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NORA announced that the Neuro-Optometric Rehabilitation Skills Development Program started at our 1997 annual meeting in San Diego, California.
The program was developed for the membership of NORA to initiate, develop and support the highest level of competence in clinical abilities and scientific knowledge in the field of Neuro-Optometric Rehabilitation. This process leads to a fellowship within NORA. It is not a certification process. It is a growth process designed to enhance the clinical competency of health care providers who treat patients who have suffered traumatic brain injury or neurological insults.
While the program is currently undergoing restructuring, the curriculum committee is committed to the original goals as developed by Drs. William Ludlam and Thomas Politzer. It is a multi-level program to enhance knowledge and skills of those working in the fields of rehabilitation. The Clinical Skills Development Program is chaired by Drs. Susan Wenberg and Carl Garbus.
Upon completion of the requirements of all three levels, participants will be presented with the designation of FNORA- Fellow of the Neuro-Optometric Rehabilitation Association.
Individuals may attend the Level 1 or Level II pre-conference (both are 2 days) without enrolling in a program leading to fellowship. Simply enroll and pay the course fee. The pre-conference sessions have excellent educational value. Should an individual later decide to pursue the fellowship he/she may then submit an application for the skills development program, and pay the application fee (see below).
The fellowship involves completing all parts of Levels I through III. The requirements are explained in detail below. They include passing a written test, a 12 minute presentation associated with Level I, a case history presentation, two written case histories, and a peer-review publication. There is a time limitation for completion of the fellowship program.
To start the Skills Development Curriculum process leading to fellowship a participant must:
be a member in good standing with NORA and remain current on dues during the entire process.
submit an application for the skills development program to the NORA Curriculum Committee (Application to the Skills Development process can be found on the website). The application fee is $300.00
Complete Levels I and II and begin the process of publishing within the context of the Level III program, all within 5 years.
Level 1- Covers a participant's understanding of background scientific literature which has been deemed as part of the core of understanding Neuro-Optometric Rehabilitation.
NORA Skills Level 1 Course Learning Objectives
Prevalence of Brain Injury
1. Describe the incidence, prevalence and epidemiology of brain injury 2. Describe the systems of care available in the rehabilitation continuum
Understanding the Nervous System, the Brain and Brain Injury
1.Describe the function of the autonomic and sympathetic nervous systems 2. Identify basic brain structures and functions. 3. Describe brain-behavior relationships 4. Describe how an injury to the brain can result in various behaviors and challenges 5. Understand the importance of the motor system in guiding rehabilitation
Health, Medications and Medical Management
1.Understand the role of the case history in identifying the uniqueness of each individual with a brain injury. Know the strategies for gathering Information about the person's background, injury, treatment and factors that impact their potential for optimum recovery. 2. Understand, identify and report signs and symptoms of potential medical and ocular complications that are commonly encountered in persons after a brain injury. 3. Demonstrate knowledge of the most commonly prescribed categories of medications and commonly used drugs after brain injury and their impact on vision. 4. Understand the role nutrition and exercise plays in the healing process
Understanding Functional Impacts of Brain Injury
1. Describe common cognitive, physical, emotional, behavioral, and social changes after brain injury 2. Describe how these changes affect the person's functioning.
Children and Adolescents with Brain Injuries
Recognize developmental issues for children and adolescents after brain injury, as well as, neurologic deficits.
Visual Pathways in the Brain
1. Describe the various visual pathways and note their significance 2. Understand the significance of the brain stem in the control of eye movements 3. Understand how to test the function of the cranial nerves 4. Review the various disorders of the cranial nerves involved in vision
Evaluation of the Oculomotor System
1. Know how to test the function of extraocular muscles 2. Understand the different testing procedures for the oculomotor system 3. Understand the integration of the vestibular system, oculomotor system and somatic feedback 4. Review the various disorders of the oculomotor system
Specific Visual Deficits Following Brain Injury
1. Understand Post Traumatic Vision Syndrome 2. Understand Visual Midline Shift 3. Describe visual field defects 4. Describe visual spatial neglect 5. Understand how to differentiate between visual field deficits and visual spatial neglect 6. Understand the various visual information processing deficits
The Examination of the Brain Injured patient
1. Know how to conduct a thorough case history 2. Know the goals of the patient and family 3. Understand what functions needs to be assessed 4. Know what tests will be appropriate to administer
Treatment Protocols for the Brain Injured patient
1. Understand the importance of lenses, prisms and occlusion 2. Understand how to set up a treatment plan (in office) 3. Understand what procedures to use for a specific visual deficit
Working with the Vision Rehabilitation Team
1. Know the components of a vision screen 2. Understand the process of communication with other professionals 3. Know how to communicate to the patient and their family 4. Understand how to integrate vision rehabilitation into the general rehabilitation treatment plan. 5. Understand the optometrist’s role in guiding the vision therapy program 6. Understand the optometrist’s role in the hospital setting
The course addresses
1. Working with the Rehabilitation Team 2. The Continuum of Rehabilitative Care 3. Functional Outcomes and Therapeutic Expectations 4. Review of the Twelve Cranial Nerves 5. The Vestibular System 6. Concepts in Rehabilitation
Level 2 - Is a Practical Clinical Section where diagnostic and treatment techniques are taught and tested. Lectures and workshops are presented at the pre conference Skill Development day for Skill Development
Level 2 1) Complete level I requirements 2) Attend Level II pre-conference presentation a) Register and pay for level II pre-conference attendance prior to the annual conference b) Fill out evaluation form from pre-conference 3) Complete two neuro-optometric case reports a) Use the NORA suggested format for writing up the case reports (This will be sent to you upon receipt of your application to the program) b) Submit two patient case reports that demonstrate understanding of the diagnosis and treatment of a patient with neuro-optometric rehabilitation to the curriculum committee (These can be submitted by email or snail mail) c) Receive feedback from the committee on your case reports 4) Present a case report at pre-conference a) Advise the curriculum committee of your desire to present at the next annual pre-conference three months prior to the conference b) Present one of your case reports in a 20 minute presentation at pre-conference, with a 5-10 minute discussion afterwards c) Receive speaker feedback forms from the audience present, through the committee 5) Write up a case evaluation of a video or live patient case presented at pre-conference with discussion, and present it to the curriculum committee 6) Receive a certification of completion from NORA upon completion of all of the required steps. It is not necessary to complete all aspects of Level 2 within the same year one applies.
Level 3- This phase is achieved by preparation and publication of an article, or chapter dealing with Neuro-Optometric Rehabilitation, in a refereed journal, or a comprehensive review and analysis of neuro-visual literature deemed applicable to Neuro-Optometric Rehabilitation. A certificate will be awarded upon successful completion. A five year time frame is allowed on this three level learning process.
Level 3 1) Complete level II requirements 2) Attend a writer’s workshop, forum, and research methodology seminar approved by NORA 3) Submit an outline of a proposed paper on neuro-optometric rehabilitation to the curriculum committee a) Upon approval of the topic from the committee prepare a paper on the approved topic in which you are the sole or lead author b) Submit the finished paper to the curriculum committee for review c) Submit it for publication in a peer review journal 4) Upon publication make a 30 minute presentation on your paper at pre-conference a) Notify the curriculum committee of your intention to present at pre-conference b) Present the paper at the appointed time during pre-conference c) Allow 10-15 minutes for discussion after the presentation d) Receive speaker feedback forms from the audience present, through the committee 5) Upon completion of all of the steps your name will be presented to the board by the curriculum committee as having completed Level III and the skills building curriculum process. 6) Receive certificate of completion and plaque stating your achievement
Currently, member professionals other than optometrists participate in the same program. The interaction among professionals with different educational backgrounds, working and studying together in neuro-optometric rehabilitation is a valuable one, and consideration is given to the individual's profession in evaluating case studies and responses to questions.
This is the first such program in this country where background, clinical and scientific knowledge and skills in the diagnosis and treatment of Neuro-Optometric Rehabilitation has been offered. There has been tremendous excitement generated from this new concept of Post-Graduate education.
For more information regarding the NORA Fellowship Curriculum Program please contact Susan Daniels, O.D., or call NORA toll free (866) 2CBETTR.