Pediatric Movement Disorders Fellowship

Director: Ian J. Butler, MD

The major goal of the Movement Disorders curriculum is to offer a specialized teaching and training program in areas of patient care, clinical and/or basic science research, teaching and education. The major objective of the Movement Disorders curriculum is to delineate training that will develop expertise in the recognition, diagnosis, management and rehabilitation of inpatients and outpatients with Movement Disorders. This program offers focused attention, as well as exposure to neurology, neurobiology, neuroimaging, neuro-rehabilitation and allied fields of expertise. The program is oriented toward the post-neurology residency level. It incorporates both an adult, geriatric and pediatric population, with expert faculty in each area. The faculty and participants in this program offer expertise in diagnosis, management, as well as medical and surgical therapeutic interventions for the specific disease states. The program is based in a strong academic neurology department at a university based medical center with a tertiary care hospital association and multiple affiliated ambulatory clinics. Our population base includes Harris County, the surrounding areas and a referral network from the entire state.

Clinical Care Objective

After an extensive year of supervised training and clinical experience the fellow will be:

  1. Competent in the approach and evaluation of a movement disorders patient.
  2. Able to generate an appropriate differential diagnosis.
  3. Able to choose and be competent in prioritizing the most appropriate diagnostic tools in order to efficiently work up and accurately diagnose a movement disorders patient.
  4. Able to direct medical and where indicated surgical management and intervention.
  5. Competent in performing rating scales for the various disorders or diseases such as spasticity, Parkinson’s disease, tremors, dystonia, ataxia, and gait dysfunction.
  6. Competent in assessing non-medical needs such as activities of daily living, fall precautions and environmental and home safety concerns.
  7. Certificate of Competence in the Clinical Care and Management of Movement Disorders Patients: Perform direct clinical care and management with electronic medical record documentation of 600 patient care encounters in the Quentin Meese HCHD clinics, UT Physicians clinics, and Memorial Hermann Hospital inpatients over the first year.

Over the course of a year, under direct supervision and with direction from UT MOVE faculty, literature reviews, case studies and additional input from journal club, the fellow will be able to:

  1. Create effective medical intervention for symptomatic treatment.
  2. Show competence in creating the best medical management, and optimized medical regimens for the major movement disorders such as Parkinson’s disease, generalized and focal dystonias, spasticity regardless of etiology, tremors, Huntington’s, tics, Wilson’s disease, atypical Parkinsonism, Multiple System Atrophy, progressive Supranuclear palsy, the ataxia syndromes and primary and secondary paroxysmal dyskinesias and myoclonus states.

The UT MOVE fellowship program believes that it is critically important for the fellow to learn the neural circuitry (basal ganglia, cortical, thalamic), neurophysiology (signal patterns in the normal and abnormal states), neurochemistry, neurogenetics, neuroepidemiology and the proteomics of the movement disorders. This knowledge will be obtained by continued study of the research literature, the progressive knowledge that the newer technologies bring and the results of clinical neuroscience research. Movement disorders can be classified by their causative process and include neurodegenerative, genetic, infectious, metabolic and nutritional, toxin induced or vascular related.

Educational Objective

The objectives of the Educational portion of the Movement Disorders fellowship are to train a fellow who develops expertise in identifying the disease process. Subsequently, the fellow will be responsible for teaching residents in training how to evaluate a movement disorders patient.

  1. The fellow should demonstrate competency in disease knowledge by giving a series of lectures to medical students and residents on topics related to movement disorders and their therapeutics
  2. The fellow will prepare and present one Neurology Grand Rounds presentation during the first 12 months of fellowship.
  3. The fellow is required to participate in a weekly literature review with members of the movement disorders faculty. An emphasis on evidenced based medicine is placed on reviewing the literature and the fellow will be required to critique the literature from this perspective.

Clinical and Basic Science Research Objective

In the first year of Movement Disorders fellowship training, the fellow will be encouraged to attend and participate in the local and national meetings including the Texas Neurological Society, the American Academy of Neurology and the Movement Disorders Society. The fellows will be supported in this participation.

The goals of the Clinical and Basic Science Research Objective are for the fellow to demonstrate by teaching an understanding of the basic science research in the pathophysiology, epidemiology and pathogenesis of Parkinson’s disease, dystonia, tremor and memory impairment in the dementias.

  1. An objective for the fellow in the clinical research arena is to be able to gather data from rating scales and the clinical classification of the Parkinson’s disease patients into subtypes.
  2. The fellow will become competent in the assessment of functional outcome from surgical and medical interventions, as well as quality of life outcome measures.

Goals/Objectives for the second year of the UT MOVE Movement Disorders fellowship

Second Year – Optional
In the second year of training, all the goals and objectives of the first year still apply, but the patient population for the most part is the established population from their first year of training.

The majority of Movement Disorder conditions are chronic in nature and progressive. This allows the development of expertise in management by direct patient care and contact through follow up continuity and feedback.

Clinical Care
In the second year, the fellows will be able to provide continuity of care to the population of patients they developed over the first year.

  1. The fellow will be competent in individualizing the medical regimen for each patient. As example, the fellow will be competent in addressing motor fluctuations in the Parkinson’s patient, minimizing dyskinesias, minimizing OFF time by adjusting the medical regimen or adjusting the DBS parameters.
  2. The fellow will be competent in assessing progression and symptom emergence by providing continuity of care to patients with chronic disease.

Clinical and Basic Science Research Objective
In the second year, the fellow will be able to participate in research, with 40% of their time protected in order to participate and or develop their own area of interest.

  1. The fellow will perform and participate in ongoing clinical research trials.
  2. The fellow will be responsible for writing and submitting for publication at least one manuscript during the course of the second year.

Evaluation

The fellow is evaluated by participating staff quarterly and formally semi-annually by the director and co-director of the program. Performance standards are based on national standards published under the ACGME, American Academy of Neurology, the American Neurological Association and to some extent the Movement Disorders Society. A summary letter will be generated after a successful completion of the fellowship which will detail the experience, the presentations and evaluations of the fellow by the participating faculty.