Advances in Physical and Rehabilitation Medicine

Edited by
Nachum Soroker and Haim Ring
Loewenstein Hospital Rehabilitation Center
Sackler Faculty of Medicine Tel Aviv University - Israel


Invited Keynote Lecturers
2nd World Congress of the ISPRM, Prague, Czech Republic, May 18-22, 2003


Mindy Aisen, MD
Deputy Chief Research and Development Officer, Department of Veterans Affairs, Washington, DC, USA

Gulseren Akyuz, MD
Professor of Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Marmara University, Istanbul, Turkey

Gad Alon, PhD, PT
Associate Professor, Department of Physical Therapy, University of Maryland, School of Medicine, Baltimore, MD, USA

Yitshal N Berner, MD, MPH
Head, Geriatric Medicine, Meir Hospital Kfar Saba, Sackler Faculty of Medicine, Tel Aviv University, Israel

Niels Birbaumer, PhD
Head, Institute of Medical Psychology and Behavioral Neurobiology, University of Tübingen, Germany

Amiram Catz, MD
Medical Director, Department of Spinal Rehabilitation, Loewenstein Hospital Rehabilitation Center, Raanana, Sackler Faculty of Medicine, Tel-Aviv University, Israel

M Anne Chamberlain, OBE
Charterhouse Professor of Rehabilitation Medicine, Academic Unit of Musculoskeletal & Rehabilitation Medicine, School of Medicine, University of Leeds, UK

Naoichi Chino, MD, MS, DMSc 
Professor and Chairman, Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan

Gerben DeJong, PhD
Associate Director, Brooks Center for Rehabilitation Studies, Professor, Department of Health Services Administration, University of Florida, USA

Peter B Disler, PhD, FRACP
Professor of Rehabilitation Medicine and Director, Victorian Rehabilitation Research Institute, University of Melbourne and Royal Melbourne Hospital, Australia

Catherine Dziri, MD
Professor, Department of Physical and Rehabilitation Medicine, Institut National D’Orthopedie, M. Kassab, University of Tunisia, Tunisian Public Health Ministry, Tunis, Tunisia

Wagih S El Masri(y), FRCS Ed
Consultant Surgeon Spinal Injuries, Director, Midlands Centre for Spinal Injuries, Oswestry, UK 

Reuben Eldar, MD, DPH
Professor, Head of Fleischman Unit for the Study of Disability, Loewenstein Hospital Rehabilitation Center, Raanana, Israel

Alberto Esquenazi, MD
Chair, Department of PM&R and Chief Medical Officer, MossRehab & Albert Einstein Medical Center; Director Gait & Motion Analysis Laboratory and Regional Amputee Center, Philadelphia, PA, USA

Abdulla Eyadeh, MD
Head of Department, Physical Medicine and Rehabilitation Hospital, Ministry of Health, Kuwait

Franco Franchignoni, MD
Head, Department of Occupational Rehabilitation & Ergonomics, Rehabilitation Institute of Veruno, "Salvatore Maugeri" Foundation, IRCCS, Italy

Salvatore Giaquinto, MD
Professor and Head, Department of Neurorehabilitation, San Raffaele Pisana Tosinvest Hospital, Rome, Italy

Mali Gil, MSc
Head, Speech & Language Department, Loewenstein Hospital Rehabilitation Center, Raanana, Sackler Faculty of Medicine, Tel-Aviv University, Israel

Gary Goldberg, BASc, MD
Director, Brain Injury Rehabilitation, University of Pittsburgh Medical Center; Professor, Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, USA

Martin Grabois, MD
Professor and Chairman, Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA

Carl V Granger, MD
Professor, Rehabilitation Medicine; Director, Center for Functional Assessment Research (CFAR), School of Medicine and Biomedical Sciences, University at Buffalo,USA

Gunnar Grimby, MD, PhD, FRCP
Professor em Rehabilitation Medicine, Sahlgrenska Academy at Göteborg University, Sweden

Zeev Groswasser, MD, MPH
Professor and Head, Department of Brain Injury Rehabilitation, Loewenstein Hospital Rehabilitation Center, Raanana, Sackler Faculty of Medicine, Tel Aviv University, Israel

Mark Hallett, MD
Chief, Medical Neurology Branch, Chief, Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA

Allen W Heinemann, PhD
Professor, Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois, USA

Hermie J Hermens, PhD
Cluster Manager Non-invasive Neuromuscular Assessment, Roessingh Research and Development, Enschede, Professor, Department of Biomedical Engineering, University of Twente, The Netherlands

Marta Imamura, MD, Ph.D
Division of Physical Medicine And Rehabilitation, Department of Orthopaedics and Traumatology, University of Sao Paulo School of Medicine, Sao Paulo, Brazil

Eli Isakov, PT, MD
Professor and Head, Orthopedic Rehabilitation Department & Kinesiology Laboratory, Loewenstein Hospital Rehabilitation Center, Raanana, Sackler Faculty of Medicine, Tel Aviv University, Israel

Shin-Ichi Izumi, MD, PhD
Professor and Chairman, Division of Rehabilitation for the Physically Disabled, Tohoku University Graduate School Of Medicine, Sendai, Japan

Garth R Johnson, FREng
Professor, Centre for Rehabilitation and Engineering Studies, University of Newcastle upon Tyne, UK

Ofer Keren, MD 
Vice Director, Department of Brain Injury Rehabilitation, Director, Clinical Neurophysiological Unit, Loewenstein Hospital Rehabilitation Center, Raanana, Sackler Faculty of Medicine, Tel Aviv University, Israel

Jun Kimura, MD
Professor Emeritus, Kyoto University, Japan, Professor, Department of Neurology,University of Iowa Health Care, USA

Crt Marincek, MD, PhD
Professor and Medical Director, Institute for Rehabilitation, Ljubljana, Slovenia

Karl H Mauritz, MD
Professor and Chairman Klinik Berlin and Department of Neurological Rehabilitation, Free University Berlin, Germany

John L Melvin, MD, MMSc
Michie Professor and Chairman, Department of Rehabilitation Medicine, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA, USA

Trilok N Monga, MD
Professor, Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Executive, Rehabilitation Care Line, Houston VA Medical Center, Houston, Texas, USA

Lewis M Nashner, ScD
NeuroCom International Incorporated, Clackamas, USA

Hugo Nunez Bernadet, MD
President of the Uruguayan PMR Society and Cono Sur Organization, Physical Medicine & Rehabilitation Department, Republic University, Uruguay

Avi Ohry, MD
Director, Section of Rehabilitation Medicine, Reuth Medical Center, Tel Aviv, Professor of Rehabilitation Medicine, Sackler Faculty of Medicine, Tel Aviv University, Israel

Zaliha Omar, MD
Associate Professor, University of Malaya, Kuala Lumpur, Malaysia

Bryan J O’Young, MD
Clinical Associate Professor, New York University, The Rusk Institute, Department of Rehabilitation Medicine, USA

Chang Il Park, MD, PhD
Director, Rehabilitation Hospital, Yonsei University College of Medicine, Seoul, South Korea

Haim Ring, MD, MSc PM&R
Professor and Chairman, Neurological Rehabilitation Department C, Loewenstein Hospital Rehabilitation Center, Raanana, Chairman, Rehabilitation Medicine Department, Sackler Faculty of Medicine, Tel Aviv University, Israel

Itzhak Siev-Ner, MD
Head, Department of Orthopedic Rehabilitation, Sheba Medical Center, Tel Hashomer, Sackler Faculty of Medicine, Tel Aviv University, Israel

Bengt H Sjölund, MD, PhD
Professor of Rehabilitation Medicine, Department of Community Medicine and Rehabilitation, Umeå University, Sweden

Nachum Soroker, MD
Head, Department of Neurological Rehabilitation B, Loewenstein Rehabilitation Hospital, Raanana, Sackler Faculty of Medicine, Tel-Aviv University, Israel

Henk J Stam, MD, PhD
Professor and Head, Department of Rehabilitaton Medicine, Chairman Institute of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, The Netherlands  

Dobrivoje S Stokic, MD
Director, Neurophysiology Laboratory, Director, Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA

Gerold Stucki, MD, MS
Professor and Chairman, Department of Physical Medicine and Rehabilitation, Director, ICF Research Branch, WHO-FIC Germany, University of Munich, Germany

Luigi Tesio, MD
Head, Department of Rehabilitation, Salvatore Maugeri Foundation, IRCCS, Pavia, Italy

Jan Vacek, MD
Department of Rehabilitation Medicine, Postgraduate Medical School, Prague, Czech Republic

Guy G Vanderstraeten, MD, PhD
Professor, Department of Physical Medicine and Rehabilitation, University Hospital, Ghent, Belgium 

Jean-Jacques Vatine, MD
Director, Outpatient and Research Division, Reuth Medical Center, Tel Aviv, Israel

Nicolas E Walsh, MD
Professor and Distinguished Chairman, Department of Rehabilitation Medicine, University of Texas Health Science Center, San Antonio, Texas, USA

Anthony B Ward, MD
North Staffordshire Rehabilitation Centre, Haywood Hospital, Stoke-on-Trent, UK

Harold P Weingarden, MD

Director, Rehabilitation Day Hospital, Department of Neurological Rehabilitation, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Israel 

Steven L Wolf, PhD, PT, FAPTA
Professor, Department of Rehabilitation Medicine, Professor of Geriatrics, Department of Medicine, Associate Professor, Department of Cell Biology, Emory University School of Medicine, Professor, Adult and Elder Health, Nell Hodgson Woodruff School of Nursing at Emory University, Atlanta, GA, USA

Mark Ylvisaker, PhD
Professor, Department of Communication Disorders, College of Saint Rose, Albany, New York, USA

Mark A Young, MD, MBA, FACP
Chair, Physical Medicine & Rehabilitation, The Maryland Rehabilitation Center & Workforce and Technology Center, State of Maryland Division of Rehabilitation, Department of Education, USA

CEO & Medical Director, Concussion Care Center of Virginia, Ltd. & Tree of Life Services, Inc.  Richmond, Virginia, USA; Associate Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA






Part I P&RM in Neurological Disorders
Diseases and Trauma of the Brain;
Motor Control, Cognition, Language and Behaviour

Human Brain Plasticity and Recovery from Stroke
M. Hallett

The Emerging Role of Transcranial Magnetic Stimulation in the Assessment of Stroke Rehabilitation Intervention
A.J. Butler and S.L. Wolf

Assessment Measures for Stroke Rehabilitation
N. Chino and M. Liu

Therapy Services and Relationship to Functional Improvement Patterns Following Stroke
A. Heinemann, R. Bode, P. Semik and C. O’Reilly

An Analysis of the Rate of Functional Gain That May Be Expected During Inpatient Rehabilitation for Patients with Stroke
C. Granger and K. Ottenbacher

The Aftermath of Rehabilitation for Patients with Severe Stroke
S. Giaquinto

Differential Diagnostic Issues in Acquired Brain Injury:The Dilemma of Mild Traumatic Brain Injury
N. D. Zasler

Perceived Needs of Persons with Traumatic Brain Injury and Relationship to Services
A. Heinemann, K. Sokol, L. Garvin and R. Bode

Factors Determining Return to Work After Severe Traumatic Brain Injury
Z. Groswasser and O. Keren

The Breakdown and Re-Establishment of Functional Behavioral Structures and Correlated Brain Pathophysiology
G. Goldberg

Theory Driven Cognitive Rehabilitation: The Case of Spatial Neglect
N. Soroker

Event-related Potentials in Language Rehabilitation
S. Giaquinto

New Directions in the Assessment and Treatment of Aphasia
M. Gil

The Thought Translation Device: A Brain-Computer Interface for the Paralyzed
N. Birbaumer


Diseases and Trauma of the Spinal Cord

Trends in the Assessment of Functional Outcomes after Spinal Cord Lesions
A. Catz and M. Itzkovich

Where is the Evidence that Surgical Intervention is Beneficial for Spinal Injuries?
W. El Masri (y)

Gait Rehabilitation in Spinal Cord Injury
K.H. Mauritz

Neurophysiological Monitoring for Intrathecal Baclofen Pump Management and Troubleshooting
D.S. Stokic and S.A. Yablon


Neuropathies, Myopathies and Peripheral Nerve Lesions

Management of Peripheral Neuropathic Pain: An Overview

J.J. Vatine, S. Faran and Y. Lerman




Part II P&RM in Orthopedic and Musculoskeletal Disorders
Limb Trauma, Surgery and Amputation

Prosthetic Restoration and Rehabilitation from Surgery to Community Reintegration
A. Esquenazi

Rehabilitation for People Who Have Had Joint Replacements
F. Khan, P. Disler and J. Pallant

Compartment Syndromes of the Lower Leg
A. Steyaert and G. Vanderstraeten


Rheumatoid Arthritis; Osteoarthritis; Osteoporosis

Assessment of Rheumatoid Arthritis, Osteoarthritis and Ankylosing Spondylitis
G. Stucki

Work and Rheumatic Diseases
M.A. Chamberlain

Clinical Practice Guidelines for Rehabilitation Management of People with Osteoporosis
M. Grabois

The Bone and Joint Decade
N. Walsh


Back and Other Musculoskeletal Pain

Evidence-Based Medicine in Treating Low Back Pain
T. Parlevliet and G. Vanderstraeten

An Analysis of the Rate Per Day of Pain Improvement That May Be Expected and Factors Affecting Improvement in Outpatients with Low Back Pain
C. Granger, J. Lackner, M. Kulas and C. Russell

Evaluating Rehabilitation Programs for Fibromyalgia & Other Chronic Musculoskeletal Pain
P. Disler, J. Pallant, J. Exton, F. Thomas, L. Boyd, J. Stone, P. Lowthian and D. Lewis



Part III P&RM in Other Specific Conditions
Geriatric Population

Rehabilitation Goal Setting in the Aged
Y.N. Berner

Novel Interventions to Reduce Falls in Older Adults: Tai Chi and Beyond
S.L. Wolf and M. O’Grady


Pediatric Population

Traumatic Brain Injury in Childhood
A.B. Ward

Contextualized Hypothesis-Testing Assessment of Children and Adolescents with Cognitive Impairment after Brain Injury
M. Ylvisaker

Neuropsychological Rehabilitation of Communication, Cognitive, and Behavioral Disturbances Following TBI in Children and Adolescents
M. Ylvisaker

Comprehensive Management of Cerebral Palsy
C. Il Park

Transitional Services
M.A. Chamberlain


Part IV Topics of General Interest in P&RM

Current and Future Treatment Strategies for Chronic Pain
B.H. Sjölund

Multidisciplinary Pain Programs: Evolution and Reinvention
M. Grabois

Pain Management and the Musculoskeletal System: Gender Differences
M.A. Young



Management of Spasticity – A Scientific Basis for Outcome Measures
G.R. Johnson

Sexual Disability

Sexuality and Disability
T. Monga

Wound Care

Prevention and Treatment of Chronic Wounds
I. Siev-Ner

Premature Aging

Premature Aging: A Danger to Life Expectancy and Quality of Life of the Disabled
A. Ohry


New Concept in Nerve Conduction Studies
J. Kimura

Surface Electromyography in Rehabilitation: A Mature Tool to Assess Neuromuscular Function(ing)
H. Hermens


Biomechanics; Kinesiology; Dynamic Posturography;
Motion and Gait Analysis

Biomechanical Factors in the Complexity of Stress Fracture Formation
E. Isakov and J. Mizrahi

Impairment Based Approach to Managing Balance and Mobility Disorders: Applications for Computerized Dynamic Posturography
L.M. Nashner

Recent Advances in Ambulatory Monitoring of Activities of the Hand and Arm
H.J. Stam, F.C. Schasfoort and J.B.J. Bussmann

Gait Analysis: When and Why It Should Be Used
E. Isakov



Orthoses for Different Kinds of Disabilities
È. Marinèek and H. Burger


Advanced Technologies in Rehabilitation

Rehabilitation Engineering: Research Perspectives from the US Veterans Health Administration
M. Aisen


Functional Electrical Stimulation

Advances in Functional Electrical Stimulation, 2003, and a Look to the Future
H. Weingarden

Training Dosage and Timing of Electrical Stimulation May Be the Key for Maximizing the Effects of NMES in Neuro-Rehabilitation
G. Alon


Organization and Management of Rehabilitation Services;
Quality of Care

Rehabilitation in General Hospitals and Rehabilitation Centers
J. Melvin

Community-Based Rehabilitation: The Concept and Its Implementation
R. Eldar

Quality of Care Improvement Mechanisms in Rehabilitation Medicine
R. Eldar


Scope of Speciality; Educational Needs; Ethical Considerations

International Rehabilitation Education: A Comparative Analysis and Discussion
M. Young, P. Disler, G. Akyuz, H. Nunez Bernadet, C. Dziri, A. Eyadeh, M. Imamura, S.I. Izumi, Z. Omar, B.J. O’Young, H. Stam and J. Vacek

Publishing in Peer-Reviewed Journals: Time to Review the Peer Review
H. Ring, M. Aisen, P. Di Benedetto, M. Grabois, G. Grimby, D. Johnson, N. Walsh and N. Zasler

Ethical Considerations in Contemporary Rehabilitation Medicine: Theoretical Background, Models and Practice
A. Ohry

Complementary Medicine in Rehabilitation
I. Siev-Ner and D. Gamus


Evidence-Based Rehabilitation; Outcome Measurement; Assessment of Disability, Participation and Quality of Life

Outcome Research in Rehabilitation: Variable Construction, Trial Design and Statistical Inference
L. Tesio

Assessment of Handicap / Participation
G. Grimby

Health-related Quality of Life Assessment
F. Franchignoni and C. Bertolini

Value and Application of the WHO-ICF in Rehabilitation Medicine
G. Stucki, A. Cieza and T. Ewert

The Case for Public Disclosure of Rehabilitation Outcomes
G. DeJong



Global Physical & Rehabilitation Medicine Education: The Prague 2003 ISPRM Educational Summit
M.A. Young, P.Disler




Physical and Rehabilitation Medicine 2003

Nachum Soroker and Haim Ring
Loewenstein Hospital Rehabilitation Center, Sackler Faculty of Medicine, Tel Aviv University, Israel


By the turn of the century, physical and rehabilitation medicine (P&RM) became one of the most rapidly developing disciplines within the medical professions, deepening its roots in basic science, strengthening its theoretical basis and employing sophisticated methodologies for assessment and treatment.

In 2003, P&RM has gone far from its starting point where preoccupation with motor, especially locomotor, dysfunction was the hallmark of the specialty, and physical therapies were the main remediation maneuvers. These are equally important today but the field of interest has broaden to include various other domains of disease-related dysability, including problems of perception, language, cognition, affect and comportment. In accord, P&RM now is naturally linked to a large variety of basic and applied sciences and disciplines like neuroscience, cognitive science, biomechanics, linguistics, etc.

In addition, the value of P&RM practices is now recognized more and more in clinical domains outside of P&RM traditional mainstream, like oncology, organ transplantation, cardio-pulmonary diseases, etc. This broadening, with the new opportunities it offers, also poses serious questions concerning definition and delineation of the specialty, as well as organization of services.

For example, in stroke - the most prevalent nosological entity in P&RM practice today - the rehabilitation physician who wishes to maintain a reasonable standard of knowledge in all the aspects relevant to the rehabilitation of his patients, has to deal with huge amounts of rapidly accumulating information on brain plasticity, motor control, language, perception, attention, memory, executive functions, etc. In many countries this physician should also take care of the necessary measures to ensure optimal secondary prevention for his patient. For example, in the Loewenstein Hospital (Raanana, Israel), where the editors of this volume work, stroke patients are treated in specialized wards and it is the rehabilitation physician who has to order and interpret brain-imaging, doppler and hyper-coagulability examinations. Even with the use of consultants invited to the rehabilitation center, it is the rehabilitation physician who is finally responsible for taking measures to obtain optimal control over known risk factors, discover unrecognized risk factors and treat intercurrent infections prevalent in the early post-onset period. It is unlikely to achieve a reasonable degree of mastery in all these fields without employment of a kind of sub-specialization. P&RM confronts this problem differently in different countries. The optimal system is a matter of further discussion.

Evolving from a rather empirical approach, P&RM strives now to work on a more solid, evidence-based, methodology. For this purpose, several fields of action can be identified: a. Application of quality-assurance standards to improve quality of care; b. Standard use of outcome measurement for all interventions. This includes interventions aimed at various levels (impairment, disability/activity, handicap/participation, quality of life, secondary prevention), including cost-effectiveness evaluation. c. Services organization aimed to ensure continuum of care for the disabled. d. Introduction of new technologies and procedures, and novel pharmacological treatments.

Outcome measurement (including cost-effectiveness evaluation) have become probably the most salient contribution of P&RM to the realm of medicine in general. Standard application of valid and reliable tools help organize the clinical work, assess the degree to which preset goals are achieved, enable comparison of different remediation strategies, assess the added value of novel treatments, evaluate cost-effectiveness of used policies, etc. With new theoretical frameworks like the WHO-ICF, this remains a very important field of research and further development. The linkage between impairment and disability (using the older WHO-ICIDH terminology) and the active preoccupation in P&RM with efforts to restore impaired mechanisms underlying disability, calls for development of new outcome measures looking at the mechanistic level. For example, tools designed for longitudinal assessment of aphasic language impairments of different kinds, in addition to available global measures of communication behaviour.

One of the major and significant interrogates from the service-delivery point of view is the location for conducting the rehabilitation treatment (specialized P&RM ward within a general hospital vs. separate rehabilitation center; disease-specific ward vs. ward with a large case mix; day hospital vs. problem-specific community-based rehabilitation [CBR] services). A second issue concerns the optimal timing for rehabilitation (early after onset, when the rehabilitation process might be interrupted by frequent medical problems and clinical instability, or later, when the medical condition is more stabilized but unwanted outcomes of delayed treatment probably occurred). It is becoming clear that the continuum of care, namely the establishment of a paradigm of venue-wise treatment dictating as clear as possible the way the different modalities (in-patient, day hospital, CBR, etc.) integrate, is the right answer for the benefit of all parties involved. Most importantly, for patients’ benefit.

Advanced technologies aimed to solve locomotion, communication and perceptual problems of disabled persons are rapidly developing and even proliferating, bringing on one hand potential benefits and on the other hand potential dangers and high costs. Hence, the need for a balanced approach taking into consideration issues pertinent to "patient-device" interface as well as cost-effectiveness considerations both on the side of the patient and the side of the medical system. In 2003 this is becoming another responsibility of the P&RM specialist.

With the development new pharmacological products, notoriously botulin toxin for the treatment of spasticity, or medications aimed to enhance cognitive functioning in victims of degenerative diseases of the brain, the therapeutic arsenal in the hands of the P&RM specialist increases. Here again, outcome measurement and careful cost-effectiveness evaluation are domains where the rehabilitation physician has an important and responsible role.

This Volume

All the above issues are contemplated from different personal angles in this publication, aimed to present current knowledge and theoryzing in major domains of P&RM. The book contains 65 chapters written by the keynote lecturers of the 2nd World Congress of the International Society of Physical and Rehabilitation Medicine (ISPRM), held in Prague, Czech Republic, May 18-22, 2003.

Each keynote lecturer was asked to organize the contents of her/his chapter in accord with the mission of the congress, set as follows: a. Presentation of recent advances and future challenges in rehabilitation science; b. Linking clinical practice in P&RM to basic science through presentation of theory-driven procedures of assessment and intervention; c. Emphasis on outcome measurement and evidence-based P&RM.

The chapters are divided in four parts coresponding to the construction of the scientific program of the Prague congress: a. P&RM in Neurological Disorders (19 chapters); b. P&RM in Orthopedic and Musculoskeletal Disorders (10 chapters); c. P&RM in Other Specific Conditions (7 chapters); d. Topics of General Interest in P&RM (29 chapters).

Being a "reflection on advances in rehabilitation and future challenges" (the congress motto), the authors, each one a leader in her/his field, had the assignment to review the addressed issues with a futuristic approach. Readers will find stimulating novel ideas in various chapters of the book that will be of help in introducing new approaches for assessment and treatment into their own P&RM practice.

The editors of this book served as congress chairperson and chairman of the the organizing committee (Haim Ring) and chairperson of the scientific committee (Nachum Soroker). Preparation of this publication took place in parallel to the preparations for the congress, with the aim of having this volume ready by the congress time. An appology is due for all possible errors that might have occurred during this rapid intensive process. The publisher of this book is ‘Monduzzi Editore’, who publishes also the general proceedings in a separate volume containing 160 manuscripts submitted by participants to the congress.



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