Looking along the physiological and physical changes in aging, in the light of a major burn, co-morbidities, surgical intervention and precaution, a geriatric burn patient requires a delicate balance of ideal burn care and rehabilitation to achieve functional independence. A 70-year-old patient, with 30% total body surface area flame burn injury, underwent bilateral partial calcanectomy secondary to calcaneus osteomyelitis, and Meek micrograft technique for burn injury on bilateral lower extremities, is presented in this case report. In order to ensure good graft take, her knees were immobilized causing bilateral soft tissue contractures. Subsequently, upon initiation of ambulation, gait abnormalities observed include absence of heel off and toe off, with heel walking. The patient was admitted for intensive inpatient rehabilitation, where significant improvement in the knee range of motion and ambulation were achieved. The patient was eventually discharged ambulatory with walker. Despite expected complications, rehabilitation management proved to be beneficial in improving function and ambulation in geriatric burn patient.

Objective. The study compared functional outcomes among post-operative geriatric fragility hip fracture patients who received complete and incomplete rehabilitation.

Methods. This is an ambispective cohort study of 50 acute fragility hip fractures over a 40-month period (October 2017 to November 2020) treated with either arthroplasty or internal fixation under the UP-PGH Orthogeriatric Fracture Liaison Service (FLS). Patients were contacted and interviewed through Telemedicine. They were asked to answer two questionnaires - the Modified Harris Hip Score (MHHS) and the EuroQol-5D-5L (EQ-5D-5L). The scores were tallied and used to describe and compare the post-operative functional outcomes between the two rehabilitation pathways.

Results. Among the 50 patients included in this study, twenty-three (46%) patients underwent complete rehabilitation, while 27 (54%) underwent incomplete rehabilitation. The average corrected MHHS was at 82.5 suggesting good outcomes among all patients, with a higher-than-average outcome of 83.6 among patients who underwent complete rehabilitation, and an outcome of 75.9 among patients who underwent incomplete rehabilitation. Results to the EQ-5D--5L survey showed that a majority of patients who underwent complete rehabilitation reported having 'no problems' in terms of self-care, and anxiety or depression. However, the same group had more patients reporting 'any problems' in terms of mobility. On the other hand, a bigger proportion of patients from the incomplete rehabilitation group presented with 'any problems' in terms of usual activities. Proportions were similar for both groups in terms of pain or discomfort, with neither group having patients who reported extreme pain or discomfort.

Conclusion. In spite of the heterogenous nature of the hip fracture population, functional outcome measures show generally good outcomes of patients under the UP-PGH Orthogeriatric FLS, with no significant difference among patients who receive complete rehabilitation from those who undergo incomplete rehabilitation. Continuing this study may better describe and differentiate the functional outcomes in order to pave the way for evidence-based protocols dedicated to providing the highest quality of care for acute fragility fracture patients.

Musculoskeletal conditions are among the leading causes of consultations in Rehabilitation Medicine. A fellowship program in Musculoskeletal Rehabilitation Medicine was proposed to enrich physiatrists’ knowledge and skills in evaluating and managing musculoskeletal conditions. In this paper, we shared the process of developing the curriculum of the fellowship program, which was proposed to and eventually approved by the Postgraduate Institute of Medicine, College of Medicine, University of the Philippines Manila. A core group of consultants, considered as experienced clinicians and educators in Musculoskeletal Rehabilitation Medicine in the study institution, designed the program from the scope of training to learning competencies, outcomes, and assessment methods. To our knowledge, developing the fellowship program in this constantly evolving area in Rehabilitation Medicine is the first of its kind in the Philippines and a milestone in the history of postgraduate education in the longest-running training program for aspiring physiatrists.
Physical and Rehabilitation Medicine

A 22-year-old male who came in contact with a high-voltage wire, with entry point at the head and exit points at the ankles, presented with flaccid paraplegia and loss of sensation of bilateral lower extremities with no radiographic abnormalities. Several burn-related medical complications arose during the admission, as well as episodes of demotivation. Bilateral below the knee amputation was done because of extensive burn injuries of the lower extremities. The rehabilitation management for a patient with multiple disabilities needed to be tailored depending on the limitations and needs of the patient at a certain point in time. Despite the challenges, satisfactory results were achieved, through telerehabilitation and employing a multidisciplinary team approach.
Spinal Cord Injuries ; Amputation, Surgical

Objectives: The objective of this study was to determine the coping strategies and job satisfaction among rehabilitation medical and paramedical staff deployed to different areas at the University of the Philippines Manila Philippine General Hospital, a designated COVID-19 referral center. Method: This was a cross-sectional study that utilized total population sampling of the medical and paramedical staff of the Department of Rehabilitation Medicine deployed to other areas in PGH and who carried out non-rehabilitation-related clinical work responsibilities during the COVID-19 pandemic. Electronic informed consent was obtained from each participant. Two sets of validated and reliable self-administered online questionnaires, namely, the Brief Coping Orientation to Problems Experienced (COPE) Inventory Tool and Satisfaction of Employee in Health Care (SEHC) Survey, were used to determine coping strategies and work satisfaction, respectively. Descriptive statistics (such as frequencies, percentages, ranges, means) were used to present the data. Results: A total of 50 medical and paramedical staff participated in the study. The participants’ age ranged from 22 to 60 years (mean: 30.2 ± 8.7). The majority were single (84%), women (64%), and with a Bachelor of Science degree. Most of the participants were assigned in the orange zone, which included the COVID ward nurses’ station and donning/doffing areas; with 30% who rotated in the COVID wards. There were three types of coping strategies utilized by the department staff: (1) emotion-focused coping, (2) problem-focused coping, and (3) dysfunctional coping. Problem-focused coping was the most common general strategy (mean COPE score for all problem-focused strategies, 3.1 ± 0.9). Acceptance was the most common specific coping strategy, followed by active coping and a tie among positive reframing, planning, and self-distraction. The work satisfaction rate was at 76.9% ± 13.2. Three out of 4 participants would recommend their workplace to other healthcare workers. Conclusion The medical and paramedical staff of the Department of Rehabilitation Medicine in a COVID referral center had relatively high job satisfaction despite their health risks and changes in responsibilities among others. The majority utilized functional coping strategies to help them adapt to the work demands. The sources of motivation and values of the staff are areas for future research to help explain their positive outlook about their jobs and generally high recommendation about their workplace in the middle of the COVID-19 crisis.
Job Satisfaction ; Health Personnel

Patients with burns are predisposed to heterotopic ossification and contracture formation. While radiographs and bone scans are used to detect heterotopic ossification, musculoskeletal ultrasound can be used to diagnose and localize the lesion in patients with contractures. A 14-year-old girl with multiple contractures of the limbs from thermal burn injury sustained three years ago underwent in-patient rehabilitation in a sub-acute burn rehabilitation unit. Despite close monitoring and daily therapy sessions, the patient had minimal improvement in the range of motion of bilateral hips. Musculoskeletal ultrasound demonstrated hyperechogenic focus on the posterolateral aspect of the bilateral hips. This report documents the advantage of diagnostic musculoskeletal ultrasound in localizing and guiding the treatment of heterotopic ossification in a burn patient with contractures.
Diagnostic Imaging ; Ossification, Heterotopic ; Burns ; Rehabilitation ; Pediatrics

Neuropathic pain has been described following an electrical injury, whether as an immediate response or a late-onset sequela. There is much information on high-voltage injuries in literature due to its dramatic presentation, but limited studies on low-voltage injuries. However, low-voltage injuries can be as diverse and may have symptoms varying from minimal cutaneous involvement to full-thickness injury. Significant injuries may result from multiple factors, including prolonged duration of exposure and a higher amount of current transmitted. We illustrate an atypical presentation of a low-voltage injury in a 17-year-old female. The patient had a low voltage electrical injury with no cutaneous burn noted on the affected extremity. She initially presented with allodynia, which seemed disproportionate to the clinical findings expected in a low-voltage injury. The patient underwent an electrodiagnostic study, which showed cervical polyradiculopathy (C5, C6, C7 polyradiculopathy) and neuromusculoskeletal ultrasonology, which showed enlarged right C5 nerve root. Medical management, daily physical and occupational therapies, and psychological management, were instituted, which resulted in significant improvement of the patient’s pain level and functional status. We describe the importance of the multimodal approach (medical and rehabilitation) in managing this atypical case.
Hyperalgesia ; Pain Management

OBJECTIVES: This study is a retrospective cohort that aims to describe the profile of orthopedic geriatric patients aged 60 years old and above with acute hip fractures occurring within one month of admission in the Philippine General Hospital managed by a multidisciplinary team approach. METHODS: Data collection from the database was done to gather information regarding the patient profile, time to surgery, causes for delay in consultation, length of hospital stay, and follow-up rate, since this model was implemented. RESULTS: Overall, we saw a decrease in the time from admission to surgery and a decrease in the length of hospital stay, when compared to previous data. Follow-up rates and compliance to maintenance medication are at 96% and 72% respectively. CONCLUSION: The implementation of a multidisciplinary approach and fracture liaison service presents us with favorable results in addressing hip fractures and osteoporosis.
Orthopedics ; Osteoporotic Fractures ; Geriatrics ; Interdisciplinary Research ; Osteoporosis ; Orthopedic Procedures

Early into the pandemic, medical attention centered on the immediate need for intensive medical care of patients diagnosed to have coronavirus 2019 (COVID-19). As more data emerged on the best medical care possible, attention was also given to the complications and long-term sequelae of COVID-19.
COVID-19