Clinical Experience - Sports Neurology Fellowship Program

The fellow will spend most of their time in the sports neurology clinics at Ochsner Health under the direction and supervision of sports neurology faculty. When not on another rotation, the fellow will be expected to be in sports neurology clinic 4.5 days a week with a half day of administration time. During their clinic time, the fellow will provide direct care to sports neurology patients. The fellow will see a combination of new patients and follow up patients. For the first 6 months, the fellow will staff all patients with the supervising attending and be expected to take 45 minutes for follow up patients and 60 minutes for new patients. For the second 6 months, the fellow will staff all new patients with the supervising attending and be given the opportunity/have the expectation to self-manage all follow up patients and be expected to take 30 minutes for follow up patients and 60 minutes for new patients.

During their clinic time, the fellow will learn:

1. To become an expert in recognizing the signs and symptoms of sports neurology disorders.
2. To become an expert in the management and treatment of sports neurology disorders.
3. To become an expert in developing a safety plan for athletic participation for athletes with
4. neurological disease.
5. Occipital trigger point/nerve blocks by anatomical location and by ultrasound.
6. Neurotoxin injections for headaches.
7. Interpretation of dynamic cervical spine x-rays.
8. Review of other types of neurologic imaging studies.
9. To utilize learned skills from the ancillary rotations.
10. To incorporate current advances in sports neurology found in the literature.
11. Billing

Instructors: Neuromuscular Faculty at Ochsner Health

This rotation is the only optional one during the fellowship as some fellows will have had more neuromuscular training during neurology residency than what is minimally required and therefore the fellow may opt out of this rotation if they so choose by notifying the fellowship director prior to their arrival for fellowship. If the fellow elects to undertake this rotation, time from sports neurology clinic will be removed to allow for the necessary time for this rotation. During this rotation, the fellow is exposed to peripheral nerve, plexus, radicular, myelopathic, muscular, and neuromuscular junction pathology. As this rotation is in addition to the minimally required neuromuscular training the fellow received during their neurology residency, the fellow will be expected to already have basic knowledge in neuromuscular medicine. The fellow will use this rotation to enhance their knowledge base to recognize neuromuscular pathology as it relates to the field of sports neurology.

By the end of this rotation, the fellow will be able to:

1. Identify common signs and symptoms of peripheral nerve lesions, plexus lesions, radiculopathies, myelopathy, muscular disorders, and neuromuscular junction disorders.
2. Describe the appropriate management and treatment options of peripheral nerve lesions, plexus lesions, radiculopathies, myelopathy, muscular disorders, and neuromuscular junction disorders.
3. Identify common signs and symptoms of common entrapment neuropathies.
4. Understand the relationship between the biomechanics of repetitive use injury in athletes or injury as it relates to athletic equipment.
5. Identify the presentation and pathophysiology of muscle injury, nerve injury, plexus injury, and spinal cord injury in sports neurology.
6. Describe the appropriate management and treatment options of muscle injury, nerve injury, plexus injury, and spinal cord injury in sports neurology.
7. Understand the utility of electrodiagnostic and neuroimaging studies in the diagnosis of neuromuscular disorders.
8. Interpret electromyography and nerve conduction studies.
9. Assess the neuromuscular system at an advanced level.
10. Conduct basic electromyography/nerve conduction studies.

Instructors: Physical Medicine and Rehab or Anesthesiology Interventional Pain Management Faculty at Ochsner Health

During this rotation, the fellow is exposed to the acute and chronic management of spinal disorders and peripheral joint disorders. The fellow will use this rotation to understand when to appropriately refer sports neurology patients to interventional pain management and to understand what treatments sports neurology patients may undergo within interventional pain management.

By the end of this rotation, the fellow will be able to:

1. Describe the role of interventional pain management as it relates to sports-related injuries.
2. Describe ultrasound-guided, electromyographical-guided, or fluoroscopic-guided joint and nerve therapies.
3. Review ultrasound, fluoroscopy, Xray, CT, and MRI imaging for sports-related injuries.

Instructors: Neuropsychologists, Health Psychologists, and Social Workers who treat neurological injury at Ochsner Health

During this rotation, the fellow is exposed to the evaluation and management of acute and chronic mood, sleep, and cognitive disorders that result from neurological and psychiatric disease. The fellow will use this rotation to learn basic therapy techniques to manage sports neurology patients with mood, sleep, and/or cognitive disorders as well as to understand when to appropriately refer sports neurology patients to neuro- or health psychology.

By the end of this rotation, the fellow will be able to:

1. Describe the role of neurocognitive testing in sports neurology.
2. Interpret an array of cognitive tests.
3. Conduct basic sleep hygiene to sports neurology patients.
4. Describe the role of cognitive behavioral therapy in sports neurology.
5. Conduct basic cognitive therapy to sports neurology patients.
6. Conduct basic mood therapy to sports neurology patients.
7. Identify the signs and symptoms of mood, sleep, and cognitive disorders that result from sports neurological injury.
8. Describe the interaction of preexisting psychiatric disease with acute and chronic sports neurological injury.
9. Recognize that some patients are prone to forms of psychiatric disease regardless of sports neurological injury.
10. Differentiate between mood, sleep, and cognitive disorders that result from primary sports neurological injury versus primary psychiatric disease.
11. Conduct appropriate mood, sleep, and cognitive screening during sports neurology evaluation.
12. Describe the utilization of sports neurology specific validated symptom scales.

Instructors: Sports Medicine and Neurology Physical, Occupational, and Speech Therapists at Ochsner Health

During this rotation, the fellow is exposed to the evaluation and management of vestibular disease, myofascial disease, and cognitive impairment. The fellow will use this rotation to learn basic therapy techniques to manage sports neurology patients with vestibular disease, myofascial disease, speech impairment, and cognitive impairment as well as to understand when to appropriately refer sports neurology patients to physical, occupation, and/or speech therapy.

By the end of this rotation, the fellow will be able to:

1. Identify signs and symptoms of vestibular dysfunction.
2. Assess the vestibular system at an advanced level.
3. Differentiate between central and peripheral vestibular disease.
4. Differentiate between primary vestibular disease and mimics of vestibular disease.
5. Describe the role of vestibular therapy in sports neurology.
6. Assess cervical, postural, and periscapular muscle dynamics.
7. Identify signs and symptoms of cervical, postural, and periscapular muscle impairment in sports neurology.
8. Describe the role of myofascial physical therapy in sports neurology.
9. Describe the role of speech therapy in sports neurology.
10. Differentiate between primary speech production impairment, cognitive speech production impairment, and psychiatric speech production impairment.
11. Identify signs and symptoms of speech impairment in sports neurology.
12. Conduct appropriate vestibular, myofascial, speech, and cognitive screening during sports neurology evaluation.

Instructors: Sports Medicine Faculty at Ochsner Health

During this rotation, the fellow is exposed broadly to primary care sports medicine thru multiple providers including physicians, advanced practice providers, and athletic trainers. The fellow will use this rotation to understand the team dynamic between sports medicine and sports neurology and how to mutually care for an injured patient as well as to participate in patient and community educational activities. As a part of this rotation, the fellow will work alongside primary care sports medicine providers to provide year-round neurological sideline coverage for select local schools at the high school and/or college level for contact sports. This coverage will mostly take place after any clinic hours in the evening or on the weekends. If other opportunities for sports coverage arise, the fellow will strongly be encouraged to attend.

By the end of this rotation, the fellow will be able to:

1. Describe the role of primary care sports medicine in sports neurology.
2. Coordinate patient care with primary care sports medicine to treat neurological injury, perform baseline neurological testing, and to develop safety plans for athletic participation in patients with neurological disease.
3. Describe the role of primary care sports medicine during sideline coverage.
4. Participate in patient and public education activities including but not limited to concussion protocol, return to play protocol, preventative care for neurological injury, current data on neurological injury in sports, current guidelines on athletic participation in those patients with neurological disease, and current data on enhancing neurological performance in sport.
5. Identify signs and symptoms of neurological injury on the sidelines of athletic competition.
6. Describe go and no-go criteria for returning to play in the acute sideline and clinic settings.
7. Identify signs and symptoms of musculoskeletal injury and the impact of these types of injuries on the neurological system.
8. Communicate professionally and effectively with team personal, school personal, media, athletes, families, and primary care sports medicine providers while maintaining appropriate patient confidentiality.
9. Describe the differences in healthcare and injury educational resources for athletes at differing levels of competition (school aged, college, and professional) and how these differences impact injury management.
10. Recognize that school policy, team policy, and state laws may contraindicate each other and contraindicate appropriate patient care.
11. Recognize that patient care is the priority over policy.

Instructors: Neuroophthalmologists at Ochsner Health

During this rotation, the fellow is exposed to neuroophthalmological disease. The fellow will use this rotation to understand how neuroophthalmological disease is a concern in some sports neurology injuries as well as to understand when to appropriately refer sports neurology patients to neuroophthalmology.

By the end of this rotation, the fellow will be able to:

1. Describe the role of neuroophthalmology in sports neurology.
2. Identify signs and symptoms of neuroophthalmological disease in sports neurology.
3. Describe when to order diagnostic testing as it relates neuroophthalmology.
4. Conduct appropriate neuroophthalmological screening during sports neurology evaluation.
5. Describe the appropriate management and treatment options of neuroophthalmological disease in sports neurology.