Neurology & Neuro Disability Curriculum

Neurology & Neuro disability Curriculum

This version of the curriculum has been modified by the London Specialty School of Paediatrics for use by local trainers. It identifies which competencies will be provided on regional training days, on simulation courses and compulsory training courses as part of the training package. All competencies in black font have been identified as competencies trainees are expected to obtain in their local trusts, by clinical experience or by local teaching programmes.

Red – regional training Blue – simulation Green – external courses Black – local learning

Level of Training Knowledge Skills Generic Level 1 have knowledge and be able to take an accurate understanding of the neurological and neuro- pathophysiology of common developmental history disorders affecting the nervous system be able to examine the nervous system of a know and understand the newborn baby, child and common causes of disability young person

understand concepts of be able to perform a disability and what this reliable assessment of means for the child and neuro-developmental family status at key stages, including the newborn understand the life- period, the first year of life, threatening nature of acute nursery age, school entry neurological deterioration and late primary education and when to call for help be able to recognise a understand the principles disabled child and use of neuro- radiological imaging to be able to initiate management of children have a basic understanding with neurological and and experience of neuro- neurodisabling conditions in physiological tests acute settings and know when and whom to call for help understand the principles of prescribing and monitoring therapy be able to recognise, initiate diagnostic tests and outline the management of have experience of working common disorders with multi-disciplinary teams

be able to work with understand the implications families and professionals for families of children with in the care of disabled neurological and neurodisabling conditions children

understand the impact of develop a commitment to developmental disorders on advocacy on behalf of the life of child and family at disabled children and their different developmental families* stages

understand the need for a range of communication skills with disabled children, their families and other professionals

be aware of local services

understand the need to work with other services outside neurology and neurodisability such as child protection, education, services for looked after children and adult services.

understand the importance of seeking the views of all children to inform decisions about their individual care and about planning services

be aware of how agencies work together to address how children with health and medical needs are managed at school Level 2 be aware of local services be able to distinguish and how to access them simple developmental delay from developmental be aware of the role of the disorders and to manage Designated Medical Officer simple cases to the Local Education Authority (LEA) be able to recognise and come to a likely diagnosis of be aware of the statutory common developmental requirement to notify disorders such as cerebral children who may have palsy, dyspraxia, ADHD, special educational needs to specific learning difficulties the LEA and to know how to and arrange timely and do so appropriate specialist assessment know how equipment can be used to lessen the effects of have worked on specific disability and how to refer cases with multi-disciplinary teams know about and be prepared to find out about have experience of a range self-help and support groups of communication skills for children and their with disabled children, their families with conditions in families and other their specialist area and be professionals aware of the requirement to tell parents about these have experience of working groups with other services outside neurology and know about what benefits neurodisability such as child may be payable to the protection, education, disabled child and/or carers services for looked after and how they may be children and adult services accessed have experience of how know about local respite agencies work together to facilities and how they may address how children with be accessed health and medical needs are managed at school

have had experience of working in special schools

have experience of the local Special Educational Needs (SEN) panel

be able to write SEN medical reports on simple cases

have experience of SEN annual reviews and transition planning

be able to write reports on medical or developmental conditions for parents and non-clinical staff in education and elsewhere that are easily understood by the lay person, and that explain the implications of the condition and how it may impact on the child and her or his carers in non- clinical settings Seizures Level 1 know the common causes of be able to initiate seizures in newborn babies treatment for acute and children continuing seizures

be aware of common be able to form a epileptic syndromes differential diagnosis

begin to understand the understand the principles of links between epilepsy and initial and continuing behaviour problems anticonvulsant therapy in babies and children understand the place and principles of the EEG and work effectively with the neuro-imaging in multidisciplinary team investigation know about the long term implications of epilepsy Level 2 know about common be able to refer to intensive epileptic syndromes care teams appropriately and maintain patient safety understand the links until that team takes over between epilepsy and behaviour problems be able to decide initial and continuing anticonvulsant know about the long term therapy in babies and implications of epilepsy, children including different epilepsy syndromes and the risk of be able to advise parents learning difficulties, accident about education and safety or sudden death Faints and Level 1 be able to formulate a be able to make a likely differential diagnosis for diagnosis funny turns faints and "funny turns" be able to explain likely understand the diagnoses to parents investigations that may differentiate between these causes Level 2 continuing development of be able to initiate the level 1 competencies investigations that may differentiate between these causes Acute focal Level 1 understand the implications be able to demonstrate the of acute focal neurological signs neurological signs signs begin to gain experience of understand the principles of interpretation of CT and investigation MRI scans

have experience of how diagnoses are given to parents Level 2 continuing development of be able to interpret the level 1 competencies signs

have experience of interpretation of CT and MRI scans

be able to initiate consultation to give diagnoses to parents Ataxia, Level 1 know the common possible be able to recognise the causes of ataxia, clumsiness signs clumsiness and and abnormal movement abnormal patterns recognise which urgent patterns of investigations are needed movement know the indications for investigations Level 2 continuing development of level 1 competencies Hypotonia, Level 1 know about the common be able to demonstrate the causes of hypotonia, signs neuropathies neuropathies and and myopathies myopathies be able to form a likely know about the relevant differential diagnosis neurophysiological and metabolic investigations Level 2 continuing development of be able to elicit and level 1 competencies interpret the signs

be able to initiate appropriate tests Meningism and Level 1 know the likely causes or recognise early signs of pathogens of meningism meningitis and encephalitis altered and altered consciousness consciousness use a validated coma score understand the principles of treatment recognise signs and implications of raised intra- know about prophylactic cranial pressure therapy for contacts of meningitis initiate therapy appropriately be aware that organic brain conditions can lead to call for help promptly psychotic symptoms recognise the need for know when it is safe to urgent referral to audiology perform a lumbar puncture specialists after bacterial meningitis know the principles of establishing brain stem death Level 2 continuing development of assess and manage early level 1 competencies presentations of meningitis and encephalitis

ensure prophylactic therapy for contacts of meningitis

assess and initiate management of raised intra-cranial pressure Neural tube Level 1 know about antenatal be able to recognise diagnosis of neural tube syndromes defects and defects and other congenital other anomalies be able to communicate congenital sympathetically with abnormalities know about the ethical parents principles involved in management decisions Level 2 know about antenatal be able to recognise the diagnosis of neural tube signs and symptoms of defects and other congenital blocked shunts anomalies and their prevention Trauma to Level 1 be aware of the implications be aware of acute of severe head injury and management and need to central or the possibilities for transfer appropriately peripheral rehabilitation nervous system recognise the place of know about other occupational and neurological trauma such as physiotherapy brachial plexus injury Level 2 continuing development of be able to lead initial acute level 1 competencies management and transfer appropriately

work effectively with the multidisciplinary team to manage the medium and longer term implications and rehabilitation Fever or illness Level 1 Fever or illness in a child be able to assess child with with complex disabilities: be complex disabilities who is in a child with aware of the range of unwell complex diagnostic possibilities, disabilities including chest infection, be able to recognise aspiration, gastro- important indicators of oesophageal reflux, specific conditions oesophagitis, constipation, hip and joint problems, dental problems etc know when and where to get help

know when and where to get help Level 2 continuing development of level 1 competencies Neuro Level 1 be familiar with the main be able to assess investigations that will development developmental differentiate between the regression causes of neuro- developmental regression and how to access further expert help

understand the implications Level 2 continuing development of be able to recognise level 1 competencies regression of developmental skills and refer appropriately for investigation Disordered Level 1 understand the common be aware of the work of the causes of disability, child development team or development disordered development, centre and learning difficulties

know about the current theories on the pathophysiology of cerebral palsy

know about common secondary disabilities

understand the complications of cerebral palsy and disordered development Level 2 know about common have experience of working secondary disabilities and with the child development co-morbidities team or centre

recognise common causes of disordered development, manage simple problems and refer complex difficulties appropriately for specialist investigation and assessment Speech and Level 2 know the common causes of be able to distinguish speech and language delay simple phonological delay language delay, and disorders from more significant including disorders hearing know about multi- disorders disciplinary investigation and be able to recognise therapy for those with more abnormal speech and complex disorders language patterns

know the risk factors for recognise when referral to sensineural hearing an appropriate specialist is impairment know the needed principles of hearing testing at various ages recognise the need for referral of sudden hearing know the support available impairment for hearing impaired children recognise the need for referral to audiology know how to communicate specialists or to an ENT with a hearing impaired surgeon child or language disordered child including the child with recognise autistic features autism in disordered developmental assessments understand the importance and know how to refer of hearing assessment in appropriately children with speech and language problems and autistic spectrum disorders Conductive Level 2 know about the common have experience of hearing causes of conductive hearing tests at various ages hearing loss loss be able to recognise when know the principles of further assessment is hearing testing at various required and how to access ages and of management of it hearing impairment Sensorineural Level 2 know about the risk factors be able to recognise and common causes of syndromes and situations hearing loss sensorineural hearing loss where sensorineural hearing loss is likely to be able to recognise when occur further assessment is required and how to access be aware of the assessment it, including investigations of sensorineural hearing that may be appropriate loss

be aware of the principles of be able to communicate management, including with the child with cochlear implantation, and sensorineural hearing loss educational approaches to sensorineural hearing loss Weakness Level 2 know the possible causes of be able to take a relevant weakness and patterns of history presentation be able to elicit and interpret appropriate signs Abnormal head Level 2 know how to recognise be able to plot and abnormal head shapes and interpret a head growth shape and size to differentiate between chart serious and non-serious causes be able to reach a likely diagnosis and initiate know the common causes of investigations for abnormal hydrocephalus, head growth macrocephaly and microcephaly know about the insertion and ongoing management of ventricular-peritoneal shunts Headache Level 2 know the possible biological, be able to recognise when psychological and social headache may indicate factors that can contribute serious illness and arrange to headache prompt investigations

be able to initiate appropriate investigations and treatment Problems of Level 2 understand the common be able to identify infants causes of sensory and children at risk of language, impairment, the various language, hearing or visual hearing and tests available and when impairment vision they are appropriate be able to recognise when know about the principles of sensory impairment may testing contribute to developmental difficulties and to refer appropriately for further assessment Specific Level 2 understand how specific be able to identify when learning difficulties present specific learning difficulties learning at school might be present and how difficulties to refer appropriately for further assessment