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C O N F E R E N C E R E P O RT SBritish Society of Rehabilitation Medicine ConferenceConference details: 14-15 June, 2012; Southampton, UK. Reviewed by: Dr John Burn, Rehabilitation Consultant, Poole General Hospital.The Major Trauma Centre (MTC) initiativehas thrust rehabilitation into the limelightand it was the focus of this year’s meeting.The identification of patients who needspecialist services will be a particular responsibilityof Rehabilitation Medicine (RM) specialists.Presentations from both Manchester andLondon described a cultural change wherebyRM specialists were forming an integral part ofacute trauma teams and moving patientsquickly on to appropriate rehabilitation facilities.To do this well services need to be availableon the acute site and RM physicians need toacquire new skills, particularly in musculoskeletalconditions. There was extensivediscussion on the requirements for‘Rehabilitation Prescription’. Well organisedMTCs are securing this not only for patientswith an Injury Severity Score (ISS) of > 15 butalso for > 8 (three fractured ribs) thus securingmore ‘best practice tariffs’. These monies willhave to be invested in enhanced services forthis not just to be a paper exercise.The conference brought unfamiliarspecialisms to the BSRM. Mr Michael Fox fromStanmore described surgical approaches tobrachial plexus injury and Dr Chris Lowe fromPoole Hospital described continuing problemsafter Critical Care. Survival is reduced for 15years after ARDS and this is determined principallyby weakness. This affects almost 50% ofpatients and, although not completely understood,is detectable as a reduced 6 minutewalking distance for at least 5 years afterwards.There are recommendations for early mobilisationbut little supporting evidence as yet.Public awareness of rehabilitation has beenenhanced by the work amongst veterans atHeadley Court. Prof Greenberg, visitingprofessor of psychiatry, gave a robust defence ofthe psychological management of Britishservice personnel. Despite, or maybe becauseof, fewer mental health personnel, the rate ofPTSD is significantly less than in the US armyand, although peaking at 6% at 4 years, appearsto decrease subsequently. The incidence ofPTSD is less for the majority of combatants whodescribe their leadership as good or very goodor who have fewer stresses at home. Early (lessthan 4 year) army discharges or reservists aremore at risk. There is no significant increase insuicide or imprisonment but rates of alcoholabuse are frighteningly high: up to 25%.Spiritual care was introduced into a BSRMmeeting by Dr Collicut, both a neuropsychologistand an Anglican priest. She distinguishedreligion from spirituality by describing threeaxes of Transcendence, Meaning and TheSacred. Traumatised patients face keen questionsof meaning (why me?) but often becauseof cognitive and physical problems are less ablespiritually to address them. Spiritual help cannotbe left to faith practitioners but crosses professionalboundaries. She suggested focusing onShalom (wholeness/peace) through supportingdignity and identity, conveying hope, andexpressing solidarity and loving kindness.The conference finished with a symposiumon the definitions and management of minorbrain injury. We were encouraged to movebeyond the dualisms of ‘is it structural oremotional?’, and address the combined problemsof patients using a number of treatmentsthat can be practised in the clinic.In all, a broad and satisfying conference thatdemonstrated to visitors and members alike theincreasing range of the specialty. The nextconference, from 7th – 9th November 2012,willbe hosted by colleagues in Belfast and willinclude presentations on teleneurology, assistivetechnology, transcranial magnetic stimulationand the transitional rehabilitation of childrenwith cerebral palsy. lPREVIEW The Fifth Practical Cognition CourseCourse details: 1-2 November, 2012, Newcastle upon Tyne, UK.This very successful course is for consultantsand trainees in neurology, psychiatry,neuropsychology and rehabilitation medicinewho want to develop their practicalexpertise in cognitive assessment and relatethis to clinically relevant neuroscience. Therewill be a practical introductory session tocognitive assessment followed by four sessionsof case presentations discussing the assessment,diagnosis and management of commoncognitive syndromes. The course begins andends with the patient. Case presentations willfeature video material illustrating disorders thatclinicians may encounter in daily practice.Each session will also include a talk from aninvited expert, who will provide a framework forunderstanding the clinically relevant neuroscience.The case presentations and talks arehighly interactive and lively discussion isencouraged.This year’s programme will cover memory,sleep and cognition, hallucinations and motorfunction and cognition. Our highly acclaimedspeakers include Kirsty Anderson (Newcastle),David Burn (Newcastle), Tom Kelly(Newcastle), Andrew Larner (Liverpool),Sinéad Mullally (UCL) and Peter Woodruff(Sheffield). The course is organised by neurologistsTim Griffiths (Newcastle) and Chris Butler(Oxford), sponsored by the Guarantors of Brainand will be accredited for CME points.The course will be held in the Beehiveconference centre on the main campus ofNewcastle University within the city. The registrationfee includes a superb dinner on the firstevening at the Quayside in Newcastle.The Practical Cognition course has receivedhighly enthusiastic feedback in previous years.Participants have enjoyed the practicalapproach to an area of clinical work that isextremely important but often neglected in postgraduateeducation. Here are links to reviews oflast year’s course by a trainee psychiatrist[http://careers.bmj.com/careers/advice/view-article.html?id=20006682] and consultantneurologist [http://www.acnr.co.uk/contents11-6.htm].Bookings can be made online (www.practicalcognition.com)or by telephoning LauraPereira on 0191 222 8320. Places are limited andshould be reserved early. l32 > ACNR > VOLUME 12 NUMBER 4 > SEPTEMBER/OCTOBER 2012
C O N F E R E N C E R E P O RT SThe 10th European Congress of NeuropathologyConference details: 6-9 June, 2012, Edinburgh, Scotland. Reviewed by: Dr Valerie Critcher, Specialist Registrar in Neuropathology at the Royal Hallamshire Hospital,Sheffield, UK.An invitation from the European Confederation ofNeuropathological Societies (Euro-CNS) and the BritishNeuropathological Society drew almost 400 participants fromacross the globe to the Edinburgh International Conference Centre forthis Neuropathology Congress. The meeting was preceded by the Euro-CNS training course on Leukoencephalopathies.Plenary LecturesThe programme included plenary lectures by eight distinguishedspeakers working at the forefront of neuroscience research and its applicationto improvements in diagnosis and treatment. In his talk on themolecular pathology of CNS tumours, Professor David Louis focused ondevelopments in this rapidly expanding field that have been translatedinto valuable diagnostic and prognostic tools. An example was the use ofMGMT promoter methylation to help distinguish glioblastoma recurrencefrom pseudoprogression during temozolomide therapy. Professor JohnHardy discussed how advances in sequencing and DNA chip technologyare being used to identify different types of genetic risk for neurodegenerativediseases, thereby increasing understanding of the aetiologies.Professor Richard Gilbertson described his laboratory’s cross-speciesgenomics approach to the subgrouping of CNS tumours. This is helpingto explain why tumours of similar histopathological appearance mayshow very different biological behaviours. For example, ependymomasarising in the forebrain, hindbrain and spinal cord have distinct molecularprofiles, reflecting their different stem cell type origins. Professor WilliamBrown illustrated his techniques of creating three dimensional views ofvascular networks to investigate the vascular changes in deep whitematter in ageing, neurodegeneration and dementia. The increasingcomplexity and diversity of prion diseases were discussed by ProfessorPierluigi Gambetti. He talked about the identification and characterisationof novel forms such as variably protease-sensitive prionopathy whichis suggested to represent a sporadic form of Gerstmann-Sträussler-Scheinker disease. Professor Ingmar Blümcke described how the surveyof over 5,000 surgical epilepsy specimens collected at the EuropeanEpilepsy Brain Bank has enabled correlation between histopathology,preoperative imaging and clinical response to surgery, which in turn isleading to more specifically tailored resection strategies. Developmentsin understanding the pathogenesis of lysosomal diseases were explainedby Professor Steven Walkley. He showed that the complex role of lysosomeswithin a major metabolic regulatory network indicates that braindysfunction in lysosomal diseases is not simply the consequence ofabnormal storage of non-degraded materials. In the final lecture to theCongress, Professor Robin Franklin described the work in his laboratoryon the biology of remyelination. The findings show that declining efficiencyof remyelination with age is largely due to failure of stem celldifferentiation. Evidence that the innate immune response has a key rolein remyelination led to an interesting discussion on the effects of antiinflammatorytherapy in multiple sclerosis.Seminars and WorkshopsA total of 10 symposia and 7 workshops provided platforms to discussaspects of research and diagnostic practice related to a wide range ofneurological/neurosurgical disorders. There were sessions dedicated toregenerative neuroscience and to brain inflammation. A personal highlightwas the lecture by Professor Arie Perry in which he presented a verypractical approach to the subtyping of glioblastomas, with emphasis onthe clinical relevance of making the distinctions.PostersOver two hundred posters, grouped into ten themes, were displayed in theexhibition hall throughout the Congress, giving ample opportunity forA friendly encounter between congress participantsin the exhibition hall.viewing. The standard was high and twenty-six poster presenters wereinvited to give oral presentations within the above symposia and workshops.In addition, there were two plenary poster discussions. For these,eight discussants were asked to reflect on what they had found of interestamong the posters. I enjoyed the different approaches taken by the eightindividuals to present their choices and seeing which strategies had mostsuccess in promoting audience participation in the ensuing discussions.Social EventsThe large exhibition hall provided a place to encounter old friends andmake new acquaintances. On day two the delegates were treated to anexclusive evening reception in Edinburgh Castle. This included a chanceto view Scotland’s Crown Jewels and experience the stirring sounds of apipe band through the mist over Crown Square. The Gala Dinner was heldin the newly refurbished National Museum of Scotland, surrounded bythe eclectic Window on the World exhibition in the Grand Gallery.Entertainment was provided by the excellent Kilter Ceilidh Band and Iobserved that many eminent neuropathologists are also adept at Strip theWillow and other traditional dances performed that night.ConclusionsThe scientific programme was scheduled so that in general sessions witha bias towards clinical diagnostics ran alongside those with a more dedicatedresearch content. This allowed delegates to select the topics mostrelevant to their areas of interest and there was truly ‘something foreveryone’ throughout the Congress. Inevitably clashes occurred and sowe hopped between the auditoria to catch the anticipated highlights fromeach symposium and workshop. Some of the sessions suffered from lessthan strict timekeeping, thus limiting the opportunities for discussion andone of the plenary poster sessions had to be cut short. In the welcomeaddresses there had been references to the inclement weather and to therecent outbreak of Legionnaires’ disease in Edinburgh. Nonetheless I amsure that most delegates remained within the Conference Centre eachday not because of these external factors but as a consequence of suchan informative and enjoyable meeting. lThe Abstracts of the 10th European Congress of Neuropathologyare published in: Clinical Neuropathology. 2012;31(4):232-5.Details of future Euro-CNS events, including the neuropathologytraining courses, can be found at: www.euro-cns.orgACNR > VOLUME 12 NUMBER 4 > SEPTEMBER/OCTOBER 2012 > 33
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