The Therapy Insights Podcast Therapy Insights

Perioperative neurocognitive disorders (PND) are a group of cognitive disorders that manifest in relation to surgery and anesthesia (Evered et al., 2018a) and encompass former classifications of perioperative cognitive impairments, including postoperative delirium (POD) and postoperative cognitive dysfunction (POCD). PND are common following anesthesia and surgery, affecting up to 65% of adults over age 65 years (Rudolph and Marcantonio, 2011).
 
In this episode, we discuss:
- What post operative cognitive dysfunction (POCD) is and the shift towards new nomenclature that aligns with the DSM-V and new ICD-10 codes.
- Risk factors for developing perioperative neurocognitive disorders (PND).
- What therapists can do to contribute to a proactive interdisciplinary approach to manage perioperative neurocognitive disorders when they do occur. 
- A proposed brain ERAS (Enhanced Recovery after Surgery) protocol to reduce the risk of PND.

In this episode, the Cultural Expansion Cooperative speaks with Zahya Ghaddar, SLP and PhD Candidate based in Beirut, Lebanon.
A little background for this episode: On August 4, 2020, a large amount of ammonium nitrate stored at the Port of Beirut in the capital city of Lebanon accidentally exploded, causing at least 218 deaths, 7,000 injuries, and $15 billion U.S. dollars in property damage, leaving an estimated 300,000 people homeless. The blast physically shook the entire country of Lebanon. It was felt in Turkey, Syria, Palestine, and Israel, as well as parts of Europe, and was heard in Cyprus, more than 150 miles away. It was detected by the United States Geological Survey as a seismic event of magnitude 3.3, and is considered one of the most powerful accidental artificial non-nuclear explosions in history.
Additionally, Lebanon is experiencing an economic crisis related to inflation caused by a significant decline in the country’s GDP. The Lebanese pound has lost more than 90% of its value, driving up the cost of almost everything in a country reliant on imports, and demolishing purchasing power. A soldier's monthly wage, once the equivalent of $900, is now worth about $50. Poverty rates are sky-rocketing in the population of about 6.5 million, with around 80% of people classed as poor. Lebanon's banks are paralysed. Savers have been frozen out of U.S. dollar accounts. Withdrawals in local currency apply exchange rates that erase up to 80% of the value. Reliant on imported fuel, Lebanon is facing an energy crunch. Even before the crisis, power was in short supply, including in the capital. Now households are lucky to receive more than a few hours a day. Fuel prices have soared. A ride in a shared taxi, a popular form of transport, cost 2,000 pounds before the crisis but now costs about 40,000 pounds. Lebanese have emigrated in the most significant exodus since the civil war. Believing their savings are lost, many have no plans to return. A 2021 Gallup poll found a record 63% of people surveyed wanted to leave permanently, up from 26% before the crisis. Among those leaving are doctors. The World Health Organization has said most hospitals are operating at 50% capacity. It says around 40% of doctors, mostly specialists, and 30% of nurses have permanently emigrated or are working part-time abroad. All of this data is from a Reuters article titled, “Just how bad is Lebanon's economic meltdown?” published on June 23, 2022.
This not only to provides context for Zahya’s references in her interview, but also reminds us that we are globally connected and as a global profession, we can work to support each other and advocate for our field beyond national borders. We want to recognize the hard work that all Lebanese therapists are contributing to their communities right now, even in the face of fuel, medication, food, and wifi shortages. We all have a lot to learn from you in regards to being resourceful, resilient, and responsive to community needs.

In this podcast episode, learn more about Mershen Pillay’s mission to transform curriculum to work within a Black African-first framework.

From our guest, Mershen Pillay: "I went to the only Black university in South Africa that trained audiologists and speech therapists… it was what was called a 'struggle' university so it had a strong political, sort of historical link to resisting racist policies in South Africa… and so when I looked at my class- that’s who I saw: other brown people… But everything that we were taught came from North America and Western Europe, and so I literally didn’t see anything of myself in those textbooks and journal articles… our training was very white-Euro-centric. Years later, I went backpacking through Europe and landed in London. I got into a job a few days later, and it was all familiar."

In this episode, we explore the following (fictional) case study: Alejandro is a 55 yo male who was first diagnosed with Parkinson’s at the age of 48. He was taken to the emergency room due to a fall in his home that resulted in mild head trauma as well as a broken wrist. A friend hadn’t heard from him in a couple of days and found him on the floor. After his acute stay in the hospital, he was taken to a post-acute care facility. While working with a team of speech, occupational, and physical therapists, the therapy team learns that he has no running water at home and that he uses a bucket for a toilet. He has a dog that he has been unable to get outside recently and so urine and feces has been collecting in the house. Alejandro is also worried about his dog and is wondering if anyone is taking care of him. When asked what he eats at home, it’s unclear if he has consistent access to food. He is quite private and is wary of others entering his home and is not willing to do a home eval. He wants to go home as soon as possible.

Until now, people who are incarcerated have not been screened for TBIs. We know that TBIs can cause changes in behavior and personality that can lead to incarceration, and once inside, make it more difficult to fully heal and functionally return to the community. The Washington Department of Corrections is one of the first, if not the first, state correctional agencies in the U.S. to implement a system-level response to TBIs among the incarcerated population. How did this happen? Through a persistent effort to build relationships, foster inter-agency collaboration, and a strong commitment to sustaining the mental health resources necessary to build and grow a program that supports a TBI screening program, cognitive skills training program, and peer mentoring program. This is a fascinating and deeply inspiring conversation with Risa Klemme, ADA compliance manager for the Department of Corrections, and Dr. Mark Harniss, Associate Professor in Rehabilitation Medicine, Director of the Center for Technology and Disability Studies, and Director of the UW Disability Studies Program. When people come together to change massive systems bit by bit, we all get collectively closer to our shared humanity. A heartfelt thank you to Risa and Dr. Harniss for their time and devotion, not only to this podcast episode, but to their legacy of collaboratively building the TBI program in the state of Washington.

Neuropsychologist Dr. Dennis J. Zgaljardic dissects 7 quotes (published on brainline.org) written by people who have survived brain injuries. From pace of progress, family dynamics, feelings of worthlessness, behavior plans, identity transformations, functional goals, anosognosia, confabulation, and "non-compliance," this episode has it all. Dr. Zgaljardic's experience in the realm of rehabilitation medicine offers wonderful insight into how speech, occupational, and physical therapists can fully engage within the complex dance of a therapist-client relationship within the context of traumatic brain injury.