Functional Capacity Evaluation with

Traumatic Brain Injury (TBI) and Concussion

Practical solutions to choosing assessment tools, developing treatment plans and setting return to work goals.

This course is designed for those evaluators who have completed the Functional Capacity Evaluation Certification Program (FCECP) and have developed sound understanding and practice using the related primary principles of safety, reliability, validity, practicality and utility.

While traditional FCE protocols typically address physical disability and its effect on function, as well as physical durability and employability, they do not naturally accommodate the variety of condition-specific variables typically found in those who have been classified with mild, moderate and severe traumatic brain injury. Following completion of this course, you will be able to adapt your working knowledge to accommodate the physical, cognitive and behavioral function demands of this client group specific to referrers' requests.

Reconstructing the Executive Functions

The Executive Functions are the foundation of effective human behavior. They provide the groundwork for inhibition, attention, working memory, self-talk, emotional self-regulation, problem-solving, the use of "time" and symbolic behavior. Focused in the frontal lobes, they are the most recent and fragile of the brain's structures. Minor injury to these processes can result in major changes in an individual's personality, emotional control and ability to function autonomously. Until recently, the frontal lobes have been considered the "dark" part of the brain. With developments in Neuropsychology and Neurology over the past 20 years, we are beginning to better understand the structure and function of the role played by the Executive Functions in the self-regulation of behavior.

This section of the course provides an overview of the two part structure of the frontal processes: The "prepotent behavior" system that mediates ongoing, learned behavior (the Behavior Activating System) and the Executive Functions, which kick in when the prepotent system is unable to overcome a "problem." Materials provided for the participant of this course include measures to evaluate functioning at both the prepotent level and the executive levels.

While there are many tests available for evaluating different aspects of cognitive functioning, few provide direction for rehabilitation. What has been missing is a model of the Executive Functions. One has been proposed by Russell Barkley and will be presented during the course. To complete this introduction to the Executive Functions, an Internet-mediated, cognitive rehabilitation intervention program will be introduced.

While cognitive rehabilitation of brain injury is in its infancy, there is light at the end of the tunnel. We are seeing changes in individuals well beyond that which would normally be expected in "spontaneous recovery," leading us to believe that we are actually fostering growth and/or accommodation in neuronal, dendritic and synaptic patterns.

Clinical Review, Planning and Evaluation

As with all evaluations, appropriate assessment planning to cover all eventualities is vital. Building on our knowledge of the Executive Functions, participants will learn how to clinically review medical information specific to concussion and brain injury, how to determine evaluation duration and to design an appropriate mix of assessment tools. This includes the integration of standardized cognitive testing into the evaluation as a whole, to be used alongside cognitive evaluation during other functional tasks in a variety of contexts.

Reliability and Validity

For the experienced evaluator these topics are established. However, injury sequelae following head trauma can require additional condition-specific analyses to more clearly provide outcomes regarding consistency of client performance and reliability of client self-reports.

Course Topics and Objectives

• Introduction to the Behavior Activation and Behavioral Inhibition Systems
• Implications of over- and under-activation of BAS and BIS
• Overview of the role of the "prepotent behavior" system in day-to-day functioning
• An introduction to Barkley's model of the Executive Functions
• A review of the 5 components of the Barkley model: Inhibition (attention), Working Memory, Self-Talk, Emotional Self Control and basic Problem-Solving
• A review of the BRIEF (Behavior Rating Inventory of Executive Functions)
• An introduction and overview of the Neuropsychonline cognitive rehabilitation program
• A review and summary of the basic strategy for reconstructing the Executive Functions
• A final discussion of our experiences with Traumatic Brain Injury Rehabilitation over the last decade
• Preparation for the advanced FCE-TBI presentation by Ms. Fiona Allen which follows this foundation work
• Review of medical findings, injury mechanics and cognitive and behavioral definitions (including concussion vs. TBI)
• Translating the medical documents to better plan, perform and document safe, reliable and defensible FCE's and anticipate the probable functional presentation of the client by the time of initial review
• Understanding the legal considerations implicit with brain injury
• Discussion of Physical Effort and Reliability of Pain and Disability Report tests as related to TBI and concussion
• Exploration on how to complete a cognitive, sensory and behavioral demands analysis
• Understanding some of the standardized cognitive tests available
• Other test administration - use of standardized or home-built tests with emphasis on cognitive demands
• Test administration - implementation, time considerations and cost
• Education and analysis of learning during implementation - how these can be used as an additional assessment tool
• Writing the report
• How to document the essential functions of a specific job task as they relate to cognitive, sensory and behavioral demands
• Practice management issues - space design, equipment, supplies

This course will use digital video case studies to look at different areas of an evaluation.

INSTRUCTORS

Robert Ellis, PhD

Fiona Allen, BHSc (HONS) OT

HOURS

14 Contact Hours

TUITION

US $475