The Therapy Insights Podcast

What would it look like if, as a healthcare system, we were able to draw from data points from real experiences of real people around the world? What if we could magnify the power of existing medical research methods by incorporating a broader range of people, experiences, and perspectives, including those of practicing clinicians? One of the biggest challenges we face is bridging the gap between clinical research and clinical practice. The concept of the learning health system is not one magical platform that offers to solve this problem, but rather it is a way of thinking, of collaborating, and of experiencing the world that has the potential to radically transform healthcare. Join us in our conversation with Josh Rubin, program officer for learning health system initiatives at the University of Michigan Medical School’s first-in-the-nation Department of Learning Health Sciences, president and CEO of the Learning Health Community, and executive director of the Joseph H. Kanter Family Foundation. James Laskin, DPT also joins in on the conversation to provide the perspective of both a clinical research and a practicing clinician. Ready to have your mind shift and start answering some of the biggest questions of our time? So are we.

In this episode, we explore the following (fictional) case study: Alejandro is a 55 yo male who was first diagnosed with Parkinson’s at the age of 48. He was taken to the emergency room due to a fall in his home that resulted in mild head trauma as well as a broken wrist. A friend hadn’t heard from him in a couple of days and found him on the floor. After his acute stay in the hospital, he was taken to a post-acute care facility. While working with a team of speech, occupational, and physical therapists, the therapy team learns that he has no running water at home and that he uses a bucket for a toilet. He has a dog that he has been unable to get outside recently and so urine and feces has been collecting in the house. Alejandro is also worried about his dog and is wondering if anyone is taking care of him. When asked what he eats at home, it’s unclear if he has consistent access to food. He is quite private and is wary of others entering his home and is not willing to do a home eval. He wants to go home as soon as possible.

How do we connect with people who have a brain injury? How do we not let our therapy devolve into power struggles? How do we help improve insight without crushing people’s hope? To explore these questions today, we’re talking with Andrew Hill.

Andy is a licensed clinical social worker in Missoula, Montana. Before his career in therapy started, he was offered a temp job working exclusively with adults with brain injuries, helping them with everyday tasks and skills. This temp job led him to a degree in social work from the University of Montana. While there, he completed a practicum at Community Bridges through Community Medical Center, a program that specialized in TBI recovery. He has worked in a variety of settings, and now works in private practice. His clinic, Missoula Therapy, provides in a variety of services and is currently the only practice in Montana specializing in traumatic brain injury recovery. His current client base is about 75% people with brain injuries and he is working towards working with brain injuries exclusively. He is the only psycho-therapist certified in brain injury treatment in the state of Montana. Through his work with people with brain injury, he has earned an honorary Blackfeet name, Awaasaapsii napikwan, which he explains in our interview.

Perioperative neurocognitive disorders (PND) are a group of cognitive disorders that manifest in relation to surgery and anesthesia (Evered et al., 2018a) and encompass former classifications of perioperative cognitive impairments, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). PND are common following anesthesia and surgery, affecting up to 65% of adults over age 65 years (Rudolph and Marcantonio, 2011).

In this episode, we discuss:

What post operative cognitive dysfunction (POCD) is and the shift towards new nomenclature that aligns with the DSM-V and new ICD-10 codes.

Risk factors for developing perioperative neurocognitive disorders (PND).

What therapists can do to contribute to a proactive interdisciplinary approach to manage perioperative neurocognitive disorders when they do occur.

A proposed brain ERAS (Enhanced Recovery after Surgery) protocol to reduce the risk of PND.

Until now, people who are incarcerated have not been screened for TBIs. We know that TBIs can cause changes in behavior and personality that can lead to incarceration, and once inside, make it more difficult to fully heal and functionally return to the community. The Washington Department of Corrections is one of the first, if not the first, state correctional agencies in the U.S. to implement a system-level response to TBIs among the incarcerated population. How did this happen? Through a persistent effort to build relationships, foster inter-agency collaboration, and a strong commitment to sustaining the mental health resources necessary to build and grow a program that supports a TBI screening program, cognitive skills training program, and peer mentoring program. This is a fascinating and deeply inspiring conversation with Risa Klemme, ADA compliance manager for the Department of Corrections, and Dr. Mark Harniss, Associate Professor in Rehabilitation Medicine, Director of the Center for Technology and Disability Studies, and Director of the UW Disability Studies Program. When people come together to change massive systems bit by bit, we all get collectively closer to our shared humanity. A heartfelt thank you to Risa and Dr. Harniss for their time and devotion, not only to this podcast episode, but to their legacy of collaboratively building the TBI program in the state of Washington.