A neuropsychological assessment is a comprehensive assessment of cognitive, emotional, and behavioral functions using standardized tests and procedures. Various thinking abilities and emotional factors are evaluated, including but not limited to:
- Working Memory
- Memory and Learning
- Processing Speed
- Executive Functions:
- Problem Solving and Conceptualization
- Planning and Organization
- Language Abilities
- Visual Spatial Abilities
- Fine Motor Skills
- General Intelligence
- Academic Achievement
- Social Skills
Neuropsychological rehabilitation integrates neuropsychological test results to facilitate learning and adaptation to changes associated with brain related disorders or injury. It involves understanding the individual’s learning strengths and weaknesses to facilitate optimal functioning. Neuropsychological therapy applies the science of human learning with an understanding of brain related problems in order to most effectively treat various brain disorders and injuries. Psychotherapy (e.g. cognitive behavioral therapy), cognitive training, education, and behavioral management are typically used within the context of rehabilitation.
This kind of therapy involves understanding patients’ subjective experience of brain disease or injury, and the frustration and confusion they undergo. The symptom picture is usually a mixture of premorbid (before injury) cognitive and personal characteristics along with the neuropsychological changes directly associated with brain pathology. By closely observing the patient’s behavior, the clinician can teach him or her about the direct and indirect effects of brain damage. Therapy provides guidelines for the remediation of higher cognitive disturbances and for the management of patients’ interpersonal problems.
According to the National Institute of Mental Health, more than a quarter of American adults experience depression, anxiety or another mental disorder in any given year. Others need help coping with a serious illness, losing weight or stopping smoking. Still others struggle to cope with relationship troubles, job loss, the death of a loved one, stress, substance abuse or other issues. And these problems can often become debilitating. A psychologist can help you work through such problems. Through psychotherapy, psychologists help people of all ages live happier, healthier and more productive lives. In psychotherapy, psychologists apply scientifically validated procedures to help people develop healthier, more effective habits. Psychotherapy is a collaborative treatment based on the relationship between an individual and a psychologist. Grounded in dialogue, it provides a supportive environment that allows you to talk openly with someone who’s objective, neutral and nonjudgmental. You and your psychologist will work together to identify and change the thought and behavior patterns that are keeping you from feeling your best.
Cognitive Behavioral Therapy (CBT) is an evidence-based form of psychotherapy that emphasizes the important role that our thoughts, beliefs (cognitions) and behaviors play in determining how we feel and behave. For example, a client’s hopeless thought such as “I am never going to be able to do this” can result in greater feelings of sadness and anxiety. Psychologists can help clients begin to change their thought patterns and their behaviors in ways that can reduce negative symptoms of anxiety and depression while increasing positive feelings.
CBT has been shown to be especially helpful for treating anxiety, depression, and a number of other emotional and behavioral difficulties. Neuropsychologists utilize CBT along with other approaches to treatment, creating a treatment plan for each individual. CBT is one method utilized within the larger context of neuropsychological rehabilitation.
Cognitive rehabilitation was defined by The Brain Injury Interdisciplinary Special Interest Group (BI-ISIG) of the American Congress of Rehabilitation Medicine as a “systematic, functionally-oriented service of therapeutic cognitive activities, based on an assessment and understanding of the person’s brain-behavior deficits.” “Services are directed to achieve functional changes by (1) reinforcing, strengthening, or reestablishing previously learned patterns of behavior, or (2) establishing new patterns of cognitive activity or compensatory mechanisms for impaired neurological systems”. Cognitive rehabilitation techniques are designed to improve the quality of life and functional outcomes for individuals with acquired brain injuries or other brain related disorders. Cognitive rehabilitation is one aspect within the larger context of neuropsychological rehabilitation.
Sports Concussion Management
Clinical management of sports related concussions incorporates the use of ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing). Developed by clinical experts who pioneered the field, ImPACT is the most-widely used and most scientifically validated computerized concussion evaluation system. ImPACT provides trained clinicians with neurocognitive assessment tools and services that have been medically accepted as state-of-the-art best practices — as part of determining safe return to play decisions. Concussion often results in measurable changes in brain function. These changes are often not visible to the naked eye. ImPACT measures subtle changes in cognitive functioning that cannot be accurately measured by relying on the client to report symptoms. ImPACT has been scientifically validated through over 15 years of university-based research. The information can be valuable in assisting parents, teachers and other professionals in making decisions about the athlete’s academic needs during the recovery process. ImPACT is particularly important in helping to determine whether academic accommodations are needed after injury.
School assessments are usually performed to determine whether a child qualifies for special education programs or therapies to enhance school performance. They focus is on achievement and skills needed for academic progression. Generally, they do not diagnose learning or behavior disorders caused by altered brain function or development. A neuropsychological evaluation is comprehensive in its scope, covering general intellectual ability, various domains of cognitive functioning, emotional and behavioral functioning, in addition to academic abilities. A neuropsychologist can help provide a roadmap for optimal learning in all environments whether it is at school, home, or in other social settings. The focus is on how an individual learns information. For example, a school evaluation may identify difficulties with math and provide opportunities for extra practice, tutoring, or accommodations. A neuropsychological evaluation would identify difficulties with sequential thinking, visual spatial deficits, or working memory that impact a student’s ability to do math and provide recommendations to treat the cause of the poor achievement. Often the intervention requires more than what is recommended for school purposes. Treatment may involve therapies and/or medications for various brain disorders that are a barrier to learning.
Medical Legal evaluations are more comprehensive neuropsychological assessments that also include a more extensive review of available records. They address issues of causation that are relevant to legal decisions such as competency, civil damages, and work capacity. When needed, neuropsychological expert testimony in depositions and in court provides opinions about the patient’s ability to function based on these evaluations.
A medical-legal or forensic evaluation addresses additional questions that are not typically the focus of a routine clinical assessment. A clinical evaluation involves the assessment of a client’s strengths and weaknesses with the goal of using one’s cognitive strengths to circumvent their weakness areas. A key goal of a clinical evaluation is to provide an individual with suggestions to improve their daily functioning. The results of such a clinical evaluation are protected via state and federal laws (such as HIPPA) and professional ethics. Therefore, those results cannot be released without a client’s expressed written permission, except in some certain situations dictated by law.
In a medical-legal evaluation, the referring party, which is typically an attorney, is the party who receives the results of the assessment. The individual being evaluated may or may not have an opportunity to review the results of the assessment. In addition to developing a strengths-and-weakness profile, a medical legal assessment involves the assessment of a client’s premorbid functioning, in terms of vocational, educational, and daily living achievement and skills. In a comprehensive medical-legal assessment all sources of available information are reviewed to most accurately characterize an individual’s past and present functioning. Such a medical-legal assessment includes detailed assessment of an individual’s motivation to perform optimally. It allows a clinician to assess the veracity or legitimacy of an individual’s complaints as well as provide solid documentation of the degree of actual psychological and cognitive injury.
The following evaluations are provided, but not limited to:
- Independent Medical Exams (IME)
- Neuropsychology Expert Testimony
- Workers’ Compensation Qualified Medical-Legal Evaluations:
- Qualified Medical Evaluations (QME)
- Agreed Medical Evaluations (AME)
- Cognitive Capacity Evaluations
- Fitness for Duty Evaluations
Clinical and Program Consultation
Neuropsychological consultation is essential to patients in acute and post-acute brain injury rehabilitation programs. Consultation services provided include the clinical coordination of treatment for individuals who are receiving services from a multidisciplinary teams in the community and home setting. The goal is to assist in returning individuals to maximal productive activity and quality of life following traumatic brain injury and other brain related disorders.
Presentations and Seminars
Educational lectures can be provided for various groups including schools, professional associations, or patients. Topics can be tailored to the needs of the institutions. Example of topics include brain health and aging, strategies to manage ADHD, learning disabilities, clinical management of concussions, behavioral management, and guidelines to optimizing your executive functions.