Building Capacity: Formal Introduction and Implementation of Recommendations for the Management of Persons with DOC #2840

INSTRUCTIONAL COURSE DETAIL

Session Detail PDF #2840

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TUE 26 OCT: 8:00 AM – 5:00 PM

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SPEAKERS

Risa Nakase-Richardson, PhD; John Whyte, MD, PhD; Joseph Giacino, PhD, FACRM; Douglas I Katz, MD; Brian David Greenwald, MD; Mark Sherer, Phd; Ross Zafonte, DO; Alan Weintraub, MD

Risa Nakase-Richardson, PhD; John Whyte, MD, PhD; Joseph Giacino, PhD, FACRM; Douglas I Katz, MD; Brian David Greenwald, MD; Mark Sherer, Phd; Ross Zafonte, DO; Alan Weintraub, MD

 

Risa Nakase-Richardson, PhD;
John Whyte, MD, PhD;
Joseph Giacino, PhD, FACRM;
Douglas I Katz, MD;
Brian David Greenwald, MD;

Mark Sherer, ABPP FACRM PhD;
Ross Zafonte, DO;
Alan Weintraub, MD

DIAGNOSIS

Brain Injury

FOCUS

Clinical Practice

Training/instruction in new knowledge/skills (attendees will develop new competencies that can be applied in practice or research)

DESCRIPTION

The need for increasing workforce capacity in the overall management of DOC populations is increasing. Rehabilitation experts have developed minimal competency guidelines for the rehabilitation of persons with DOC yet educational opportunities are not commonly available. Therefore the purpose of this course is to provide beginner and intermediate content in the assessment, treatment, and ethical management of individual patients with severe brain injury.Content areas include: a) accurate DIAGNOSIS, b) empirically-determined prognosis, c) unique medical management, d) rehabilitation treatment content and outcome monitoring, e) caregiver education and training, f) development of long-term care plans, and g) management of common ethical issues.

ABSTRACT BODY

A growing international literature has demonstrated optimistic outcomes of survival and steady functional recovery for brain injury survivors with disorders of consciousness (DOC). As the evidence for positive outcomes grows in the scientific literature, the need for increasing workforce capacity in the overall management of DOC populations is increasing. Rehabilitation experts representing the ACRM, VA, and NIDRR TBI Model Systems have developed minimal competency guidelines for the rehabilitation of persons with DOC yet educational opportunities exist primarily within formal fellowship training not available to professional audiences. Further, clinicians building skills in DOC management must learn to apply published guidelines and group data to individual cases which may be challenging. Therefore the purpose of this course is to provide beginner and intermediate content in the assessment, treatment, and ethical management of individual patients with severe brain injury. Content areas include:  a) accurate diagnosis, b) empirically-determined prognosis, c) unique medical management, d) rehabilitation treatment content and outcome monitoring, e) caregiver education and training, f) development of long-term care plans, and g) management of common ethical issues.  Within each content area, implications of the standards will be discussed in detail for the individual clinician and rehabilitation program. Specific content will address 1) an update on the status of rehabilitation guidelines for persons with DOC, 2) an overview of standardized and individualized approaches to accurate diagnosis and serial tracking (including detailed emphasis on administration of neurobehavioral measures  3) current evidence base for pharmacological and non-pharmacological management approaches for treatment of DOC, and 4) common ethical challenges facing clinicians managing patients with severe TBI including a) termination of supportive care, competency assessment, and experimental treatments.  The course presenters represent various specialties engaged in DOC rehabilitation and engaged in development of the standards presented.

LEARNING OBJECTIVES

  1. Discuss the current state of the science for rehabilitation potential of persons with DOC
  2. List at least three content domains for the minimal competency standards for persons with DOC
  3. Discuss examples of how each standard can be implemented in acute rehabilitation settings.
  4. List common ethical issues that arise during acute DOC rehabilitation.

COURSE OUTLINE

I.  Overview of Current State of DOC Rehabilitation (15 Minutes)

  • Acute Rehabilitation and Management
  • Chronic Care

II.  Status of the Minimal Competency Standards (15 Minutes)

III.       Review of the Standards with Exemplars and Case Illustrations

  1. Diagnosis (60 Minutes)
  2. Review of diagnostic criteria
  3. Coma
  4. Vegetative State
  5. Minimally Conscious State
  6. Emerged from Minimally Conscious State
  7. Evidence base review of DOC Scales
  8. When to introduce individualized assessment (quantitative behavioral assessment)
  9. Expertise development to meet standards
  10. Prognosis (60 Minutes)
  11. Types of prognostic statements
  12. Factors to consider in prognostic statements
  13. The timing and frequency of prognostic statements

BREAK (15 Minutes)

III.        Medical Management ( 75 Minutes)

  1. Review of common comorbidities in acute DOC
  2. Frequency and timing of tests for common comorbidities

Lunch break  (60 min) // lunch not included

IV.  Rehabilitation Treatment & Outcome Monitoring (90 Minutes)

  1. Pharmacologic Treatment
  2. Non-pharmacologic treatment
  3. Outcome Measures
  4. Patient
  5. Program
  6. Family

V.  Caretaker Education and Support (45 Minutes)

  1. Family Education
  2. Family Training
  3. Supportive models for family

BREAK ( 15 Minutes)

VI. Long-Term Care (45 Minutes)

  1. Development of transition plans that maximize benefit of acute rehabilitation
  2. Models for successful transition for ongoing continued care and access to primary care and brain injury specialists

VII.       Management of Ethical Issues (45 Minutes)

  1. Experimental treatments and off-label treatment modalities
  2. Capacity issues
  3. Termination of Supportive Measures
  4. Other Issues
  5. Models for management of common ethical issues

IV.  Future Directions

Final Questions and Answers

BIO SKETCHES

Risa Nakase-Richardson, PhD

Dr. Nakase-Richardson is a clinical neuropsychologist in the Polytrauma Rehabilitation Program at James A. Haley VAMC with 15 years of experience working in TBI neurorehabilitation in both clinical and research capacities. She has served as PI or Investigator on 10 grants funded by NIDRR in the Department of Education, VA, DOD, and National Academy of Neuropsychology. She has 42 publications in peer-reviewed journals and over 100 presentations at national and international conferences. Her primary area of interest has been early neurobehavioral recovery and outcome. Her work has lead to development of new assessment instruments for use in early neurobehavioral recovery, development and preliminary evaluation of program interventions for managing sequelae of severe brain injury, and phenomenologic studies that have helped contribute to the empirical base of understanding the diagnostic distinctions among syndromes of impaired consciousness. Her most recent interest has been in understanding the role of sleep in neurologic recovery. During her tenure in neurorehabilitation, she has actively participated towards the improvement of rehabilitation of persons with TBI serving in various capacities in national organizations including: a) Co-Chair of the TBI Model System and American Congress of Rehabilitation Medicine Disorder of Consciousness Workgroups, b) Executive Committee Member of the Brain Injury Special Interest Group of the American Congress of Rehabilitation Medicine and Liason between VA and NIDRR in the TBI Model System program of research. She currently supervises VA and USF neuropsychology, rehabilitation psychology, and pulmonary sleep medicine fellows in clinical and research projects.

John Whyte, MD, PhD

Dr. John Whyte is a physiatrist and experimental psychologist specializing in traumatic brain injury rehabilitation. He is the founding director of the Moss Rehabilitation Research Institute, begun in 1992. His research focuses on cognitive impairment after TBI, including assessment and treatment, with a major emphasis on disorders of attention, executive function, and consciousness. His research has been funded by NIH, NIDRR, the Department of Defense, and several private foundations. He was a member of two Institute of Medicine policy panels (“The Future of Disability in America,” 2007; “Cognitive Rehabilitation after TBI”, 2011). In addition to his empirical research, he has a longstanding interest in the special challenges posed by rehabilitation treatment trials, the difficulties in defining rehabilitation treatments, and the role of theory in guiding rehabilitation research. In 2008 Dr. Whyte received the Robert L. Moody Prize for Distinguished Initiatives in Brain Injury Research and Rehabilitation, in 2010 the Distinguished Academician Award from the Association of Academic Physiatrists, and in 2012, the Joel A. DeLisa, MD Award for Excellence in Research and Education in the Field of Physical Medicine & Rehabilitation.

Joseph Giacino, PhD, FACRM

is the Director of Rehabilitation Neuropsychology and Research Associate in the Department of Physical Medicine and Rehabilitation at Spaulding Rehabilitation Hospital in Boston, Massachusetts, consulting neuropsychologist in the Department of Psychiatry at Massachusetts General Hospital, Associate Professor in the Department of Physical Medicine and Rehabilitation at Harvard Medical School and Adjunct Professor at the MGH Institute of Health Professions. Dr. Giacino’s clinical and research activities are centered on the development and application of novel assessment and treatment methods for individuals with severe acquired brain injury (ABI) and disorders of consciousness (DOC). He served as co-chair of the Aspen Workgroup (responsible for developing the diagnostic criteria for the minimally conscious state [MCS]) and was co-lead author of the Mohonk Report, which provided recommendations to the U.S. Congress for lifelong care of patients with DOC. He chairs the Vegetative and Minimally Conscious State Guideline Development Panel, co-sponsored by the American Academy of Neurology, American Congress of Rehabilitation Medicine and National Institute on Disability and Rehabilitation Research, which is charged with revising existing clinical guidelines for management of patients with DOC. He is currently Project Director of the Spaulding-Harvard TBI Model System funded by the National Institute on Disability and Rehabilitation Research (NIDRR) and has served as Principal Investigator on 4 different NIDRR-sponsored projects- three focusing on the development of novel fMRI paradigms for detection of conscious awareness in patients with DOC, and a recently-completed 12-site clinical trial which demonstrated that amantadine hydrochloride (AH) accelerates recovery in patients with prolonged disturbance in consciousness. He was also Co-PI of an FDA-approved pilot study of deep brain stimulation aimed at restoring speech and motor functions in patients with chronic post-traumatic MCS.

Brian David Greenwald, MD

Dr. Brian D. Greenwald  is currently the Medical Director of Center for Head Injuries and the Associate Medical Director of JFK Johnson Rehabilitation Institute. He is a Clinical Associate Professor in the Department of Physical Medicine and Rehabilitation at Robert Wood Johnson Medical School. He completed his residency training in the Department of Physical Medicine and Rehabilitation at New Jersey Medical School. He was fellowship trained in brain injury rehabilitation at Virginia Commonwealth University. He is board certified in Physical Medicine and Rehabilitation. Prior to joining JFK-Johnson Rehabilitation Institute Dr. Greenwald was the Medical Director of Brain Injury Rehabilitation at the Mount Sinai Hospital’s Rehabilitation Center in New York City and the Medical Director for the New York Traumatic Brain Injury Model Systems. Dr. Greenwald has been serving on the Board of Trustees for the Brain Injury Association of New Jersey since 2002. In 2012 he was the given the Kristjan Ragnarsson Angle Award from the Sarah Jane Brain Foundation for leading research advancing the field of pediatric acquired brain injury. He was the recipient of the 2009 Physician of the Year Award at Mount Sinai Medical Center. He is recognized by his peers through the Castle Connolly surveys as one of the Top Doctors in the New York Metro Area. Dr. Greenwald has published multiple articles and book chapters in the areas of brain injury rehabilitation. Currently he is involved in several research studies to improve the care of brain injury survivors.

Douglas I Katz, MD

Douglas I. Katz, MD is Professor of Neurology at Boston University School of Medicine. He received his undergraduate degree from Brandeis University, his medical degree from the State University of New York at Stony Brook and completed his neurology training at Boston University. Following a fellowship in behavioral neurology at Boston University and the Boston VA, he has focused his clinical, teaching and research career on neurorehabilitation and brain injury and is a recognized expert in the field. He has been Medical Director of the Brain Injury Program at Braintree Rehabilitation Hospital in Massachusetts for over 25 years, one of the first dedicated brain injury rehabilitation programs in the US. Dr. Katz’s research interests include predictors of recovery after traumatic brain injury, disorders of consciousness, and pharmacologic treatment of cognitive problems after TBI. He has numerous publications in these areas. He has co-edited two books, including a highly-regarded comprehensive text on brain injury, Brain Injury Medicine, recently released in its 2nd edition. Dr. Katz is Vice President of the American Congress of Rehabilitation Medicine and was recently on the Boards of the American Society of Neurorehabilitation and the Brain Injury Association of America. His honors include the Sheldon Berrol Clinical Services Award from the Brain Injury Association of America (2001) and the Ken Viste award from the American Society of Neurorehabilitaiton (2012).

Mark Sherer, ABPP, FACRM, PhD

Dr. Mark Sherer is senior scientist, director of research, and director of neuropsychology at TIRR Memorial Hermann. He is a clinical professor of Physical Medicine and Rehabilitation at Baylor College of Medicine and the University of Texas Medical School at Houston. Dr. Sherer is a board certified neuropsychologist with over 25 years experience as a clinician, administrator and educator in brain injury rehabilitation. He is a fellow of the American Psychological Association, the National Academy of Neuropsychology, and the American Congress of Rehabilitation Medicine. Dr. Sherer has served as principal investigator for grants on TBI recovery, impaired self-awareness, telephone counseling for persons with TBI, TBI community integration, and rehabilitation of brain tumor patients and currently serves as the principal investigator for the Texas TBI Model System of TIRR grant. He has published more than 100 articles and book chapters and has given numerous presentations to state, national and international conferences. Dr. Sherer serves on editorial boards for Journal of Head Trauma Rehabilitation, The Clinical Neuropsychologist, and Rehabilitation Psychology.

Alan Weintraub, MD

Alan Weintraub, MD has been Medical Director of the Brain Injury Program at Craig Hospital since 1986. Dr. Weintraub also serves as the Medical Director for the Rocky Mountain Regional Brain Injury System, a federally designated Model System of Care with extensive clinical, research and dissemination activities. Over his tenure in the field of Traumatic Brain Injury Care and Rehabilitation, Dr. Weintraub has served as Medical Director of post acute residential brain injury programs and several long term subacute brain injury programs. He also is an Assistant Professor at the University of Colorado Health Sciences Center and an active consultant to the Colorado Division of Worker’s Compensation Medical Treatment Guidelines TBI Task Force. In 2011, Dr. Weintraub received the prestigious North American Brain Injury Society ( NABIS ) award for Innovative Clinical Treatment. Dr. Weintraub has special interests in pharmacological management of adults with brain injury, spasticity, sports-related concussion and the long term consequences of brain injury. He is actively involved in local, regional and national organizations and is devoted to the aging and long term needs of brain injured survivors and their families. For over 25 years, Dr. Weintraub has lectured extensively to broad audiences, and written on a number of specific clinical and research topics related to both traumatic and acquired brain injury.

Ross D. Zafonte, DO

Ross D. Zafonte, DO is the Earle P. and Ida S. Charlton Chairman of the Department of Physical Medicine and Rehabilitation at Harvard Medical School, Vice President Medical Affairs Spaulding Rehabilitation Hospital, and chief of Physical medicine and rehabilitation at Massachusetts General Hospital. He has published extensively on traumatic brain injuries (TBI), other neurological disorders, as well as presented on these topics at conferences nationally and internationally. Dr Zafonte’s textbook is considered one of the standards in the field of Brain Injury care. Having served as principal investigator on numerous NIDRR TBI Model Systems and NIH Clinical Trials Center grants, Dr. Zafonte is currently the PI on an eight-center NIH multisite clinical trial for the treatment of TBI -- the largest clinical treatment trial in the history of North America. Dr Zafonte has helped to direct a tremendous growth in both the rehabilitation research and clinical arenas at Spaulding and the MGH. Specific areas of success include the awarding of a Department of Defense TBI/ PTSD center grant, numerous NIH and NIDRR funded projects, enhanced relationships with the Veterans Administration, the development of a gait laboratory focused on novel prosthetic design for those with amputation, and a neuroprosthetic program making “science fiction” come alive.

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