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RUSK Insights on Rehabilitation Medicine

RUSK Insights on Rehabilitation Medicine is a top podcast featuring interviews with faculty and staff of RUSK Rehabilitation as well as leaders from other rehabilitation programs around the country. These podcasts are being offered by RUSK, one of the top rehabilitation centers in the world. Your host for these interviews is Dr. Tom Elwood. He will take you behind the scenes to look at what is transpiring in the exciting world of rehabilitation research and clinical services through the eyes of those involved in making dynamic breakthroughs in health care.
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Now displaying: August, 2019
Aug 21, 2019

This special panel presentation features three leaders in the space: 

Tara Denham, supervisor of vestibular physical therapy, is a leading expert in the field of vestibular therapy and founder of the Vestibular Physical Therapy Center at Rusk. As an American Physical Therapy Association certified vestibular clinician, she lectures extensively to a wide range of audiences. 
 
Eva Mihovich has served as a Senior Psychologist at Rusk Rehabilitation, NYU Langone Health Centers for over 20 years, and is a clinical instructor at the NYU School of Medicine. She currently coordinates Psychological Services at the Vestibular Rehabilitation Department at Rusk Rehabilitation. Her Ph.D. is from New York University. 
 
Dr. Jennifer Fay is a board-certified clinical specialist in Neurologic Physical Therapy through the American Board of Physical Therapy Specialties and is a clinical instructor in the Department of Physical Medicine and Rehabilitation in the NYU School of Medicine. 
 
Artmis Youssefnia is Senior Level II in the vestibular therapy department at Rusk Institute: NYU Langone Health System. She has over 20 years of experience working with patients with pulmonary disease and vestibular dysfunction and does extensive community outreach/education. She also is adjunct professor for Cardiovascular Pulmonary Examination at NYU Physical Therapy school.
 
This is the first of a two-part series. In this episode, the panel covers: 
why terms previously used were abandoned and how the classification 3PD represents an improvement over them; core symptoms of 3PD; kinds of health professionals involved in making an accurate differential diagnosis; specific clinical tests to detect the presence of 3PD; how well patients perform in describing their symptoms in constructive ways that aid in arriving at a correct diagnosis; what is known about the exact etiology of 3PD from the standpoint of any common initial events that might precede its development; whether 3PD can co-exist with other kinds of dizziness problems; if onset of 3PD associated in any way with certain demographic factors; and episodes that can trigger the onset of 3PD, such as a panic attack or generalized anxiety disorders
Aug 7, 2019

Dr. Barr is an Associate Professor of Neurology and Psychiatry at the NYU School of Medicine. He has over 30 years of experience in clinical practice, training, and research in the field of clinical neuropsychology. He has been on the editorial boards of multiple professional journals and has served as an officer and board member of a number of professional societies, including a term as President of the Society for Clinical Neuropsychology (Division 40) of the American Psychological Association (APA) in 2011.  He has an active clinical practice in neuropsychological assessment with ongoing research programs on cognitive and behavioral aspects of epilepsy in addition to other programs in mild traumatic brain injury and forensic neuropsychology. He also maintains an active social media presence on topics related to sports concussion and chronic traumatic encephalopathy (CTE). His doctorate in clinical psychology is from New School University.

This is the second of a two-part series of a live Grand Rounds presentation given at RUSK. 

In Part 1 of his presentation, Dr. Barr discussed how he takes a translational approach by applying findings from sports studies to clinical practice. Athletics provide a natural laboratory for studying concussion. Unlike other kinds of concussion injury, the motivation for patients is to return to the field of athletics rather than not to do so. Currently, no obvious concussion test exists. Neuropsychological assessment represents one means of documenting symptoms. A focus in this presentation is on subjective symptoms. Some athletes either fail to report their concussion symptoms or hide them in order to remain on the field while some patients may misreport symptoms that pertain to conditions, such as anxiety and depression rather than concussion. Perhaps not as much attention should be paid to cognitive symptoms (e.g., attention and memory), which may be short-lived, as to emotional symptoms that can persist over longer periods of time. He described how the Sports Laboratory Assessment Model (SLAM) is used. A transition then occurred in the battery of neuro psychological tests from paper and pencil to computer applications.

Part 2 involves a discussion of what has occurred in neuropsychological testing since 2001 and how the SLAM model was used to replicate other studies conducted in the early part of the 21st century. Batteries of different tests were administered to large numbers of college athletes to show natural recovery curves. The results show that sideline battery testing does a good enough job while neuropsychological testing added little to the results. Questions then arose regarding how various computerized tests work and which ones should be used. In addition to studies of athletes, research also was done as part of the translational process that involved emergency room patients. Poor test-retest reliability was found for all the different measures. The test lacked reliability to identify changes.  By 2012, it became apparent that baseline neuropsychological testing of athletes was not as important as originally envisioned. Some patients experience symptoms that last beyond one month and these are the individuals who end up in the offices of psychologists. He also discussed post-concussion persistent symptoms.

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