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Educational Objectives
Neurorehabilitation Outpatient Rotation

Medical Knowledge

1. Summarize the basics of brain neuroanatomy and neurophysiology including:
   1. Circulation of the blood and CSF
   2. Neuroanatomy, development and function of cerebral systems structures:
      1. Sensory and perceptual systems
      2. Brainstem and cranial nerves
      3. Motor systems (cortical, subcortical)
      4. Limbic system
      5. Reticular activating system
      6. Higher cortical cognitive systems
      7. Dominant and non-dominant language systems
      8. Vestibular systems
      9. Autonomic nervous systems
   3. Neuroanatomy, development and function of spinal cord structures:
      1. Sensory systems
      2. Motor systems
      3. Autonomic nervous systems
   4. Neuroanatomy, development and function of peripheral nerve structures:
      1. Anterior horn
      2. Dorsal horn
      3. Axon, including motor and sensory nerves
      4. Neuromuscular junction
      5. Autonomic nervous system
2. Summarize the epidemiology, risk factors, neuroanatomic correlates, and pathophysiology of traumatic and non-traumatic neurological conditions, including but not limited to:
   1. Stroke: thromboembolic, lacunar, hemmorhagic
   2. Pre-cerebral and cerebral vascular aneurysms
   3. Traumatic brain injury
   4. Non-traumatic brain injury, including infections, neoplasms, hydrocephalus, and hypoxic brain injury
   5. Multiple sclerosis (MS), including relapsing-remitting MS, secondary-progressive MS, primary-progressive MS, relapsing-progressive MS
   6. Parkinsonism
   7. Traumatic spinal cord injury
   8. Non-traumatic spinal cord injury, including infections, neoplasms, syringomyelia, transverse myelitis, aortic aneurysm rupture, spondylosis with myelopathy, intravertebral disc disorder with myelopathy, spinal stenosis with myelopathy
   9. Motor neuron disease, including amyotropphic lateral sclerosis (ALS)
   10. Traumatic peripheral nerve injury
   11. Hereditary, toxic, and idiopathic peripheral neuropathy
   12. Demyelinating polyneuropathies, including Guillian-Barre syndrome, chronic demyelinating polyradiculoneuropathy
   13. Neuromuscular disorders, including myasthenia gravis, Lambert-Eaton syndrome
3. Summarize the medical, neurological, and musculoskeletal complications that occur with traumatic and non-traumatic neurological conditions, including:
   1. Pain syndromes, including shoulder pain, bursitis/tendinitis, neuropathic pain
   2. Complex regional pain syndrome
   3. Seizures
   4. Psychiatric disorders, including depression and anxiety
   5. Deep venous thrombosis and pulmonary embolism
   6. Spasticity
   7. Contractures
   8. Decubiti
   9. Deterotopic ossification
   10. Neurogenic bowel and bladder
   11. Cardiac and pulmonary complications
4. Summarize and differentiate between speech-language disorders that occur with traumatic and non-traumatic neurological conditions, including:
   1. Aphasia
   2. Apraxia
   3. Dysarthria
   4. Apraxia
   5. Dysprosodias
   6. Cognitive-communication impairment
   7. Dysphagia
5. Diagnosis and treatment of neurobehavioral and cognitive-communication disorders after brain damage, including:
   1. Medication and environmental management of the agitated patient
   2. Pharmaceuticals for enhancing alertness and cognition
   3. Behavioral modification
   4. Neuropsychological testing
   5. Cognitive remediation
   6. Effects of premorbid personality and social milieu
6. Formulate and support short-term and long-term prognoses for patients with traumatic and non-traumatic neurological conditions.
7. Discuss the mechanics of wheelchair propulsion by occupants and attendants.
8. Describe the range of wheelchairs available and their costs: self- propelled, attendant propelled and electric; indoor vs. outdoor.
9. Describe the environmental factors that may limit the usefulness of wheelchairs.
10. Discuss the need for different types of special seating: supportive, contoured, anti-pressure, static.

Patient Care

1. Perform a detailed history and neurological exam including mental status, cranial nerves, reflexes, tone, muscle testing and sensation.
2. Synthesize an appropriate medical and rehabilitation problem list and comprehensive care plan for an outpatient rehabilitation program in an appropriate setting, such as outpatienttherapies, day hospital, or cognitive remediation program, taking into consideration age and medical comorbidities.
3. Describe effective pharmacologic interventions used to facilitate motor, sensory, and cognitive recovery in the treatment of traumatic and non-traumatic neurological conditions
4. Assess and treat the medical, neurological and musculoskeletal complications that can occur in association with traumatic and non-traumatic neurological conditions, including:
   1. Motor and sensory disorders, including orthotics
   2. Pain syndromes, including shoulder pain, bursitis/tendinitis, neuropathic pain, complex regional pain syndrome
   3. Seizures
   4. Psychiatric disorders, including depression and anxiety
   5. Deep venous thrombosis and pulmonary embolism
   6. Spasticity
   7. Contractures
   8. Decubiti
   9. Deterotopic ossification
   10. Neurogenic bowel and bladder
   11. Cardiac and pulmonary complications
   12. Dysphagia
5. Summarize the role, advantages, and limitations of relevant diagnostic procedures:
   1. EEG
   2. CT scans
   3. MRI scans
   4. Evoked potentials
   5. Angiographic studies
   6. Dynamic imaging (SPECT and PET)
6. Demonstrate the ability to prescribe a wheelchair for a patient: needs assessment, fabrication issues, and fitting.
7. Explain to a patient the risk and safety factors involved in wheelchair use.
8. Explain to a patient the availability of community resources for wheelchair provision,wheelchair repair and transportation needs.

Interpersonal and Communication Skills

1. Communicate PM&R management recommendations to the referring physician, other medical/surgical services and/or the allied health team.
2. Summarize the role of the physician in family teaching, with anticipatory guidance.
3. Present information to patients & other care team members in an effective manner.
4. Establish trust and maintain positive rapport with patients, caregivers & family members.
5. Demonstrate effective listening skills.
6. Promote teamwork in the clinical setting.
7. Complete dictations and chart notes in a legible & timely manner.

Professionalism

1. Demonstrate sensitivity and responsiveness to age, culture, disability and gender of patients and colleagues.
2. Consider effects of personal, social and cultural factors in the disease process and patient management.
3. Demonstrate reliability, punctuality, integrity and honesty in all interactions with patients and colleagues.
4. Accept personal responsibility for own actions & decisions.
5. Apply sound ethical principles in practice (e.g., informed consent, confidentiality, veracity, provision or withholding of care).

Practice-Based Learning and Improvement

1. Demonstrate skill in supervising junior residents and medical students in information gathering, decision-making, and patient management.
2. Evaluate and/or modify own practice based on feedback from others.
3. Use information technology to appraise & assimilate evidence from scientific studies to enhance patient care outcomes.

Systems-Based Practice

1. Summarize the physicians role in advocating for care needs, as well as for cost effective, appropriate services for patients in various systems of care
2. Demonstrate the ability to coordinate PM&R consultation recommendations with other medical/surgical services and the allied health team
3. Determine when referral to specialists in other medical or surgical disciplines should be made
4. Demonstrate how to access various community resources on behalf of the patient
5. Demonstrate integrity and responsibility in interactions with insurance and/or disability-oriented agencies.