We are housed within an academic medical center, working alongside neurologists in an outpatient setting. Supervised clinical work will comprise the majority of the trainee experience, estimated to require approximately 60%-80% of the fellow’s time and effort. Fellows will conduct neuropsychological evaluations, including the administration, scoring and interpretation of standardized and newly developed tests, under the supervision of core program faculty. The major referral source of outpatients are the UT Health San Antonio and Biggs Institute specialty services. In addition, we also see patients referred by generalist and specialty physicians practicing within our community, including government and military agencies.

We maintain strong relationships with our Level IV Epilepsy Center and Parkinson’s Disease Center of Excellence, and our fellows are actively involved in performing Wada procedures and preoperative neuropsychological evaluations for patients receiving surgical resections for epilepsy or those receiving deep brain stimulation for movement disorders. We are the primary resource for our nationally-recognized ALS Center, and our fellows provide brief neuropsychological assessment to determine the presence of cognitive or behavioral change for our ALS patients.

UT Health San Antonio and the Biggs Institute is one of 33 centers in the nation and the only center in Texas recognized as an NIA designated Alzheimer’s Disease Research Center (ADRC). Our joint clinic with neuropsychology, neurology, and social work, the Management In Neurodegenerative Disease (MIND) clinic, serves as the backbone for enrollment into the South Texas ADRC, and fellows will have the opportunity to work closely with our behavioral neurologists in the early identification and management of young onset and atypical dementias. Moreover, we have specialized caregiver programs for families living with neurodegenerative disease, and fellows are welcome to gain experience counseling patients and loved ones in how to manage challenging dementia syndromes.

Fellows typically conduct neuropsychological evaluations 3 to 4 days per week, under the supervision of the core faculty member. In practice, trainees are expected to have ~3 new consults a week their first year, and ~4 new consults a week their second year. The exact number may vary depending on the intensity of the consult (e.g., lengthy pre-surgical evaluation vs. screening case).

Year 1

During Year 1, fellows will conduct the majority of testing without psychometrist support to broaden their knowledge of test administration and normative procedures. Year 1 emphasizes the importance of surgical applications of neuropsychology, and fellows will work closely with faculty on pre- and postoperative evaluations for epilepsy and/or movement disorders.

Year 2

During Year 2, fellows will transition to working with psychometrists and learn how to manage professional relationships though extensive work in our multidisciplinary clinics. As part of their assessments within these clinics, fellows will interact with the attending neurologist and resident physicians working on the case. Fellows will discuss their evaluation findings with the treatment team and/or present them at case conferences. Some cases might involve behavioral interventions for patients with affective, anxiety, or behavioral disorders; others might require cognitive rehabilitation.

Clinical Opportunities

MIND Clinic
A multidisciplinary clinic consisting of visits with a neuropsychologist, behavioral neurologist, and social worker for those with suspected neurodegenerative conditions. Involves time-limited interviews with patient and collateral and cognitive testing, and rapid verbal communication of test results, differential, and recommendations to the team. These cases may be brought to a multidisciplinary consensus conference for final diagnoses

ALS Clinic
Part of the ALS Association Certified Treatment Center, our ALS clinic is a multidisciplinary clinic with neuropsychology, neuromuscular neurology, occupational therapy, physical therapy, speech pathology and social work.

During a pre-clinic multidisciplinary meeting, suspicion for neurocognitive change is ascertained, and time during the clinic is reserved for a brief, ALS-tailored evaluation. Results are communicated to the team and family to improve treatment.

South Texas Comprehensive Epilepsy Center
In collaboration with University Health, the South Texas Comprehensive Epilepsy Center is accredited as a Level 4 center by the National Association of Epilepsy Centers.

The center involves outpatient pre-surgical neuropsychological evaluations, Wada evaluations and participation on the weekly surgical conference. Team consists of neuropsychology, epileptology, neurosurgery, radiology and nursing.

Activities include discussion of cognitive, mental health and environmental concerns to the team and aiding discussion on risk-benefit ratio for different surgical options. To a lesser extent, non-surgical outpatient evaluations and brief inpatient interventions for those found to have PNES during monitoring are a part of this experience.

Deep Brain Stimulation (DBS) Block
Activities include outpatient evaluation of patients with movement disorders being considered for DBS and participation in monthly multidisciplinary conferences with neuropsychology, movement disorders neurology, neurosurgery and nursing.

Team discussions involve cognitive and behavioral concerns that may impact decisions such as proceeding with surgery or lead placement. Part of the movement disorders program which partners with the American Parkinson’s Disease Association.

MS Screening 
A brief evaluation centered on MS-typical cognitive and mental health symptoms in a way that reduces fatigue and helps monitor disease state and inform treatment.

Part of the National Multiple Sclerosis Society Partner-in-Care group.

Older Adult Patients
A routine outpatient evaluation for elders with suspected neurodegenerative conditions from myriad referral sources. Set in somewhat briefer blocks to limit fatigue.

General Neurology Patients
A prototypical outpatient block for miscellaneous referrals that do not fit in the above blocks or clinics.

Minor Clinical Experience: Functional Neurological Disorders
During their second major clinical rotation block of their first year, interested fellows can facilitate education sessions with patients that have been diagnosed with functional neurological disorders. The majority of patients will likely be recently diagnosed with non-epileptic seizures though there may be opportunity to see referrals from the movement disorders division.

These education sessions can be conducted as inpatient on the epilepsy monitoring unit (EMU) or outpatient at the UT Health San Antonio Medical Arts & Research Center. The goal is to provide education regarding the diagnosis of functional neurological disorders and to lay the foundation for follow-up mental health treatment. One of those options includes cognitive behavioral therapy for functional neurological disorders that is offered as an individual outpatient service with Johanna M. Messerly, PsyD, or Amy E. Werry, PsyD.

External Clinical Opportunities 
Polytrauma Rehabilitation Outpatient Clinic at the South Texas Veterans Health Care System