Contemporary Clinic spoke with Tomika S Harris, DNP, CPNP-PC; Traci Gonzales, APRN, CPNP; and Cheryl L. Grave, RN, CPNP-PC about Cerebral Palsy Awareness Month and how CP affects the average person.

These experts are leaders of the Children and Youth with Special Health Care Needs Special Interest Group at the National Association of Pediatric Nurse Practitioners.

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Tomika S Harris, DNP, CPNP-PC; Traci Gonzales, APRN, CPNP; and Cheryl L. Grave, RN, CPNP-PC are leaders of the Children and Youth with Special Health Care Needs Special Interest Group at the National Association of Pediatric Nurse Practitioners.

Cerebral Palsy Awareness Month and The Impact of Cerebral Palsy

interviewed Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association, on muscular dystrophy research and care during the COVID-19 pandemic and beyond.

Have the focus and opportunities available for researchers in the muscular dystrophy field been impacted by the COVID-19 pandemic?

 Well, COVID-19 affects all of us. So, it's not just on a professional level—we’re all affected personally as well. I'm speaking to you, as you might imagine, from my home. Normally, I would speak to you from maybe a care center or some other place where the patients were. But nowadays, we're all home.

COVID-19 affects folks with neuromuscular disease, who are at very high risk—I mean talk about having extra problems. Plus, the vaccines that are available now are injected into muscle.

Well, we do not have clinical trials of how folks with muscle disease whose muscles are destroying, being wasted etc., how they're going to take the vaccine. So, we are keenly, as an organization, on top of every detail related to the understanding of COVID-19—not just as a vaccine—but how people are able to absorb the vaccine and get the benefit from it.

We have, through our advocacy groups, worked with the CDC, and you can go on our website and identify all the advances that we have in terms of information available for our patients and others. We’ve worked with the CDC and others to develop not only guidelines for delivering vaccine to folks with neuromuscular disease, but also to help identify, and our own researchers are evaluating every patient that gets a vaccine to determine, ‘Okay, how are they reacting to it.’

So far, we've seen positive benefits, and we are delighted with that. But like everybody else, this is not a scientific term, so I apologize, but we just keep our fingers crossed that everything continues to go well, and our folks get vaccinated, and do not have to end up with the disorder.

Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association, discusses how the COVID-19 pandemic has impacted the muscular dystrophy field.

How the COVID-19 Pandemic Has Impacted the Muscular Dystrophy Field

interviewed Lea Davis, PhD, an associate professor of medicine in the Department of Medicine at Vanderbilt University Medical Center and an investigator in the Vanderbilt Genetics Institute, on a recent study she co-authored that was published in 

 on the epidemiology of functional seizures among adults treated at a university hospital.

Why are confirmed associations between functional seizures and psychiatric conditions, such as [post-traumatic stress disorder (PTSD)], anxiety, depression, and sexual assault trauma, potentially important in terms of understanding and treating functional seizures?

 So functional seizures really kind of exist at the boundary between psychiatry and neurology, which is actually one of the reasons why they've been historically so poorly understood and so understudied.

We have this kind of historical separation between psychiatry and kind of the rest of medicine, and functional seizures are one of those boundary conditions where you really need a treatment team and support from multiple domains.

So, I think reaffirming that this is a truly an association that we see in a much larger population is important from that perspective, but then also the relationship that functional seizures seem to have kind of specifically with trauma I think is going to be important in our understanding of how and why these seizure conditions develop.

So, I have kind of come to think of functional seizures as potentially being a neurological consequence of trauma. Now, that doesn't mean that trauma is the only thing that can cause functional seizures, I think it's a heterogeneous kind of condition, so there are lots of potential causes. But certainly, we see that there is a stark over-representation of trauma in functional seizure cases.

Contemporary Clinic® interviewed Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, on the confirmed associations between functional seizures and psychiatric conditions.

Expert: Functional Seizures ‘Exist at the Boundary Between Psychiatry and Neurology’

interviewed Bethany Hall, MSN, the owner of Healing Connection, on the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall explains why educating the medical community on how to approach care for children with CDT is important.

Why did you create Healing Connection, and what is the focus of the organization in relation to educating the medical community on CDT?

So, I founded Healing Connection based on a lot of what we just talked about. I saw that there were a lot of gaps in the system, so in addition to what we do with medical providers, we also do a lot of work with social workers, with foster and adaptive families, but as far as in the medical community, I really founded this to reach out in advocacy and education.

So, my first goal is advocacy: To help raise awareness that this is a real problem. Oftentimes, we don't realize it because these children are getting labeled with mental health diagnoses really early on in life. So, I would see in the emergency department 3, 4, or 5 year olds that were already on heavy medications, psychiatric medications, and just really to the point where they couldn't even express emotion because they were given these diagnoses that more than likely had at least a large part of that based in trauma.

So, is dealing with trauma going to get rid of all mental health problems? Of course not, but I think until we give these kids the adequate help they need to deal with their trauma, we'll never really know how much of what we're dealing with is trauma and difficulty with creating those important connections in life, and how much of this is true mental illness and would require medication.

So as a member of the medical community, as an adoptive mom, I just realized how much there was a lack of training in education, and I've witnessed that firsthand, and that the access to care is struggling. I just think that the more educated we as a medical community can become in our respective areas—so for instance family practice, internal medicine, pediatrics—those are the gatekeepers to our medical community. So, nurse practitioners in those areas have a powerful opportunity to be the gatekeepers to services.

So, when we look at Dr. Burke Harris's practice, she has got a social worker on staff, she's regularly referring children to educational services, and so that's a very robust program that she has. But we can all take steps in that direction to educate ourselves about services in our communities that our patients can utilize, and then instead of just keeping ourselves in the box of referrals to maybe a specialist with an [otorhinolaryngologist] or a kidney doctor, we're really looking to how can I broaden what I can do in referrals, whether that be social worker, psychologist, or programs like Healing Connection, in my community. Where I can find people that will coach these parents and will walk alongside them.

So, I think the more we can educate ourselves especially in those areas, the better we can advocate for our patients. And again, the more holistic we can create care plans, rather than just playing what we call whack-a-mole, trying to focus on symptom management, and throw one med, and if that doesn't work, we throw another. Sometimes in the medical community, we can kind of get stuck in that symptom management mode, and the reality is that if we can be proactive and educate ourselves in this area, I think we can really make a lot of gains and have a more holistic complementary approach.

Contemporary Clinic® interviewed Bethany Hall, MSN, the owner of Healing Connection, on the importance of educating the medical community on how to approach care for children with complex developmental trauma.

Nurses Have an Important Role in the Care of Children With Complex Developmental Trauma

interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

 on the use of cannabis in treating symptoms of obsessive-compulsive disorder (OCD).

In the study, did you find that participants developed a tolerance to cannabis over time, as you mentioned, and did any developed tolerance affect the benefits observed in treating OCD symptoms?

 Yeah, we explore tolerance in 2 ways. So, first, we examined whether people increased their dose of the drug over time, and we did not find evidence that people with OCD use higher quantities of the drug over time. In fact, there was even evidence that the dose they used to treat intrusions was decreasing over time, which is kind of unexpected.

The other way we explored tolerance was to examine whether people's self-reported reductions in these symptoms got smaller over time, as they continued to use cannabis to manage them. We found that the magnitude of the reduction in intrusions was smaller over time, which is evidence that they may be developing some tolerance to the effects on intrusions specifically. In contrast, symptom reductions for compulsions and anxiety remain constant over time, suggesting no tolerance was developing for those symptoms.

Contemporary Clinic® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on recent findings that showed that patients with OCD who used cannabis to manage acute symptoms did not develop a tolerance to the drug over time.

Patients With OCD Using Cannabis Were Not Found to Develop a Tolerance to the Drug

interviewed Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association (MDA), on muscular dystrophy research and care during the coronavirus disease 2019 (COVID-19) pandemic and beyond.

Would you mind discussing further the Task Force on Genetics, and the importance and impact of its findings on understanding muscular dystrophy?

 Well to your audience, there was a time probably before many of you were born when we didn't know how to do research into human genetics because we couldn't actually study human DNA. The first time we were allowed to study human DNA was back in the 70s—that's last century folks. Then in the 80s, the Muscular Dystrophy Association created the Task Force on Genetics, whose specific aim was to identify the genetic cause of muscular dystrophy.

No one had ever identified a gene underlying a human disease without knowing what that gene did. When we started looking for the gene, we didn't know if the gene was expressed in muscle—even though muscle was hurt, the gene could have been expressed in nerve. There were even some theories that the gene somehow disoriented capillarity, and so it could have been in that area. We didn't know what area it was in.

So, the Task Force on Genetics set up a program which I oversaw, and we had a strategy for going after the genes underlying Duchenne muscular dystrophy. There are a lot more diseases, but we knew that Duchenne muscular dystrophy was an x-linked disorder, so it was on the x chromosome, and anyway, without going through all the details, that was our focus.

We held a conference in Cold Spring Harbor in 1983 to develop the overall strategies. In 1986, I was on a stage with Jerry Lewis and Dr. Lou Kunkel's lab that had discovered the gene underlying Duchenne muscular dystrophy, the very first gene underlying a human disease ever discovered without knowledge of the gene protein. The gene protein came next, so we have in the 70-year history of the Muscular Dystrophy Association created history in terms of human genetic diseases, and it's been my great, good fortune to have been involved every step of the way.

Contemporary Clinic® interviewed Donald Wood, PhD, the recently elected president and CEO of the Muscular Dystrophy Association, on the history of the Task Force on Genetics, and the importance and impact of its findings on understanding muscular dystrophy.

How the Groundbreaking Discovery of the Gene Underlying Duchenne Muscular Dystrophy Changed the Field

interviewed Bethany Hall, MSN, the owner of Healing Connection, on how understanding the role nurse practitioners have in understanding and approaching care for children with complex developmental trauma (CDT).

In this discussion, Hall discusses the cumulative nature of the economic and social burden of childhood trauma, making trauma competent caregiving in the field of nursing critical.

What is the role of trauma competent caregiving in the field of nursing, and what role do nurse practitioners have in understanding and approaching care for children with CDT?

So, I love nurses. I was a nurse before I was a nurse practitioner. Nurses are, in my opinion, the hearts and hands of the medical community. So, nurses spend a lot more time in a patient bedside in building a rapport with patients than any of us as nurse practitioners or physicians do. So, they have a unique opportunity as they raise their own education and awareness to build rapport with these patients, to be advocates for them, to help train the other people around them, and how to approach a child that has experienced trauma, to do things like increase their feeling of safety, to make their surroundings more comfortable, to help them know that they have a voice in their medical care, that they can speak out about how they're feeling or how their medications are making them feel, or interacting with their other activities of daily living.

So, the more nurses are educated, I think they can do great work with the patients one-on-one, and in their multiple interactions with patients. As far as nurse practitioners and physicians, I think the more we understand that there is meaning behind the behavior of our patients, the better we can create plans that are holistic in nature and that take into account the changes that have occurred in these children as a result of trauma in their brains, their bodies, and their biology.

So, I mentioned earlier I think this is changing somewhat. Dr. Nadine Burke Harris has written a book called 

 and basically [it] catalogs her journey of educating herself on childhood trauma, how she created her pediatric practice, and how she changed it to really create a holistic and family-based approach that takes into account a child's [Adverse Childhood Experiences (ACE)] score. So, in her practice now, utilizing the ACE score is just like getting a vital sign, so it's just like a blood pressure, every child gets their ACE score. That really helps drive care, helps them make sure that if there are problems in the family, that if the child is still in the midst of trauma that they're experiencing, then providing resources to the parents.

Oftentimes children who have parents who are neglectful or abusive, it is a direct result of their parents’ experiences as children. So, she takes a family-based approach of saying how can we help you to heal from your trauma so that you can be a better parent to your child, and how can we give you resources—if it's food, clothing, or safety as far as a living situation—how can we help you and give you resources because, when we can help the parents, then we help the children, and we really improve health outcomes across the board. So, I think the more that we educate ourselves, the better we can do, and from a public health standpoint, the need for us to educate ourselves as nurse practitioners can't be overstated.

So, the cumulative economic and social burden of childhood trauma is extremely high, and I think it's something that we just don't realize as a medical community. I have here based on the data from a variety of sources I was looking up right before our interview a conservative annual cost of childhood abuse and neglect is estimated at about 103.8 billion dollars, so that includes like the direct cost associated with hospitalizations like I was talking about with the emergency department mental health care for these children—child welfare systems, law enforcement—to kind of create these systems that we need around them. But it also includes indirect costs related to the secondary or long-term effects of their abuse, which again then you're talking about special education services, juvenile delinquency services, long-term mental health care, criminal justice system, loss of productivity to society.

So, it's our job—I feel like the onus is on us as a medical community to understand that this is a public health crisis that's gone unnoticed for a long period of time as we live through this pandemic. That's only likely to increase. So, the impact on parents and their ability to parent well and the impact on these children with compounded stressors that may or may not be able to be discussed and given space to help them work through these things, so that they don't become traumatic is often not there. So, I think it can't be overstated the role that we have as nurse practitioners to educate ourselves and then to become champions among our colleagues in this area.

Contemporary Clinic® interviewed Bethany Hall, MSN, the owner of Healing Connection, on the role of trauma competent caregiving in the field of nursing.

Understanding and Approaching Care for Children with Complex Developmental Trauma

Contemporary Clinic spoke with pediatric nurse practitioner Brenda Cassidy, DNP, RN, MSN, CPNP-PC, from NAPNAP about how health care professionals can pay attention to the red flags of human/child trafficking victims.

Cassidy also discusses the dangers of online predators during the COVID-19 pandemic and what she hopes to see for the future of HCPs in this area.

Contemporary Clinic spoke with pediatric nurse practitioner Brenda Cassidy, DNP, RN, MSN, CPNP-PC, from NAPNAP about how health care professionals can pay attention to the red flags of human/child trafficking victims.

Spotting the Red Flags of Human Trafficking in the Healthcare Setting

During the discussion, Davis addressed the difference between functional seizures and epileptic seizures in patients, and how providers can identify this difference.

What exactly is the difference between functional seizures and epileptic seizures in patients, and what methods are available to identify the difference?

 So, the seizure itself can look very similar. Functional seizures often look like grand mal seizures, and they can be really difficult to distinguish from epileptic seizures, even for experts who are well-trained in understanding functional seizures. Really the gold standard for being able to diagnose functional seizures is a video EEG, which means that somebody is under video observation, and they have the cap with all the wires attached to their scalp to measure electrical activity, and this can often take 2 or 3 days of a person being under observation, where they're basically just waiting for a typical seizure—a seizure like the kind that the patient typically experiences, and then they look to see [if] those seizures also correspond with electrical activity in the brain that is a signature of epilepsy or not. If it does not correspond with aberrant brain activity that is indicative of epilepsy, then it's classified as a functional seizure.

Contemporary Clinic® interviewed Lea Davis, PhD, of the Vanderbilt University Medical Center and Vanderbilt Genetics Institute, on the difference between functional seizures and epileptic seizures, and how providers can identify the difference.

Identifying the Difference Between Functional Seizures and Epileptic Seizures

interviewed Carrie Cuttler, an assistant professor in the Department of Psychology at Washington State University, on a recent study she co-authored that was published in the 

In this discussion, Cuttler addresses the short-term versus long-term effects of cannabis on OCD, and how these may impact patients with OCD who use cannabis.

In the study, you noted that cannabis may have some beneficial short-term effects, but potentially less long-term effects on OCD. What do you mean by short-term versus long-term effects, and how might these differing effects impact how cannabis could potentially be used to treat patients with OCD?

 Yeah, so by short-term effects, I really mean the acute effects. So, I mean the effects of the drug when people are under the immediate influence of cannabis. And again, our results show that people perceived and reported approximate 50% reductions in these OCD symptoms from immediately before too shortly after inhaling cannabis.

Now by long-term effects, I mean like the more lasting effects of the drug after its acute effects have worn off, so when the person's no longer under the immediate influence of the drug. To examine these effects, we actually tracked people's baseline ratings of their symptoms over time. So, we just looked at their ratings immediately before cannabis use to self-medicate and looked at this as a function of the repeated use of cannabis over time. 

We found that these baseline ratings of intrusive thoughts and compulsive behaviors really stayed pretty constant over time, which either means people just self-medicate once their symptoms hit a certain threshold, which is certainly possible, or it could mean that the repeated use of cannabis over time does little to treat the core symptoms of OCD. Instead, these findings are suggesting that using cannabis might simply kind of just maintain these symptoms over time.

In other studies, I've actually found a similar pattern of results. Collectively, they indicate that cannabis is really serving as a band-aid in that it's temporarily masking these symptoms, but it's not addressing the root core issues that are underlying these problems. 

So, people experiencing these symptoms may turn to cannabis, and they may find that yeah it effectively reduces their symptoms in the short term while they're intoxicated or under the influence, so it's negatively reinforcing in that way—it's taking away a bad feeling and making them want to keep using it, but it's not decreasing these symptoms in the long-term. It's not addressing the root core issue. Instead, it's really just maintaining these symptoms over time. 

So, when the effects of the drug wear off in 1 to 4 hours, the symptoms are going to return, leading them to potentially use more cannabis, and then eventually increasing the risk for becoming dependent on it. As such, people with OCD should really be seeking out therapy to learn how to effectively reduce their symptoms in the long-term.

Contemporary Clinic® interviewed Carrie Cuttler, PhD, an assistant professor in the Department of Psychology at Washington State University, on the short-term versus long-term effects of cannabis on OCD.