field of downloadable apps. Unfortunately, a significant proportion of clinicians lack awareness of ‘rehab tech’ or experience in how to successfully manage its therapeutic use, especially where the recipient may be cognitively impaired following head injury.
• Some technologies risk creating dependence rather than promoting recovery. For example, one seminar addressed the use of mobile phone apps to assist patients with mild to moderate traumatic brain injuries. These apps provide the patient with constant notifications to perform various activities of daily living which the patient claims were impacted by, among other things, loss of memory, organizational skills and processing. The counter-argument is that these apps do the thinking for the patient, and eliminate the brain stimulation needed for true brain recovery.
• The conference was attended by significant numbers of alternative medicine providers. We encountered art, music, dance, and animal therapists, as well as emerging products such as portable cryotherapy units to deliver cold therapy for pain conditions.
• Significant attention was devoted to the controversial diagnosis (at least in legal circles) of complex regional pain syndrome (CRPS). While there remain questions regarding whether CRPS is a physical or psychological injury, and regarding the true aetiology of CRPS, clinicians are exploring various therapies to deal with what was described as a chronic and debilitating condition.  These therapies include injections, prescription medication, physical therapy and psychological treatment, all of which have resulted in varying degrees of success.
• Some new treatments are raising regulatory and compliance issues for the U.S. Food and Drug Administration agency and similar bodies. It was clear from the conference that there is ethical opposition to superhumans being created from techniques such as osseo-integration, where an amputee has titanium surgically implanted in the injured limb to allow for bone-anchored prosthetic fitting not requiring a conventional socket.
• Medicine is still striving for transformational step-changes in big projects such as curing paralysis, which are given funding impetus by the efforts of inspirational figureheads such as Christopher Reeve, or former Indy Car driver Sam Schmidt who was left C4 quadriplegic after a crash and delivered a keynote presentation during the conference on rebuilding his life after spinal cord injury.

In conclusion, we left the conference feeling optimistic that the prospects of successful rehabilitation following serious injury have never been greater and that the next few years will see further revolutionary progress. We are committed to monitoring this fast-changing sector so that Kennedys and its clients can deliver modern rehabilitation solutions and better claims outcomes.

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