Rotations

Required Major Rotation (six-month duration) Location(s): TIRR TMC – Brain Injury Stroke Program Supervisor(s): Lindsey Harik, Ph.D., Juliette Galindo, Ph.D., Keira Hays, Ph.D.

This rotation will provide the fellow with exposure to acute rehabilitation with patients who have suffered from acquired or traumatic brain injuries. The fellow will gain experience assessing patients with varying levels of consciousness and functional abilities. The fellow will be expected to perform neuropsychological screenings/comprehensive testing, devise behavior management plans, participate in weekly multidisciplinary rounds, and provide family/patient education. Co-treatment sessions or observation of the sessions delivered by other rehabilitation disciplines are often a part of this rotation. It is expected that after completing this rotation, the trainee would be able to perform the responsibilities of an inpatient neuropsychologist within a rehab setting with minimal supervision.

This rotation may be taken in combination with Specialty Rehab to fulfill the six-month inpatient Texas Medical Center rotation requirement.

Required Major Rotation (six-month duration) Location(s): TIRR TMC – Outpatient Clinic; TIRR West University Supervisor(s): Petya Demireva, Ph.D., ABPP-CN; Juliette Galindo, Ph.D.; Corwin Boake, Ph.D., ABPP-CN

The primary clinical activities occurring during the Outpatient Neuropsychology rotation will include outpatient neuropsychological assessments with adult and older adult patients with various types of cognitive and behavioral dysfunction. Patient populations include adults with neurodegenerative diseases (Alzheimer’s, vascular dementia, FTD, PD, Lewy body, etc.), stroke, brain tumors and other cancers, TBI, and neuropsychiatric disorders.

Typical referral questions will include assistance with differential diagnosis; measuring baseline functioning; individualized treatment planning; information about capacity; counseling for both patients and their families; neurocognitive surveillance and others. The fellow’s responsibilities will include review of patient records and referral information to prepare an appropriate test battery; testing of the patient and selecting appropriate normative data for scoring and interpretation; report writing, including differential diagnosis; feedback to patient and family members. There may also be opportunities to provide supervised supervision to trainees/psychometrists in test administration and/or report writing. Opportunities when seeing oncology patients include attendance of Tuesday noon brain tumor board at Mischer Neuroscience Institute and program development. Following the completion of the rotation, the fellow is expected to be able to function in an assessment and consultation capacity with outpatients with minimal supervision.

Required Major Rotation (six-month duration) Location(s): TIRR Outpatient Kirby-Glenn Supervisor(s): Kirstine Carter Ph.D., ABPP-CN, Jerome Caroselli, Ph.D.

This rotation takes place in one of our outpatient facilities and will provide the fellow with experience working with patients who are in the post-acute phase of recovery, and are transitioning back to community life. The fellow will be involved in a variety of activities including completing neuropsychological screenings, completing comprehensive outpatient neuropsychological evaluations, running educational and psychotherapeutic groups, individual cognitive rehabilitation intervention, attending multidisciplinary rounds, providing individual psychotherapy to aid with adjustment, assist with school/work transition planning and implementation, and provide family education. The rotation is designed to equip the fellow with the skills required to function relatively independently within a comprehensive interdisciplinary post-acute rehabilitation setting.

Optional Major or Minor Rotation (three or six-month duration) Location(s): TIRR TMC – Specialty Rehab Program Supervisor(s): Danielle Blinstrubas, Ph.D., ABPP-RP

This rotation will expose the fellow to rehabilitation of patients who have suffered from a variety of conditions requiring medical intervention and rehabilitation. The fellow can expect exposure to a wide variety of patient populations during this rotation. Patients on the specialty rehabilitation service include individuals with amputations, orthopedic interventions (i.e. hip replacements, spinal surgery, etc.), as well as patients suffering from various neurological conditions such as Guillain-Barré syndrome (GBS), Multiple Sclerosis (MS), Chronic inflammatory demyelinating polyneuropathy. The fellow will be expected to perform psychological and neuropsychological screenings (as indicated), provide family education and support, as well as provide supportive psychotherapy to aid with adjustment.

This rotation may be taken in combination with Inpatient Neuropsychology to fulfill the six-month inpatient Texas Medical Center rotation requirement.

Optional Major or Minor Rotation (three or six-month duration) Location(s): TIRR TMC – Spinal Cord Injury Program Supervisor(s): Jacob Williams, Ph.D. & Nausheen Noor, Ph.D.

This rotation will expose the fellow to rehabilitation of patients who have suffered from spinal cord injuries requiring medical intervention and rehabilitation. The fellow can expect exposure to a wide variety of patient populations during this rotation. Patients on the spinal cord injury service are quite varied and include traumatic injuries, orthopedic interventions (i.e. spinal surgery, etc.), as well as patients suffering from various neurological conditions such as Guillain-Barré syndrome (GBS), Amyotrophic Lateral Sclerosis (ALS), and transverse myelitis. The fellow will be expected to perform psychological and neuropsychological screenings (as indicated), provide family education and support, supportive psychotherapy to aid with adjustment, as well as targeted interventions for various conditions that may impede progress in rehab (e.g. pain, sleep, anxiety, and depression). Fellows will be expected to collaborate with other team members in the context of a multi-disciplinary approach. Attendance of team rounds and family conferences is strongly encouraged. Supervision will be provided by staff Clinical Psychologists. Other opportunities may include tiered supervision of a graduate practicum student and program development.

If this rotation is chosen as a minor, it must be paired with a required Inpatient Neuropsychology Major Rotation.

Optional Major or Minor Rotation (six-month duration) Location(s): TIRR TMC Inpatient Supervisor(s): Katherine O’Brien, Ph.D.,

As one of the very few DOC programs in the country, the DOC Program at TIRR provides fellows with a unique experience to interact with a population that is not always provided the opportunity for care from a Neuropsychologist or acute rehabilitation team.

The DOC program accepts patients who are estimated to be either in a vegetative or minimally conscious state based on a pre-admission screen. Most common etiologies of injury include TBI and anoxic/hypoxic injuries. Our standard tools of assessment and intervention are modified significantly to match the needs of the patients and families. Clinicians within the DOC service utilize creative problem solving and are often thinking “outside the box.” Education and support to the family are critically important and is ongoing throughout the admission. We encourage and expect families to be highly involved and to provide their input and observations- they know the patient best.

The role of Neuropsychology in the DOC program is four-fold: 1) assessment of level of consciousness, command following, other areas of cognition, and mood, 2) education to family (and patient if appropriate), 3) development of communication system alongside SLP and other disciplines, 4) supportive counseling to family. All members of the DOC team work together closely to maximize the accuracy of observations regarding level of consciousness for the patient. The service also includes the possibility for experience in program development, and/or research opportunities. Specific responsibilities of the fellow will include: a) educating family on general principles of disorders of consciousness, as well as diagnostic signs and prognostic indicators; b) weekly CRS-R with OT and documentation; c) assuring continuity of interpretation of CRS-R and other behavioral data across disciplines; d) developing and analyzing IQBA, behavioral checklist, ECAB, etc.; e) observation of patients in therapy at least 1x/wk to understand patient presentation with other clinicians, in varying positions, and during different times of day, etc.; f) attending weekly rounds and at least one family rounds; g) scheduling medication trials and ensuring close observation of patient status; h) attending DOC journal club.

If this rotation is chosen as a minor, it must be paired with a required Inpatient Neuropsychology Major Rotation.

Optional Major or Minor (six-month duration) Location(s): TIRR TMC – Outpatient Clinic; TIRR West University Supervisor(s): Cullen Gibbs, Ph.D., Ana Arenivas, Ph.D., MPH

This rotation will provide the fellow with the opportunity to evaluate children and adolescents within a community-based setting. The number of evaluations completed per week will depend on whether this experience is chosen as a major or minor rotation. For each patient, the fellow will plan an appropriate test battery, complete the background interview with the patient’s parent/caregiver, test the patient, prepare the report, and participate in the feedback session. Patients evaluated within the pediatric service present with a variety of neurodevelopmental (e.g., ADHD, learning disabilities, autism) and medical (e.g., TBI, epilepsy) conditions. Ages seen range from infancy to young adulthood (typically between 3 and 20 years old). Within this rotation, the fellow may have opportunities to assist pediatric speech/language, occupational, or physical therapists with treatment sessions. Other opportunities may include participation in multidisciplinary return-to-school rounds meetings and/or participation in cognitive rehabilitation with pediatric patients.

Optional Minor (six-month duration) Location(s): Baylor Neurology Clinic TMC Supervisor(s): Michelle York, Ph.D. ABPP-CN; Adriana Macias Strutt, Ph.D. ABPP-CN; Stephen R McCauley, Ph.D., Jennifer Stinson, Ph.D., ABPP-CN

This outpatient neurology rotation will provide the fellow with experience conducting comprehensive neuropsychological evaluations of patients with varied neurological disorders including movement disorders (opportunities for DBS evaluations may be available), MCI, dementias, Parkinson-Plus Syndromes, Epilepsy, Huntington’s Disease, and many others. While on this minor rotation, the fellow would be expected to complete one outpatient evaluation per week (including testing, scoring and preparation of the comprehensive report within a reasonable timeframe). Additional opportunities, including multidisciplinary case review meetings for DBS eligibility and observation of neurosurgery may be available. This rotation would provide the fellow with additional skills in conceptualization, differential diagnosis, and consultation to neurology physicians within the outpatient setting

Optional Minor (six-month duration) Location(s): MD Anderson – TMC Supervisor(s): Mariana Bradshaw, Ph.D., ABPP-CN; Jennie Rexer Ph.D., ABPP-CN; Jeffrey Wefel, Ph.D., ABPP-CN; Kyle Noll, Ph.D.

This outpatient minor rotation is housed within the Division of Neuropsychology in the Neuro-Oncology Department at UT MD Anderson Cancer Center – top ranking tertiary cancer center. Patients served are drawn from a broad variety of oncology populations, including those with primary brain tumor, concerns of cancer and cancer-treatment related neurocognitive changes, as well as comorbidity of MCI, dementias and other neurologic disorders in the context of a cancer diagnosis. The fellow will be expected to complete one neuropsychological evaluation per week, but may also take advantage of additional opportunities to be involved in clinical research and hospital-specific didactics. This rotation is designed to help broaden the fellow’s oncology-specific experiences within the outpatient setting.

Optional Minor (six-month duration) Location(s): TCH – TMC Supervisor(s): TBA

This rotation structure is under construction. The rotation will feature experience on a pediatric inpatient rehab unit, including patients in a variety of age ranges and some pediatric minimally conscious patients. There are opportunities for program development. Additional details will be shared as they become available.

Optional Minor (six-month duration) Location(s): Center for Clinical Neurosciences – Texas Medical Center Supervisor(s): Joshua Breier, Ph.D.

This outpatient rotation is designed to provide specialized experience in the evaluation of patients with epilepsy and related diseases, including presurgical evaluations and in consultation to physicians regarding surgical approaches. The fellow's responsibilities include conducting a clinical interview of patient and family, administering a battery, test scoring and interpretation, and preparation of a comprehensive neuropsychological report in a timely manner. Additional opportunities for intraoperative mapping may be available to interested fellows.

Optional Minor (six-month duration) Location(s): Vary Supervisor(s): Mark Sherer, Ph.D., ABPP-CN; Angelle Sander, Ph.D.; additional supervisors may be identified to best suit the fellow’s interests and experience.

This minor rotation provides an opportunity to obtain additional mentoring in data cleaning, analysis, and preparation of scholarly presentations and/or manuscripts for submission. Opportunities for grant writing may also be available to the advanced fellow.

It is expected that fellows completing this rotation will produce a poster, presentation or will submit a paper for publication on a topic relevant to their focus of study prior to the end of the fellowship. Funding may be available to help defray the costs of conference registration and lodging.