Neurological Setting Research Articles

Adrenergic inhibition facilitates normalization of extracellular potassium after cortical spreading depolarization

Cortical spreading depolarization (CSD) is a propagating wave of tissue depolarization characterized by a large increase of extracellular potassium concentration and prolonged subsequent electrical silencing of neurons. Waves of CSD arise spontaneously in various acute neurological settings, including migraine aura and ischemic stroke. Recently, we have reported that pan-inhibition of adrenergic receptors (AdRs) facilitates the normalization of extracellular potassium after acute photothrombotic stroke in mice. Here, we have extended that mechanistic study to ask whether AdR antagonists also modify the dynamics of KCl-induced CSD and post-CSD recovery in vivo. Spontaneous neural activity and KCl-induced CSD were visualized by cortex-wide transcranial Ca2+ imaging in G-CaMP7 transgenic mice. AdR antagonism decreased the recurrence of CSD waves and accelerated the post-CSD recovery of neural activity. Two-photon imaging revealed that astrocytes exhibited aberrant Ca2+ signaling after passage of the CSD wave. This astrocytic Ca2+ activity was diminished by the AdR antagonists. Furthermore, AdR pan-antagonism facilitated the normalization of the extracellular potassium level after CSD, which paralleled the recovery of neural activity. These observations add support to the proposal that neuroprotective effects of AdR pan-antagonism arise from accelerated normalization of extracellular K+ levels in the setting of acute brain injury.

Pharmacogenetics of Carbamazepine and Valproate: Focus on Polymorphisms of Drug Metabolizing Enzymes and Transporters.

Pharmacogenomics can identify polymorphisms in genes involved in drug pharmacokinetics and pharmacodynamics determining differences in efficacy and safety and causing inter-individual variability in drug response. Therefore, pharmacogenomics can help clinicians in optimizing therapy based on patient’s genotype, also in psychiatric and neurological settings. However, pharmacogenetic screenings for psychotropic drugs are not routinely employed in diagnosis and monitoring of patients treated with mood stabilizers, such as carbamazepine and valproate, because their benefit in clinical practice is still controversial. In this review, we summarize the current knowledge on pharmacogenetic biomarkers of these anticonvulsant drugs.

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

BackgroundConversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown. Aim1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND. MethodFeasibility study. ResultsThe study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients. ConclusionIt is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.

Ferroptosis in hepatic ischemia‑reperfusion injury: Regulatory mechanisms and new methods for therapy (Review)

Ischemia‑reperfusion injury (IRI), also called reoxygenation injury, is the outcome of inflammatory processes and oxidative damage through the induction of oxidative stress. In the clinical setting, IRI contributes to severe hepatic injury, including liver cell death by apoptosis and ferroptosis. Ferroptosis is a novel type of cell death in hepatic IRI that involves small molecules that inhibit glutathione biosynthesis or glutathione peroxidase4 (GPX4), which is a glutathione‑dependent antioxidant enzyme, causing mitochondrial damage. Currently, ferroptosis has been systematically described in neurological settings, kidney diseases and different types of cancer, while few studies have analysed the presence of ferroptosis and the regulatory mechanism of ferroptosis in hepatic IRI. Exploring the exact role played by ferroptosis in the liver following hepatic IRI in accordance with existing evidence and mechanisms could guide potential therapeutic interventions and provide a novel research avenue.

Caring Relations at the Margins of Neurological Care Home Life: The Role of ‘Hotel Service’ Staff in Brain Injury Rehabilitation

Context: Domestic staff in hospitals and aged long-term care have been shown to perform a range of caring roles alongside their cleaning work. Objective: This paper explores the roles these people and other ‘hotel service staff’ (catering, domestic, maintenance, finance and administrative) play in the rehabilitation of people with brain injuries residing in long-term care settings. Methods: This research draws on in-depth ethnographic data collected in 2014–15 over five months at two neurological long-term care settings in the UK; including interviews and observations of day-to-day happenings in the lives of around 60 brain injured residents and the work of 16 hotel service staff. The data was subject to a situational analysis – underpinned by grounded theory and discourse analysis. Findings: Hotel service staff contribute to and compliment the rehabilitation of patients’ cognitive skills, communication and physical functioning, and provide opportunities for occupation and interaction. The therapeutic accomplishments achieved by involving patients in mundane tasks of everyday life (e.g., gardening, managing money, sharing food), fit with the aims of more ‘formalized’ rehabilitation – to restore patients’ abilities to carry out ‘activities of daily living’. Limitations: This study has been unable to fully explicate how hotel service staff have, or gain, the skills to interact so positively with brain injured residents. The study was confined to two sites and may not be reflective of practice elsewhere. Implications: The study findings highlight how the work and interactions of hotel service staff contribute not only to care but to the rehabilitation of people with severe brain injuries. This has implications for service design as well as health and social care education.

Influence of Autoimmune Antibody Testing on the Use of Immunotherapy on an Inpatient Neurology Service.

To determine the frequency of autoimmune antibody testing in an inpatient neurology setting and its influence on immunotherapy use on an inpatient neurology service. A retrospective descriptive cohort study of patients admitted to the neurology inpatient service at a large tertiary academic medical center who had autoimmune and/or paraneoplastic antibody testing performed between 10/1/2017 and 10/1/2018. Characteristics of patients' initial clinical presentation, antibody testing results, test timing in relation to initiating immunotherapy, and final diagnosis using consensus criteria were extracted and analyzed. Case reports of patients with positive antibody panels are presented. Of 1,604 patients, 50 patients (3.1%) had an antibody panel sent. Tests resulted after an average of 17 days (range 7-27). The most common clinical presenting symptom in those with a panel sent was encephalopathy. There were 5 (10%) positive serum panels and no positive CSF panels. Only one of these 5 patients had autoimmune encephalitis and was treated with immunotherapy. Of those with negative serum and CSF panels, 15 were treated acutely with empiric immunotherapy and the remainder with supportive care. Of those treated with immunotherapy, 14/15 (93%) were treated before the panel tests resulted. Four patients who had negative panels but were empirically treated met consensus criteria for an autoimmune-mediated neurologic process. Our study suggests that the results of antibody testing did not influence inpatient neurologists' decision to treat with immunotherapy as most treatments began prior to final results being available.

Rapid Implementation of Virtual Health in a Pediatric Neurology Practice During COVID-19.

During the COVID-19 pandemic, the Division of Neurology at BC Children's Hospital rapidly transitioned to almost exclusively virtual health. In April 2020, 96% of outpatient visits were done virtually (64%) or by telephone, and only 4.2% were in-person. Total clinic visit numbers were unchanged compared to previous months. Neurologists reported high satisfaction with the virtual history and overall assessment, while the physical examination was less reliable. Additional in-person visits were rarely required. Rapid, sustained adoption of virtual health is possible in a pediatric neurology setting, providing reliable care that is comparable to in-person consultations when physical distancing is necessary.

Impact of pharmacists on outcomes for patients with psychiatric or neurologic disorders.

IntroductionPsychiatric and neurologic illnesses are highly prevalent and are often suboptimally treated. A 2015 review highlighted the value of psychiatric pharmacists in improving medication-related outcomes. There is a need to describe areas of expansion and strengthened evidence regarding pharmacist practice and patient care impact in psychiatric and neurologic settings since 2015.MethodsA systematic search of literature published from January 2014 to June 2019 was conducted. Publications describing patient-level outcome results associated with pharmacist provision of care in a psychiatric/neurologic setting and/or in relation to central nervous system (CNS) medications were included.ResultsA total of 64 publications were included. There was significant heterogeneity of published study methods and data, prohibiting meta-analysis. Pharmacists practicing across a wide variety of health care settings with focus on CNS medication management significantly improved patient-level outcomes, such as medication adherence, disease control, and avoidance of hospitalization. The most common practice approach associated with significant improvement in patient-level outcomes was incorporation of psychiatric pharmacist input into the interprofessional health care team.DiscussionPharmacists who focus on psychiatric and neurologic disease improve outcomes for patients with these conditions. This is important in the current health care environment as most patients with psychiatric or neurologic conditions continue to have unmet needs. Additional studies designed to measure pharmacists' impact on patient-level outcomes are encouraged to strengthen these findings.

Implementation and Follow-up Experience of an e-Consult Program in a Rural Neurology Setting.

The demand for neurology services at Geisinger exceeds the current clinical capacity. Therefore, we implemented and assessed the utility of Ask-a-Doc (AAD), which is an electronic medical record-based interface developed at Geisinger to facilitate communication between primary care physicians (PCPs) and specialists. AAD was used at the end of 2015 in our department. Based on the clinical picture, the PCP assesses whether to send an urgent AAD question with a phone request or a more elective question that can be answered by email message. The AAD message is then relayed to the on-call neurologist. We analyzed 4-year longitudinal data to assess for the efficacy of this tool in our department in improving patient care and communication. There were a total of 3,190 messages during this period. Of which, 2,927 (91.7%) were completed and routed correctly, and 263 (8.3%) messages had errors including routing issues, communication mismatch, and delayed time frame. The average specialist turnaround time was 5 hours. During this period, the number of AAD messages increased by 300% as PCPs and neurologists became more comfortable with the process. AAD provides an interface between PCPs and neurology specialists and can assist in determining whether a patient needs to be seen urgently in the clinic, the correct subspecialty, and prerequisite diagnostic tests. AAD was successfully implemented and used in our rural neurology setting, with rapid turnaround, increased usage, and accuracy.

Ictal level of awareness in psychogenic nonepileptic seizures correlates with the experience of traumatic events in childhood: A cross sectional study

There is a great amount of research regarding the particular ictal manifestations of psychogenic nonepileptic seizures (PNES) with a focus on the differences to epileptic seizures (Vogrig et al., 2019 [4]; Tyson et al., 2018 [5]; De Paola et al., 2016 [6]). Most of the research aims to define guidelines for diagnosing PNES in differentiation from epilepsy, because this differentiation is clinically relevant for clinical neurological settings. In contrast, very few studies aimed to gain insight about particular ictal manifestations of the different semiological appearances of PNES regarding distinctive psychological processes or prognostic outcomes (Brown, 2016 [7]; Pick et al., 2017 [8]; Brown, 2006 [9]; Cohen, 2013). One study revealed that a higher level of mental dissociation and cognitive impairment was associated with a higher level of traumatization in patients with PNES (Pick et al., 2017 [8]).We analyzed the seizure semiology with a focus on the level of awareness in 60 patients with PNES. Patients were divided into two groups: one with an impaired awareness during their seizures and the other one with preserved awareness during their seizures. We assessed the amount of adverse traumatic experience in childhood with the “Childhood Trauma Questionnaire (CTQ)”.We found that patients with PNES with impaired awareness showed more childhood traumatic experiences in the CTQ, especially on the subscales of sexual and emotional abuse as well as physical neglect. Furthermore, patients with PNES with impaired awareness during seizures were significantly younger, more often female, showed a lower degree on education, and a higher amount of self-harm behavior compared with patients with PNES with preserved awareness during seizures.Our study presents clinical evidence for the potential significance of the level of awareness during PNES for the etiology of PNES. Our results point toward the existence of clinical subgroups of patients with PNES with distinctive etiological mechanisms and indicate that seizure semiology might help to differentiate those potential subgroups.

COVID-19 Catatonia—Would We Even Know?

COVID-19 Catatonia—Would We Even Know?

Evaluating the Sleepy and Sleepless Patient.

This article explains the clinical approach to patients presenting with sleepiness or sleeplessness in a neurologic practice setting. Addressing the patient's sleep symptoms may help improve symptoms of their other underlying primarily neurologic disorder. New diagnostic modalities at home such as home sleep apnea testing have improved access and diagnosis of sleep apnea. Consumer health tracking devices have also helped patients focus on their sleep duration and quality, prompting them to bring their concerns to their neurologist. Like many neurologic disorders, a detailed history and physical examination are critical in the evaluation of patients with sleepiness or sleeplessness. Patients who have neurologic disorders are more likely to have poor-quality sleep. Questions about the patient's sleep schedule or screening patients for common sleep disorders such as sleep apnea and restless legs syndrome (RLS) are useful to add to a typical neurologic evaluation to better recognize sleep disorders in this population. Polysomnography, home sleep apnea testing, multiple sleep latency tests, and actigraphy can be used with the available history and examination to determine the proper diagnosis and management plan for these patients.

Bupropion for the Treatment of Apathy in Alzheimer Disease

Apathy is a frequent neuropsychiatric symptom in dementia of Alzheimer type and negatively affects the disease course and patients' and caregivers' quality of life. Effective treatment options are needed. To examine the efficacy and safety of the dopamine and noradrenaline reuptake inhibitor bupropion in the treatment of apathy in patients with dementia of Alzheimer type. This 12-week, multicenter, double-blind, placebo-controlled, randomized clinical trial was conducted in a psychiatric and neurological outpatient setting between July 2010 and July 2014 in Germany. Patients with mild-to-moderate dementia of Alzheimer type and clinically relevant apathy were included. Patients with additional clinically relevant depressed mood were excluded. Data analyses were performed between August 2018 and August 2019. Patients received either bupropion or placebo (150 mg for 4 weeks plus 300 mg for 8 weeks). In case of intolerability of 300 mg, patients continued to receive 150 mg throughout the study. Change on the Apathy Evaluation Scale-Clinician Version (AES-C) (score range, 18-72 points) between baseline and week 12 was the primary outcome parameter. Secondary outcome parameters included measures of neuropsychiatric symptoms, cognition, activities of daily living, and quality of life. Outcome measures were assessed at baseline and at 4, 8, and 12 weeks. A total of 108 patients (mean [SD] age, 74.8 [5.9] years; 67 men [62%]) were included in the intention-to-treat analysis, with 54 randomized to receive bupropion and 54 randomized to receive placebo. The baseline AES-C score was comparable between the bupropion group and the placebo group (mean [SD], 52.2 [8.7] vs 50.4 [8.2]). After controlling for the baseline AES-C score, site, and comedication with donepezil or galantamine, the mean change in the AES-C score between the bupropion and placebo groups was not statistically significant (mean change, 2.22; 95% CI, -0.47 to 4.91; P = .11). Results on secondary outcomes showed statistically significant differences between bupropion and placebo in terms of total neuropsychiatric symptoms (mean change, 5.52; 95% CI, 2.00 to 9.04; P = .003) and health-related quality of life (uncorrected for multiple comparisons; mean change, -1.66; 95% CI, -3.01 to -0.31; P = .02) with greater improvement in the placebo group. No statistically significant changes between groups were found for activities of daily living (mean change, -2.92; 95% CI, -5.89 to 0.06; P = .05) and cognition (mean change, -0.27; 95% CI, -3.26 to 2.73; P = .86). The numbers of adverse events (bupropion group, 39 patients [72.2%]; placebo group, 33 patients [61.1%]) and serious adverse events (bupropion group, 5 patients [9.3%]; placebo group, 2 patients [3.7%]) were comparable between groups. Although it is safe, bupropion was not superior to placebo for the treatment of apathy in patients with dementia of Alzheimer type in the absence of clinically relevant depressed mood. EU Clinical Trials Register Identifier: 2007-005352-17.

Interprofessional Collaboration Experiences of Student Physical Therapists and their Clinical Instructors in Orthopedic versus Neurologic Rehabilitation Settings

Interprofessional Collaboration Experiences of Student Physical Therapists and their Clinical Instructors in Orthopedic versus Neurologic Rehabilitation Settings

Remote Virtual Spinal Evaluation in the Era of COVID-19.

With the COVID-19 pandemic disrupting many facets of our society, physicians and patients have begun using telemedicine as a platform for the delivery of health care. One of the challenges in implementing telemedicine for the spine care provider is completing a comprehensive spinal examination. Currently, there is no standardized methodology to complete a full spinal examination through telemedicine. We propose a novel, remote spinal examination methodology that is easily implemented through telemedicine, where the patient is an active participant in the successful completion of his or her examination. This type of examination has been validated in a neurology setting. To facilitate the telemedicine visit, we propose that video instruction be shared with the patient prior to the telemedicine visit to increase the efficacy of the examination. Since the issuance of stay-at-home order across the states, many spine practices around the country have rapidly adopted and increased their telemedicine program to continue provide care for patients during COVID-19 pandemic. At a tertiary academic center in a busy metropolitan area, nearly 700 telemedicine visits were successfully conducted during a 4-week period. There were no remote visits being done prior to the shutdown. Implementation of our proposed remote spinal examination has the potential to serve as a guideline for the spine care provider to efficiently assess patients with spine disease using telemedicine. Because these are only suggestions, providers should tailor examination to each individual patient's needs. V. It is likely that physicians will incorporate telemedicine into health care delivery services even after the COVID-19 pandemic subsides because of telemedicine's efficiency in meeting patient needs. Using the standard maneuvers provided in our study, spine care providers can perform a nearly comprehensive spine examination through telemedicine. Further studies will be needed to validate the reproducibility and reliability of our methodology.

Newton’s Laws, G-forces and the impact on the brain

Abstract The thrill to go fast and push boundaries is something that many seek. From John Stapp’s rocket sled at Edwards Air Force Base in the late 1950’s to todays’ Formula 1 drivers, the “need for speed” is broadcast across TV screens weekly. So too are the horror stories of crashes, many at over 300km/hr. Yet “need for speed” continues. It appears that the higher and faster the rollercoaster, the better. This leads to several questions. How does the brain stand up to speed and G-forces? Do Newton’s Laws still have reference in today’s world? There has been much attention in the general press on the possibility that high G-force rollercoasters are inducing brain injury in riders. However, research does not wholeheartedly support this notion, but rather the risk of brain injury from a rollercoaster is not in the rides, but in the rider – caused by previously undetected brain or neck conditions. That said there is some truth that high G-forces do affect the brain at a chemical and structural level. This paper will discuss the mechanism of head injury at speed and generally what Newton’s Law means in a neurological setting in todays’ world. Formula 1 racing and rollercoaster rides will be evaluated within a neuroscience context.

Cone-beam CT for imaging of the head/brain: Development and assessment of scanner prototype and reconstruction algorithms.

Our aim was to develop a high-quality, mobile cone-beam computed tomography (CBCT) scanner for point-of-care detection and monitoring of low-contrast, soft-tissue abnormalities in the head/brain, such as acute intracranial hemorrhage (ICH). This work presents an integrated framework of hardware and algorithmic advances for improving soft-tissue contrast resolution and evaluation of its technical performance with human subjects. Four configurations of a CBCT scanner prototype were designed and implemented to investigate key aspects of hardware (including system geometry, antiscatter grid, bowtie filter) and technique protocols. An integrated software pipeline (c.f., a serial cascade of algorithms) was developed for artifact correction (image lag, glare, beam hardening and x-ray scatter), motion compensation, and three-dimensional image (3D) reconstruction [penalized weighted least squares (PWLS), with a hardware-specific statistical noise model]. The PWLS method was extended in this work to accommodate multiple, independently moving regions with different resolution (to address both motion compensation and image truncation). Imaging performance was evaluated quantitatively and qualitatively with 41 human subjects in the neurosciences critical care unit (NCCU) at our institution. The progression of four scanner configurations exhibited systematic improvement in the quality of raw data by variations in system geometry (source-detector distance), antiscatter grid, and bowtie filter. Quantitative assessment of CBCT images in 41 subjects demonstrated: ~70% reduction in image nonuniformity with artifact correction methods (lag, glare, beam hardening, and scatter); ~40% reduction in motion-induced streak artifacts via the multi-motion compensation method; and ~15% improvement in soft-tissue contrast-to-noise ratio (CNR) for PWLS compared to filtered backprojection (FBP) at matched resolution. Each of these components was important to improve contrast resolution for point-of-care cranial imaging. This work presents the first application of a high-quality, point-of-care CBCT system for imaging of the head/ brain in a neurological critical care setting. Hardware configuration iterations and an integrated software pipeline for artifacts correction and PWLS reconstruction mitigated artifacts and noise to achieve image quality that could be valuable for point-of-care detection and monitoring of a variety of intracranial abnormalities, including ICH and hydrocephalus.

A Comparative Study of Health Anxiety in Neurology and Psychiatry Settings.

Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates. Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12. Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings. Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.

Responsiveness of the Activity Participation Outcome Measure in adult patients with Traumatic Brain Injury in an acute private neurological rehabilitation setting in South Africa

INTRODUCTION: Acute neurological rehabilitation aims to reduce the burden of care of patients with traumatic brain injury (TBI) and increase their activity participation. Tracking change throughout the rehabilitation is essential for funders of the service as well as the patient. Valid, reliable and responsive outcome measures are thus needed for accurate measurement of change This study compared the responsiveness to change of the Functional Independence Measure™+ Functional Assessment Measure (FIM™+FAM) with the Activity Participation Outcomes Measure (APOM). This was administered TBI patients in the acute neurological rehabilitation phase in a private health care facility in South Africa. METHOD: A quantitative, prospective, longitudinal cohort design was used. A sample of 24 in-patients over 12 months was scored weekly on both outcome measures. The responsiveness between the APOM and FIM™+FAM was tested using the dependent t-test for paired samples and the effect size from admission to discharge was calculated with the standardised response mean. : Both measures were responsive to change and tracked improvement in activity participation (APOM) and reduction of burden of care (FIM™+FAM). No significant statistical difference was found between the responsiveness of the two measures however positive changes were reported in each individual patient CONCLUSION: Although both measures are responsive to track change in TBI patients, the APOM includes more specific items that occupational therapists address in rehabilitation. The lack of a measure of physical components in the APOM makes it a difficult to be the only one to use in an environment where there is a high physical burden of care in patients. However, the APOM could be used in conjunction with other impairment-based scales that target physical components. It is recommended that more occupational therapists use the APOM with TBI populations Key words: Activity participation outcome measure, Traumatic Brain Injuries, Acute neurological rehabilitation, responsiveness

Implementation and Experiences of Participating in a Neurologic Service Learning Clinic in a Physical Therapist Entry-Level Program: An Educational Case Report

Background and Purpose. The integration of service learning (SL) in physical therapist entry-level education is a way of serving the community while also meeting curricular demands. Educational programs have successfully implemented service learning clinics (SLCs) while positively affecting the development of professionalism. Research examining specialized SLCs in programs is only just emerging. This case report describes the implementation and experiences of participating in a neurologic-specific SLC. Case Description. Through a partnership between the program and a local hospital, faculty, students, and members of the hospital rehabilitation leadership developed and implemented a neurologic SLC. Over the first year, 37 first- and second-year students participated. Twice a week, student dyads (first- and second-year pairs) treated patients with a neurologic diagnosis. Student reflection papers were qualitatively examined to understand the students' experiences. Outcomes. Three themes emerged: 1) “Find my ‘PT Self’”: Professional Growth, 2) “Out of my comfort zone”: Challenges for Novices, and 3) “Out of the books and into the real world”: Bringing Curriculum to Life. Discussion and Conclusion. The SLC afforded students the opportunity to treat individuals with neurological disorders, reinforce coursework, and further prepare for patient care in a neurological setting. Data regarding the value of student learning and the perceived challenges for novices will inform other programs interested in integrating SL into the curriculum, particularly a neurologic-specific experience.