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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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Jul 24, 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 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.

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