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Expert Involved in Treating Traumatic Brain Injury

Author / Coordinator: Schwebel, Goetz & Sieben
Minnesota
March 2007

Neurologist
Physiatrist
Neuropsychologist
Respiratory or pulmonary therapists
Physical therapist
Occupational therapist
Speech pathologist
Cognitive therapist
Vocational rehabilitation counselor
Educational therapist
Social worker
Therapeutic recreational specialist
Rehabilitation case manager
Pediatric neurologist
Neurologist

 

Neurologist

What is a neurologist?

A neurologist is a medical doctor with specialized training in diagnosing, treating, and managing disorders of the brain and nervous system. Pediatric neurologists are doctors with specialized training in children’s neurological disorders.
A neurologist’s educational background and medical training includes an undergraduate degree, four years of medical school, a one-year internship and three years of specialized training. Many neurologists also have additional training in one area of neurology such as stroke, epilepsy, or movement disorders.

What is the role of a neurologist?

Neurologists are principal care providers or consultants to other physicians. When a patient has a neurological disorder that requires frequent care, a neurologist is often the principal care provider. Patients with disorders such as Parkinson’s disease, Alzheimer’s disease, or multiple sclerosis may use a neurologist as their principal care physician. In a consulting role, a neurologist will diagnose and treat a neurological disorder and then advise the primary care physician managing the patient’s overall health. For example, a neurologist would act in a consulting role for conditions such as stroke, concussion, or headache.

Neurologists can recommend surgical treatment, but do not perform surgery. When treatment includes surgery, neurologists will monitor surgically treated patients and supervise their continuing treatment. Neurosurgeons are medical doctors who specialize in performing surgical treatments of the brain or nervous system.

What does a neurologist treat?

Neurologists treat disorders of the nervous system, brain, spinal cord, nerves, muscles, and pain. Common neurological disorders include:

Stroke Alzheimer’s Disease
Headache
Epilepsy
Parkinson’s Disease
Sleep Disorders
Multiple Sclerosis
Pain
Tremor Brain and Spinal Cord Injuries
Brain Tumors
Peripheral
Nerve Disorders
Amyotrophic Lateral Sclerois

How are neurological disorders treated?

Many disorders can be treated. Treatment or symptomatic relief is different for each condition. To find treatment options, neurologists will perform and interpret tests of the brain or nervous system. Treatment can help patients with neurological disorders maintain the best possible quality of life.

What is a neurological examination?

During a neurological examination, the neurologist reviews the patient’s health history with special attention to the current condition. The patient then takes a neurological exam. Typically, the exam tests vision, strength, coordination, reflexes, and sensation. This information helps the neurologist determine if the problem is in the nervous system. Further tests may be needed to confirm a diagnosis or to find a specific treatment.

Why do patients need a neurological examination?

An examination is used when a family doctor seeks a specialized opinion about a patient whose symptoms may involve the brain or nervous system. The examination may also be performed when a patient wants a second opinion from a neurologist. The neurologist’s expertise in disorders of the brain and nervous system can give patients a diagnosis and treatment for neurological disorders.

Physiatrist

What is a Physiatrist?

A physiatrist, pronounced fizz ee AT trist, is a physician specializing in physical medicine and rehabilitation. As the population of America ages, as people survive conditions that once would have been fatal, and as quality of life is an increas-ing concern, the field of physiatry is moving to the fore-front of medicine.The specialty serves all age groups and treats problems that touch upon all the major systems in the body.

How did the specialty develop?

The field of physical medicine and rehabilitation (PM&R) began in the 1930s to address musculoskeletal and neurological problems, but broadened its scope considerably after World War II. As thousands of veterans came back to the United States with serious disabilities, the task of helping to restore them to productive lives became a new direction for the field. The Advisory Board of Medical Specialties granted PM&R its approval as a specialty of medicine in 1947.

What types of conditions does a physiatrist treat?

Physiatrists are physicians who treat a wide range of problems from sore shoulders to spinal cord injuries. The focus of the specialty is on restoring function to people. Physiatrists treat acute and chronic pain and musculoskeletal disorders. They may see a person who lifts a heavy object at work and experiences back pain, a basketball player who sprains an ankle and needs rehabilitation to play again, or a knitter who has carpal tunnel syndrome. Physiatrists’ patients also include people with arthritis, tendonitis, any kind of back pain, and work- and sports-related injuries.

Physiatrists treat very serious disorders of the musculoskeletal system that result in severe functional limitations as well. They would treat a baby with a birth defect, someone in a bad car accident, or an elderly person with a broken hip. Physiatrists also treat people with spinal cord injuries, brain injuries, strokes, amputations, cancer, and multiple sclerosis.

All require a long-term rehabilitation process.

What is the physiatrist’s role in treatment?

A physiatrist may treat patients directly, lead an interdisciplinary team, or act as a consultant. Here are some scenarios that illustrate the varied roles of a physiatrist:

· A carpenter is lifting some heavy wood when he feels pain in his lower back and down his leg. He sees a physiatrist who does a thorough history and physical examination and performs all the testing needed to make the diagnosis: a herniated disc. The physiatrist develops an appropriate treatment program, monitoring and adjusting it as needed. With this treatment and rehabilitation program, the patient does not need surgery.

· A woman in a diving accident has a spinal cord injury and is paralyzed below the waist. The physiatrist assesses her injury and with the patient and a team of health care professionals determines the course of her rehabilitation. The physiatrist treats the array of medical issues that occur as the result of a spinal cord injury, and also leads the interdisciplinary team to enable the woman to reach the highest level of functioning possible. The team varies in composition depending on the needs of the patient. In addition to other physicians, the team may include health care professionals such as nurses, physical therapists, occupational therapists, social workers, neuropsychologists, and vocational counselors.

· A baby is born with cerebral palsy. The physiatrist is called in as the expert who advises on the correct treatment and rehabilitation that can affect the rest of the child’s life.

How do physiatrists diagnose?

Physiatrists’ diagnostic tools are the same as those used by other physicians, with the addition of special techniques in electrodiagnostic medicine like electromyography (EMG), nerve conduction studies, and somatosensory evoked potentials. These techniques help the physiatrist to diagnose conditions that cause pain, weakness, and numbness.

What kinds of treatments do physiatrists offer?

Physiatrists offer a broad spectrum of medical services. They do not perform surgery. Physiatrists may prescribe drugs or assistive devices, such as a brace or artificial limb. They also use diverse therapies such as heat and cold, electrotherapies, massage, biofeedback, traction, and therapeutic exercise.

Where do physiatrists practice?

Physiatrists practice in rehabilitation centers, hospitals, and in private offices. They often have broad practices, but some concentrate on one area such as pediatrics, sports medicine, geriatric medicine, brain injury, and many other special interests.

What kinds of differences do physiatrists make?

Because it is the concern of physiatrists to restore patients to maximum function, the difference they make can be dramatic. In the case of the herniated disc, the physiatrist not only takes care of the acute problem, but also treats the patient until he returns to optimal functioning, usually without surgery. The physiatrist also teaches the patient how to prevent the injury in the future.

Another example is that of a broken hip in the elderly. Physiatrists can provide aggressive rehabilitation so patients can walk and even exercise again.

And because the physiatrist is concerned with all areas of rehabilitation–social, vocational, and medical–the quality of life is significantly increased for patients.

Neuropsychologist

What is a Neuropsychologist?

A Clinical Neuropsychologist is a professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system. The Clinical Neuropsychologist is a doctoral-level psychology provider of diagnostic and intervention services who has demonstrated competence in the application of such principles for human welfare following:

“…a professional psychologist who applies principles of assessment and intervention based upon the scientific study of human behavior as it relates to normal and abnormal functioning of the central nervous system.” A Neuropsychologist has a doctorate in Psychology from an accredited university and has completed postdoctoral supervised training in Neuropsychology. Their background is in assessment and treatment of emotional disorders, behavioral disorders, chronic pain, and neurological disorders. Neuropsychologists specialize in the assessment and treatment of disorders, which affect cognition, memory, and attention/concentration.”

What does a Neuropsychology treat?

§ Traumatic brain injury

§ Birth trauma or neurological problems in development such as Cerebral Palsy, Hydrocephalus, Difficult Birth, and Down’s Syndrome

§ Early illnesses or injuries (Meningitis, for example)

§ Learning problems

§ Attention Deficit Hyperactivity Disorder (ADHD)

§ Chronic Fatigue Syndrome

§ Multiple Sclerosis

§ Parkinson’s

§ Unidentified neurologically based problems

When is a Neuropsychological Evaluation indicated?

Neuropsychological examinations are clinically indicated and medically necessary when patients display signs and symptoms of intellectual compromise, cognitive and/or neurobehavioral dysfunction that involve, but are not restricted to, memory deficits, language disorders, learning disabilities, developmental disabilities, pervasive developmental disorders, impairment of organization and planning, difficulty with cognition, and perceptual abnormalities. Frequent etiologies include: head trauma, stroke, tumor, infectious disease, toxic exposure, metabolic abnormalities, autoimmune disease, genetic defects, prenatal/perinatal/neonatal complications, and neurodegenerative disease.

What can you expect from a Neuropsychological Evaluation?

A neuropsychological evaluation provides information on the following:

• Short- and long-term predictions regarding cognition and psychological issues

• Current level of cognitive and emotional functioning and potential for change

• Recommendations for neuropsychological treatment if necessary

• Likelihood of being able to fulfill essential job requirements from a cognitive and emotional perspective

• Documentation of symptom validity through objective measures (evaluation for malingering)

• Treatment plan that summarizes the problems and the treatment options available

• Description of the prognosis

How does Neuropsychology differ from Psychology?

Clinical Psychologists specialize in the assessment of patients with “psychological problems” such as anxiety depression, marital problems, child custody, and stress related disorders. They treat problems typically caused by losses, divorces, work pressures, unrealistic expectations, and demands of everyday living. Neuropsychologists understand the relationship between neurological and psychological disorders. Their background gives greater appreciation and understanding of influence of extraneous factors such as medications, fatigue, medical diseases, and medical effects on psychological functioning.

How does Neuropsychology differ from Psychiatry?

Psychiatrists have a medical degree and have completed a residency in psychiatry.

They are concerned with diagnosis and treatment of emotional disorders.

Psychiatrists do not administer psychological or neuropsychological tests, as they are not qualified to interpret or score these tests. Even though the psychiatrist is a medical doctor, the neuropsychologist’s examination is usually more sensitive to underlying neurological or medical aspects of an individual’s complaints and symptoms.

How does Neuropsychology differ from Neurology?

A neurologist is a medical school graduate with a 3-year residency in neurology. Neurologists are concerned with diagnosis and treatment of neurological disorders.

Respiratory therapy

What is a Respiratory Therapist?

Respiratory therapy is used in the diagnosis, treatment, management, and care of patient’s cardiopulmonary problems. Increasing numbers of persons suffering from respiratory diseases need complex treatment and rehabilitation, creating a need for specialists to assist doctors and nurses. As a result, Respiratory therapy (also known as respiratory care practitioners), have become an essential part of the health team.

Respiratory Therapists work under the direction of physicians and follow their prescriptions for treating patients. Their duties range from giving temporary relief to persons with asthma, pulmonary edema, or emphysema to giving emergency care for asphyxiation, heart failure, stroke, drowning, or shock. Respiratory Therapists are among the first persons called to work with doctors and other specialists to give treatments for acute respiratory conditions, head injuries, and drug poisoning. Therapists’ duties can also include treating gangrene, carbon monoxide poisoning, tetanus, and the respiratory care of newborn infants.

Respiratory therapists are healthcare professionals who assist physicians with the diagnosis and treatment of lung disorders. Their duties include:

· Maintaining an open airway for trauma, intensive care, and surgery patients

· Assisting in cardiopulmonary resuscitation and support

· Providing life support for patients who can’t breathe on their own

· Assisting in high risk births

· Stabilizing high risk patients being moved by air or ground ambulance

· Assisting anesthesiologists in the operating room

· Administering inhaled drugs and medical gases such as asthma medication and oxygen · Conducting tests to measure lung function

· Teaching people to manage their asthma or to quit smoking

· Providing in-home respiratory care to adults and children with chronic lung disease

Most respiratory therapists work in hospitals. You’ll find them in neonatal nurseries, operating rooms, intensive care units, general wards, and emergency departments.

Respiratory therapists also work in the community, bringing their expertise to:

· Home care

· Asthma, emphysema, cystic fibrosis and other clinics

· Teaching

· Research

· Rehabilitation

· Diagnostic clinics and sleep disorder labs

· Hyper baric Oxygen Treatment

· Medical equipment sales and service

They need good judgment, excellent interpersonal skills, and the ability to maintain composure in critical medical situations.

Physical Therapist

What is a physical therapist?

The physical therapist performs services directed at preventing the onset and/or decreasing the development of conditions resulting from injury and disease. The physical therapist provides these services to people who have functional conditions resulting from musculoskeletal injuries such as sprains/strains and fractures. They also provide treatment for more serious conditions such as burns, arthritis, amputations, stroke, vertigo and multiple sclerosis.

What does a physical therapist do?

A physical therapist is a professional healthcare provider who tries to meet an individual’s health needs and wants via communication with other healthcare specialists and the use of exercise, education, and various therapeutic modalities. This can include anything from teaching patients to walk again after an injury, or helping an athlete to improve his speed, strength, or agility on the playing field.

Physical therapists perform many different functions in order to optimize a patient’s recovery. For those patients with health problems resulting from injury or disease, the physical therapist assists in the rehabilitation process to reduce the patient’s pain, and increase the patient’s strength, endurance, and stability. In addition to treatments given in the office the physical therapist must also work hand in hand with the patient to help develop a personal home therapy program for when they are no longer in the therapists care. This is done to ensure that the healing process continues and that there is no future reoccurrence of the treated condition. One of the more significant functions of a physical therapist is to aid patients in improving their ability to perform activities of daily living. This may include but is not limited to patient’s dressing themselves, eating, cooking, or taking care of their personal hygiene. Physical therapists also play a large role in injury prevention. Through education, physical therapists can help people become fit and teach them how to avoid injuring themselves either at work or at play.

Therapy Examples:

· PHYSICAL THERAPY ASSISTIVE DEVICES

· HOME EXERCISE PROGRAMS (HEP)

· BALANCE / COORDINATION TRAINING

· SPINE CLINIC

· PROSTHETIC AND ORTHOTIC TRAINING

· WHIRLPOOL

· THERAPEUTIC EXERCISE

· REHABILITATION THERAPY PROGRAMS FOR POST SURGICAL / ACCIDENT / FRACTURE PATIENTS

· TRACTION

· PARAFFIN BATH

· MODALITIES

· ULTRASOUND

· INTERMITTENT COMPRESSION PUMPS

· ELECTRICAL STIMULATION

· TENS UNITS

· MYOFASCIAL RELEASE

Where does a physical therapist work?

Physical therapists work in a variety of healthcare settings. This can include but is not limited to private physical therapy offices, hospitals, nursing homes, sport teams and organizations, community healthcare centers, rehabilitation centers, home health agencies, colleges, industrial or corporate health centers, research institutions, and pediatric centers.

What level of education does a physical therapist have?

Most physical therapists currently have either a Bachelor’s or Master’s degree. However, the trend seems to be headed towards the Doctorate in Physical Therapy (DPT). Over the last several years, new DPT programs have developed, and many established programs have made the transition to the Doctorate level. All physical therapy schools must be accredited, and all physical therapists must pass a state licensure exam once their education is completed.

Occupational Therapy

What is an occupational therapist?

Occupational Therapy helps people improve their ability to perform tasks in their daily living and working environments. They work with individuals who have conditions that are mentally, physically, developmentally, or emotionally disabling. They also help them to develop, recover, or maintain daily living and work skills. Occupational therapy practitioners not only help clients improve basic motor functions and reasoning abilities, but also compensate for permanent loss of function. Their goal is to help clients have independent, productive, and satisfying lives.

What do occupational therapists do?

The practice of occupational therapy by an occupational therapist or occupational therapy assistant includes, but is not limited to, intervention directed toward:

(1) assessment and evaluation, including the use of skilled observation or the administration and interpretation of standardized or nonstandardized tests and measurements, to identify areas for occupational therapy services;

(2) providing for the development of sensory integrative, neuromuscular, or motor components of performance;

(3) providing for the development of emotional, motivational, cognitive, or psychosocial components of performance;

(4) developing daily living skills;

(5) developing feeding and swallowing skills;

(6) developing play skills and leisure capacities;

(7) enhancing educational performance skills;

(8) enhancing functional performance and work readiness through exercise, range of motion, and use of ergonomic principles;

(9) designing, fabricating, or applying rehabilitative technology, such as selected orthotic and prosthetic devices, and providing training in the functional use of these devices;

(10) designing, fabricating, or adapting assistive technology and providing training in the functional use of assistive devices;

(11) adapting environments using assistive technology such as environmental controls, wheelchair modifications, and positioning;

(12) employing physical agent modalities, in preparation for or as an adjunct to purposeful activity, within the same treatment session or to meet established functional occupational therapy goals, consistent with the requirements of section 148.6440; and

(13) promoting health and wellness.

Where do Occupational Therapists work?

In these areas:

– Physical Rehabilitation

– Mental Health Services

– Learning Disability

– Primary Care

– Pediatrics

– Environmental Adaptation

– Care Management

– Equipment for Daily Living

– Research Posts

In these places:

– Community centers

– Education establishments

– GP Practices / Primary Care

– Hospitals

– Housing associations

– Clients homes

– Industrial and Commercial organizations

– Prisons

– Residential and Nursing homes

– Social Services and Council Departments

– Schools

– Charities and Voluntary agencies

Speech-language pathologist

What is a Speech-Language Pathologist?

A Speech-Language pathologist is a professional educated in the study of human communication, its development, and its disorders. By evaluating the speech and language skills of children and adults, the speech-language pathologist determines if communication problems exist and decides the best way to treat these problems. Where Can You Find

Speech-Language Pathology and Audiology Services?

Speech-Language Pathologists and Audiologists provide professional services in many different types of facilities such as:

· Public and private schools

· Hospitals

· Rehabilitation centers

· Nursing care facilities

· Community clinics

· Colleges and universities

· Private practice

· State and local health departments

· State and federal governmental agencies

A speech-language pathologist or audiologist will have a master’s or doctoral degree and should hold a Certificate of Clinical Competence (CCC) from the American Speech-Language-Hearing Association and/or license from the state.

Speech-Language Disorders

Speech-Language Disorders might be present when a person’s speech or language is different from that of others of the same age, sex, or ethnic group; when a person’s speech and/or language is hard to understand; when a person is overly concerned about his or her own speech; or when a person frequently avoids communicating with others.

Are Communication Disorders Serious Problems?

Yes. The ability to communicate is our most human characteristic. Human communication is essential to learning, working, and social interaction. Impaired communication can affect every aspect of a person’s life.

Common Communication Disorders

Language

Delayed Language: a noticeable slowness in the development of the vocabulary and grammar necessary for expressing and understanding thoughts and ideas.

Aphasia: the loss of speech and language abilities resulting from stroke or head injury.

Speech Disorders

Stuttering: an interruption in the rhythm of speech characterized by hesitations, repetitions, or prolongation of sounds, syllables, words, or phrases, for example, cow…boy, tuh-tuh-tuh-table, sssun.

Articulation Disorders

Difficulties with the way sounds are formed and strung together usually characterized by substituting one sound for another (wabbit for rabbit), omitting a sound (han for hand), or distorting a sound (shlip for sip).

Voice Disorders

Inappropriate pitch (too high, too low, never changing or interrupted by breaks); loudness (too loud, or not loud enough); quality (harsh, hoarse, breathy, or nasal).

What Causes Communication Disorders?

Some of the causes of speech and language disorders are related to hearing loss, cerebral palsy and other nerve/muscle disorders, severe head injury, stroke, viral diseases, mental retardation, certain drugs, physical impairments such as cleft lip or palate, vocal abuse or misuse, an inadequate speech and language models; frequency, however, the cause is unknown.

What Can You Do If You Suspect a Speech or Language Problem?

A thorough evaluation by a speech-language pathologist or audiologist is needed to determine a person’s communication strengths and weaknesses. After this evaluation, the speech-language pathologist or audiologist will be able to provide a plan for meeting individual needs.

Cognitive Therapy

What is cognitive therapy?

Cognitive therapy is one of the few forms of psychotherapy that has been scientifically tested and found to be effective in over three hundred clinical trials for many different disorders. In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more time-limited, and more problem solving oriented. Indeed, much of what the patient does is solve current problems. In addition, patients learn specific skills that they can use for the rest of their lives. These skills involve identifying distorted thinking, modifying beliefs, relating to others in different ways, and changing behaviors.

What is the theory behind cognitive therapy?

Cognitive therapy is based on the cognitive model, which is, simply that the way we perceive situations influences how we feel emotionally. For example, one person reading this pamphlet might think, "Wow! This sounds good, it’s just what I’ve always been looking for!" and feels happy. Another person reading this information might think, "Well, this sounds good but I don’t think I can do it." This person feels sad and discouraged. So it is not a situation, which directly affects how a person feels emotionally, but rather, his or her thoughts in that situation. When people are in distress, they often do not think clearly and their thoughts are distorted in some way. Cognitive therapy helps people to identify their distressing thoughts and to evaluate how realistic the thoughts are. Then they learn to change their distorted thinking. When they think more realistically, they feel better. The emphasis is also consistently on solving problems and initiating behavioral change.

What is cognitive therapy useful for?

Until relatively recently – the last decade perhaps – the answer would have been short and simple: phobias, obsessive-compulsive disorder, agoraphobia, sexual problems and depression. Since then there has been an explosive development, with new results appearing almost monthly. So now anorexia nervosa, panic attacks, chronic pain, chronic fatigue, post-traumatic stress disorder, anger and impulsiveness, stage fright, traumatic brain injury… all these and more would count CBT as the treatment of choice. and many other problems (including schizophrenia) can be seriously improved with the help of CBT.

What happens during a typical therapy session?

Even before your therapy session begins, your therapist may have you fill out certain forms to assess your mood. Depression, Anxiety and Hopelessness Inventories help give you and the therapist an objective way of assessing your progress. One of the first things your therapist will do in the therapy session is to determine how you’ve been feeling this week, compared to other weeks. This is what we call a mood check. The therapist will ask you what problem you’d like to put on the agenda for that session and what happened during the previous week that was important. Then the therapist will make a bridge between the previous therapy session and this week’s therapy session by asking you what seemed important that you discussed during the past session, what self-help assignments you were able to do during the week, and whether there is anything about the therapy that you would like to see changed.

Next, you and the therapist will discuss the problem or problems you put on the agenda and do a combination of problem solving and assessing the accuracy of your thoughts and beliefs in that problematic situation. You will also learn new skills. You and the therapist will discuss how you can make best use of what you’ve learned during the session in the coming week and the therapist will summarize the important points of the session and ask you for feedback: what was helpful about the session, what was not, anything that bothered you, anything the therapist didn’t get right, anything you’d like to see changed. As you will see, both therapist and patient are quite active in this form of treatment.

Vocational Rehabilitation Counselor

What is vocational rehabilitation counseling?

Vocational Rehabilitation (VR) is a Federal/State-funded program providing services to help individuals with disabilities enter or return to employment. It is designed to help individuals of work age with disabling physical and/or mental disabilities compete successfully with others in earning a livelihood. Vocational Rehabilitation programs take an active leadership role in advocating for the rights of individuals with disabilities, removing the physical and attitudinal barriers which often confront them, and publicizing their abilities and accomplishments to society at large.

What does a vocational rehabilitation counselor do?

1.Providing information to clients about the job market, the skills and experience necessary to obtain and work successfully at a particular job, and the types of stressors associated with different jobs.

2.Assisting clients to develop a realistic view of their skills, abilities, and limitations

3.Teaching clients basic problem solving and coping skills

4.Helping clients develop or maintain motivation for vocational services and employment

5.Aiding clients in obtaining educational services, skills training, or the necessary entitlements to obtain education and training (case management)

What level of education does a vocational rehabilitation counselor have?

Most vocational rehabilitation counseling currently have either a Bachelor’s or Master’s degree. Over the last several years, new vocational rehabilitation programs have developed, and many established programs have made the transition to the Doctorate level. All vocational rehabilitation schools must be accredited, and all vocational rehabilitation counselors must pass a state licensure exam once their education is completed.

Educational Therapist

What is Educational Therapy?

Educational Therapy offers children and adults with learning disabilities and other learning challenges a wide range of intensive, individualized interventions designed to remediate learning problems.

Educational therapy demystifies learning problems and stimulates clients’ awareness of their strengths so they can use those strengths to best advantage to overcome or compensate for areas of weakness.

Educational therapists create and implement a treatment plan that utilizes information from a variety of sources including the client’s social, emotional, psychoeducational, and neuropsychological context.

Definition of the Educational Therapist

An educational therapist is a professional who combines educational and therapeutic approaches for evaluation, remediation, case management, and communication/advocacy on behalf of children, adolescents and adults with learning disabilities or learning problems.

Qualifications and Training Backgrounds of Educational Therapists

Educational therapists generally begin their professional careers in one or more of the areas listed below:

Regular Education

Special Education

Child Development

Speech and Language

Psychological Counseling

Marriage and Family Counseling

Advocacy

Regardless of previous background, all Professional members of the Association of Educational Therapists (AET) have met rigorous professional requirements in the academic areas of elementary and/or secondary education, child development, educational assessment, learning theory, learning disabilities, and principles of educational therapy. All members have a B.A. degree and are required to hold a Masters Degree or equivalent in post-BA course work. They have completed at least 1500 supervised direct service hours, and are required to complete 40 clock hours of Continuing Education every two years. To become a Board Certified Educational Therapist (BCET)®, a member must meet the following additional requirements: Masters Degree (required); one year membership in AET at the Professional level; 1000 hours of professional practice; formal written Case Study evaluated and passed by the AET Certification Board; a written examination that demonstrates professional expertise in educational therapy.

Where does Educational Therapy work?

Private Practice

Public and Private Schools

Learning Centers

Clinics

Hospitals

Public Agencies

Businesses and Workplaces

Community Colleges, Universities, Vocational Schools

Client Issues Addressed by Educational Therapists

Learning Disabilities, a generic term, which includes (but is not limited to):

Dyslexia

Non-Verbal Learning Disorder

Reading and Writing Difficulties

Math Disabilities

Attention Deficit Disorder

Other Less Common Conditions, such as Asperger’s Syndrome, Fragile X, and Tourette Syndrome, etc. Language Processing Problems

Visual Processing Problems

Poor Motivation

Low Academic Self-esteem

Poor Organizational and Study Skills

School and Test Anxiety

Poor Social Skills

School Placement and Retention

Social Workers

What is Social Worker?

Social work is a profession for those with a strong desire to help improve people’s lives. Social workers help people function the best way they can in their environment, deal with their relationships, and solve personal and family problems. Social workers often see clients who face a life-threatening disease or a social problem. These problems may include inadequate housing, unemployment, serious illness, disability, or substance abuse. Social workers also assist families that have serious domestic conflicts, including those involving child or spousal abuse.

Social workers often provide social services in health-related settings that now are governed by managed care organizations. To contain costs, these organizations are emphasizing short-term intervention, ambulatory and community-based care, and greater decentralization of services.

Most social workers specialize. Although some conduct research or are involved in planning or policy development, most social workers prefer an area of practice in which they interact with clients.

Child, family, and school social workers provide social services and assistance to improve the social and psychological functioning of children and their families and to maximize the family well-being and academic functioning of children. Some social workers assist single parents; arrange adoptions; and help find foster homes for neglected, abandoned, or abused children. In schools, they address such problems as teenage pregnancy, misbehavior, and truancy. They also advise teachers on how to cope with problem students.

Some social workers may specialize in services for senior citizens. They run support groups for family caregivers or for the adult children of aging parents. Some advise elderly people or family members about choices in areas such as housing, transportation, and long-term care; they also coordinate and monitor services. Through employee assistance programs, they may help workers cope with job-related pressures or with personal problems that affect the quality of their work. Child, family, and school social workers typically work in individual and family services agencies, schools, or State or local governments. These social workers may be known as child welfare social workers, family services social workers, child protective services social workers, occupational social workers, or gerontology social workers.

Medical and public health social workers provide persons, families, or vulnerable populations with the psychosocial support needed to cope with chronic, acute, or terminal illnesses, such as Alzheimer’s disease, cancer, or AIDS. They also advise family caregivers, counsel patients, and help plan for patients’ needs after discharge by arranging for at-home services—from meals-on-wheels to oxygen equipment. Some work on interdisciplinary teams that evaluate certain kinds of patients—geriatric or organ transplant patients, for example. Medical and public health social workers may work for hospitals, nursing and personal care facilities, individual and family services agencies, or local governments.

Mental health and substance abuse social workers assess and treat individuals with mental illness, or substance abuse problems, including abuse of alcohol, tobacco, or other drugs. Such services include individual and group therapy, outreach, crisis intervention, social rehabilitation, and training in skills of everyday living. They may also help plan for supportive services to ease patients’ return to the community. Mental health and substance abuse social workers are likely to work in hospitals, substance abuse treatment centers, individual and family services agencies, or local governments. These social workers may be known as clinical social workers. (Counselors and psychologists, who may provide similar services, are discussed elsewhere in the Handbook.)

Other types of social workers include social work planners and policymakers, who develop programs to address such issues as child abuse, homelessness, substance abuse, poverty, and violence. These workers research and analyze policies, programs, and regulations. They identify social problems and suggest legislative and other solutions. They may help raise funds or write grants to support these programs.

What level of education does a social worker have?

A bachelor’s degree in social work (BSW) degree is the most common minimum requirement to qualify for a job as a social worker; however, majors in psychology, sociology, and related fields may be adequate to qualify for some entry-level jobs, especially in small community agencies. Although a bachelor’s degree is sufficient for entry into the field, an advanced degree has become the standard for many positions. A master’s degree in social work (MSW) is typically required for positions in health settings and is required for clinical work. Some jobs in public and private agencies also may require an advanced degree, such as a master’s degree in social services policy or administration. Supervisory, administrative, and staff training positions usually require an advanced degree. College and university teaching positions and most research appointments normally require a doctorate in social work (DSW or Ph.D.).

Recreational Therapists

What is a recreational therapist?

Recreational therapists also referred to as therapeutic recreation specialists, provide treatment services and recreation activities to individuals with disabilities or illnesses. Using a variety of techniques, including arts and crafts, animals, sports, games, dance and movement, drama, music, and community outings, therapists treat and maintain the physical, mental, and emotional well being of their clients. Therapists help individuals reduce depression, stress, and anxiety; recover basic motor functioning and reasoning abilities; build confidence; and socialize effectively so that they can enjoy greater independence, as well as reduce or eliminate the effects of their illness or disability. In addition, therapists help integrate people with disabilities into the community by teaching them how to use community resources and recreational activities. Recreational therapists should not be confused with recreation and fitness workers, who organize recreational activities primarily for enjoyment. (Recreation and fitness workers are discussed elsewhere in the Handbook.)

In acute healthcare settings, such as hospitals and rehabilitation centers, recreational therapists treat and rehabilitate individuals with specific health conditions, usually in conjunction or collaboration with physicians, nurses, psychologists, social workers, and physical and occupational therapists. In long-term and residential care facilities, recreational therapists use leisure activities—especially structured group programs—to improve and maintain their clients’ general health and well-being. They also may provide interventions to prevent the client from suffering further medical problems and complications related to illnesses and disabilities.

Recreational therapists assess clients on the basis of information the therapists learn from standardized assessments, observations, medical records, the medical staff, the clients’ families, and the clients themselves. They then develop and carry out therapeutic interventions consistent with the clients’ needs and interests. For example, clients who are isolated from others or who have limited social skills may be encouraged to play games with others, and right-handed persons with right-side paralysis may be instructed in how to adapt to using their unaffected left side to throw a ball or swing a racket. Recreational therapists may instruct patients in relaxation techniques to reduce stress and tension, stretching and limbering exercises, proper body mechanics for participation in recreation activities, pacing and energy conservation techniques, and individual as well as team activities. In addition, therapists observe and document a patient’s participation, reactions, and progress.

Community-based recreational therapists may work in park and recreation departments, special-education programs for school districts, or programs for older adults and people with disabilities. Included in the last group are programs and facilities such as assisted-living, adult daycare, and substance abuse rehabilitation centers. In these programs, therapists use interventions to develop specific skills, while providing opportunities for exercise, mental stimulation, creativity, and fun. Although most therapists are employed in other areas, those who work in schools help counselors, teachers, and parents address the special needs of students, including easing disabled students’ transition into adult life.

What level of education does a therapeutic recreational specialist have?

A bachelor’s degree in therapeutic recreation, or in recreation with a concentration in therapeutic recreation, is the usual requirement for entry-level positions. A bachelor’s degree in recreational therapy; training in art, drama, or music therapy; or qualifying work experience may be sufficient for activity director positions in nursing homes.

What are the duties and responsibilities of recreational therapists?

Therapeutic Recreation Specialists, often referred to as recreational therapists, work with individuals who have mental, physical or emotional disabilities. Select activity modalities are utilized to treat or maintain the physical, mental and emotional well being of consumers served. These interventions help individuals remediate the effects of illness or disability and achieve an optimal level of personal independence. The goals of interventions include improving physical, cognitive and social functioning.

Recreational therapists work as members of an interdisciplinary team. Relevant information about the patient is gathered from client assessment, medical record, medical staff, and family members. Individual treatment plans and programs are developed consistent with client need, abilities and interests. For instance, a recreational therapist may utilize a recreational activity, such as fishing, to aid a patient with right side paralysis, learn to use the left side and thus continue a lifetime activity. In a psychiatric setting the recreational therapist may prescribe an assertiveness program to help the depressed patient achieve greater self-confidence and independence.

Rehabilitation case manager

What is a rehabilitation case manager?

A rehabilitation case manager is a trained professional who helps to plan, organize, coordinate, and monitor services and resources for a rehabilitation patient. Case managers usually do not provide actual, direct, patient care, but may work either as part of the rehabilitation team (internal case manager) or for the patient’s insurance company (external case manager). A case manager is responsible for ensuring quality and cost-effective healthcare services.

Case managers are often rehabilitation nurses or clinical social workers. They may practice in a variety of settings, including the following:

● hospitals

● inpatient rehabilitation centers

● outpatient rehabilitation centers

● home health settings

● insurance companies

● private practice

Case managers may choose to become certified in their specialty.

Pediatric neurologist

What does a pediatric neurologist do?

Pediatric Neurologists are involved in the diagnosis and treatment of children with disorders of the nervous system. These problems may include headache, seizures, epilepsy, brain injury, movement disorders, cerebral palsy, and disorders of nerve and muscle to name only a few. Pediatric Neurologist use diagnostic tests such as electroencephalograms (EEGs) and brain imaging tests like MRI to help make a diagnosis. Neurologist do not however do surgery

What is a child neurologist (also known as a pediatric neurologist) and what does he or she do?

A child neurologist is a medical doctor who takes care of children with health questions or problems related to their brains, spinal cords (the bundles of nerves that stretch from your brain most of the way down your back), nerves, and muscles. To become a child neurologist, a person has to graduate from college, graduate from medical school, be a doctor-in-training in pediatrics (kid’s medicine) for 2 or 3 years, and then be a doctor-in-training in neurology for 3 additional years (1 year of adult neurology and 2 years of pediatric neurology).

A pediatrician or family doctor often asks for help from a child neurologist when he or she wonders if or thinks that a patient’s symptoms are related to a brain, spinal cord, nerve, or muscle problem. Many of these problems are not medically serious. Others are, but can be treated if found early. The important thing is that your pediatrician or family doctor will work together with your child neurologist to help your whole family understand, treat, and cope with the child’s condition.

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