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ACBIS - Newsletter

ACBIS Announcements

October 2017

BIAA Launches ACBIS Insider

On behalf of the Brain Injury Association of America (BIAA) and its Academy of Certified Brain Injury Specialists (ACBIS), we'd like to introduce you to our new ACBIS e-newsletter: ACBIS Insider! Thank you for being part of our network. We look forward to using this new quarterly communication as a way to keep you up-to-date with all things ACBIS, introduce you to fellow brain injury specialists, share industry best practices, and provide education on brain injury rehabilitation.

Executive Functioning: Updates to Clinical Practice Based on Current Research

Executive functioning (EF) skills are those needed in order to plan behaviors, adjust to environmental stressors and changes over time, and to carry out multiple tasks simultaneously. These skills include setting realistic goals based on accurate self-appraisal, self-monitoring behavior, and self-evaluating performance in relation to personal goals - and then changing behavior as needed in order to obtain the best result.

A review of some of the current literature seems to indicate that through the right training and practice, EF can be improved. Studies are limited and while it is clear that much more research is needed, some information can be gleaned from the current research and applied to clinical practice. A review of three articles yielded some valuable information regarding how to treat EF deficits: 
  • While the value of physical exercise is clear, aerobic exercise alone does not improve EF.
  • Drill and practice does improve EF skills (e.g., working memory and attention), but without strategy training and practice applying the drilled material in functional ways, carryover of skills appears to be minimal. This is important to keep in mind in the setting of computer-based cognitive training programs, which focus on repetitive practice with limited functional application or strategy training.
  • To be effective, strengthening EF-related skills must not focus only on practicing what is currently easy for an individual; treatment must also push toward harder levels of skill and demand.
  • There is promising evidence that strategy-based cognitive training can improve EF as well. By guiding an individual through cognitive exercises and helping to identify and apply compensatory strategies, cognitive function can be improved. Cognitive rehabilitation therapy should be combined with a metacognitive approach to address development of self-awareness/self-evaluation and the ability to predict performance and potential barriers.  
In order to raise awareness of the whens, whys, and hows of applying compensatory strategies, a metacognitive approach to EF skill improvement is recommended. By guiding an individual to ask questions to improve self- awareness (e.g., What went wrong? What would you do differently the next time? How would you change the strategy you’re using to be more effective?) we help individuals fill in the holes created by poor self-awareness associated with EF deficits. The metacognitive approach encourages generalization of compensatory strategy use and allows individuals to be more independent in applying these strategies when needed.    


This article was contributed by Bridget G. Lowery, MS, CBIST, Clinical Director, Main Line Rehabilitation Associates, Inc.

Why Should CBIS Certification be Sought After?

Since 1996, more than 15,600 direct care staff, clinicians, students and assorted others have earned the CBIS, CBIST and PCBIS (and in the earlier years, CBIS Level 1, CBIS-CE, CBIS-CI, and CBIT) credential. For each of these varying credentials, the common feature is Brain Injury Specialist. Those earning any variation of those three letters have demonstrated that they possess the knowledge, experience and determination to call themselves specialists in the care and treatment of individuals with a brain injury.

What Makes this Certification Special?

The short answer?  It’s the curriculum. This certification is purposely designed for anyone who delivers services specific to brain injury, and therefore must be robust and well-rounded. At the heart of this curriculum is the Essential Brain Injury Guide. The fifth edition boasts the most comprehensive and substantive subject matter to date, addressing the rehabilitation and long-term care needs of those with a brain injury, largely outside of acute settings. There are 25 chapters, including:
  1. Brain Injury Overview 
  2. Neuroanatomy and Neuroimaging 
  3. Neuroprotection and Neuroplasticity 
  4. Mild Traumatic Brain Injury 
  5. Disorders of Consciousness 
  6. Medical Complications 
  7. Fatigue and Sleep Disturbance 
  8. Aging with a Brain Injury 
  9. Physical Complications 
  10. Cognitive Complications 
  11. Neurobehavioral Complications 
  12. Psychosocial Complications 
  13. Substance Misuse 
  14. Legal and Ethical Issues 
  15. Rehabilitation Philosophy 
  16. Pediatrics and Adolescents 
  17. Families 
  18. Cultural Competency 
  19. Gender and Sexuality 
  20. Military Populations 
  21. Care Management 
  22. Neuropsychology 
  23. Outcome Measurement 
  24. Return to Work 
  25. Participation
The authors of the current guide represent more than 60 of the field's most experienced and respected clinicians including Jennifer Bogner, Mark Ashley, Erin Bigler, Jennie Ponsford, David Anders, Jeffrey S. Kreutzer, and John Corrigan, to name a few. With all these experienced clinicians imparting their vast knowledge, it’s no wonder CBIS certification is the gold standard for both training and certification in our field.

What are the Benefits of CBIS Certification?

CBIS certification has raised the industry standard for educational pursuit and knowledge obtainment. And, importantly, it has numerous benefits for the individuals who seek the certification:
  • It is comprehensive; it provides brain injury knowledge that for any given discipline is outside the scope of practice, providing participants with an expanded knowledge base
  • It entails ongoing, educational pursuits via the requirement of 10 annual CEUs
  • It differentiates those who obtain the certification from those who do not
  • It provides the opportunity for greater compensation in many organizations
  • For many, passing a robust, comprehensive examination builds confidence
  • It lets others know continued educational attainment is an important, ongoing goal
  • It’s a great resume builder and increases your marketability
  • It provides confidence in organizations that have high numbers of certificants
For anyone working in this field, for all of these reasons and more, CBIS certification should be a career goal!

CBIST Spotlight: Julie Schwertfeger

We are excited to introduce you to Julie Schwertfeger, CBIST, one the thousands of individuals involved with the Academy of Certified Brain Injury Specialists. Read our Q&A with Dr. Schwertfeger to learn how the Cubs winning the World Series relates to achieving her CBIST.

Why is having your CBIST important to you and how has it benefited your practice and career? 

I will never forget achieving my CBIST. This was during ACRM 2016 in Chicago. It was the very week that the Cubs won the World Series for the first time since 1908!  These two passions of mine, brain injury recovery and my home team, came together during the ACRM conference. I got my CBIST and the Cubs got the World Series. This was a banner week indeed!

I routinely seek out tools and resources to best treat my clients.  The CBIST training offered at ACRM spoke to me on this level. The CBIST material assists me in teaching brain injury clinical skills to student PTs in my faculty role at Rosalind Franklin University. These materials are able to be adapted for lay people, patients, and caregivers. The CBIST materials span topics from legal, medical, and educational supports to memory and social behavior supports.  

What are some of the latest trends in the literature and practice that you are seeing in physical therapy practice with survivors of brain injury?

Physical therapy practice is starting to incorporate cognitive behavioral therapy (CBT) and Acceptance and Commitment Therapy (ACT) techniques. There is a growth in behavior change strategies and care plans. This exciting trend of partnering and learning from our psychologist and psychiatrist colleagues will support better care for people who have brain injury and their caregivers in general.  

As a PT who has worked in brain injury rehabilitation and built high performing care team, I have developed professional relationships with survivors, occupational and speech therapists, respiratory therapists, radiologists, and neuroscience leaders who study motor learning, behavior and participation. Interprofessional collaboration is necessary to good brain injury care.  I am inspired by the work of Daniel Siegel, whose work seeks to integrate brain science across disciplines. Neuropsychiatry colleagues who work in this area use techniques that PTs also use, such as melodic intonation, rhythmic auditory stimulation, desensitization, and the motor learning principles put forth by Donald Hebbs and Kleim and Jones.

There is an encouraging trend towards the use of clinical practice guidelines, patient reported outcome measures, and clinical prediction rules and checklists. This trend includes recommendations to include the caregiver in assessment and treatment. There are also growing degrees of interprofessional plans of care and healthcare models.  Dr. Pam Duncan’s translational research (the COMPASS study) in stroke is a compelling example of the very real opportunities to improve care through low cost and practical application of guidelines. 
Why have you chosen a career in brain injury? What are you most passionate about in the field? 

My ongoing fascination regarding awareness, attention, emotion, learning and memory only increases with each case, which has been true since first working with clients emerging from coma early in my career.  Behavioral goals and use of interprofessional teams that this population demands is also very compelling to me. You learn so much by working with specialists across fields, gaining their perspective on a shared case, and observing the differences in their methods of proceeding through clinical decision making.  

We all fall into a continuum that spans from optimal brain health through brain injury. Research on early environment and attachment as well as research on healthy aging provides a foundation that ties genetic and cellular components such as protein expression and telomeres to behavioral interventions such as aerobic activity. These micro to macro considerations are illustrated in current research that I am working on with colleagues at UC Irvine, which assesses genotypes, psychological stress and cortical damage as it relates to predicting functional recovery after stroke.

Self-efficacy and agency as determinants of recovery for adults with chronic conditions, which is are important aspects of recovery noted in the research literature, require that people impacted by brain injury act as experts in their own care. This requires clinical teams that encourage and respond positively to client and caregiver agency. These are the things that I am most passionate about.    

Currently, I teach brain injury, stroke, pain, and other neuroscience topics in an interprofessional university with a primary appointment in the physical therapy program. I see the value of instilling concepts, assessments, and care planning that incorporate attention, behavior, and participation for all clients, which CBIST represents. This is provided in the training and the accompanying text and course.

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