The neuropsychologist is most important at the beginning of treatment,
when they assess a patient's needs, examine the extent of the brain
injury, and decide the course of treatment that is needed. They
periodically return and reassess the patient for improvement. Their
evaluations can continue on an outpatient basis for as long as they
feel it necessary. However, they are most likely to help only during
the initial phases of treatment; it is more the job of occupational
and language therapists to help patients on an outpatient basis.
First of all, the British Psychological Society provides an overview
of what a clinical neuropsychologist's role in rehabilitation is.
British Psychological Society: Careers in Neuropsychology
"Rehabilitation centres: providing post-acute assessment, training and
support for people who have sustained brain injury, or who have other
neurological problems. The neuropsychologist will play a central role
in the multidisciplinary team which aim to maximise recovery, minimise
disability, and prepare the client for return to the community or to a
Community services: performing a similar role as above but support
those who have returned to community living."
Anthony Risser, PH.D
"CLINICAL NEUROPSYCHOLOGY encompasses the understanding and diagnosis
of changes in cognition and behavior after known or suspected brain
damage. The profession is one of the health-care specialties in the
clinical neurosciences and a specialty in clinical psychology.
Identifying the nature of brain-behavior abnormalities relative to the
context of normal functioning, understanding the consequences of these
changes in the daily life of the individual, and contributing to
effective and cost-efficient treatment and management of affected
patients are basic goals of neuropsychological services, such as
performing examinations and consultations."
Wellington Hospital on Neuropsychology
"Neuropsychology is a branch of clinical psychology that aims to
identify and understand changes in thinking and behaviour that can
often result from injuries to the brain caused either by accident or
Within the Wellington Hospital the main role of the neuropsychologist
is cognitive assessment: that is identifying and measuring the extent
of any changes in thinking ability. This may include attention,
memory, reasoning and perception. Finding solutions to acquired
problem behaviours is also part of the role of the neuropsychologist.
In addition, this specialist will address the emotional and adjustment
changes that frequently follow either acute or chronic illness, in
either the patient him or herself or the patient?s relatives."
"To gain more information, patients are often asked to undergo a
series of tests. These are usually conducted by a specialist. This can
be a neurologist (specialist doctor) or a neuropsychologist
These tests are known as psychometric tests, and can examine many
different aspects of the brains' performance. They don't require
injections or operations, and allow the specialist to pinpoint in
greater detail, what jobs the brain is not doing as well since the
injury. For example, they can test things like speech, co-ordination,
memory, attention, and even thinking."
Easyweb on Head Injuries
"A neuropsychologist is a specialist with formally trained expertise
in the differential diagnosis of disorders of higher cerebral
functioning. These disorders include dementia, amnestic syndrome,
aphasia, and specific disorders of attention. Neuropsychologists have
established neuropsychology units, clinics, and departments in a
variety of acute-care, neurological, and rehabilitative medical
settings with ever increasing frequency since the middle of the 20th
Neuropsychology consultation is one modality in the diagnostic workup
of patients with any of a wide variety of complaints and clinical
"My own experiences of providing neuropsychological services suggest
that physicians, nurses, and therapists will make frequent use of
results from neuropsychology consultation--once the service is
available at a facility."
"In order to respond to these questions, a neuropsychologist must
first obtain the patient's performance on a number of standardized
psychometric test instruments that were created to examine key aspects
of normal cognition and were validated on samples of patients with
documented brain disease."
"A typical neuropsychological examination will evaluate:
* general intellectual functioning,
* ability to learn and remember new information,
* attentional capacity and concentration,
* sensorimotor functioning,
* ability to self-monitor and correct one's behavior,
* academic achievement,
* personality functioning.
These evaluations are long when compared to other examinations
patients will endure during hospitalization, oftentimes involving
three-to-six hours of formal testing. The length of time, however,
affords a neuropsychologist the unique ability to investigate in
detail functions which can be touched upon only briefly in a bedside
examination or in the mental-status screening portion of a physical
Types of Tests
"Clinical neuropsychologists evaluate patients using one of three
general methods. The first method is to use an assessment technique in
which a fixed battery of tests is given and in which we only want to
know what functions are impaired and what functions are not impaired.
The most commonly used representative of this type of test is the
Halstead - Reitan Neuropsychological Battery. The second method is to
use an assessment technique in which a fixed battery of tests is given
but in this method there is a hierarchical arrangement of items within
each subtest so that if a function is impaired, the level at which it
is impaired can be determined. The most common representative of this
type of test is the Luria - Nebraska. Common to both of these tests is
a long history of research studies examining the ability of the two
batteries to measure dysfunction of the brain and to accurately
identify why that dysfunction is occurring.
The third method used by neuropsychologists is the flexible battery
approach. By definition, the flexible approach is not a battery
because when one uses this approach one gives a group of tests
allegedly picked for just the particular patient. This means that the
particular group of tests is not given to other patients..."
What is a Neuropsychologist?
"Neuropsychological Assessment: A Key Piece of the Puzzle After Brain Injury"
Family News and Views, Vol 5 No. 3, April, 1998
By, Carolyn Rocchio
"Traditionally a patient is treated and evaluated by a number of
medical doctors after a traumatic brain injury and one or more of
these physicians may continue to follow the patient for a prolonged
period to monitor recovery and manage medications. In addition the
treatment team is composed of other professionals whose services are
well understood by families, e.g., physical therapists, speech
language pathologists and occupational therapists. However, at some
point post injury the individual with brain injury should be referred
for a neuropsychological assessment and this procedure as well as the
professional providing the services may be less well known. It can be
confusing for individuals and families to understand the differences
between a neurologic evaluation and a neuropsychological assessment.
Many patients are seen by neurologists and the kind of assessment a
neurologist performs is designed to evaluate the central nervous
system at all levels without comprehensive and specific findings to
determine the presence of dysfunction. In many cases the neurologist
may refer the patient to a neuropsychologist for more specific
information about an individual?s strengths and weaknesses as a result
of brain injury. A neuropsychologist is a psychologist with
specialized training in brain-behavior relationships and instead of
being a medical doctor (M.D.) the academic credentials for a
neuropsychologist will likely be Ph.D. or Psy.D.
What is the Neuropsychological Assessment/Evaluation?
The neuropsychological assessment is a specialized task oriented
evaluation of human brain-behavior relationships. It relies upon the
use of standardized testing methods to evaluate higher cortical
functioning as well as basic sensory-motor processes. It is
appropriate for both a neurologist and a neuropsychologist to perform
evaluations and there are some similarities to the kind of testing
they do; however, the neuropsychological assessment is designed to
provide more detailed and comprehensive information about cognitive
capabilities than the neurological evaluation.The neuropsychological
assessment is usually conducted as soon as the patient is
neurologically stable. A neuropsychological evaluation requires many
hours of interview and testing. The neuropsychologist will review the
case history, hospital records, interview the individual and his/her
family, in other words acquire information about the "person" the
individual was before the injury i.e., school performance, habits, and
lifestyle. If the evaluation is performed while the individual is in
an active rehabilitation program it is used as a basis for formation
of a treatment plan implemented by the therapists and others working
in one on one or group settings with the individual."
"The assessment is comprised of a wide range of psychological tests
that objectively measure brain functions. Ideally the assessment
should be done by a board certified neuropsychologist, not a
technician, as interview and observation provides important
information used in interpreting the results. Testing includes a
variety of different methods for evaluating attention span,
orientation, memory, concentration, language (receptive and
expressive) new learning, mathematical reasoning, spatial perception,
abstract and organizational thinking, problem solving, social
judgment, motor abilities, sensory awareness, and emotional
characteristics and general psychological adjustment."
"Once the neuropsychologist has completed the scoring and the
narrative portion of the assessment, a meeting should be scheduled
with the individual and the family to discuss the findings."
"The neuropsychologist should explain, in detail, the individual?s
abilities that remain unchanged as well as areas of the brain that are
adversely affected by the injury and how these deficits are expected
to impact on the individual?s life. It is helpful for the
neuropsychologist to be very clear and informative about ways the
injury will affect the day to day existence of the individual, e.g.,
"damage to the frontal lobes of the brain is expected to create
difficulties in planning and organizing tasks, use of good judgment,
and insight into his/her own situation" or "damage in the right
temporal area of the brain may impact on the individuals musical
appreciation, rhythm, etc." This important information can help the
family more effectively guide and support the individual and assist
with activities that utilize the preserved abilities and reinforce
strategies that compensate for deficits. To be most effective the
cognitive rehabilitation plan should be based on the results of the
neuropsychological assessment. The plan should ideally be implemented
by therapists, such as a day treatment program, residential programs,
and/or out patient services and the family needs information about
their role in supporting and reinforcing the rehabilitation goals when
the individual is in the home or community. Knowing your family
member?s deficits can increase your effectiveness as a caregiver and
decrease the discord that often develops when the family is not aware
of ways the injury has affected the cognitive abilities of a family
Brainsource-- Brain Rehabilitation
" The direction and methods of brain rehabilitation typically is
defined by the neuropsychological symptoms identified following brain
While practice in various cognitive tasks--doing arithmetic problems,
solving logic puzzles, practicing concentration skills, or
reading--may help brain rehabilitation, this is usually not enough.
Brain injury rehabilitation must be designed taking into account a
broad range of neurofunctional strengths and weaknesses. Basic skills
must be strengthened before more complex skills are added. Only
through comprehensive neuropsychological analysis can the many
possible effects of brain injury be sorted out. This pattern of
functional strengths and weaknesses becomes the foundation for
designing a program of brain rehabilitation.
Brain recovery follows patterns of brain development. Gross or
large-scale systems must develop (or be retrained) before fine
systems. Attention, focus, and perceptual skills develop (or are
retrained) before complex intellectual activity can be successful."
Wallace Kettering Neuroscience Institute
Rehabilitation neuropsychology is a special category of inpatient
care. Most patients admitted to the Kettering Medical Center
rehabilitation unit are seen by a clinical neuropsychologist who has
two primiary objectives:
* Help the patient and family adjust to the current situation and
evaluate whether the patient's mood is interfering with the
rehabilitation process. In addition to making pertinent treatment
recommendations, the neuropsychologist offers brief supportive
counseling for the patient and family.
* Provide a brief neuropsychological evaluation. Cognition is
often compromised as the result of cerebral insults such as stroke,
brain cancer or traumatic brain injury. The information gleaned from
this evaluation is used by the treatment team to assist in the
patient's care, treatment and discharge planning. The results are also
provided to the patient and family in order to help them better
appreciate the imediate effects of the patient's illness and how best
to maximize a sense of independence while maintaining appropriate
safety precautions. Finally, the data is used as a baseline by which
to compare future evaluations as described above."
Length of Treatment
The Bath Royal National Hospital outlines the steps that treatment can
take in this file:
Each step in the seven-step process takes about four to six weeks,
depending on the patient.
Treatment of Children
Bath Royal National Hospital for Rheumatic Diseases provides specific
information on what a clinical neuropsychologist should do in the case
of treating a child with a traumatic brain injury.
BRNH on Children's NeuroRehabilitation
Children and young people (5 to 18 years) with acquired brain injury
who require comprehensive assessment of their cognitive and
behavioural strengths and needs and/or therapeutic input.
Approximately 6 half day sessions over a 2-4 week period
* Initial liaison with family, school and other relevant professionals.
* Assessment meeting with family and school - if appropriate.
* Informal and formal assessment of cognitive functioning in
structured and unstructured settings to develop recommendations and
plan intervention, which may take the form of direct therapeutic input
+/- workshops with family and professionals.
Liaison and Reporting
* Involvement and support for child and family in all aspects of patient care.
* Feedback session with family. Report sent to referrer and copied
to family and local professionals within 4 weeks of last assessment
* Improved understanding of nature and extent of child's impairments
* Recommendations to meet needs
* Core indication of future impact/prognosis
* Delivery of therapeutic interventions
* Improved family and professional understanding of needs and their management"
Outpatient services are optional, depending on the recommendation of
the treatment team, and may or may not include the services of a
South London and Maudsley Hospital
Outpatient assessment, often carried out on an outreach basis and
providing an analysis of the patient's problems and advice about
Some programmes offer outpatient treatment by a neuropsychologist or
neuropsychiatrist. These include drug therapy and cognitive
behavioural treatment programmes."
british psychological society
site:bps.org.uk "neuropsychologist" + brain
rehabilitation + neuropsychologist
neuropsychologist + brain injuries
neuropsychologist + rehab
neuropsychologist + outpatient
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