Mild Traumatic Brain Injury: Challenges and Controversies in Diagnosis - Program Agenda
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Program Agenda
7:30 – 8:30 Registration and Continental Breakfast
8:30 – 8:45 Welcoming Remarks
Paul Comper, PhD, Cpsych
Clinical Neuropsychologist, Toronto Rehabilitation Institute; Co-Director University of Toronto Concussion Clinic
8:45 – 9:45 The Major in the Mild: Emotional, Cognitive and Behavioural Problems after Mild Traumatic Brain Injury
Abe Snaiderman
Director, Neuropsychiatry, Neuro-Rehabilitation Program,
Toronto Rehabilitation Institute, UHN; Clinician Teacher
Departments of Psychiatry and Medicine, University of Toronto
This presentation will examine how the brain responds to “minor” trauma, how this response affects outcomes and the types of problems patients with mild traumatic brain injury can experience.
Learning Objectives:
• Examine the concept of Mild Traumatic Brain Injury and key neuropathological structural issues “from within”
• Explore how mild traumatic brain injury affects function from an emotional, cognitive and behavioural perspective
9:45 – 10:15 Nutrition Break and Exhibit Viewing
10:15 – 10:50 Contributions of Functional MRI and Event-Related Potentials to Traumatic Brain Injury Evaluation
Alain Ptito, PhD
Director, Department of Psychology, McGill University Health Center
Neuropsychologist and Professor, Neurology/Neurosurgery, McGill University
and Montreal Neurological Institute
This session will present the clinical picture of concussion and mild head injury in athletes and motor vehicle accident (MVA) victims. Functional magnetic resonance imaging and event-related potentials data obtained from athletes and MVA victims with persistent post concussive symptoms including depression will be described. Serial functional neuroimaging studies suggestive of recovery will also be introduced. Data obtained with children aged 10-17 will also be discussed and compared to those of adults.
Learning Objectives:
• Show the potential of fMRI and ERP to help with the diagnosis of brain injury and how both techniques can contribute to tapping recovery in individuals
• Demonstrate that fMRI can be used in older children who have sustained a brain injury
10:50 – 11:00 Transition Time
11:00 – 12:00 Workshops – Session 1
These four workshops will run concurrently from 11:00am to 12:00pm and again in the afternoon from 2:45 to 3:45pm.
Workshop 1
Sleep and Wake Disturbance after mTBI
Catherine Wiseman-Hakes, Ph.D. candidate, Reg. CASLPO
Speech Language Pathologist & Doctoral Candidate; Researcher; Clinical Neuroscience, University of Toronto, Departments of Rehabilitation Science and Speech Language Pathology, Toronto Rehab Institute
This workshop will introduce the subtle and not so subtle changes to sleep and wakefulness in both the acute and chronic stages of mTBI. An overview of sleep and its role in recovery and day-time function will provide a background for understanding the impact of these disturbances, and how sleep architecture and waking EEG can potentially be used as objective biomarkers of injury and recovery. Finally, suggestions and strategies for management will be discussed.
Learning Objectives
• To understand the role of sleep in recovery and day-time function
• Identify the types of sleep and wake disturbance seen after brain injury
• Understand current pharmacologic and non pharmacologic management options.
Workshop 2
An Overview of Vestibular Dizziness in the Acquired Brain Injury Population
Jennifer Toland, PT, BScPT, MClSc(manip), FCAMT
Supervisor, Vestibular Rehabilitation Program
Sunnybrook Health Sciences Centre
Jocelyn Denomme, BPHE; BHScPT; MScPT
Physiotherapist, Vestibular Rehabilitation Program
Sunnybrook Health Sciences Centre
During this session, participants will review the function of the vestibular system with respect to dizziness and discuss the types of functional issues that may be present post brain injury. There will be discussion and hands on practice for differential testing of movement based dizziness, including differentiating cervical influences from vestibular. The treatment approaches for movement based vestibular dizziness will also be covered.
Learning Objectives
• To differentially test cervical versus vestibular influences in dizziness
• To assess and document the client’s dizziness
• To create a customized habituation program to address the movement provoked dizziness
Workshop 3
Adjudication of a mTBI Claim
Dale Orlando, McLeish Orlando LLP
John McLeish, McLeish Orlando LLP
Roger Oatley, Oatley, Vigmond LLP
Jim Vigmond, Oatley, Vigmond LLP
This workshop will examine the difficulties of the adjudication process with regards to an mTBI case. The presenters will use case studies to discuss this process and the importance of various assessments and cognitive tests.
Learning Objectives
• To understand the adjudication process
• To understand the implications of assessments and cognitive tests for adjudication
Workshop 4
Neuropsychological Testing in Mild Traumatic Brain Injury: Value and Limitations
Lesley A. Ruttan, Ph.D., C.Psych.
Clinical Neuropsychologist & Corporate Practice Leader for Psychology
Toronto Rehab/UHN
This workshop will seek to review the purpose of Neuropsychological Evaluation in cases of Mild Traumatic Brain Injury. Strengths and weaknesses of neuropsychological testing will be discussed including use of symptom validity measures. Case reviews will follow to illustrate the complexity of assessment and interpretation in this population.
Learning Objectives
• To understand the importance of a comprehensive Neuropsychological Evaluation in the context of Mild Traumatic Brain Injury
• To understand the limitations of Neuropsychological Testing in Mild Traumatic Brain Injury
• To understand the role of symptom validity measures during Neuropsychological Testing in Mild Traumatic Brain Injury
12:00 – 1:00 Networking Lunch and Exhibit Viewing
1:00 – 1:50 The Post Concussion Syndrome: Conceptualisation and Treatment
Nigel S. King, BSc, Clin.Psy.D, C. Psychol
Consultant Clinical Neuropsychologist, Head of Clinical Neuropsychology, Community Head Injury Service, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK; Clinical Tutor, Oxford Institute of Clinical Psychology Training, Oxford Healthcare NHS Trust & University of Oxford, UK; Fellow of Harris Manchester College, University of Oxford, UK
The session will first review the factors associated with the presentation of post concussion symptoms following mild traumatic brain injury and some of the reasons why a small minority of patients develop long-term or permanent problems. It will then examine the recent literature on the treatment of these difficulties for patients in both the early and late stages after injury. It will finally describe some of the intervention approaches the presenter has developed in the light of his own research, the current literature and his personal experiences of treating patients with mild traumatic brain injury.
Learning Objectives:
• To understand how post concussion symptoms occur and develop after mild traumatic brain injury
• To gain an overview of the current literature on the long-term post concussion syndrome
• To be able to manage and treat patients with mild traumatic brain injury more effectively
1:50 – 2:30 Neuroimaging after Head Injury: Advancements and Limitations
Tom A. Schweizer, PhD
Scientist, Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael’s Hospital; Assistant Professor, Division of Neurosurgery, Faculty of Medicine and Institute of Biomaterials and Biomedical Engineering, University of Toronto
This presentation will focus on identifying the various neuroimaging techniques used in TBI. The talk will then move onto a discussion of the strengths and weaknesses of new emerging technologies (e.g., Diffusion Tensor Imaging) using clinical cases.
Learning Objectives
• Identify the current imaging modalities used in TBI
• Discuss emerging technologies and their strengths and weaknesses.
2:25 – 2:45 Nutrition Break and Exhibit Viewing
2:45– 3:45 Workshops – Session 2 (4 concurrent workshops)
See above at 11:00am for descriptions
3:45 – 3:55 Transition Time
3:55 – 4:55 Mild Traumatic Brain Injury on Trial - A mock-jury trial in which the audience is the jury!
Sponsored by:
Clinicians:
Dr. Abe Snaiderman
Dr. Mark Bayley
Legal Counsels:
Roger Oatley and James Vigmond
Oatley, Vigmond LLP
John McLeish and Dale Orlando
McLeish Orlando LLP
How are mild traumatic brain injuryHow are mild traumatic brain injury diagnoses treated in a court of law? This session will present an overview of the typical challenges that you may encounter in court and give you tools to overcome them.
Review the clinical case material and diagnoses, then judge the outcome of the trial lawyers’ arguments yourself.
During this session, Dr. Mark Bayley, and Dr. Abe Snaiderman will face-off with trial lawyers from Oatley Vigmond and McLeish Orlando as they argue both sides of the case.
4:55 Closing Remarks
Paul Comper, PhD, Cpsych
Clinical Neuropsychologist, Toronto Rehabilitation Institute; Co-Director University of Toronto Concussion Clinic