Wellness in residency: Addressing the neglected need in lower middle-income countries.

The concept of wellness incorporates many domains, including mental, physical, social, and integrated well-being. However, it is not well understood in most lower middle-income countries (LMIC). The significance of practicing wellness during residency, focusing on the context of LMIC, is described here. Based on the authors' experiences of working in LMIC, the challenges faced during residency and the importance of prioritizing self-care and well-being is highlighted. Physician burnout is a global concern having a negative impact on patient care quality, patient satisfaction, and professionalism. Interventions to address wellness can be individual and organization-based. Individual interventions include mindfulness training, behavioral interventions, self-care practices, and support networks. Organizational interventions involve the establishment of wellness committees, introduction of wellness curricula, optimization of workflows, and creation of shared social spaces. There is a need for implementing wellness practices within residency programs in LMIC. By focusing on wellness, physicians can mitigate burnout, enhance their well-being, and improve patient care outcomes.

Medical Updates in Management of Hypertonia.

Identifying the subtypes of hypertonia is becoming increasingly important. Treatment strategies, including tone-modulating surgical interventions, medication type and dosing, and chemodenervation, may differ depending on the type of hypertonia present. It is important to delineate how hypertonia interferes with function and quality of life so that the appropriate intervention can be selected at the right time. Outcomes of treatment depend heavily on clear communication of goals. Botulinum toxin should not be used in isolation but as an adjunct to rehabilitation modalities.

Torsional Anatomy of the Lower Limb: The Appearance of Anatomy in Hemispastic Position.

OBJECTIVE: The aim of the study was to determine whether there are relevant anatomical variations to the typical injection sites for antispasticity procedures in the lower limb. METHODS: Sonographic images were obtained at traditional injection locations for spasticity in the lower limb. Images were recorded in neutral and contracted postures. Doppler imaging was obtained for sites that contained vasculature. The images were analyzed, and schematics were created that highlighted relevant findings. RESULTS: The adductor longus in commonly used injection sites was close to vasculature making accidental injection of the latter a higher risk. The sciatic nerve was vulnerable to injections at the proximal biceps femoris injection side if injected too deeply. Hamstring injection sites can be adjusted to the midline to improve accuracy. The proximity of the tibial nerve to the flexor hallucis longus and the deep fibular nerve to the extensor hallucis longus puts these nerves at risk for accidental injection. DISCUSSION: Contracted posture results in altered positions of lower extremity muscles that could lead to inadvertent neurovascular injection or decreased efficacy with injections. Findings in this study may be helpful for planning and executing injections to reduce spasticity in the lower extremity. CONCLUSIONS: Sonographic imaging allows a better localization of muscles associated with spasticity and can instruct the clinician to alter usual injection pathways. This article documents visual evidence that previous assumptions for injection strategies require updating.

Philippine Academy of Rehabilitation Medicine emergency basic relief and medical aid mission project (November 2013-February 2014): the role of physiatrists in Super Typhoon Haiyan.

BACKGROUND: Physiatrists have provided humanitarian assistance in recent large-scale global natural disasters. Super Typhoon Haiyan, the deadliest and most costly typhoon in modern Philippine history, made landfall on 8 November 2013 resulting in significant humanitarian needs. METHODS: Philippine Academy of Rehabilitation Medicine physiatrists conducted a project of 23 emergency basic relief and medical aid missions in response to Super Typhoon Haiyan from November 2013 to February 2014. The final mission was a medical aid mission to the inland rural community of Burauen, Leyte. Summary data were collected, collated, and tabulated; project and mission evaluation was performed. RESULTS: During the humanitarian assistance project, 31,254 basic relief kits containing a variety of food and non-food items were distributed and medical services including consultation, treatment, and medicines were provided to 7255 patients. Of the 344 conditions evaluated in the medical aid mission to Burauen, Leyte 85 (59%) were physical and rehabilitation medicine conditions comprised of musculoskeletal (62 [73%]), neurological (17 [20%]), and dermatological (6 [7%]) diagnoses. Post-mission and project analysis resulted in recommendations and programmatic changes to strengthen response in future disasters. Physiatrists functioned as medical providers, mission team leaders, community advocates, and in other roles. CONCLUSIONS: This physiatrist-led humanitarian assistance project met critical basic relief and medical aid needs of persons impacted by Super Typhoon Haiyan, demonstrating significant roles performed by physiatrists in response to a large-scale natural disaster. Resulting disaster programing changes and recommendations may inform a more effective response by PARM mission teams in the Philippines as well as by other South-Eastern Asia teams comprising rehabilitation professionals to large-scale, regional natural disasters. Implications for rehabilitation Large-scale natural disasters including tropical cyclones can have a catastrophic impact on the affected population. In response to Super Typhoon Haiyan, physiatrists representing the Philippine Academy of Rehabilitation Medicine conducted a project of 23 emergency basic relief and medical aid missions from November 2013 to February 2014. Project analysis indicates that medical mission teams responding in similar settings may expect to evaluate a significant number of physical medicine and rehabilitation conditions. Medical rehabilitation with participation by rehabilitation professionals including rehabilitation doctors is essential to the emergency medical response in large-scale natural disasters.

Longitudinal tear of the biceps brachii from peripheral intravenous catheter infiltration.

BACKGROUND: although peripheral intravenous catheter (PIV) infiltration is a frequent hospital occurrence, muscle rupture is a previously unknown complication of line infiltration. We present the case of a 21-year-old male with a history of cystic fibrosis, bilateral lung transplant, and chronic corticosteroid use, with longitudinal tear of the biceps brachii muscle as a complication of PIV infiltration. METHODS: case report describing a unique case of a longitudinal tear of the biceps brachii. RESULTS: magnetic resonance imaging revealed longitudinal tear of the biceps brachii with sparing of the proximal and distal tendons. Nerve conduction studies and electromyography revealed bicipital denervation, most likely due to mechanical compression. CONCLUSION: we hypothesize that the patient's chronic corticosteroid use predisposed him to muscle injury, as did basilic vein thrombosis caused by PIV infiltration, and this combination of factors led to bicipital rupture. To our knowledge, this is also the first case report to document longitudinal tear of the biceps brachii with sparing of the distal and proximal tendinous insertions of the muscle.

Lower extremity bone mineral density in children with congenital spinal dysfunction.

AIM: To assess lower extremity bone mineral density (BMD) of children with congenital spinal dysfunction and examine factors that may influence BMD in this population. METHOD: Forty-four children (25 females, 19 males) aged 6 to 18 years (mean 11 y 11 mo, SD 3 y 6 mo) with congenital spinal dysfunction (35 with myelomeningocele, seven with lipomas, one with sacral agenesis, one with caudal regression) were enrolled in the study. A health survey including ambulatory status, history of bladder augmentation, and history of fracture was administered. Each participant had a physical examination including Tanner stage and neurological level. Dual-energy X-ray absorptiometry scans of the lateral distal femur (LDF) and, when possible, lumbar spine were obtained. We reported LDF BMD results as z-scores for three regions of interest (metaphyseal, metadiaphyseal, and diaphyseal). Univariable and multivariable analyses examined relationships between LDF BMD and the other variables. RESULTS: BMD was significantly related to ambulatory status (14 non-ambulatory, 15 partly ambulatory, 15 fully ambulatory) and neurological level (13 with low-level lesions, 15 medium-level, 16 high-level) in the univariable analysis (p<0.01 for both in all three regions). Neither history of fracture, nor Tanner stage, nor history of bladder augmentation showed a significant relationship to BMD. The significance of ambulatory status and neurological level in the univariable analysis failed to persist in the multivariable analysis of this study with a small sample size. INTERPRETATION: The LDF measurement proved to be a viable technique for assessing BMD in children with congenital spinal dysfunction. LDF BMD was sensitive to differences in three categories of ambulation. The overall influence of neurological level was not deemed as important as ambulation.