Multi-Disciplinary Team - Duke ALS Clinic

	• Each time you come to clinic, you will have the opportunity to meet with the following team members: (Click on the team member's photo to enlarge)
		Dr. Richard S. Bedlack Clinic Director (See Director page for more)
		Stacey Asnani Clinic Coordinator and Social Worker Medical social workers have a Master’s degree in the field of social work and have specialized training and experience focusing on health related issues and their impact on physical, emotional, social and spiritual functioning. Social work provides screening, assessment and intervention to patients and their families, empowering them to deal with the stresses that accompany a diagnosis of ALS. As part of the multidisciplinary treatment team, the clinical social worker provides the following services: • Psychosocial Assessment • Patient & Family Education • Counseling and Emotional Support • Advanced Directive Consultation • Community Resource Referrals • Home Health and Hospice Care Coordination • Health Insurance, Social Security & Disability Benefit Guidance and Advocacy • Support Group Referrals • Management of the ALS Clinic Library
		Candace Boyette Nurse Practitioner Candace received her undergraduate degree in Nursing from the University of North Carolina at Greensboro and her Masters Degree in Nursing from the University of North Carolina at Chapel Hill. She is licensed as a Family Nurse Practitioner by the NC Medical Board and is certified by the American Nurses Association. She has been in practice 23 years. Nurse practitioners focus on patients’ conditions as well as the effects of illness on the lives of the patients and their families. Informing patients about their health care and encouraging them to participate in decisions are central to the care provided by NP’s. The role of the nurse practitioner in the ALS clinic parallels the services provided by the clinic physicians and other health care professionals as part of a multidisciplinary team. Specifically, Candace’s role involves taking health histories and providing neurological examinations, diagnosis and treatment, interpretation of laboratory and radiology results, prescribing and managing medications and other therapies, providing health teaching and counseling to support healthy lifestyle behaviors. In addition to health care services, Candace participates in clinical research studies throughout the Duke Division of Neurology.
		Jill Chitty Marcus Speech Therapist Jill received her undergraduate and graduate degrees in Speech-Language Pathology from the University of Florida in Gainesville. She has been working at Duke University Medical Center for over 5 years in adult neurogenics, movement disorders, traumatic brain injury, dysphagia sevices, augmentative communication, and laryngectomy care. She currently serves as the outpatient Clinical Coordinator for the Division of Speech Pathology & Audiology. Speech Pathology provides valuable services to patients with ALS and other forms of motor neuron disease, which changes one's ability to communicate with their environment and affects their ability to safely eat and drink. As a part of the multi-disciplinary team that cares for these patients, the Speech Pathologist provides evaluation and treatment for both progressive dysarthria of speech (slurred speech) and dysphagia (swallowing problems). These services include: Evaluation of progressive dysarthria including assessing the role of assistive technology in meeting communication needs Full augmentative communication evaluations when speech becomes difficult to both produce and comprehend Addressing computer access when the use of the upper extremities becomes difficult Clinical evaluation of dysphagia (sometimes including objective assessment when necessary) Recommendations to increase safety when eating and drinking Patient and family education on the impact of communication and swallowing disorders as they relate to ALS To learn more about services provided by the Division of Speech Pathology & Audiology visit www.dukespeechandhearing.com.
		Jennifer Haynes Speech Therapist
		Meredith Gaylord Speech Therapist
		Faye Tripp Occupational Therapist Fay has been at Duke for 16 years. She has a Master of Occupational Therapy Degree from UNC. She holds advanced certifications as a Work Capacity Evaluator and as a Driver Rehabilitation Specialist. She is the Coordinator of Clinical Education for Occupational Therapy students here at Duke. She has lectured and presented at state and regional meetings on a wide variety of topics including upper extremity amputation, Parkinson's disease and Driving Safety in the Older Adult. Her areas of interest include neurology, upper extremity amputation and prosthesis in use in adults and children, adaptive parenting techniques for the physically challenged parent and work conditioning.
		Sandra Dawson Clinic Nurse
		Susan Steves RD, LDN Nutritionist Susan Steves is a Registered Dietitian and is licensed to practice Dietetics in North Carolina. Susan has been a dietitian for 19 years earning her Bachelor of Sciences degree in Dietetics from Buffalo State College in 1987. She has worked at Duke in the inpatient Neurosciences department for the past 6 years. Susan also has experience in outpatient nutrition education, long-term care, and nutrition management. She was also a chef for 10 years prior to becoming a dietitian. Susan's role on the ALS interdisciplinary team is to help the patients maintain and/or achieve good nutritional status throughout the disease process. Nutrition plays an important role in maintaining quality of life. Susan completes a full nutrition assessment during the first visit and continues to follow the patients' intakes and swallowing issues as needed. She monitors weights at each visit and encourages weight maintenance. Susan provides information regarding nutritional supplements, increasing calories and protein in their diets and helps with diet modifications as needed. She provides tips and recipes for maintaining good nutrition.
		Tyler J. Story, Ph.D. Neuropsychologist Assistant Professor of Psychiatry Tyler received his Ph.D. in clinical psychology from UCLA, with an internship in neuropsychology at the UCLA David Geffen School of Medicine. He then completed a two-year post-doctoral fellowship in neuropsychology at Duke. Tyler recently joined the faculty at Duke as Assistant Professor of Psychiatry. Neuropsychology is the study of the interaction between the brain and behavior, particularly as it relates to domains of cognition, such as memory, general cognitive ability, attention/concentration, language use, problem solving, visual-spatial skills, and emotional and personality functioning. Neuropsychologists provide comprehensive assessments of these functions and interpret results within the context of neurological, general medical, and psychiatric conditions. The role of a neuropsychologist in an ALS clinic can involve screening of emotional distress (e.g., depression and anxiety) and facilitating treatment for these symptoms. While changes in cognitive functioning are less in common in ALS than in other neurological illnesses, some patients do experience declines in concentration, working memory, and problem-solving skills, which may be relevant to ongoing treatment. If appropriate, patients may be referred for a comprehensive assessment to rule out alternative causes of these symptoms.
		Suzanne Gilroy ALSA Representative Suzanne is a North Carolina native, who represents the Jim Catfish Hunter Chapter of the ALS Association. She is in clinic to explain the many services offered by the chapter including respite care grants, transportation grants, assistive technology grants, flex grants, three durable medical equipment loan closets and a series of ALS specific support groups throughout North Carolina.
		Linda Fishman-Cates Physical Therapist Physical therapy provides many services and options for people diagnosed with ALS and other motor neuron disorders. ALS and motor neuron disorders have the tendency to change one's physical status over time and affects individuals in different ways. Our philosophy is to tailor our interventions to meet your specific needs with an ultimate goal of optimizing your independence. Some people who attend our clinic live near by, but many people are not from the local area. Physical therapy provides direct services and consultation to provide you with information and education on a variety of areas that may affect your lifestyle. As we have contact with many people diagnosed with ALS, we hope to offer you and your local healthcare providers information on how to best meet your needs wherever you live. Interventions may include the following: a) Exercise programs with an emphasis on safety, joint protection and energy conservation. b) Education on aquatic (pool) therapy c) Education and recommendation for equipment that facilitates independence and enhances quality of life at home and in the community. This may include braces to keep you walking, power equipment (wheelchairs) to allow access to areas within and outside of your home and a variety of other devices for safety and independence at home (patient lift devices, bathroom equipment, etc.) d) Specific problem solving to address mobility issues including negotiation of stairs, transfers off the floor and into the car, as well as bed mobility. e) Caregiver and family education on how to assist an individual with mobility related issues. Consideration for safety and avoidance of injury is emphasized.
		Elisa Santana Physical Therapist
		Kevin Caves, ME, ATP, RET Assistive Technologist Kevin Caves, a rehabilitation engineer, is the Director of Rehabilitation Engineering Research Center on Communication Enhancement at Duke University Medical Center. He has been involved in assistive technology research and direct services for people with ALS for over 16 years at Duke University and Rancho Los Amigos Medical Center in California. Kevin has worked on several federally and state funded grants on assistive technology and has presented nationally and internationally on computer access, environmental control, AAC, seating, positioning, mobility and the integration of control of technologies. Certifications include: RESNA Assistive Technology Practitioner (ATP), 1998 RESNA Rehabilitation Engineering Technologies (RET) 2004. For more about Kevin's work and Assistive Technology here at Duke, see http://speech.surgery.duke.edu/modules/div_spch_pc/index.php?id=3
		Andrea Johnson Respiratory Therapist
		Karen Grace Research Coordinator
		Debra Heydt Research Coordinator
		Dan Harrison Equipment Vendor
		Jennifer Greene MDA Representative
•Other Team Members: Yvonne Golightly, Research Coordinator