Post Workshop Survey and Evaluation for Faculty | Comprehensive Clinical Management

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Name*
First Last
Email*
(Please review that this is the email used for registration.)
Will you need AOTA CEUs?**
- No
- Yes
What is your specialty focus?*
- Physiatry
- Occupational Therapy
- Physical Therapy
- Speech-Language Pathology
- Other
Please specify your specialty focus*
Type of practice:*
- Hospital Setting
- Community Setting
- Academic Institution
- HMO/Managed Care Organization
- Long-term Care/Skilled Nursing Facility
- School Health Program
- Outpatient Clinic
- Home Health Care
- Early Intervention Service
- Mental Health Program
- Other
Please specify your type of practice*
The knowledge and/or skills gained from the course can be applied to my work.*
- Yes
- No
- Unsure

How well did this workshop meet the following learning objectives?*

	Excellent	Good	Fair	Poor
Recognize the importance, benefits, challenges, and practical concerns regarding the interdisciplinary team approach for management of patients with spasticity in order to develop individualized treatment plans
Interpret the clinical evidence, guidelines, and recommendations on the use of neurotoxins and adjunctive rehabilitation interventions (physical therapy /occupational therapy/speech-language therapy), both alone and in combination, in order to establish appropriate treatment strategies for these patients
Assess neuromuscular pathology and individual patient functional goals, in order to identify appropriate muscles, determine dosing, maximize therapeutic benefit, and minimize complications
Evaluate methods of guidance and localization (ie, EMG, e-stim, ultrasound), in order to incorporate best practices for proper placement of neurotoxin
Facilitate interaction and improve communication among members of the interdisciplinary treatment team, in order to encourage appropriate referrals for both neurotoxin injection and adjunctive therapy that may optimize patient outcomes

What questions, if any, remain unclear to you?
Did you achieve the learning goals you identified at the beginning of the conference?*
- Yes
- No
As a result of this course, I will likely make changes to my practice in these categories:*
- Clinician-Patient Communication
- Diagnosis
- Documentation (appropriate)
- Patient Education
- Quality Improvement
- Patient Safety
- Treatment Approach
- Medication
Will you make any of the following practice changes as a result of this workshop?*
- Yes
- No

Practice Changes*

	Yes	No
I will utilize more refined screening criteria to identify patients for botulinum neurotoxin treatment
I will refer patients where appropriate for neurotoxin treatment
I will recommend or prescribe PT/OT/SLT where indicated for patients receiving neurotoxin treatment
I will use routine outcome measurements (eg, Modified Ashworth Scale) more often or more consistently
I will establish or strengthen case documentation shared by treatment team members
I will form or expand a treatment team of interdisciplinary members for case management
I will share today’s course materials with clinicians who did not participate here today
I will more often or more consistently discuss with patients the importance of home exercise therapy as an adjunct to their clinical care

I will make the following additional specific change in my practice.
Please evaluate this activity as a whole:*
Excellent Good Fair Poor
Program Content
Relevance to my clinical practice
Effectiveness in meeting identified need
Overall, I would rate this workshop as:*
- Excellent
- Good
- Fair
- Poor
What was the most effective aspect(s) of this workshop and why?
What was the least effective aspect(s) of this workshop?

Overall Evaluation*

	Excellent	Good	Satisfactory	Fair	Poor
Welcome and Program Objectives - Cindy Ivanhoe, MD
Managing Patients With Spasticity: From Evidence to Best Practice - Cindy Ivanhoe, MD
Guidance, Localization, and Placement of Botulinum Toxin: What Works Best? (Pediatric and Adult Limb Spasticity) - Katharine Alter, MD
Optimizing Patient Outcomes Post-BoNT Using Rehabilitation Therapy - Laura Wiggs, PT, NCS, CBIS
The Speech Language Pathologist’s Perspective: A Key Member of the Comprehensive Clinical Management Team - Sofia Tilton, MS, CCC-SLP
Video Grand Rounds: A Patient Case Study - Cindy Ivanhoe, MD
Video Grand Rounds: A Patient Case Study - Laura Wiggs, PT, NCS, CBIS
Video Grand Rounds: A Patient Case Study - Katharine Alter, MD
Video Grand Rounds: A Patient Case Study - Craig Davis, OTR

Presentation Free of Commercial Bias*

	Yes	No
Welcome and Program Objectives - Cindy Ivanhoe, MD
Managing Patients With Spasticity: From Evidence to Best Practice - Cindy Ivanhoe, MD
Guidance, Localization, and Placement of Botulinum Toxin: What Works Best? (Pediatric and Adult Limb Spasticity) - Katharine Alter, MD
Optimizing Patient Outcomes Post-BoNT Using Rehabilitation Therapy - Laura Wiggs, PT, NCS, CBIS
The Speech Language Pathologist’s Perspective: A Key Member of the Comprehensive Clinical Management Team - Sofia Tilton, MS, CCC-SLP
Video Grand Rounds: A Patient Case Study - Cindy Ivanhoe, MD
Video Grand Rounds: A Patient Case Study - Laura Wiggs, PT, NCS, CBIS
Video Grand Rounds: A Patient Case Study - Katharine Alter, MD
Video Grand Rounds: A Patient Case Study - Craig Davis, OTR

Applicable to My Practice*

	Yes	No
Welcome and Program Objectives - Cindy Ivanhoe, MD
Managing Patients With Spasticity: From Evidence to Best Practice - Cindy Ivanhoe, MD
Guidance, Localization, and Placement of Botulinum Toxin: What Works Best? (Pediatric and Adult Limb Spasticity) - Katharine Alter, MD
Optimizing Patient Outcomes Post-BoNT Using Rehabilitation Therapy - Laura Wiggs, PT, NCS, CBIS
The Speech Language Pathologist’s Perspective: A Key Member of the Comprehensive Clinical Management Team - Sofia Tilton, MS, CCC-SLP
Video Grand Rounds: A Patient Case Study - Cindy Ivanhoe, MD
Video Grand Rounds: A Patient Case Study - Laura Wiggs, PT, NCS, CBIS
Video Grand Rounds: A Patient Case Study - Katharine Alter, MD
Video Grand Rounds: A Patient Case Study - Craig Davis, OTR

Commercial Support and Disclosure*
Yes No
Disclosure of faculty relationships with commercial organizations was made available to me before the presentation.
The commercial supporters were acknowledged in the printed materials.
*If you answered “No” to any of the Commercial Support and Disclosure sections above or either of these questions, please provide further detail.
Comments:
What topics would you like to see addressed in future workshops?

	Excellent	Good	Fair	Poor
Program Content
Relevance to my clinical practice
Effectiveness in meeting identified need

	Yes	No
Disclosure of faculty relationships with commercial organizations was made available to me before the presentation.
The commercial supporters were acknowledged in the printed materials.