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 first 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.
Dr. Olesya Yevdayev is a Senior Physical Therapist in the Outpatient Physical Therapy Department at Rusk Rehabilitation, NYU Langone Health. She has a Bachelor of Science degree from Touro College and a Bachelor of Arts degree from Hunter College. She earned her Doctor of Physical Therapy degree from Touro College where she received an Outstanding Clinical Achievement award. She has 7.5 years of professional experience in orthopedics/ sports rehabilitation utilizing the Mulligan Method, McKenzie Method, and manual therapy with a concentration on pelvic floor, pregnancy, osteoporosis, oncology, and lymphedema rehabilitation. She also is involved in community services, patient education, and has presented lectures at NYU in Brooklyn and the 26thCancer Conference.
Dr. Kimberly Sackheim is an Assistant Professor in the Department of Physical Medicine & Rehabilitation at New York University Langone Health and private owner and founder of an office for pain management that will open in August 2019. She has a focus on interventions for spinal issues, joints/tendons, headache and also pelvic pain. She is board certified by the American Board of Physical Medicine & Rehabilitation with sub-specialties in both pain management and brain injury medicine. She completed her residency in physical medicine and rehabilitation at Mount Sinai Medical Center, New York, NY. Her fellowship training took place at the Beth Israel Medical Center. She treats all types of pelvic pain disorders, including pelvic floor dysfunction, rectal pain, headache, jaw pain, along with spine and joint pain.
This is the second of a two-part series. In Part 1, the guests discuss: the kinds of pelvic floor disorders that women can experience; symptoms that patients can present with; whether only women experience pelvic floor problems; causes of painful symptoms at the pelvic, rectal, or vaginal area and injections available to treat these kinds of pain; extent to which delivering children and growing older influence the occurrence of pelvic floor disorders; if the type of child delivery method, such as vaginal delivery, increases the probability a woman will develop a pelvic floor disorder later in life; how modalities other than surgery, such as physical therapy can contribute to positive outcomes; and the kinds of procedures involved in the administration of pelvic floor physical therapy and the basis on which various approaches either singly or in combination are best suited for a particular patient?
In Part 2, they discuss: Periods of time, such as weeks or months when most rehabilitation interventions take place and whether it ever occurs that further treatment is not associated with additional improvements; if there are instances, such as the presence of a patient’s advanced old age or co-morbidities where watchful waiting may represent the best choice instead of any other kind of intervention; steps that can be taken to lower the percentages of women who experienced urinary incontinence, yet had not talked to a doctor about this problem; pelvic floor muscle training to treat overactive bladder and who provides it; the role of botulinum toxin as a form of treatment for pelvic floor dysfunctions among elderly patients; extent to which patient education is involved in efforts to improve knowledge of, attitude towards, and practice of pelvic floor muscle exercise; frequency of urinary incontinence symptoms and other pelvic floor disorders among adolescent females; and pelvic floor muscle training as a means of primary prevention of urinary incontinence in asymptomatic women and secondary prevention for women with small muscle strength who are considered dysfunctional, but asymptomatic.