TALK PMR

I’m a recent Brain Injury grad and now Faculty at a BI program. I’m happy to answer any questions you may have!

Matthew.puderbaugh wrote: ↑Wed Jun 05, 2024 12:55 am I’m a recent Brain Injury grad and now Faculty at a BI program. I’m happy to answer any questions you may have!

Thanks so much for Joining Dr. Punderbaugh and I really appreciate you being here to share your knowledge. I guess two questions I would have to ask in regards to brain injury fellowships. Is how can a Student and Residents expose themselves to Brain Injury Rehab if not based in an academic institution and the second would be how does the scope of practice compare to Neurology Rehab fellowships. I imagine there must be some spillover but are their certain cases we shine more in or vice versa. Thanks again!

Sorry for the delay! June has been a busy month!
For many medical students and residents, their first introduction into Brain Injury Medicine will be taking care of TBI patients in the acute inpatient rehabilitation setting. That was my first introduction when I worked as a nursing aide on rehab units while in college. Being able to work with those patients can be a powerful experience, as you see patients in their recovery of consciousness and function.

As a medical student; if you are interested in Brain Injury, I strongly suggest doing PM&R rotations at sites that are associated with a level 1 trauma, especially sites that offer an inpatient consult service. If it is a good experience and you like working with those types of patients, then look at applying to residencies that have a Brain Injury Fellowship associated with them. It doesn't mean that you will do fellowship there, but it will increase your exposure and help you determine if that is something you want to pursue. In addition, rotations in Neurology, and if inclined, Neurosurgery, are also helpful to see what other aspects of Brain Injury care there are.

As a PM&R Resident, seek out any attending who may have Board Certification in BIM or fellowship training to ask them questions. When I was applying to fellowship, I reached out to a lot of different faculty, fellowship directors, and other attendings to get an idea of what the fellowship may help with and if it would be worth it (it was for me!).

Brain Injury Medicine became a formal subspecialty and ACGME accredited status in 2011. Prior to that, there were several programs that started with Neuro-Rehab or Neurotrauma Rehabilitation fellowship. Many programs have switched and gotten ACGME accreditation and fall under the BIM banner. Until 2021 PM&R physicians, psychiatrists, and neurologists could take the BIM boards without going through fellowship (grandfathered in). Now, all individuals need to go through a fellowship to sit for the BIM boards. PM&R, Neurology, Psychiatry, and Child Psychiatry can all attend BIM fellowships (most of them are through PM&R departments), and some individuals (such as international graduates, and other specialities) may be able to participate outside of the match.

While the majority of BIM fellowship will focus on TBI, there are also opportunities for anoxic, stroke, and brain cancer cases as well. Oftentimes, you will also see a lot of Spinal Cord Injury due to the overlap in injury patterns.

Hope that helps!
-Dr. Puderbaugh

Thank you Dr. Punderbaugh for your insight. Sorry for the delay as I am studying for boards. I am a person interested in procedures throughout my week to help me get through the day. Even if it is just TPIs something to break free from the mundane. While I am well aware that no matter what you do in Physiatry you can work your schedule to cater to procedures, I would like to know what procedures tend to be the bread and butter in Brain Injury. Thanks again for answering my questions.

Good Question! There are a lot of injection opportunities within PM&R. I commonly do botulinum toxin for headache, spasticity, CD, occasionally facial spasms/blephrospasms, and salivary gland injections. I also do ultrasound guided joint injections (shoulder, hip, knee, etc) as well as nerve (carpal tunnel). I also do triggerpoint and occipital nerve injections. I also still do EMGs and am the only one who offers OMT in our clinic currently, so I definitely keep myself busy!

That’s actually a pretty extensive list of procedural skills done daily. In terms of OMT what techniques do you tend to favor on your specific patient population. For example,
Do you tend to find that cranial manipulations have benefits ?
Thank you again this truly offers a unique opportunity for 3rd and 4th year residents to be exposed to Brain Injury fellowships.