Fundamentals of Concussion: Assessment & Management of Persistent Symptoms
3.0 CE Credits

Presented by: 
Leighton Chan, MD, MPH
Chief, Rehabilitation Medicine Department, Clinical Center
National Institutes of Health






Marla Shapiro, PhD, HSP, NCSP, DBSM  
IA, GA, and NE Licensed Psychologist
Developmental and Sports Neuropsychology
Behavioral Sleep Medicine







Vicki Anderson, PhD
Head, Psychology Service, RCH
Theme Director, Clinical Sciences Research, MCRI







Brain injuries frequently occur in sports and non-sports related activities. While the majority of patients recover without complication, there are individuals who have persistent symptoms. This 3-hour virtual workshop is designed to inform the audience of some of the most exciting outcome measures in the assessment and treatment of concussion. The speakers will provide information on injury mitigation and discuss approaches to preventing and treating persistent symptoms following concussion with emphasis on sports-related concussion in children and adults.

Learning Objectives
As a result of attending this workshop, participants will be able to:
1. Describe the current clinical indications for obtaining TBI related biomarkers
2. Develop and design strategies for educating athletes and sports medicine teams about sleep
3. Discuss multimodal approaches to concussion management

Target Audience: Health care providers are the primary audience, including clinical psychologists, school psychologists, neuropsychologists, athletic trainers, pediatricians, school nurses, and others with an interest in treating concussion.
Instructional Level: Intermediate


Dr. Leighton Chan is a Tenured Senior Scientist and the Chief of Rehabilitation Medicine at the NIH Clinical Research Center, a 200-bed research hospital on the NIH campus. Born and raised in New York City, he received his BA degree from Dartmouth College and his MD from the UCLA School of Medicine. He received residency training at the University of Washington in Seattle. Subsequently, he completed a Robert Wood Johnson Clinical Scholar Research Fellowship and was a Congressional Fellow for the Honorable Jim McDermott (Washington). In 2007, after 10 years on the faculty of the University of Washington, Dr. Chan took his current position at NIH where he manages a department of 100 staff and students who support NIH's Intramural Research Program. Dr Chan is also the Co-Director of the Center for Neuroscience and Regenerative Medicine (CNRM), one of the largest Traumatic Brain Injury research centers in the world. The CNRM links the Walter Reed National Military Medical Center and the Uniform Services University with the NIH Intramural Research Program and focuses on improving the recovery of injured warfighters. Dr. Chan has published more than 185 peer reviewed articles, including 11 in JAMA, Lancet, and NEJM, and has received research funding in excess of $50 million. He is currently the Co-Editor-in-Chief of the Archives of Physical Medicine and Rehabilitation, the oldest and largest academic journal in the field of rehabilitation. In 2007, he was elected to the Institute of Medicine (now the National Academy of Medicine).  

Dr. Marla Shapiro brings a unique multidisciplinary approach to complement medical services, with particular expertise in developmental and sports neuropsychology, biofeedback, and behavioral sleep medicine. She has more than 25 years of clinical experience working with children, adolescents, and adults with brain injuries.

Dr. Anderson is the Director of Psychology at The Royal Children’s Hospital in Melbourne and the Director of Clinical Sciences Research at Murdoch Children’s Research Institute. She is a pediatric neuropsychologist of 30+ years. Her research and clinical interests are in disorders of childhood that impact the brain, including both developmental and acquired disorders. Her recent work focuses on translating her early career findings into clinical practice to optimize child outcomes. Major translational achievements include design and development of child assessment tools (Test of Everyday Attention for Children), novel, iPad-delivered social competence tools (PEERs), digital health tools for managing child concussion symptoms, and e-health parenting and parent mental health interventions for families of children with neurodevelopmental disorders and chronic illnesses. 

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Introduction to Sports Neuropsychology

(1.5 CE Credits)

Presented by:
Robert L. Conder, Psy.D., ABPP
Clinical, Rehabilitation, & Sports Neuropsychology
Carolina Neuropsychological Service
Neuropsychologist, Duke Raleigh Hospital

Sports Neuropsychology is an emerging subspecialty, especially given the widespread concern over the effects of concussions at all levels of athletic performance. Yearly, an estimated 38 million children and adolescents participate in organized sports, and it is estimated that 1.6-3.8 million youth concussions are sustained yearly. While based in the fundamentals of Neuropsychology, a Sports Neuropsychology framework requires modification in both assessment and treatment methodologies. This presentation will review the neuroscience, assessment, prevention and management of sports concussions. A repeatable, focused and sensitive assessment model for sports concussion will be delineated. Emphasis will be given to pediatric and adolescent return-to-play and return-to-classroom issues. Predictors of prolonged recovery will be explicated, as will treatment interventions which can speed up or maximize the recovery process. The topic of Chronic Traumatic Encephalopathy will be addressed. A model school-based Concussion Education, Prevention and Management Program will be presented. The implications of Youth Sport Safety Legislation, such as has been introduced in at least 38 states, will be addressed. Finally, suggestions for professional education and training in the field of Sports Neuropsychology will be offered.

After the webinar, participants will be able to:

  1. define a sports concussion, and identify similarities and differences from a traumatic brain injury;
  2. describe management techniques to reduce psychological and academic morbidity post-concussion, including parent, teacher and school consultation;
  3. prepare brief and focused assessment batteries and describe how these differ from a traditional neuropsychological or psychoeducational assessment battery;
  4. explain model guidelines for reduction of sports concussions; and be introduced to educational/advocacy guidelines for parents, players, coaches and schools.
Target Audience:Primarily neuropsychologists who wish to expand their practice to work with athletic populations of any age.

Instructional Level:Introductory

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Neurological Underpinnings and Neuropsychological Outcomes of Concussion

1.5 CE Credits

Presented by:
Gerard A. Gioia, Ph.D.
Division Chief & Professor, Pediatric Neuropsychology
Director, Safe Concussion Outcome, Recovery & Education (SCORE) Program
Children’s National Medical Center
George Washington University School of Medicine

This webinar will discuss our current state of knowledge in the evaluation and management of concussion/mild traumatic brain injury (mTBI). Good clinical practice is informed by a solid understanding of the underlying neuropathophysiology of this injury, paired with the functional assessments and treatment. Our current understanding of the neurometabolic cascade and diffuse axonal injury is explored, as well as functional outcomes in the cognitive, behavioral, and social-emotional domains. Participants will learn the range of clinical assessment tools that are currently available. Complementing the assessment process, participants will learn treatment/intervention strategies to support recovery. An active model of rehabilitation, addressing cognitive and social-emotional factors and highlighting the self-efficacy of the recovering person, will be articulated. The benefits of aerobic activation will also be discussed. This course will illustrate how the clinical skillset of the neuropsychologist is ideally suited to the evaluation and management of concussion/mTBI.

After the webinar, participants will be able to:

  1. Explain the underlying pathophysiology and associated clinical presentation of concussion. 
  2. Describe various domains and methods to assess concussion dysfunction.
  3. Discuss targets and models of active treatment and management.

Target Audience: Clinical neuropsychologists with interest in learning current models and methods of serving persons with mild TBI/concussion.

Instructional Level: Introductory to Intermediate

About Gerard A. Gioia, Ph.D.
Dr. Gioia is a pediatric neuropsychologist and Chief of the Division of Pediatric Neuropsychology at Children’s National Health System, where he directs the two Neurobehavioral Evaluation Core Laboratories of the Clinical & Translational Science Institute and Intellectual and Developmental Disabilities Research Center, as well as the SCORE Concussion Program. He is Professor of Pediatrics and Psychiatry at the GWU School of Medicine. Dr. Gioia is a clinician, researcher, teacher/ trainer. He is a researcher interested in the construction of developmentally and psychometrically sound tools to define neuropsychological outcomes in children with various neurologic disorders. He has been active in public health activities, working with the CDC on their “Heads Up” concussion educational toolkits for healthcare professionals, parents, children, coaches and school personnel. Dr. Gioia has participated in the 2004, 2008, 2012 and 2016 International Concussion in Sport Group Consensus meetings; the American Academy of Neurology Sports Concussion Guideline Author panel; and the CDC’s evidence based guideline development for mild TBI. He works with the Washington Capitals of the NHL and Baltimore Ravens of the NFL, and consults with youth sports of ice hockey, lacrosse, football, rugby, and soccer. He is the President-Elect of the Sports Neuropsychology Society, and is a member of the Medical Advisory Committee for USA Football; National Advisory Board of the Positive Coaching Alliance; Advisory Council of the former US Surgeon General David Satcher’s National Council on Youth Sports Safety.

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The Spectrum of Concussion: Recovery Time, Treatment, Rehabilitation, and Possible Long-Term Effects on Brain Health

(2.0 CE Credits)

Concussion has received enormous attention from the medical and scientific communities as well as extensive media coverage and public-policy interest. Although much has been learned, there remain critical unanswered questions relating to the clinical care, treatment, and ultimate wellbeing of student and professional athletes. This workshop will review the spectrum of concussion, from acute effects to possible long-term effects on brain health. Topics covered will include: (i) comorbidity factors that influence athletes’ trajectories of recovery from concussion; (ii) factors relating to fast and slow recoveries; (iii) improving assessment, treatment, and rehabilitation; (iv) examining possible long-term effects of multiple concussions on later-in-life brain health; and (v) a critical review of chronic traumatic encephalopathy.

After the presentation, participants will be able to:

1. Delineate anticipated recovery times for those who sustain a sport-related concussion.
2. List factors or characteristics associated with a slower recovery from concussion.
3. Develop and compile more personalized treatment and rehabilitation plans for those who are slow to recover.
4. Describe and critique what is known (and not known) about risks for long-term effects of multiple concussions, including accelerated aging, neurodegenerative diseases,  and chronic traumatic encephalopathy.

 

Presented by:
Grant L. Iverson, Ph.D.
Professor, Department of Physical Medicine & Rehabilitation, Harvard Medical School
MassGeneral Hospital for Children™ Sports Concussion Program 
Traumatic Brain Injury Program, Home Base, A Red Sox Foundation
Massachusetts General Hospital Program

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Chronic Traumatic Encephalopathy (CTE) and the Long-Term Consequences of Sports-Related Repetitive Subconcussive Brain Trauma: What We Know Now and What We Need to Know Next

1 CE Credits

 

Presented by:
Robert A. Stern, Ph.D.
Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology
Boston University (BU) School of Medicine
Director of Clinical Research, BU CTE Center
Senior Investigator, BU Alzheimer’s Disease Center


Description
Chronic traumatic encephalopathy (CTE) is a neurodegenerative disease found in individuals with a history of exposure to repetitive head impacts (RHI), such as former American football players, soccer players, and boxers. Referred to as “punch drunk” or dementia pugilistica since the early 20th century, the term “CTE” has been used since the 1950s to describe the clinical and neuropathological changes seen in individuals with RHI exposure. However, it is only in the past decade that CTE has received increased attention due to a growing number of deceased former NFL players being diagnosed with the disease postmortem. The tremendous growth in media attention to CTE has led to many misconceptions and misunderstanding about CTE. As with other neurodegenerative diseases, at this time CTE can only be confirmed by neuropathological examination. However, there are now consensus diagnostic criteria for the clinical presentation of CTE, and there have been several studies indicating potential neuroimaging and fluid biomarkers to detect and diagnose CTE during life. This workshop will provide an overview of what is currently known about CTE and what knowledge gaps exist, as well as current and future directions in research.

After the session, participants will be able to:
Describe the neuropathological features of chronic traumatic encephalopathy (CTE).
Explain what is currently known about risk factors for developing CTE.
Discuss the clinical features associated with CTE and the current diagnostic criteria for Traumatic Encephalopathy Syndrome.
Describe the possible fluid and neuroimaging biomarkers for CTE.
Explain the current gaps in knowledge about CTE and what research is needed to close those gaps.

Target Audience: Neuropsychologists and trainees

Instructional Level: Intermediate

Dr. Robert Stern is Professor of Neurology, Neurosurgery, and Anatomy & Neurobiology at Boston University (BU) School of Medicine. He is an internationally recognized expert on chronic traumatic encephalopathy (CTE) and the long-term effects of repetitive head impacts in athletes. He is Co-Founder and Director of Clinical Research for the BU CTE Center, and he is the lead investigator of a $17 million, 7-year NIH grant for a multi-center study to develop methods of diagnosing CTE during life as well as examining potential risk factors of the disease. Dr. Stern’s other major area of funded research includes the diagnosis and treatment of Alzheimer’s disease. From 2010-2019 he was Clinical Core Director of the NIH-funded BU Alzheimer’s Disease Center. He oversees several clinical trials for the treatment and prevention of Alzheimer’s and has conducted research on innovative new tests to detect and diagnose the disease. Dr. Stern has over 250 publications, is a member of several medical journal editorial boards, and is the co-editor of two recent textbooks: Sports Neurology (Dr. Brian Hainline, co-editor), part of the Handbook of Clinical Neurology series, and the Oxford Handbook of Adult Cognitive Disorders (Dr. Michael Alosco, co-editor). He is a clinical neuropsychologist and has developed several widely used neuropsychological tests, including the Neuropsychological Assessment Battery (NAB). He is a Fellow of the National Academy of Neuropsychology and the American Neuropsychiatric Association. Dr. Stern is a member of the court-appointed Medical Scientific Committee for the NCAA Student-Athlete Concussion Injury Litigation, as well as the Mackey-White Health and Safety Committee of the NFL Players Association.


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Navigating Post-Concussion Challenges: Shifting Perspectives for Persistent Symptoms

1.5 CE Credit


Presented By:
Donna K. Broshek, Ph.D.
University of Virginia Health
John Edward Fowler Professor, Chief of Psychology, Director of Neuropsychology Assessment Clinic
Psychiatry and Neurobehavioral Sciences
Director, Acute Concussion Evaluation Clinic; Executive Director, Sports Neuropsychology Society

Post-concussion syndrome (PCS) was originally intended to refer to symptoms occurring after the acute phase of typical concussion recovery. Unfortunately, this terminology has lost meaning over time and is frequently misunderstood by patients and misused by clinicians. Persisting Symptoms after Concussion (PSaC) has been proposed as new terminology to shift the focus from a patient’s failure to recover from concussion to encouraging health care providers to conduct active evaluation of persisting symptoms. The goal of active evaluation is to identify treatable causes of persisting symptoms, including considering non-concussion related etiologies. The change in terminology is intended to shift the clinical focus to recovery, including identification of treatable conditions, and implementing evidence-based active recovery to improve functioning and quality of life. Sociocultural and health equity barriers affecting access to care will also be addressed. This presentation will provide a definition of PSaC, explain the basis of the terminology, and discuss the maxims underlying the care of patients presenting with persisting symptoms, including respecting the brain injury, understanding the injury in context, examining the patient’s view of the injury, and learning from other persisting clinical presentations such as chronic pain. Finally, a brief overview of risk factors for PSaC will be discussed and active treatment options will be presented.

Learning Objectives:
After the webinar, participants will be able to:

  1. Describe why the term post-concussion syndrome is not a helpful or informative diagnosis.
  2. Apply new terminology for symptoms after concussion.
  3. Describe how multiple individual factors can influence recovery.
  4. Explain the importance of individualized assessment and management of athletes/patients with prolonged concussion symptoms.

Target Audience: clinical neuropsychologists, clinical psychologists, other health care providers, and students

Instructional Level: Introductory to Intermediate

Dr. Donna Broshek is the John Edward Fowler Professor at the University of Virginia School of Medicine and a board certified clinical neuropsychologist. Her primary appointment is in the Department of Psychiatry and Neurobehavioral Sciences, where she is Director of the Neuropsychology Assessment Clinic and Chief of Psychological Services. Dr. Broshek is the inaugural Executive Director of the Sports Neuropsychology Society (SNS), as well as a Fellow and Past-President of SNS. She is also a Fellow of the American Epilepsy Society and the National Academy of Neuropsychology. Dr. Broshek is a member of the NBA/WNBA Concussion Committee, a founding member of the International Congress for Athlete Brain Health and Chair of the Persisting Symptoms after Concussion Workgroup for the Athlete Brain Health Foundation, Board member of the Concussion in Sport Group, and a consultant to the US Olympic and Paralympic Committee. Dr. Broshek also serves on the Board of Directors for The BridgeLine, a community organization for adults with brain injuries. Dr. Broshek received the Distinguished Career Award from the National Academy of Neuropsychology in 2019 for her exemplary service to the field of neuropsychology. She has been active in research on sports concussion and mTBI, as well as national clinical trials for the treatment of intractable epilepsy. Dr. Broshek has been active at the local, regional, and national levels in promoting concussion education and safety.

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Secondary Factors in Neuropsychological Functioning 
2 CE Credits

Presented by:
Peter Andrew Arnett, Ph.D.
Psychology Professor
Director of the Neuropsychology of Sports Concussion and Multiple Sclerosis (MS) Programs
Penn State University

 






Secondary factors – depression, anxiety, fatigue, sleep, and pain, among others – are very common in many neurological conditions. These factors generally intersect with neurocognitive functioning, often in a negative way. However, many secondary factors are treatable and represent a potentially reversible cause of cognitive impairment. Additionally, even when treatment does not reverse cognitive impairment, it can significantly improve patient quality of life.  

The first part of this two-part webinar series will explore secondary factors and how they are related to neuropsychological functioning more generally. The second part will consider the prevalence and clinical relevance of these secondary factors in the context of specific neurological conditions including sport-related concussion, multiple sclerosis (MS), and mild cognitive impairment (MCI)/dementias. Participants will learn how to assess and consider these factors clinically, and how to incorporate this knowledge into routine neuropsychological assessments to improve patient care.  

After the session, participants will be able to:
1. Describe common secondary factors and how they intersect with neurocognitive functioning.
2. Discuss methods for identifying secondary factors in clinical practice. 
3. Explain the complexities of how secondary factors manifest in particular neurological conditions including sport-related concussion, multiple sclerosis (MS), and mild cognitive impairment (MCI)/dementias.  
4. Discuss ways in which careful assessment and understanding of secondary factors can improve clinical care, particularly as it relates to individualized care.  

Target Audience: Clinical neuropsychologists and trainees, as well as other healthcare professionals who wish to learn more about how to measure and consider secondary factors in clinical practice to improve patient care. 

Instructional Level: Intermediate

Dr. Peter Arnett received his Ph.D. in Psychology (Clinical) from the University of Wisconsin – Madison, and completed a post-doctoral fellowship in Clinical Neuropsychology at the Medical College of Wisconsin. He is currently a tenured Psychology Professor and Director of the Neuropsychology of Sports Concussion and Multiple Sclerosis (MS) Programs at Penn State University where he has been for the past 23 years. He also completed a six-year term as the Director of Clinical Training of the doctoral program in clinical psychology at Penn State. During that time, he wrote the APA accreditation report covering the seven-year period from 2007 to 2014, as well as the program’s first Psychological Clinical Science System (PCSAS) accreditation, which was approved and became official in 2017.  The Penn State clinical program is now one of less than 50 (out of over 300 nationwide) that has PCSAS accreditation.  Dr. Arnett is a licensed psychologist and clinical neuropsychologist, and has also either supervised or seen himself hundreds of cases of individuals who have suffered from mTBI/concussion, MS, epilepsy, mild cognitive impairment (MCI)/dementia, and toxic exposure, among others. 

Dr. Arnett’s research has focused on clinical neuropsychology, with an emphasis on studying secondary influences on cognitive functioning in persons with MS and mild traumatic brain injury (concussion).  He is a fellow of the National Academy of Neuropsychology (NAN), was President of NAN for the 2020 year, and previously served on the Board of Directors of the International Neuropsychological Society (INS).  He has authored over 180 research articles and book chapters/commentaries, and has edited two books.  One is entitled, Secondary Influences on Neuropsychological Test Performance (2013), and the other, Neuropsychology of Sports-Related Concussion (2019). Dr. Arnett has also given many national and international talks on concussion/mTBI, MS, secondary influences on cognitive functioning, and other topics relating to clinical neuropsychology. Dr. Arnett is an editorial board member of several journals, and has received grant funding from the National MS Society, NIH, and NIMH. He has served as primary mentor and dissertation chair for 25 doctoral students. Dr. Arnett is currently a host of the Brain Beat podcast sponsored by the NAN Foundation.
 


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Sports Concussion: Diagnosis, Management, and Long-Term Risk

3.0 CE Credits


William Perry, Ph.D.
Professor of Psychiatry
University of California, San Diego
Past President and Executive Director 
National Academy of Neuropsychology 

C. Munro Cullum, Ph.D., ABPP-CN
Professor of Psychiatry, Neurology & Neurotherapeutics, and
Neurological Surgery
Pamela Blumenthal Distinguished Professor of Clinical Psychology
Vice Chair and Chief, Psychology Division, Department of Psychiatry
Senior Neuropsychologist, O’Donnell Brain Institute
University of Texas Southwestern Medical Center
President, Sports Neuropsychology Society 

Donna K. Broshek, Ph.D., ABPP-CN
John Edward Fowler Professor of Psychology
Department of Psychiatry and Neurobehavioral Sciences
Co-Director, Acute Concussion Evaluation Clinic at University of Virginia School of Medicine 
Past President and Executive Director, Sports Neuropsychology Society

Andrew J. Gardner, Ph.D. 
Associate Professor, School of Medicine and Public Health, The University of Newcastle, Australia.
Co-Director, Sports Concussion Clinic, Hunter New England Local Health District. 
Hunter Medical Research Institute (HMRI)

Grant L. Iverson, Ph.D. 
Professor, Department of Physical Medicine & Rehabilitation, Harvard Medical School
Director, Massachusetts General Hospital for Children Sports Concussion Program
Associate Director, Traumatic Brain Injury Program, Home Base, A Red Sox Foundation and Massachusetts General Hospital Program

Jeffrey T. Barth, Ph.D.
John Edward Fowler Professor Emeritus
University of Virginia School of Medicine 

This 3-hour workshop is designed to provide foundational information about sports-related concussion to practitioners. While the focus will be on sports-related concussion, the information is of value to all practitioners who work with concussed individuals. Both typical and complicated recovery will be discussed as well as long-term risks. 

After the webinar, participants will be able to:

1. Explain concussion diagnosis and typical recovery. 
2. List the individual factors that can influence recovery after sports-related concussion.
3. Explain how terminology about persisting symptoms after concussion can influence clinical care.
4. Describe the importance of individualized assessment and management of athletes with persisting symptoms after concussion.
5. Differentiate 20th century descriptions of neurological disorders in boxers from modern descriptions of chronic traumatic encephalopathy (CTE) and traumatic encephalopathy syndrome.
6. Describe the later life health issues of retired professional rugby league players.


Target Audience: Health care providers are the primary audience, including clinical psychologists, school psychologists, neuropsychologists, athletic trainers, pediatricians, school nurses, and others with an interest in treating concussion.

Instructional Level: Introductory to intermediate

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