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Residency Practicum Program

The Residency Practicum Program will provide a hands-on forum for PGY3 or PGY4 residents of
neurology, physiatry, or both to be mentored by a Preceptor (a specialist in treating spasticity,
muscle overactivity, and spastic paresis). Residents will travel to a Preceptor’s office, clinic, or
institution for a ¾-day practicum. Preceptors will schedule patient cases to share with their residents.
The goal of the Residency Practicum Program is to provide education about spasticity and muscle
overactivity and elaborate on various treatment techniques for residents in training. Nominated residents
should be interested in increasing their knowledge of spasticity and other muscle overactivity conditions
and improving their management skills.

For more detailed information and frequently asked questions, please click here.

If you would like to nominate a resident for the Residency Practicum Program, please complete the Resident Nomination Form.

* = required field.

Resident Nomination Form

Residency Training Director

*First Name:

*Last Name:

MI:

*Degree:

*Title:

*Affiliation:

*Address:

*City:

*State:

*ZIP:

*Office Phone:

(eg, xxx-xxx-xxxx)

Ext.:

Fax:

*E-mail:

Resident Nominee

*First Name:

*Last Name:

MI:

*Degree:

*Title:

*Specialty:

*Year of Residency:

*Affiliation:

*Address:

*City:

*State:

*ZIP:

*Office Phone:

(eg, xxx-xxx-xxxx)

Ext.:

Fax:

*E-mail:

This e-mail address will be used to contact the resident for scheduling.

Best time to contact:

Because you have attended or shown interest in our programs, we may send you information on this and similar programs utilizing the e-mail address provided. You may unsubscribe at any time by clicking on the “unsubscribe” link on any e-mails sent from us.
	Please do not send me information via e-mail.
*Briefly describe your nominee’s experience in the diagnosis and management of spasticity and other muscle overactivity conditions and their exposure to and aptitude in various treatment modalities, including chemodenervation agents.

How did you hear about this program?

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We value the confidentiality of the information you choose to share with us and are committed to its protection. All personal information you provide is stored in a secure location and will never be sold or distributed to any third party.

The NeuroRehab Preceptor Program is jointly sponsored by the Annenberg Center for Health Sciences at Eisenhower and CogniMed Inc.

This program is supported by an independent educational grant provided by Allergan, Inc.
© 2010 CogniMed Inc. All rights reserved.