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PUBLISHED: Feeling the Pinch

MOST Jamaicans would’ve watched with bated breath and fingers, toes and knees crossed, hoping that hurdler Omar McLeod would’ve pulled off yet another miracle in the men’s 110m hurdles final at the recently held World Championships in Beijing, China, to medal for Jamaica.

Though he hit all 10 hurdles in the semi-final, he was lucky enough to still run 13.14sec to advance to the final. However, that approach was not good enough to put him on the podium. McLeod did, in fact, hit the hurdles in the final, but his sheer grit and determination only allowed him a sixth-placed finish in a time of 13.18sec.

Following his purposeful dash to the finish line, McLeod disclosed on his Instagram page that he learnt after the semi-finals that he had a pinched nerve in his right lower back, which he said resulted in him hitting the hurdles.

“Honestly, every time I hurdle I felt severe pain in my right lower back, but then I’d just ignore it and say it’ll go away eventually,” McLeod said in his post. “The doctor told me that was the reason I was helplessly hitting the hurdles.”

The National Collegiate Athletic Association champion insisted that, throughout the season, his races were always well executed.

“Y’all know that throughout the season, majority, if not all my races have been somewhat flawless and clean, so I know that was questionable as to why or how could I hit all 10 hurdles in the semi-final,” McLeod reasoned.

“I just could not understand why I was awfully hitting hurdles like that,” he continued. “It really scared me!”

However, even after learning about his pinched nerve, McLeod was still resolute about giving his best in the final.

“But with all of that, I still wanted to go out there and represent my country to the fullest, knowing that I would still have a disastrous race,” the former Manchester High and Kingston College student said. “I tried my very best in the finals to just go out as hard as possible and try to hold on for dear life, and I’m tremendously proud of myself.”

If his hashtags are anything to go by, McLeod already has his sights set on Rio 2016.

“I really have to thank God that he brought me through this and I’m a living testimony of how great he is. ‘Never Give up!’ #RoadtoRio #ReFocus #GodisGreat #WarriorChild #Blessed #BackToTheDrawingBoard,” his Instagram post concluded.

Dr Paula Dawson, a US Board-certified physiatrist and the founder of the Rehabilitation Institute of the Caribbean, explained the nuances of pinched nerve in a recent interview with the Jamaica Observer.

“In the general sense, a pinched nerve is usually when the nerve root that is exiting the spine is impinged, whether by compression from a disc or an inflammation around the nerve root, causing pain in the distribution down the legs where that nerve would normally supply sensation,” Dr Dawson told Your Health Your Wealth.

She explained that each nerve has a special place on the body where it gives sensation to the skin as well as makes the muscles move. The nerves from the lower back will go to the legs, which will allow for the movement of muscles.

“Now the pain that you feel is the sensory, which is the sensation part of the nerve which is letting you know that the nerve is inflamed,” the physiatrist said. “The inflammation of the nerve root gives the nerve root pain, and nerve root pain is called radicular pain, also called pinched nerve in a sense.”

Outisde of the pain that is felt, other symptoms include weakness in the muscles that the nerve supplies, reflexes in the nerve root being diminished, loss of sensation or numbness, as well as in really bad cases, it can cause loss of strength in the legs, loss or control of the bowel and bladder, and numbness and tingling in the legs.

She pointed out that back pain is quite common and that with athletes, sometimes they are unable to differentiate the pain that is being felt.

“Athletes will tell you that they always have pain somewhere,” Dr Dawson told Your Health Your Wealth. “And people don’t realise how tough it is for athletes in their training. They will train through pain, so sometimes they feel the pain and they don’t even know it is pain, they think it is just training pain,” the physiatrist said, adding that lower back pain can be more common among cricketers, volleyballers and people who do a lot of jumping.

“Hurdlers, I suppose, because they are doing that continuous flexion (bending) and when you flex the body you put the disc under pressure,” Dr Dawson opined. “You put the back under pressure.”

She stated that therapy, medication, injection, and surgery are the four treatment options for pinched nerve.

“The thing with pinched nerve is that 90 per cent of the time, back pain which moves into the leg will go away on its own, and it is what you do that prevents it from coming back,” Dr Dawson shared. “And 80 per cent of the time they do come back.”

However, with the ever-present issue of banned substances at the fore of athletics, Dr Dawson explained just how athletes can approach treatment.

She said therapy is the first line of treatment and it could include different movements, stretches, and certain exercises that can completely resolve the pain.

If therapy fails, then medication would be next on the list.

“The medication that we normally give would be an anti-inflammatory like Advil, Ibuprofen… or Cataflam,” she said, adding that in some cases neuropathic medication might also be given to patients.

“I have athletes with pinched nerve and they are taking Neurontin, which is World Anti-Doping Agency-approved, meaning it is not a banned substance,” Dr Dawson explained.

If neither therapy nor medication works, then injections would be next, but Dr Dawson explained that the only injection that can be safely done under World Anti-Doping Agency (WADA) guidelines is an epidural steroid injection.

She said a special substance approved by WADA is used and is given in the joint or in the epidural space. Dr Dawson said, however, that if the same substance is given in the muscle or through IV, it is considered a banned substance.

“It really is just giving them the anti-inflammatory at the point where the nerve is located, whereas oral medication is taken systemically, so you don’t get the medication as concentrated to the point where the pinched nerve is as you do with epidural injection,” the physiatrist divulged.

And, surgery is usually the last resort.

She insisted, though, that strenghthening the core – which is the abdominals, the diaphragm, the pelvic floor, and the back muscle – helps to stabilise each segment where the discs are and it will prevent movements that will cause pain.

Though not familiar with McLeod’s specific case, Dr Dawson told Your Health Your Wealth that patients who have general pinched nerve, with correct rehabilitation and their compliance, medication to help them, and sometimes epidural injection, they can recover without going on to surgery.

In spite of the pinched nerve, McLeod was grateful to God for a “remarkable season” and thanked everyone for their love and support, admitting that making the World Championships team for Jamaica was his dream come true.

“I was already a winner in my book simply for the mere fact that I was able to make the finals and line up beside all these great hurdlers that I grew up watching and only aspired to be like,” he also said in his Instagram post.

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PUBLISHED: Rehabilitation Institute of the Caribbean: The Caribbean’s First Multidisciplinary Rehabilitation Centre

The Rehabilitation Institute of the Caribbean Ltd. (Rehab Caribbean) is the Caribbean’s first multidisciplinary Rehabilitation centre.  It is an outpatient rehabilitation centre for Physical Medicine and Rehabilitation (PM&R, also called Physiatry); that provides medical care for adults and children; enabling them to recover physically and regain their skills after injury or illness.

The Rehab Institute utilises a comprehensive multidisciplinary medical treatment approach which consists of medications, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipment, orthotics (braces), prosthesis (artificial limbs), as well as patient education and neuropsychology treatment.

Rehab Caribbean also aids in improving function, performance, pain and quality of life for its patients who are inclusive of athletes and patients with general muscle, bone and joint condition; neck/back pain and arthritis; spinal cord injury; brain injury or stroke and occupational injury.

Services are based on a collaborative approach among Physiatrists, Orthopaedic surgeons, Neurosurgeons, Neurologists and other specialist Doctors. Core services are delivered by the facility’s team which is comprised of dynamic and well-trained Physiatrist, Physiotherapist, Occupational Therapist, Neuropsychologist/Clinical Psychologist, Speech and Language Therapist, Massage Therapist, Nutritionist and other rehabilitation professionals who are skilled in patient care.

The Institute was established by Dr. Paula Dawson the only US board certified Physiatrist in Jamaica.  Dr. Dawson also has training in Interventional Spine, Musculoskeletal and Sports Medicine Rehabilitation and is currently pioneering the development of the discipline of Physical Medicine and Rehabilitation in Jamaica.

The Rehabilitation Institute of the Caribbean started seeing its first patient in 2012 but was officially opened on Thursday, July 4, 2013 under the patronage of Lady Patricia Allen and Javier Bell, 400m 2013 National athlete.

For more information, please contact the Rehabilitation Institute of the Caribbean at Unit 2B & C, Liguanea Post Mall, 115 Hope Road (across from Sovereign Centre) in Kingston or 978-4010/631-4000 or appointments@rehabcaribbean.com.  Additional information is available at http://www.rehabcaribbean.com.

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PUBLISHED: One-stop Shop for Physical Rehab

In two years, the Rehabilitation Institute of the Caribbean has not only doubled its square footage but has also almost quadrupled its patient population. However, the institute’s founder, Dr Paula Dawson, has her sights set on doing even greater things over the next three years.

Dr Dawson, who is one of three US Board-certified physiatrists in the Caribbean, opened the doors to the institute in 2012, and, since then, has been on a mission to provide complete medical care for functional performance under one roof.

“We are seeing anywhere between 30 and 40 patients a day… about 200 to 300 sessions per week,” Dr Dawson told the Jamaica Observer in a recent interview.

However, with a shortage of rehab doctors in the region, she is aiming even higher.

“I used to see patients and I needed that patient to do occupational therapy or physiatry or speech and language therapy and I couldn’t really find the components together,” explained Dr Dawson. “So, having all of this together allows me to better provide that care for each patient.”

“We want to bring the model of multidisciplinary care, where you have the patients being seen for a particular problem in one place,” explained the physiatrist, who also lectures full-time in physical medicine and rehabilitation, and sports medicine at the University of the West Indies (UWI), Mona.

“For example, a stroke patient might have weakness, so he gets physiotherapy. A stroke patient may (also) have problems getting dressed, so they have occupational therapy; they may not be able to swallow, so they may need a speech and language therapist; and they may have cognitive issues, so they may need a neuropsychologist,” she explained.

“On top of that, they may need also aquatic therapy, which we have; we have a heated pool with underwater treadmill and underwater bike. So patients can get everything here now,” she continued.

The institute, which is an outpatient centre for physical medicine and rehabilitation, provides medical care for adults and children, enabling them to recover physically and regain their skills after injury or illness. Its treatment approach essentially includes medication, physical modalities, physical training with therapeutic exercise, movement and activities modification, adaptive equipment, orthotics (braces), prostheses (artificial limbs), as well as patient education, and neuropsychology treatment.

But, according to Dr Dawson, the institute is now operating at 10 per cent of the capacity that she envisions.

“What I want to have it become, and I don’t like the word medical tourism, but I do want Rehab Institute of the Caribbean to be a rehab centre where people from the region can come for specialist rehab treatment,” insisted Dr Dawson.

The institute’s team now includes a physiatrist, physiotherapist, occupational therapist, neuropsychologist or clinical psychologist, speech and language therapist, massage therapist, and nutritionist.

Dr Dawson, who also has training in interventional spine, musculoskeletal and sports medicine rehabilitation, wants the institute, which is located in the Liguanea Post Mall in Kingston, to have multiple units.

“In three years, we want to have a multi-unit institute where each specific rehab has its own space to allow for maximum care, without any limitations,” she declared. “Our goal is to have an institute… that provides the individual specialist care in the different areas of rehab [whether it is] in physical therapy, occupational therapy, speech therapy, neuropsychology, neurological disease, paediatric, cardiac rehab, prosthetics… and bracing, and other basic medical equipment where patients can come in and get affordable, good-quality products.”

This, she said, will include a paediatric section with a rock-climbing wall for children to strengthen their arms, a regular therapy section, a sports section, a neurological section for stroke patients, and cardiac rehab.

She admitted to the Sunday Observer that physiatry is relatively new, and though there are good doctors in Jamaica and that on the island currently there is some amount of opportunity for rehabilitation medicine as it relates to having a co-ordinated approach to patient care, this does not exist in one location.

“Another way we explain physiatry is, take for example, an orthopaedic surgeon or a cardiologist or a brain surgeon who may save somebody’s life. They may have been in a motor vehicle accident and the limb is mangled, they may have to cut it off or they’ll bleed to death; or they may have had a brain injury or heart attack or something, so you cut the leg off, the surgery is done; the quality of life — that’s where we come in,” Dr Dawson explained.

“We’ll do the bracing, dealing with all the complications, the bedsores… Physiatrists would say that while the surgeons and internists might save somebody’s life, we add quality to those years,” Dr Dawson argued.

“It’s bringing the body back to maximum performance without surgery, by using therapy, exercise and medication,” she continued.

She is hopeful that there is a bright future for physiatry in Jamaica, however.

“I am hoping that one or two students in every class at UWI will go into physiatry. So far, since I have been lecturing, I have at least two in each class. I hope they will go and do the residency and come back to Jamaica, and the rest of the Caribbean, so we can have more physiatrists providing more rehabilitation medicine,” she said.

Though the institute has grown, Dr Dawson said that not many people are aware of what physiatry is, and the role it plays in rehabilitation, pain management, arthritis, sports medicine, and stroke, but that is gradually changing. And, she is committed to raising the level of awareness about this branch of medicine.

“Once patients come and understand what it is, they are like, ‘why didn’t I hear about it before?’,” shared Dr Dawson.

However, although more people are learning about it, compliance remains a major problem.

“Compliance is an issue, but our therapists are very encouraging; we have to motivate the patient. A lot of patients who have had severe pain are motivated by the pain, there are patients who forget the pain until it comes back again,” said Dr Dawson. She is, however, countering this by providing patients with handouts to remind them of simple exercises to help them stay on the right path.

She shared that, based on the rehabilitation services offered, not everyone will walk or regain full cognitive ability or even their ability to swallow, but physiatry takes people back to their maximum potential within their limitation.

So how does the physiatrist feel after working with a patient who has been able to achieve their full potential?

“I feel wicked! I feel happy for the patient,” said an elated Dr Dawson. “I mean, it is just amazing.”

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PUBLISHED: Featured Alumnus – Dr. Paula Dawson

Paula “Genie” Dawson knew she would become a medical doctor. But she didn’t know that she would become a pioneering doctor making her mark in the field of rehabilitation medicine. As a physiatrist, Dr. Dawson’s speciality is playing an increasingly significant role in maintaining fitness in patients and addressing disability impairments.  The goal of physiatry is to decrease pain and enhance performance without surgery.

It’s a little different from geriatrics which Paula once fancied, when she thought her life’s work would involve removing pain and discomfort of elderly patients.

Paula’s involvement in sports is what triggered the change of heart. She can be described as the ultimate sportswoman – football, cricket, hockey, volleyball, netball, table tennis and athletics – she has done it all.

Now the ultimate sports physician in the making, trained to lead the team of medical professionals who will diagnose and treat pain; restore maximum function lost through injury, illness or disabling conditions using non surgical methods, and in reality, simply treating the whole person.

Paula entered the Mona campus of the UWI in 1992 in the Faculty of Natural Sciences with the aim of becoming a medical doctor.

“My first day on campus really set the tone for my life as a student and has informed my behaviour as a professional, working at Mona.

“I remember “Freshers’ week” on Taylor Hall. As an older Freshette, I found the antics very entertaining rather than intimidating, so I enjoyed it immensely. I was struck by the creativity of the seniors in carrying their message of Hall unity, which I think is the ultimate aim of the orientation exercise. It was awesome.”

Paula Dawson 1

Paula, you see, worked for a few years after leaving high school, (Mount Alvernia High and ICHS 6th form) before taking on tertiary education.

First year was quiet, doing little else but studying and interacting on the block with fellow students. Nonetheless, she was awarded “Freshette” of the year, partnering Matthew “Knife” Harvey as “Freshman” of the year. Her second year, however, saw her involvement in sports, becoming Sports Rep, organising and motivating colleagues for success, and forming bonds of friendship which remain strong today.

Paula soon found out that an honours degree in Biochemistry and Zoology did not guarantee a place in the Medical Faculty. It took her all of four…yes, four days after the start of the school year to attend her first lecture as a medical student in 1995.

And it was love at first class. “I loved medicine even before I truly knew what it was all about. So I was excited.”

On the day she heard her name as a successful candidate in the final medical exams she said, “I felt a sense of being on track with my destiny. I loved medicine and my patients before I even met them. Realising the depth of my heart’s involvement with the patients I saw in due course, I decided against specialising in geriatric care. The thought of not being able to keep my patients alive and well, was not enough so I chose a specialty where I can improve the quality of life in all patients, Physiatry.”

Paula Dawson 2

A founding member of the UWI women’s football team, a six-a-side venture initially, along with Roosevelt ‘Cammo’ Campbell, really a Taylor Hall grouping, Paula began to see the need for quality holistic medical support for sportsmen and women. Vin Blain, along with her friends, Slug, Termite, to name a few, supported the sporting ventures, making the Mona team a force to be reckoned with, locally and regionally.

The tireless, hard-studying Paula, who graduated with her medical degree in 2000 also served as Class President, 1998-2000, chairman of Smoker, class of 2000. She did her Residency at Long Island Jewish Hospital where she was appointed Chief Resident in her final year and a fellowship at Northwestern University and Rehabilitation Institute of Chicago, prepared her for her life of service.

Paula Dawson 3

Paula Dawson advises student: “Become involved in campus life. You can do anything; achieve any level you set your sights on. All you need to do is give your best…and some.”

Dawson is pioneer for Physiatry in Jamaica and a co-founder of the UWI Sports Medicine Clinic. She teaches at the medical school and at the Physical Therapy school, works with elite and ordinary athletes, and hopes for a larger corps of Physiatrists to support the UWI Centre for Sporting Excellence and Rehabilitation.

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Rehab Caribbean leads the way: REHABILITATION NOW

The Rehabilitation Institute of the Caribbean launched a new radio feature called REHABILITATION NOW, a program on a program on Physical Medicine & Rehabilitation for patients who have pain and/or dysfunction from injury or disease that affects muscles, tendons, nerves and joints.

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PUBLISHED: Fluoroscopy-guided intra-articular sacroiliac joint steroid injection for sacroiliitis in ankylosing spondylitis: a Case Report

INTRODUCTION

A fundamental clinical feature of ankylosing spondylitis (AS) is sacroiliitis, which is inflammation of the sacroiliac joints. It is characterized by back pain and stiffness affecting the sacroiliac joint and axial skeleton (1–3). The sacroiliac joint is commonly the first joint involved and may also be the most painful symptomatically. While the aetiology of AS is unknown, genetic and environmental factors play a major role. The prevalence of AS is approximately 0.1–1% in the general population (4, 5) and onset of this potentially debilitating disease may occur as early as in childhood. However, onset is usually in the second and third decades of life and affects men two to three times more often than women (6, 7). Nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroid and disease-modifying antirheumatic drugs (DMARDs) have been used to treat patients withAS (2) and fluoroscopy-guided intra-articular sacroiliac joint (IASIJ) steroid injection has been incorporated in the treatment of sacroiliitis (8, 9).

 

CASE REPORT

A 20-year old male gave a history of having undifferentiated inflammatory type cervical, thoracic and lumbar spine pain as well as right sacroiliac joint pain, rib/costochondrial pain and variable peripheral arthritis affecting the right hip, ankles, right rotator cuff and bilateral epicondylitis since 2010. He was subsequently diagnosed with AS in 2012. He then presented to the University Hospital of the West Indies (UHWI), Physical Medicine and Rehabilitation (PMR) clinic with a two-month flare-up of pain in the right groin, right buttock and low back. His presenting visual analogue scale (VAS) pain score on the 11-point Likert scale was 4/10 in the right groin which intensifies with walking (8/10), and right low back pain (5/10) which worsens to 7/10 on waking in the morning. He was evaluated as having an Oswestry Disability Index of 40%moderate disability. Functional impairment assessment using Bath Ankylosing Spondylitis Functional Index (BASFI) was 4.9 out of 10 and active disease evaluation using the Bath Ankylosing Spondylitis Disease Activity Index was 7.3 out 10.

He was being treated by a rheumatologist and current medication included sulfasalazine and non-steroidal anti-inflammatory medication. He had also been treated with Actemra (tocilizumab) which controlled the fatigue and generalized inflammatory symptoms. However, his pain persisted. He was placed on amitriptyline and paroxetine for depression. Physical therapy was also incorporated in his treatment and he was also lifting light weights at the gym a few days per week. On examination, he was found to walk with a normal gait. He was able to heel and toe walk, but heel walking worsened the right low back pain. Bilateral lower extremities reflexes were 3+ and symmetrical. His strength was normal grade 5/5 in both lower extremities and sensation was intact. Straight leg raise was negative. Slump sit test was positive on right but negative on the left side. Pelvic anterioposterior glide and pelvic compression tests were negative while Patrick’s FABERE (Flexion, Abduction, External Rotation and Extension) and pelvic distraction tests as well as Gaenslen’s sign were positive on the right. There was tenderness on palpation over the right sacroiliac joint.

Radiological findings included: magnetic resonance imaging (MRI) which showed a normal lumbosacral spine and pelvis/hips X-ray which showed bilateral sacroiliitis with evidence of subchondral sclerosis and marginal erosive changes right greater than left (Figure). He was assessed as having sacroiliitis on the right greater than on the left, with the right being symptomatic

 

Fluoroscopy-guided right sacroiliac joint steroid injection was done. The technique used had the patient position prone. The region overlying the inferior aspect of the right sacroiliac joint was identified using superficial landmarks and fluoroscopy. Under sterile condition, the area over the right sacroiliac joint was cleaned with betadine and draped. A 22-gauge needle was used to anaesthetize the skin using 4 ml of 1%lidocaine. Using fluoroscopic guidance, a 22-gauge quinke needle was used to enter the right sacroiliac joint from below. One millimetre of Omnipaque (iohexol) was used to confirm an intra-articular flow pattern and there was no vascular uptake. He was then injected with 1 ml of triamcinolone 40 mg/ml and 0.8 ml of 1% lidocaine. Pre-procedure VAS at rest was 4/10 and with activity, 6/10. Post-procedure VAS at rest was 0/10 while with activity, 2/10.

At follow-up within a week, the patient reported 95% improvement in the right buttock pain over the sacroiliac joint (SIJ). He rated the right buttock pain VAS of 1/10. He still had low back pain and also complained of right shoulder pain. His Oswestry Disability Index after IASIJ steroid injection was 16% which is rated minimal disability as compared to 40% before injection which is moderate disability. He was also prescribed a sacroiliac joint belt to be worn daily and a pelvic stabilizing rehabilitation programme was outlined.

 

DISCUSSION

Ankylosing spondylitis is a progressive inflammatory seronegative autoimmune disease which causes inflammation of the spine and sacroiliac joints, resulting in axial skeleton rigidity and if left untreated can advance to fusion of the spine ie Bamboo spine (10, 11). Sacroiliitis is regarded as a hallmark in diagnosing AS (3). Other clinical presentations include positive HLA-B27 test, radiological findings (including sclerosis or erosion of the sacroiliac joint), low back pain, peripheral arthritis and extra-articular involvement – such as uveitis, and cos tosternal involvement restricting chest expansion – may also occur (2, 6).

The prevalence of AS is highest in the northern European countries, whereas persons of Afro-Caribbean descent have the least (12). The use of NSAIDs and fluoroscopyguided steroid injection is widely used to treat sacroiliitis, along with physical therapy (8, 9). It is to be noted that in the index case, the symptoms of low back pain persisted post IASIJ injection; this is not surprising as the treatment is localized to the site injected. Further treatment must be incorporated for the alleviation of the lumbosacral spine pain. In this case, NSAIDs and DMARDs gave minimal relief of the patient’s sacroiliac joint pain, and intervention with fluoroscopyguided steroid injection for intra-articular capsule injection gave 95% improvement in the patient’s perceived pain, a decrease of VAS from 6/10 with activity to 1/10. Additionally, Oswestry Disability Index improved from 40% moderate disability to 16% minimal disability. This is consistent with a study done by Karabacakoglu et al, who found that fluoroscopy-guided intra-articular corticosteroid instillation in the SIJ may be regarded as an effective therapy since there was a 90.9% (20 of 22 joints) reported improvement (13).

 

REFERENCES

1. Ball J. Enthesopathy of rheumatoid and ankylosing spondylitis. Ann Rheum Dis 1971; 3: 213–23.

2. Sieper J, Braun J, RudwalietM, BoonenA, ZinkA. Ankylosing spondylitis: an overview. Ann Rheum Dis 2002; 61 (Suppl 3): iii8–iii18.

3. Creemers MCW. Ankylosing spondylitis: what do we really know about the onset and progression of this disease? J Rheumatol 2002; 29: 1121–3.

4. Maugars Y, Mathis C, Berthelot JM, Charlier C, Prost A. Assessment of the efficacy of sacroiliac corticosteroid injections in spondylarthropathies. Br J Rheum 1996; 35: 767–70.

5. Hamersma J, Cardon LR, Bradbury L, Brophy S, van der Horst-Bruinsma I, Calin A et al. Is disease severity in ankylosing spondylitis genetically determined? Arthritis Rheum 2001; 44: 1396–1400.

6. Brophy S, Calin A. Ankylosing spondylitis: interactions between genes, joints, age of onset and disease expression. J Rheumatol 2001; 28: 2283–8.

7. O’Shea FD, Boyle E, Riarh R, Tse SM, Laxer RM, Inman RD. Comparison of clinical and radiographic severity of juvenile-onset vs. adult-onset ankylosing spondylitis. Ann Rheum Dis 2009; 68: 1407–12.

8. Khan MA, Garcia-Kutzbach A, Espinoza LR. Treatment of ankylosing spondylitis: a critical appraisal of non-steroidal anti-inflammatory drugs and corticosteroids. Am J Med Sci 2012; 343: 350–2.

9. Dussault RG, Kaplan PA,AndersonMW. Fluoroscopy-guided sacroiliac joint injection. Radiology 2000; 214: 273–7.

10. Jimenez-Balderas FJ,Mintz G. Ankylosing spondylitis: clinical course in women. J Rheumatol 1993; 20: 2069–72.

11. Gran JT, Skomsvoll JF. The outcome of ankylosing spondylitis: a study of 100 patients. Br J Rheum 1997; 36: 766–71.

12. Kaipiainen-Seppanen O,Aho K, HeliovaaraM. Incidence and prevalence of ankylosing spondylitis in Finland. J Rheumatol 1997; 24: 496–9.

13. Karabacakoglu A, Karakose S, Ozerbil OM, Odev K. Fluoroscopyguided intra-articular corticosteroid injection into the sacroiliac joint in patients with ankylosing spondylitis. Acta Radiol 2002; 43: 525–7.

 Correspondence:
Dr PUA Dawson,
PhysicalMedicine and Rehabilitation, c/o Dean’s Office,
Faculty of Medical Sciences,
The University of theWest Indies,
Kingston 7, Jamaica,West Indies.
E-mail: paula.dawson@uwimona.edu.jm

 

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Rehabilitation Institute of the Caribbean Grand Opening

The Rehabilitation Institute of the Caribbean had it’s Grand Opening on July 4, 2013. It was a wonderful affair with our many special and distinguished guests. The ribbon was cut by Her Excellency Lady Patricia Allen, Javere Bell (National 400 meter Champion 2013) and our Medical Director Dr. Paula Dawson. The evening started with everyone mingling and touring the state of the art facility. Select Brands Jamaica joined us for the evening and featured a few of their wines and spirits for our guests enjoyment.

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Published: Jamaican Rehab Centre looks to Canada

KINGSTON, JAMAICA—He’d been invited here as guest speaker at the inaugural Disability Friendly Awards last November and Ontario Lt.-Gov. David Onley was about to discover how the other half lives.

The man speaking to him — eyeball to eyeball, 1950s polio victim to polio victim, aged wheelchair beside modern scooter — was Don Taylor.

Don, in his early sixties, is a prime advocate on the island and educator at the Sir John Golding Rehabilitation Centre; and he’s been wearing the same pair of leg braces for 35 years, held together with steel scraps from friends in the car repair business.

“It was astonishing,” Onley recalls. “In Ontario, every two years you’re eligible to get a new pair of the braces. The province pays 75 per cent. For my most recent pair I paid $700 or $800 net.”

A couple weeks after Onley left, Taylor fell, broke his leg and separated his shoulder.

The province’s lieutenant-governor wouldn’t forget Taylor, nor the thousands trapped in a society emerging from decades of neglect of its citizens with disabilities and little money to grease the process of change.

Five months later, Onley was back — this time with a team of Canadians and Americans committed to jerking the once-leading edge rehab centre into the 21st century.

Half an hour into last month’s tour of the centre, at the Mona campus of the University of the West Indies in the foothills of the Blue Mountain range, the doctors, therapists, architects, Rotarians and builders had concluded that the mission was possible, though not a slam dunk.

“There’s a desperate need to do something,” says Dr. Geoff Fernieof the Toronto Rehab Centre. “There’s a hell of lot of people whose lives are unfulfilling, simply because they are not able to get rehabilitation.

“The economy is going downhill; it’s very worrying. There are all sorts of competing priorities. We can’t solve all those problems, but whatever the obstacles, we must do something. That’s what motivates me.”

Less than six months after his initial visit, Onley’s team has prepared a master plan to rebuild, reposition and re-energize the John Golding centre. And on Saturday night, Onley is to give a sneak preview to some of Toronto’s most educated and powerful citizens — graduates and supporters of the University of the West Indies attending its elite annual gala.

The gala exists to honour high-achieving people of Caribbean descent and fund the several scholarships it delivers. If Onley’s dream is to become a reality for Taylor and others who don’t have the means to travel to Miami and elsewhere for their rehab needs, it is this group that will have to fund the makeover.

“This is bigger than Jamaica,” said Seth Ramocan, the island’s active consul general stationed in Toronto. “This brings world focus on how other than First World countries address accessibility issues.”

John Golding arrived in Jamaica from England just ahead of the polio outbreak of 1954. An orthopedic specialist, he set up a treatment centre for the victims and when the numbers swelled he decided to stay.

A sort of Renaissance man, he built the complex from scratch, adding elements as he saw the need. A rehab centre to reinvigorate failed muscles; a prosthetics and orthotics shop for those needing limbs and braces; a shoemaking shop that churns out low-cost, though decidedly unstylish footwear; a residence for students who can’t access island schools; a swimming pool for rehab; recreational facilities now used by Jamaican Paralympic athletes like Sylvia Grant.

He became a hero of the poor and is considered a national hero. They named the centre after him when he died in 1996 but it has fallen into disrepair and neglect, despite the efforts of people like staff physiotherapistSuzanne Harris-Henry and Taylor.

Like Onley, Taylor had polio as a child. He was one of the lucky Jamaican kids to grab a spot at the experimental school for children with disabilities that Golding started.

Taylor has grown impatient with the slow pace of progress on the accessibility file. And he welcomes the burst of energy that has come to the centre since the interest from Canada.

“Sir John’s seen as the poor people’s hospital,” Taylor tells the Canadians. “People with means go abroad.”

To tour the once-proud facilities is to understand why.

The first stop at the orthotics shop is a downer — a tired-looking tiny space. The equipment works, but the technology is old. In the GTA alone one could find 20 to 25 facilities, not including hospitals, that make orthotic devices and braces.

The shoemaking facility churns out one design, “really, really ugly-looking orthotic shoes. You have a choice of shoe or boot,” Onley says of his initial visit.

“I started thinking of the different places I had gone to, about a dozen that would make custom-made shoes. There is a store on Kennedy with 50 to 70 different models, most of them stylish . . .

“By the time I got to the orthopedic shoemaking facility what I saw was a machine from post-World War 2 Britain.

The top guy here, Basil Johnson, surveys the rows of identical shoes, sighs and admits to the visitors: “Y’know, I’m tired.”

He should be. He’s 76 years old and had to return from retirement when a replacement was not found. He has trainees, but they don’t embrace the task as enthusiastically as he did. He’s a polio victim who learned the job in this very shop.

As soon as Onley was appointed Ontario’s representative of the Queen in 2007, he made it clear he’d use his platform to advocate for people with special needs. “Never in my wildest dreams did I imagine” it would spread to the Caribbean, he said Friday.

But having seen the need, he couldn’t just return home to advocate for Ontarians alone.

At the core of the Caribbean challenge is this: hundreds of citizens with disabilities have no opportunity and no options. Polio has been eradicated, but the patients continue to arrive, thanks to strokes, gunshot wounds and accidents on the roads and on farms.

The Golding centre has room for 30 adult men, 30 children and eight females. By World Health Organization standard the island of three million needs five to 10 times the capacity. Then, there are those who arrive from the rest of the English-speaking Caribbean as this is the sole public facility that can address their needs.

Jamaica may have been the first country to adopt the United Nations Convention on the Rights of Persons with Disabilities and is a leader in the Caribbean, but it is decades behind a place like Ontario.

Public accessibility is an emerging dream. Curb cuts are sporadic in the capital. Finding an accessible vehicle for public transportation is a near impossibility. And at the Golding Centre, founded in the 1950s ahead of many industrialized nations, innovation has given way to despair despite heroic efforts of front-line staff and advocates.

In short, the government has no money. And the populace has higher priorities than equal access for its more vulnerable citizens.

That has not dimmed the ambitions of Taylor or of Senator Floyd Morris, a visually impaired advocate and politician, or Christine Hendricks of the Jamaica Council for Persons with Disabilities — all attending a meeting with the Canadians this day.

“It’s an exciting time to be alive, to be honest,” Hendricks tells the Canadian team. “Jamaica is ready to take off and at times we do not know how. It’s good to be guided.”

For Gordon Shirley, University of the West Indies principal, former Jamaican ambassador to the U.S. and a powerhouse on the island, the Canadian presence is a huge boost to the local advocates toiling on the file with slow and limited progress.

With Onley’s lightning quick push for changes, Shirley and others got the government to complete a memorandum of understanding that will turn the Golding centre over to the university. Golding’s son, Mark, the country’s justice minister, says Onley’s initiative provided the impetus to achieve quickly what might normally take years.

“Everything in due season,” he says. “This is a fantastic coming together of different strains that have merged. It gives Jamaica access to the minds of the people at the pinnacle of rehab care in the world. And it happened because the lieutenant-governor saw the centre and recognized the need and the potential.”

Joining Onley on the fact-finding mission last month were Carleton University, the Toronto Rehab Centre, the Mike Holmes group and the Rotary club. Tim Hortons and Scotiabank chipped in assistance.

Jon Sader, from the American energy group Sader Power, and his team worked with TV home renovation star Mike Holmes to quickly put together a master plan for the project.

Onley says his role of convening the enablers is nearly over.

“There is such a significant Jamaica diaspora here in the GTA and a large Caribbean contingent with a fair amount of resources at their disposal. I feel that if they knew about the state of affairs they would do something to improve it.”

The group plans a public campaign to raise the funds that will remake the rehab centre.

Dr. Paula Dawson, the island’s only rehab specialist spells out the need:

“We need the space, the facilities for a residency program. Help me train and educate others so they can go out and serve St. Vincent, Grenada and the rest of the Caribbean. Each one teach one.”

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PUBLISHED: Pioneering Physical Medicine and Rehabilitation

Physical Medicine and Rehabilitation (PM&R), also referred to as Physiatry (pronounced fizzy-at’-tree), treats patients who have experienced traumatic injury, disabling diseases or following surgery, to regain control of their lives by restoring function. Treatment is aggressive, nonsurgical management of the body’s musculoskeletal system, which includes bones, joints, muscles, ligaments, tendons, and nerves. Some areas of PM&R include rehabilitation for: Musculoskeletal, Sports Medicine, Spine (neck and backp pain), Spinal Cord injury, Brain Injury and Paediatric and Spasticity Management.

Dr. Paula Dawson is researching the efficacy of interventional (fluoroscopic) treament for back and neck pain, using X-ray guidance to inject areas of the spine that cause pain, e.g. Herniated disc, spinal stenosis, spondylosis.

She is also pioneering the use of neurolytic medications: (Phenol and Botulinum toxin type A) in the treatment of spasticity (disabling muscle stiffness) in adults with neurological diseases including brain injury, spinal cord injury and children with cerebral palsy.

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