Residents Interested in MSK/Sports Medicine
There is an exciting opportunity now available for resident leadership development and resume building under the mentorship of current leaders in the musculoskeletal (MSK) field!
The Musculoskeletal Rehabilitation Council is in the process of developing many projects and publications including:
- CORE: The MSK Medicine Council Quarterly Information Letter articles
- Expert review articles for the PM&R Journal
- PM&R Knowledge Now® updates
They are interested in resident participation and developing future leaders in the field, and are now inviting residents to submit a short paragraph expressing your interest in participating, including your qualifications, and any particular areas of interest. Please provide a copy of your CV as well if available. Selected residents will be contacted by the MSK Council and will have the opportunity to work directly under the mentorship of the Council leaders on your topics of interest.
Please submit your information and short paragraph to firstname.lastname@example.org for consideration.
Let’s Play Hockey!
Andrea Paulson, MD
Graduation Year 2016 –
University of Cincinnati / Cincinnati Children’s
Growing up in rural Minnesota everyone skates. Whether it is figure skating or playing hockey, everyone skates. I started figure skating at age 3. In junior high, I switched to ice hockey, which I continued in college and still play today. Without question, some of my most cherished memories growing up involve my time at the rink. However, even though I was active in adaptive sports and Special Olympics, I had never heard of sled hockey until I became a PM&R resident in Cincinnati.
Sled hockey, also known as sledge hockey in Canada and Europe, was started in the 1960s at a rehabilitation center in Stockholm, Sweden by individuals who wanted to continue to play hockey despite a disability. It was first introduced to the Paralympic Winter Games in 1976 in Sweden. However, it did not become an official Paralympic event until 1994. The U.S. Sled Hockey team has won the last two Paralympic Winter Games gold medals, in Vancouver in 2010 and Sochi in 2014.
Sled hockey is essentially a sitting version of traditional ice hockey; players sit in sleds with two blades on the bottom and propel themselves with their upper bodies using sticks in both hands. The sticks have sharp points on one end, allowing traction on the ice, and a more traditional hockey stick blade on the other end for passing and shooting. The majority of the rules are the same as traditional ice hockey with a regulation ice rink, standard size nets and pucks, two referees, 6 players per team, and three 20-minute periods. As in traditional ice hockey, the game is very fast paced and is full-contact. Sled hockey has a wide range of players that includes men and women, children and adults. Within the sport, individuals have varying mobility limitations including amputations, spinal cord injuries, cerebral palsy, and spina bifida.
During my residency, I met a patient who first introduced me to the world of sled hockey. I found out that Cincinnati has a sled hockey team named the Ice Breakers that has been allowing all people to play hockey since 2008. Since learning about the sport, I have also had the opportunity to play with the Ice Breakers team. Sled hockey definitely takes some time to get the hang of, but is always a good work out and tons of fun. I spent most of the first practices tipped over on my side; however, I am proud to say that I can now turn and even stop. Players of all ages from 7 to 60+ years old are on the ice playing together and it gets very competitive with full contact. Thankfully, the sled does offer some protection for your backside and legs! This is an incredible sport that offers a great form of exercise, camaraderie, and teamwork that can be played by nearly anyone. I hope to stay active in sled hockey and bring it to even more individuals to make lasting memories.
A Two Part Series- Journey to the East: A Physiatry Resident Goes to Japan & Other Musings on International Electives in PM&R Residency
MD Graduation Year 2017
Johns Hopkins University
Part 1 – Before Japan
I have recently begun a 4-week trip to Japan for an international clinical and research elective, which starts on February 1st, 2015. I feel fortunate to be selected to participate in this exceptional opportunity, the first of its kind for a PM&R resident. The rotation represents the culmination of several decades of physiatry research collaborations and partnerships between the Johns Hopkins University and Fujita Health University (FHU), spearheaded by the former department chair of Hopkins PM&R, Dr. Jeffrey Palmer, one of the world’s premier experts in deglutition research and dysphagia rehabilitation.
Amidst filling up tomes of requisite administrative and legal paperwork, official ratifications of documents by both institutions, concatenations of congratulatory e-mails and discussions with colleagues at FHU about scheduling, attending national board meetings of the residents’ physician council and finishing up a demanding physiatry-consults rotation, my last two months have been a frenzy of consuming commitments. Yet, I am beyond giddy with excitement as I look forward to my first trip to Japan, a country that continues to bedazzle many with its unique cultural tapestry of traditional values interwoven with modern lifestyles and first class technological wonders: elaborately adorned kimono-clad geishas meets the Pearl Bridge across the Akashi Strait; Zen-bequeathing ancient sacred temples clash with rapidly-accelerating super-high speed bullet trains (Shinkansen) — it is a world of contradictions, simultaneously quixotic, and at once beautiful.
As part of months of preparations, I’ve been scurrying internet websites (the Japan National Tourism Organization & Trip-Advisor), guidebooks (Lonely Planet & National Geographic), blogs, social media, news-outlets — to cull bits of wisdom about what to expect. I’ve been advised to pack lightly but to stack up on winter clothing, as February tends to be the harshest of the winter months. I’ll be in Nagoya, the largest city in the Chubu region of Japan on the Pacific coast of central Honshu — the largest and main island of the Japanese Archipelago, with Tokyo as its capital. I’ve gathered that Tokyo tends to be a major tourist attraction, a bubbling metropolis of culinary delights and Japanese architectural masterpieces. Nagoya, however holds its own with grand museums, is home to the Toyota Manufacturing Plant and the Nagoya castle, which is featured in classic American films such as the Godzilla trilogy of movies. With so much to see in a short time, I plan to focus my itinerary on the major national monuments and neighboring cities of Kyoto and Nara. Excellent and reliable public transport systems promises to make for an easy adventure of inter-and intra-city travels.
A central aspect of cultural immersion during international medical and clinical rotations is knowing the local language. Coming from a family of polyglots adept at languages, I was drawn to the Japanese language’s phonotactic and phonemic vowels and picked up some basics about 15-years ago from next-door Japanese neighbors prior to moving to the United States. Having been out of practice for more than 10 years, I’ve been frantically brushing up on my rudimentary Japanese phrases, with renewed focus on medically relevant terms. I anticipate that knowing the basics would make for easier communication and more meaningful interactions during my time in Japan.
One of the things I’m curious about is how culture and societal norms shape the practice of physiatry around the globe. As a result of its historical and geographic isolation, Japan appears to remain genetically and culturally homogeneous. It is the fastest aging population of any country in the world, with about 25% of its populace constituting of adults 65 yrs or older. (1) Its life expectancies of 78.9 years for women and 73.5 for men are the highest in the world. (2) That more people are living longer presents intriguing challenges for Japanese geriatric rehabilitation, with potential lessons that could be applicable to the United States. A recent study comparing stroke rehabilitation outcomes between the two countries indicates that Japanese health insurance covers longer days of hospital stays in rehabilitation with average length of stays of 90-120 days, in sharp contrast to an average of 26 days in the United States. (3) Patients are thus more likely to be discharged home than to a nursing facility. From a physiatry resident’s perspective, this would make for a fascinating educational experience, given the potential to be able to follow disease pathology and rehabilitation of impairments for a longer duration than is possible in the United States.
Related to this, it appears that the cultural approach to disabled persons differs between the two countries. Some attribute this to the Japanese embrace of a more communal rather than atomistic individual world view. So for example, in Japan the term "welfare" has a much more broad, positive and literal meaning — it refers to promoting the wellbeing or welfare of Japanese citizens — whereas, in the United States, "welfare" has a more negative connotation; it conjures images of public dependence, charity, and poverty. The Japanese term for disability — shōgai — represents a hindrance or obstacle in one’s path and seems to capture disability, impairment, and activity limitations in one word, although they do accept the English distinctions and differentiation of these words in accordance with the World Health Organization’s international classification of functioning disability and health. (2)
With the rarity of international electives during PMR residency, the elective in Japan provides an exposure to rehabilitation systems and frameworks in a different culture. From a personal perspective, I hope to have a career that involves global rehabilitation work and this marks the nascent stages of that process. The experience promises to be a culturally enriching and academically rewarding one, which would expand my global purview of rehabilitation. I am eagerly looking forward to learning more about the contrasts and similarities of physiatry in Japan vs. US and sharing my reflections with fellow PMR residents. In Part 2 of this series, I will discuss my research at FHU involving innovative use of three-dimensional visualizing of swallowing via a 320-detector-row multi-slice CT scanner to better understand deglutition and dysphagia.
- Izumi S, Saitoh E. A brief history and international perspective of the japanese association of rehabilitation medicine: The 50th anniversary in 2013. PM R. 2014 Nov;6(11):1044-7.
- Myers JE, Matsui R. Rehabilitation in japan: An overview. J Rehabil. 1984;50(3):19-26.
- Murakami M, Inouye M. Stroke rehabilitation outcome study: A comparison of japan with the united states. Am J Phys Med Rehabil. 2002 Apr;81(4):279-82.