Educational Experiences
Electrodiagnosis is used to evaluate various muscle, nerve and neuromuscular junction disorders. Training in this technique leverages coordinated education to broaden knowledge base in physiology and anatomy and apply it to various traumatic, acquired and hereditary neuromuscular conditions to assist in diagnosis, localization of pathology, and monitoring of numerous disorders. Electrodiagnostic experience starts in the PGY-2 year and is continuous throughout the outpatient rotations, representing approximately six months of full-time experience with both pediatric and adult patients between UC Davis, VA Mather, and Shriners Hospitals for Children, Northern California. The structured Electrodiagnostic instruction and ample experience in both common and unusual conditions during training provide a solid foundation for graduates to practice independently, and also prepare graduates for the certification examination by the American Board of Electrodiagnostic Medicine. Didactic training encompasses 6-month weekly workshops and bimonthly case discussions.
Our large regional Neuromuscular Disease Clinics provides multidisciplinary care for neuromuscular disorders sponsored by the Muscular Dystrophy Association (MDA), Amyotrophic lateral Sclerosis Association, and Parent Project Muscular Dystrophy. These multidisciplinary clinics are directed by Physical Medicine and Rehabilitation faculty with subspecialty board certification in Neuromuscular Medicine. Diagnostic workups including electrodiagnostic studies, molecular genetic studies, and muscle biopsies with histopathologic evaluations are coordinated by Physical Medicine and Rehabilitation faculty, fellows and residents. Neurology, orthopaedic surgery, pulmonology, cardiology, endocrinology, pathology and medical genetics faculty are available for consultation. The clinics include pediatric and adult neuromuscular disease clinics, restrictive lung disease clinic, a multidisciplinary ALS Center of Excellence Clinic as designated by the ALS Association in collaboration with the neurology department, a multidisciplinary Duchenne center of excellence, as well as a leading regional post-polio clinic. Precision medicine genetic-based therapies, and clinical trials focused on novel therapeutic agents are coordinated through these clinics. UC Davis has the only PM&R based ACGME-accredited Neuromuscular Medicine fellowship in the United States.
Training in the care of children with congenital and acquired disability is provided through inpatient and ambulatory clinics at both UC Davis Medical Center and Shriners Northern California. Outpatient clinics and educational opportunities include general pediatric rehabilitation, spasticity management, spina bifida, spinal cord injury, cerebral palsy, brachial plexus, pediatric amputee, sports medicine, pediatric neuromuscular disease clinics as well as comprehensive gait and motion analysis training. Many of these clinics are interdisciplinary, with faculty from orthopaedic surgery and urology in attendance, as well as a nurse specialist, physical and occupational therapy, and medical social worker. The pediatric rehabilitation inpatient program at UC Davis is a comprehensive multi-disciplinary program providing trainees experience in managing patients on an acute inpatient rehabilitation service, as well as providing consultation on patients throughout the hospital. While rotating on the Shriners acute inpatient rehab unit, trainees will primarily manage patients with spinal cord injury, burn injury, or complex orthopedic conditions. The Shriners Northern California regional facility is the only Shriners Hospital in the United States with a burn institute, full service orthopaedic hospital, and pediatric spinal cord injury unit within a single complex. This facility is located across the street from UC Davis Medical Center.
The comprehensive spine program is run as a multispecialty program including physical medicine and rehabilitation, orthopaedic surgery, neurosurgery, and pain management with onsite physical therapy, psychology and orthotic services. This program focuses on providing the skills to thoroughly evaluate spinal disorders, prescribe conservative treatment, and provide knowledge of surgical indications.
Prosthetics training is primarily through the adult and child limb deficiency/amputee clinics. The UC Davis Medical Center amputee clinic is a multidisciplinary clinic attended by faculty and prosthetic consultants from the community. A large number of traumatic amputees are evaluated as well as those with extremity loss due to vascular disease. The VA amputee clinic provides similar experience with the advantage of an on-site prosthetics and orthotics lab. The pediatric amputee clinic at Shriners evaluates children with both congenital and acquired limb deficiencies, and also has on site prosthetic and orthotic fabrication. Orthotic training is primarily through post-polio, neuromuscular disease, pediatric rehabilitation, spina bifida, and general rehabilitation clinics. Instruction in prosthetics/orthotics involves didactic seminars including visits to the prosthetics laboratory for exposure to fabrication and fitting skills.
The pediatric spinal cord injury (SCI) program, housed primarily at Shriners Hospitals for Children, Northern California, includes both acute as well as secondary rehabilitation and offers reconstructive options such as phrenic pacers, upper extremity tendon transfers for restoration of upper extremity function, and reconstructive GI and urologic management of bowel and bladder. The dedicated pediatric spinal cord injury unit at Shriners Hospitals for Children, Northern California is one of only three in the entire United States. Inpatient adult SCI training is provided at both UC Davis Health and at Mercy General Rehabilitation Unit. Long term management of medical and rehabilitation issues related to spinal cord injury are addressed in the Spinal Cord Injury outpatient clinics (UC Davis Health and Shriners Hospital) and the VA clinics.
At UC Davis and Shriners Hospital, PM&R physicians direct multidisciplinary spasticity management clinics for adults and children, where patients with spasticity and dystonia are managed with medications, botulinum toxin injections and other chemodenervation procedures, intrathecal baclofen pumps, and selective dorsal rhizotomy.
From weekend warriors to collegiate and professional athletes to grandparents with joint pain, a broad spectrum of patients with joint, tendon, muscle and ligament problems are treated in our sports medicine clinics. In addition to traditional evaluation and management, use of musculoskeletal ultrasound and various bedside procedures are fully integrated in the clinic experience. Residents will also gain sub-specialty knowledge through Sports Medicine and MSK-specific didactics, workshops, as well as ample opportunity for event sideline learning. Division I collegiate athletics, professional soccer, California International Marathon, ultramarathon events, martial arts competitions and other regional sporting events provide excellent opportunities for hands-on training. UC Davis PM&R has a competitive ACGME accredited PM&R Sports Medicine Fellowship which was one of the inaugural PM&R Sports Medicine Fellowships in the country. We have eight Sports Medicine board certified/board eligible faculty from PM&R, Family Medicine, Internal Medicine, and Emergency Medicine who are actively engaged in PM&R resident training and are providing opportunities for resident research, publications, and conference presentations. All non-operative sports medicine services at UC Davis and the UC Davis intercollegiate Athletics Sports Medicine program are organized under the Department of PM&R with operative sports medicine services organized under the Department of Orthopaedic Surgery. Plans for extensive growth in PM&R Sports Medicine over the next two years include a second multidisciplinary sports medicine clinic which will be housed in the new Edwards Family Athletic Center under construction on the UC Davis campus adjacent to the UC Davis Health Football Stadium.
Traumatic brain injury rehabilitation is provided in multiple settings. The UC Davis Health adult and pediatric inpatient rehabilitation services and the inpatient rehabilitation service at Mercy General Hospital provide acute inpatient rehabilitation. Outpatient care is continued in the Hospital Discharge clinic and general clinics. Mild concussive injuries are assessed in both general PM&R and sports medicine clinics. With newly recruited faculty who are fellowship trained in Brain Injury Medicine and others who are certified in Brain Injury Medicine, we will be expanding resident exposure to comprehensive care for persons with brain injury to include a multidisciplinary brain injury clinic with clinical and translational research opportunities.
Within the UC Davis Medical Center (a Level 1 trauma center), we provide an active inpatient consultation service. Inpatient rehabilitation is provided at the new 52-bed UC Davis Rehabilitation Hospital and 6-bed pediatric rehabilitation unit at Shriners Children's Northern California. At Shriners, we also have acute inpatient pediatric rehabilitation for spinal cord injury, complex orthopedic conditions, and burn injury. UC Davis PM&R residents also rotate at Dignity Health/ Mercy Medical Center inpatient rehabilitation which affords the opportunity to experience a community-based acute inpatient rehab facility model.
The Department of PM&R offers undergraduates, medical students, residents, fellows, and post-doctoral scholars ample clinical research opportunities in the rehabilitation sciences through the Neuromuscular Disease Clinical Trials Research Laboratory, the UC Davis Biomechanics, Rehabilitation, and Integrative Neuroscience (BRaIN) Lab, and the sports medicine human performance laboratory. The UC Davis (BRaIN) Lab conducts patient-oriented research investigating neural control of movement in an effort to identify mechanisms of movement dysfunction in age-related and neurologic conditions, with a focus on recovery of function after stroke. In addition, UC Davis has one of 26 NIH-funded NeuroNEXT clinical trials sites in the U.S. and the only NINDS NeuroNEXT site in the country that is housed primarily in a PM&R Department. In 2022, the new Edwards Family Athletic Center on the Davis campus adjacent to UC Davis Health football stadium will feature a new human performance laboratory. Residents and fellows are encouraged to perform a mentored research project with investigators from these research groups during their training.
