The NeuroRehab Preceptor Program is a comprehensive CME mentoring initiative for practicing neurologists and physiatrists, as well as neurology and physiatry residents, on the management of spasticity and other conditions that result from motor activity dysfunction.
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This monograph by explores the diagnosis and management of spasticity, a serious condition once incompletely treated through surgical means and oral medications while patients advanced to severe disability. Effective management of spasticity in children often, but not always, requires a multidisciplinary approach with the team comprising a pediatrician, a parent/caregiver, and to the extent possible, the affected child. Clinicians treating childhood spasticity should be aware of the numerous tools available for objective assessment and quantification of the degree of spasticity and should understand its impact on both patients and caregivers. Topics include increasing caregiver awareness within a healthcare team approach, choosing appropriate local and systemic therapies, managing expectations for long-term treatment, and patient-specific goal setting. Although CME credit is no longer available for this program, it is available for your use as reference material.
Click here to access the monograph.
Katharine E. Alter, MD
Medical Director, Rehabilitation Programs
Mount Washington Pediatric Hospital
Functional and Applied Biomechanics Section
National Institutes of Health
Katharine E. Alter, MD, is a pediatric and adult physiatrist practicing in the Baltimore, MD–Washington, DC, area. She is Medical Director of Rehabilitation Programs at Mt. Washington Pediatric Hospital, in Baltimore, an affiliate of Johns Hopkins University and the University of Maryland Health Systems. Dr Alter is also Senior Clinician/Scientist in Rehabilitation Medicine and Medical Director of the Functional and Applied Mechanics section in Rehabilitation Medicine and in the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (NIH).
Dr Alter is a co-investigator on numerous protocols at the NIH, investigating spasticity, movement disorders, upper motor neuron syndromes, botulinum toxin therapy, proprioception, magnetic resonance imaging, and ultrasound imaging. She has authored numerous peer-reviewed publications related to these projects and, most recently, an atlas on the topic of ultrasound guidance for chemodenervation procedures.
Dr Alter is active in a number of community groups and national specialty organizations. She chairs the Research and Awards Committee of the American Academy of Cerebral Palsy and Developmental Medicine and serves on the Neuromuscular Ultrasound taskforce of the American Academies of Neuromuscular and Electrodiagnostic Medicine and Physical Medicine and Rehabilitation. Dr Alter is a member of the Board of Directors of the Commission for Motion Laboratory Accreditation. She is board certified by the American Boards of Pediatrics, Physical Medicine and Rehabilitation, and Electrodiagnostic Medicine and holds a subspecialty certificate in pediatric rehabilitation.
This monograph by , explores the diagnosis and management of spasticity, a serious condition once incompletely treated through surgical means and oral medications while patients advanced to severe disability. Topics include increasing caregiver awareness within a healthcare team approach, choosing appropriate local and systemic therapies, managing expectations for long-term treatment, and patient-specific goal setting. Although CME credit is no longer available for this program, it is available for your use as reference material.
Click here to access the monograph.
Ib R. Odderson, MD, PhD
Associate Professor of Rehabilitation Medicine
University of Washington
Rehabilitation Medicine Clinic
University of Washington Medical Center
Ib R. Odderson, MD, PhD, is Associate Professor of Rehabilitation Medicine at the University of Washington, in Seattle, and Medical Director of the Rehabilitation Medicine Clinic at the University of Washington Medical Center.
Dr Odderson received a medical degree from Vanderbilt University, in Nashville, Tennessee, and a doctorate from Indiana University, in Bloomington. He held a visiting fellowship at the National Institute of Mental Health, in Bethesda, Maryland.
Dr Odderson helped pioneer the treatment of hyperhidrosis with botulinum toxins. He has written articles on reduction of saliva production with rimabotulinumtoxinB and served as guest editor for a journal on the use of botulinum toxins. He authored the book Botulinum Toxin Injection Guide, and his work appears in such journals as Neurorehabilitation and Neural Repair, Annals of Neurology, and Physical Medicine and Rehabilitation Clinics of North America.
Dr Odderson is a Fellow of the American Academy of Physical Medicine and Rehabilitation. He is a member of several organizations, including the American Association of Electrodiagnostic Medicine, the American Academy of Neurology, and the American Paraplegia Society. Dr Odderson has been identified as one of Seattle's top doctors in Seattle Magazine and Consumer's Checkbook several times.
These free CME-certified online case studies review the signs and symptoms, early diagnosis, referral criteria, multidisciplinary management, and treatment options for multiple sclerosis. Faculty are , and . Although CME credit is no longer available for this program, it is available for your use as reference material.
Click here to view the case studies.
Michael B. Chancellor, MD
Michael B. Chancellor, MD, is Director of the Neurourology Program at Beaumont Hospital, Royal Oak, and Professor of Urology at Oakland University William Beaumont School of Medicine, in Royal Oak, Michigan.
Dr Chancellor received a medical degree from Medical College of Wisconsin, in Milwaukee. After an internship in surgery and a residency in urology at the University of Michigan, in Ann Arbor, he completed a fellowship in neurourology at the College of Physicians and Surgeons of Columbia University, in New York, New York.
Because of his world-renowned expertise in the areas of stem cell and tissue engineering and drug discovery, Dr Chancellor is frequently invited to lecture at US and international meetings, often as the keynote speaker. He was the first urologist to use botulinum toxin to treat lower urinary tract dysfunction. He founded Lipella Inc and Cook MyoSite, which is in a multicenter North American trial of adult autologous muscle-derived stem cells to treat stress urinary incontinence. He has been funded for more than 10 years by the National Institutes of Health.
Dr Chancellor has contributed hundreds of journal articles to the peer-reviewed literature—most recently, Pharmaceutical Research, Urology, and Journal of Urology—and book chapters, including in the forthcoming editions of Campbell's Urology and Textbook of Female Urology and Urogynecology. He serves on the editorial boards of a dozen journals and as a reviewer on many others.
He holds memberships in the Sexual Medicine Society of North America, the Association of Reproductive Health Professionals, and the International Society of Sexual Medicine. He was awarded the New Research Directions in Urinary Incontinence Symposium Best Basic Research Grant Prize from the National Institute of Diabetes and Digestive and Kidney Diseases in 2009 and, among many other honors, has also earned the Urodynamics Society Paul Zimkin Award, the grand prize of the International Jack Lapides Essay Contest, and the Pfizer-American Urological Association Visiting Professorship Award.
Bhupendra O. Khatri, MD
Bhupendra O. Khatri, MD, is Director of the Regional Multiple Sclerosis Center and Director of the Center for Neurological Disorders, both in Milwaukee, Wisconsin.
Dr Khatri received his Doctor of Medicine degree from Grant Medical College, in Mumbai, India. He completed an internship and a residency at the Medical College of Wisconsin, in Milwaukee, where he served as Chief Resident of Neurology and was Associate Professor of Neurology until 1990, when he started the Center for Neurological Disorders. He held a fellowship in plasmapheresis and clinical neuroimmunology at the University of California, San Francisco.
A board-certified neurologist active in clinical research related to multiple sclerosis (MS), Dr Khatri is principal investigator on more than a dozen studies. He is a pioneer in the field of plasmapheresis, performing approximately 1500 procedures each year. He was among the first to conduct double-blind, placebo-controlled studies on plasmapheresis in Guillain-Barré syndrome as well as in acute and chronic progressive MS. He also participated in the phase 3 study on fingolimod in relapsing-remitting MS. He has published more than 70 original articles and abstracts in peer-reviewed journals and contributed 6 chapters about MS to textbooks.
Nationally and internationally known for his work in MS, Dr Khatri travels extensively—including to Portugal, Brazil, Mexico, India, and the Netherlands—to promote research in and treatment for MS. He holds memberships in the American Academy of Neurology, the American Society of Apheresis, and the American Association of Physicians from India and sits on the Medical Advisory Committee of the National MS Society, Wisconsin Chapter. He was most recently honored with the Patient's Choice Award for Most Compassionate Doctor.
Originally presented at the 51st Annual Scientific Meeting of the American Headache Society/14th International Headache Congress, these presentations review the classification, biology, and mechanisms of chronic migraine and compare clinical study data for investigative prophylactic treatment options. David W. Dodick, MD, FRCP(C), FACP, served as Chairperson for this activity, with faculty Andrew C. Charles, MD, and Stephen D. Silberstein, MD, FACP.
Click here to view the presentations.
- Summary of NeuroRehab Preceptor Program Learning Objectives
- Overview of spasticity, including pathophysiology and spastic paresis development
- Clinical assessment of muscle overactivity in upper motor neuron syndrome
- Treatment options for spasticity and muscle overactivity, including injectable medication
- Overview of causes
- Possible upper limb symptoms to observe and evaluate, including
- Clenched fist; thumb-in-palm deformity; flexed wrist; flexed elbow; pronated forearm; functionally limited arm after stroke; adducted, internally rotated, flexion-restricted shoulder; intrinsic plus hand
- Possible lower limb symptoms to observe and evaluate, including
- Equinovarus foot, flexed hip, nonflexing hip, adducted thigh, adducted hip, stiff knee, flexed knee, valgus foot, hyperextended big toe
- Assessment tools
- Upper limb measures, including
- Modified Ashworth Scale, Barthel Index, modified Frenchay Scale
- Lower limb measures, including
- Gait analysis
- Upper limb measures, including
- Comprehensive summary to assist in patient evaluation and treatment selection
- Checklist to be filled out and submitted for each patient selected to participate in the NeuroRehab Clinical Consult Program
- Overview of pharmacotherapies for spasticity and muscle overactivity
- Oral medications, including
- Muscle relaxants, anxiolytics/benzodiazepines,
α2-adrenergic agonists, and anticonvulsants
- Physical therapy
- Occupational therapy
- List of suggested articles and other resources to obtain additional information about spasticity, muscle overactivity, and current treatments