Neurorehabilitation

June 2011, Volume 17, Issue 3
BROWSE ISSUES

Neurorehabilitation

June 2011, Vol.17, No.3

Guest Editor:

Mary L. Dombovy, MD, MHSA, FAAN

ISSN: 1080-2371

Online ISSN: 1538-6899

REVIEW ARTICLES
Introduction: The Evolving Field of Neurorehabilitation
Dombovy, Mary L.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 443-448
doi: 10.1212/01.CON.0000399065.23826.f0
Neurologic Examination in Rehabilitation
Gelber, David A.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 449-461
doi: 10.1212/01.CON.0000399066.31449.c5
Cognitive and Behavioral Disorders in Neurorehabilitation
Schneider, William N.; Wong, Tony M.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 462-470
doi: 10.1212/01.CON.0000399067.69567.f2
Treatment of Language, Motor Speech Impairments, and Dysphagia
Anderson, Maria; Anzalone, Jessie; Holland, Lauren; Tracey, Elvira
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 471-493
doi: 10.1212/01.CON.0000399068.77191.12
Orthoses and Adaptive Equipment
Ransom, Cecilia Lim
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 494-509
doi: 10.1212/01.CON.0000399069.77191.5b
Management of Medical Complications
Dohle, Carolin I.; Reding, Michael J.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 510-529
doi: 10.1212/01.CON.0000399070.54320.0c
Emerging Therapies in Neurorehabilitation
Dombovy, Mary L.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 530-544
doi: 10.1212/01.CON.0000399071.61943.e3
Stroke Rehabilitation
Good, David C.; Bettermann, Kerstin; Reichwein, Raymond K.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 545-567
doi: 10.1212/01.CON.0000399072.61943.38
Spinal Cord Injury
LiVecchi, Mark A.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 568-583
doi: 10.1212/01.CON.0000399073.00062.9e
Traumatic Brain Injury
Dombovy, Mary L.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 584-605
doi: 10.1212/01.CON.0000399074.07686.76
Neurorehabilitation for Other Neurologic Disorders
Dombovy, Mary L.
CONTINUUM: Lifelong Learning in Neurology
June 2011 - Volume 17 - Issue 3, Neurorehabilitation - p 606-616
doi: 10.1212/01.CON.0000399075.07686.3f
Editor's Preface
Articles
Key Points
Abbreviations
Appendix
Issue Overview

Issue Overview

CONTINUUM: Lifelong Learning in Neurology June 2011 - Volume 17 - Issue 3, Neurorehabilitation - [no page #] doi: 10.1212/01.CON.0000428387.00714.9b

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills

Learning Objectives

Upon completion of the Continuum: Lifelong Learning in Neurology Spinal Cord, Root, and Plexus Disorders issue, participants will be able to:

  • Identify neurophysiologic processes underlying recovery from neurologic injury and disease
  • Explain the rationale behind pharmacologic treatment in traumatic brain injury and stroke
  • Predict outcomes following stroke and traumatic brain injury
  • Manage common problems in the rehabilitation setting
  • Recognize the effects of frontal lobe impairment and propose a treatment plan
  • Justify the need for rehabilitation services in neurologic disease and injury
  • Design an appropriate rehabilitation program for patients with stroke, traumatic brain injury, and spinal cord injury
  • Integrate rehabilitation management principles into acute care settings
  • Explain the common sequelae of stroke, traumatic brain injury, and spinal cord injury to patients and families, including outcomes and treatment options
  • Describe how the scope of authority for parents to accept or refuse medical treatment for their children differs from the authority of autonomous adults to accept or refuse treatment
  • Describe how to balance benefits and burdens in deciding whether parents have a strong obligation to accept the recommendations of the health care team

Core Competencies

The Continuum Neurorehabilitation issue covers the following core competencies:

  • ▸ Patient Care
  • ▸ Medical Knowledge
  • ▸ Practice-Based Learning and Improvement
  • ▸ Interpersonal and Communication Skills
  • ▸ Professionalism
  • ▸ Systems-Based Practice

Disclosures

CONTRIBUTORS

Mary L. Dombovy, MD, MHSA, FAAN, Guest Editor

Vice President, Neurology and Rehabilitation Services, Unity Health System, Rochester, New York; Clinical Associate Professor, University of Rochester, Rochester, New York

*Dr Dombovy’s institution is compensated for her litigation and testimony.

†Dr Dombovy discusses the unlabeled use of pharmaceuticals and information on investigational treatments.

Maria Anderson, MS, CCC/SLP

Director of Clinical Services, Department of Neurology and Rehabilitation, Unity Health System, Rochester, New York

*Ms Anderson reports no disclosure.

Jessie Anzalone, MA, CCC/SLP

Speech-Language Pathologist, Unity Health System, Rochester, New York

*†Ms Anzalone reports no disclosure.

Anna M. Barrett, MD

Director of Stroke Research and Chief, Translational Rehabilitation, Kessler Foundation, West Orange, New Jersey; Professor of Neurology and Neurosciences/PM&R, UMDNJ-NJMS, Newark, NJ

*Dr Barrett has received personal compensation for activities with emedicine.com and has received research support from the Kessler Foundation, NIH, O’Brien Technologies, Inc., and Pfizer, Inc./Eisai Co., Ltd.

†Dr Barrett reports no disclosure.

Kerstin Bettermann, MD, PhD

Assistant Professor of Neurology, Penn State College of Medicine, Hershey, Pennsylvania

*Dr Bettermann receives personal compensation for litigation consultation and research support from the Pennsylvania Department of Health.

†Dr Bettermann reports no disclosure.

Carolin I. Dohle, MD

Neurorehabilitation Fellow, Burke Rehabilitation Center, White Plains, New York

*Dr Dohle reports no disclosure.

David A. Gelber, MD

Medical Director, Rehabilitation Program, Memorial Medical Center/Springfield Clinic, Springfield, Illinois

*Dr Gelber receives personal compensation for record review and expert witness testimony.

†Dr Gelber reports no disclosure.

David C. Good, MD, FAAN

Professor and Chair, Department of Neurology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania

*Dr Good serves on a global advisory panel supported by Allergan, Inc. and receives compensation for serving on a National Institutes of Health committee and US Food and Drug Administration panels.

†Dr Good discusses the unlabeled use of generic drugs.

Peter H. Gorman, MD, FAAN

Associate Professor, Department of Neurology, University of Maryland School of Medicine, Baltimore, Maryland; Chief, Division of Rehabilitation Medicine, Kernan Orthopaedics and Rehabilitation Hospital, Baltimore, Maryland

*Dr Gorman anticipates receiving research support for a clinical trial from Geron and has served as an expert witness. Dr Gorman has received a grant from the US Department of Defense for a clinical trial on aquatic therapy and Lokomat therapy in spinal cord injury.

Dr Gorman reports no disclosure.

Lauren Holland, MS, CCC/SLP

Speech-Language Pathologist, Unity Health System, Rochester, New York

*†Ms Holland reports no disclosure.

Mark A. LiVecchi, DMD, MD, FAAPMR

Attending Physician, Acute Rehabilitation and Brain Injury Unit, Unity Health System, Rochester, New York; Clinical Instructor, University of Rochester, Rochester, New York

*†Dr LiVecchi reports no disclosure.

Geoffrey Miller, MA, MB, MD, MPhil, FRCP, FRACP

Professor of Pediatrics and Neurology, Yale University, New Haven, Connecticut

*†Dr Miller reports no disclosure.

Laura B. Powers, MD, FAAN

Dr Powers is retired from private practice.

*Dr Powers serves as ICD-9-CM Advisor for the Coding Subcommittee of the AAN Medical Economics and Management Committee.

†Dr Powers reports no disclosure.

Cecilia Lim Ransom, MD

Attending Physician, Unity Health System, Rochester, New York; Clinical Instructor, University of Rochester, Rochester, New York

*Dr Ransom reports no disclosure.

†Dr Ransom discusses the use of the Rex and ReWalk exoskeletal orthoses, which are still under investigational use.

Michael J. Reding, MD

Associate Professor, Weill Medical College, Cornell University, New York, New York; Director, Stroke Rehabilitation Program, Burke Rehabilitation Center, White Plains, New York

*†Dr Reding reports no disclosure.

Raymond K. Reichwein, MD

Associate Professor, Department of Neurology; Director, Stroke Program; Codirector of Penn State University/Hershey Medical Center Institutional Stroke Program; Codirector of Penn State Clinical Neuroscience Institute Stroke Program, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania

*Dr Reichwein is a member of Boehringer Ingelheim’s speakers’ bureau, and he receives research support from AGA Medical and Pfizer, Inc. for a stroke research trial. Dr Reichwein receives personal compensation for medical record review and depositions and receives a federal grant for outpatient stroke research.

†Dr Reichwein reports no disclosure.

William N. Schneider, PhD

Neuropsychologist, Unity Health System, Rochester, New York

*†Dr Schneider reports no disclosure.

Elvira Tracey, MA, CCC/SLP

Clinical Supervisor, Speech-Language Pathologist, Unity Health System, Rochester, New York

*†Ms Tracey reports no disclosure.

Susan M. Vogl, MPA

Administrative Director, Department of Rehabilitation and Neurology, Unity Health System, Rochester, New York

*†Ms Vogl reports no disclosure.

Tony M. Wong, PhD, ABPP-CN†

Associate Professor of Physical Medicine and Rehabilitation, University of Rochester, Rochester, New York; Director of Neuropsychology, Unity Health System, Rochester, New York

*Dr Wong has consulted for the Federal Defenders office in Philadelphia, Pennsylvania.

†Dr Wong reports no disclosure.

MULTIPLE-CHOICE QUESTION WRITERS

Ronnie Bergen, MD

Assistant Professor of Clinical Neurology, University of Arizona College of Medicine, Tucson, Arizona

*†Dr Bergen reports no disclosure.

D. Joanne Lynn, MD, FAAN

Associate Dean for Student Life and Associate Professor of Neurology, Ohio State University College of Medicine, Columbus, Ohio

*DrLynnholdsapproximately$10,000worthof stock in Abbot Laboratories, Bristol-Myers Squibb, Hospira, Inc., and Johnson & Johnson Services, Inc. Dr Lynn is the principal or co-investigator for clinical trials supported by Accelerated Cure Project for Multiple Sclerosis; Acorda Therapeutics, Inc.; Actelion Pharmaceuticals Ltd.; Allergan, Inc.;BiogenIdec; BioMS Medical Corporation; EMD Serono, Inc.; Genentech, Inc.; Genzyme Corporation; Immune Tolerance Network; National Institutes of Health; National Multiple Sclerosis Society; Novartis Pharmaceuticals Corporation; Teva Neuroscience, Inc.; UCB; and University of California, San Francisco.

†Dr Lynn reports no disclosure.

*Relationship Disclosure

†Unlabeled Use of Products/Investigational Use Disclosure

†Dr Wong died on April 23, 2011.

Methods of Participation and Instructions for Use

Continuum: Lifelong Learning in Neurology® is designed to help practicing neurologists stay abreast of advances in the field while simultaneously developing lifelong self-directed learning skills. In Continuum, the process of absorbing, integrating, and applying the material presented is as important as, if not more important than, the material itself.

The goals of Continuum include disseminating up-to-date information to the practicing neurologist in a lively, interactive format; fostering self-assessment and lifelong study skills; encouraging critical thinking; and, in the final analysis, strengthening and improving patient care.

Each Continuum issue is prepared by distinguished faculty who are acknowledged leaders in their respective fields. Six issues are published annually and are composed of the syllabus text, a set of multiple-choice items with preferred responses, case-based sections pertaining to ethical and practice issues related to the issue, and a patient management problem.

The syllabus text emphasizes clinical issues emerging in the field in recent years. Case reports and vignettes are used liberally, as are tables and illustrations. A CD of patient case vignettes relating to the issue topic accompanies one issue each year.

The practice of neurology presents a series of ethical challenges for the clinician. These rarely have simple or straightforward solutions, but require careful consideration by the neurologist. The Ethical Perspectives section provides a case vignette that raises one or more ethical questions related to the Continuum topic. Discussion follows the case to help the reader understand and resolve the ethical dilemma.

In addition to the lifelong learning of new clinical and scientific knowledge, neurologists must understand the constantly evolving environment in which they practice. Changes occur rapidly in reimbursement and regulatory areas, in the integration of evidence-based medicine, and in the implementation of patient safety measures into clinical practice. The Practice section presents a case-based example of these issues as they relate to the clinical topic as well as a coding table relevant to the issue topic.

The text can be reviewed and digested most effectively by establishing a regular schedule of study in the office or at home, either alone or in an interactive group. If program subscribers use such regular and perhaps new study habits, Continuum’s goal of establishing lifelong learning patterns can be met.

Multiple-Choice questions accompany each syllabus text. They are not intended as an examination but rather as a means of stimulating thought and helping you assess your general understanding of the course material. Subscribers may complete the questions online. Your responses will be kept completely confidential. Then, review the preferred response and critique for each multiple-choice item. Upon submission of the evaluation at the end of the Multiple-Choice Questions, you may earn up to 10 hours of American Medical Association (AMA) Physician’s Recognition Award (PRA) Category 1 Credit™.

Beginning in 2011, each Continuum issue also includes an interactive Patient Management Problem for which participants may earn an additional 2 AMA PRA Category 1 Credits™. The patient management problem should help sharpen critical thinking skills used daily in the clinical practice of neurology.

The opinions of subscribers play a vital role in the future development of the program. Let us know what you think of each issue, using the comment section provided on the answer form. A transcript of credits earned will be available to you on the AAN website within two business days. (Note: Participants have up to 3 years from the date of publication to earn CME credits for each issue, unless otherwise notified by the AAN.)

© 2011 American Academy of Neurology