Repetitive Neurotrauma Program

For these patients, concerns are approached at every appropriate angle including:

• Memory and Cognitive Difficulties
• Behavioral and Emotional Issues
• Imbalance and Physical Symptoms
• Sleep disturbance
• Pain

Every patient will be seen by one of the physician concussion specialists (Drs. Alexander, Stillman and Meehan, see below) and by a neuropsychologist. Because the problems presented by patients with repetitive trauma are complex, it is very likely that most patients will require assessment by other members of the team.

Michael Alexander MD, Cognitive Neurology Unit, BIDMC – Dr. Alexander has over 30 years’ experience treating brain injuries

Alexandra Stillman MD, Cognitive Neurology Unit, BIDMC – Dr. Stillman is trained in the care of individuals with brain injury with a special interest in post-traumatic headaches

William Meehan MD, Director of The Micheli Center for Sports Injury Prevention, Division of Sports Medicine, Boston Children’s Hospital – Dr. Meehan has many years’ of experience treating athletes with concussions and has numerous publications in this area

Stephanie Changeau NP, Cognitive Neurology Unit, BIDMC – Ms. Changeau is a nurse practitioner with neurological training in both inpatient and outpatient settings

Nancy Madigan PhD, Staff Neuropsychologist, Cognitive Neurology Unit, BIDMC – Dr. Madigan has over 20 years’ experience in cognitive assessment, with involvement in specialized assessment in those with brain injury since 2012

Karen Torres PsyD, Staff Neuropsychologist, Cognitive Neurology Unit, BIDMC- Dr. Torres has evaluated civilian adults, collegiate athletes, and professional football and hockey players with repeated sports-related and non-sport related concussions since 2012

A team of Neuropsychiatrists within the Cognitive Neurology Unit: Mark Thall MD and Adam Stern MD

A team of BIDMC Sleep Medicine physicians available for rapid consultation

A specialist in complex headache management – Slavenka Kam-Hansen MD/PhD, Neurology, BIDMC (available for consultation)

A specialist in gait and balance – Brad Manor PhD, Cognitive Neurology Unit and Director of the Mobility and Brain Function Program at the Institute for Aging Research Berenson Allen Center OR David Howell PhD, Division of Sports Medicine, Department of Orthopaedics, Boston Children’s Hospital

We will ask you to obtain a referral from your physician – PCP or treating specialist – that includes basic information about your history or for you to complete a short questionnaire to confirm appropriateness. For referral information and clinic information, contact our office: 617-667-4084.

For this clinic we will not see patients referred by attorneys. We will see referrals from Workman’s Compensation or liability case managers only after detailed clearance and preauthorization.

Of note, this clinic is NOT geared towards treatment of patients who have had a concussion from which they have never fully recovered (Post-Concussion Syndrome), which requires a very different approach. Such a program is not currently offered within the Cognitive Neurology Unit.

We see patients in the Repetitive Neurotrauma Program twice monthly. We will schedule an appointment at the first opening. There are two paths to evaluation in this clinic. In either case it would be helpful to obtain copies of any recent cognitive test results and any brain MRI or CT studies. These should be on a CD to be reviewed by the treatment team.

For individuals living within the Boston area, the initial appointment will consist of an intake evaluation with the nurse practitioner, a 60 minute evaluation by one of the concussion physicians and a cognitive evaluation by the neuropsychologist. These appointments will take approximately a half day. The team will meet to discuss the appropriate next steps in assessment. Additional consultation(s) will be scheduled and care provided as appropriate, which may include referrals to Sleep Medicine, Psychiatry, Pain (headache) Management and/or balance testing. After all evaluations have been completed and the team has met to analyze the results and consider potential treatments, a follow-up appointment will be scheduled to discuss findings and final recommendations.

For individuals who live at a distance, the intake evaluation with the nurse practitioner will be by phone. She will review the assessment results with the team, and referred individuals will be scheduled for all evaluations/consultations that appear appropriate on site. This will consist of the same 60 minute evaluation by one of the concussion physicians and a cognitive evaluation by the neuropsychologist. As indicated, any or all consultations with Sleep Medicine, Psychiatry, Pain (headache) Management and balance testing will also be scheduled, identified by the telephone interview as major problems. These evaluations/consultations will be completed over the course of two days. Recommendations to local hotels or B&Bs can be provided. It will take time to review findings from all evaluations/consultations. Patients can opt to return home to be called in several days or may return to meet with the team to discuss findings and recommendations. We may be able to suggest treatment resources nearer to one’s home, though it is important to note that there is a possibility that resources in your vicinity may be limited. Patients will be provided copies of all evaluations and conclusions/treatment recommendations which can be shared with the referring and/or other treating physicians.

Our administrative staff will try to obtain insurance preauthorization for each of the steps of the assessment. If patients have previously been seen for this problem by other physicians or neuropsychologists, insurance coverage may be limited.

The Repetitive Neurotrauma Program is located at the Beth Israel Deaconess Medical Center, East Campus – Cognitive Neurology Unit in the Kirstein Building.

The office number is 617-667-4084.