Spain Rehabilitation Center



Patient Characteristics:
Patients on this service have acquired brain injury, usually by traumatic means. As a result of the brain injury they exhibit physical and cognitive disabilities which rapidly improve in many cases. Age ranges from sixteen years to geriatric cases, with preponderance of cases being in the young adult range. All activities take place at SRC, a multi-disciplinary rehabilitation facility.

Distribution of Clinical Activities:
The day begins with inpatient rounds, during which brief bedside cognitive assessment takes place.  Interview of new admissions/family members takes place to generate consultation reports.  The remainder of the day is spent in assessing outpatients, many of whom are returning inpatients for whom issues of return to driving, work, and independent living are paramount.  Based on experience/interest the intern may be administering and scoring tests.  For those with a prime interest in neuropsychology the focus is often on interpretation of test results, providing feedback, and report writing.  All interns participate in interviews of patients and family members, as well as feedback.  There are typically one or two neuropsychological evaluations per day.  The day starts early but is over at 5:00 at the latest.  Typically, everything is completed by the end of the day, including reports.

Assessment Characteristics:
Interns learn to administer a basic bedside cognitive screening to document progress in inpatients.  The neuropsychological assessments vary in breadth from 2 hours extended screenings to full day batteries depending on the case.  Psychometricians are available to administer tests, but interns can perform administration to fill in gaps in experience.

Intervention Characteristics:
Interventions with patients are primarily brief and directive due to the short length of stay. Behavior/environmental management is an important component.

Return to Top


Patient Characteristics: 
Inpatient case load is almost exclusively acute onset spinal cord injury with some related conditions: transverse mellitus, anterior artery syndromes, spina bifida etc. This is a predominantly young male population, disproportionately African American based on community epidemiology. Causes of spinal cord injury are typically motor vehicle crashes, falls and violence. Pre-existing conditions such as substance use and concomitant complications such as chronic pain and cognitive dysfunction/limitations can compound the coping/adjustment process.

Distribution of Clinical Activities: 
The intern will spend 50% of the time in evaluation, 25% writing reports, the remainder in interventions and consultation with staff and family.

Assessment Characteristics: 
A thorough pre and post injury psychosocial history is the primary assessment tool supplemented by cognitive screening and, pain assessment measures and at times personality measures as needed. More indepth assessments can be completed with outpatients who are referred.

Intervention Characteristics: 
Given brief hospital stays and difficulty accessing patient time, interventions are typically brief, ranging from stress management (relaxation training, cognitive behavioral techniques) to individual psychotherapy. Sex education/counseling is sometimes needed. Family education and family therapy are often needed as well. A psycho-educational approach is often used to initiate therapeutic involvement. Long term therapy cases frequently available.
Return to Top


NEUROPSYCHOLOGY – STROKE, Michelle Keiski, Ph.D.

Patient Characteristics:
The primary population on this service is stroke patients, although patients undergoing rehabilitation for other medical conditions are seem also. Patients range in age from young adults to the elderly, the majority being older adults. Most are experienceing congnitive and/or physical disabilities, often both.

Distribution of Clinical Activities: 
Approximately 60% of the intern’s time is spent in assessment and consultation. Assessment activities include consult-driven bedside neurobehavioral status assessments and regular follow-up on the inpatient stroke service. Interns may also participate in brief post-discharge follow-up of stroke patients and/or traditional outpatient neuropsychological assessments for referrals from a variety of sources. The remainder of the intern’s time is spent in problem-focused consultation with other team members, supervision, and report writing. Attendance of interdisciplinary treatment team meetings is encouraged as scheduling permits. Although this rotation has a neuropsychology emphasis, interns with a broader interest in rehabilitation psychology can be accommodated. 

Assessment Characteristics: 
Interns will learn to employ both psychometric and qualitative techniques to evaluate the neurocognitive status of inpatients with stroke or other medical conditions. Outpatient neuropsychology assessments are more comprehensive and follow a psychometrically oriented flexible battery approach. Opportunities for personality assessment are less frequent. Interns will generally participate in interviewing, testing, feedback, and report writing. Specific training emphasis will depend on intern experience and interest.

Intervention Characteristics: 
Interventions tend to be problem-focused and involve supportive contact and education with patients and families. Collaboration with other treatment team members is integral to consultation, and opportunities sometimes arise to help implement simple behavioral interventions.
Return to Top


NEUROPSYCHOLOGY/REHABILITATION PSYCHOLOGY - MEDICAL / TRAUMA – Amy Knight, Ph.D.

Patient Characteristics:
Patients on this service encompass a wide range of medical trauma, including fractures, burn, crush, amputations, and other major trauma without severe head injury, although mild TBI and post-operative confusion are common.  Medical patients are also seen with peripheral weakness from infectious diseases, autoimmune disorder, cancer, cardiopulmonary, and post-surgical debility. Among older people there is an increased risk for delirium and sometimes dementia. Age range is from the 20’s to geriatric cases.  Adjustment disorders and acute stress reactions are the focus of clinical intervention on the inpatient service. Outpatient neuropsychological testing typically includes evaluation of patients with mild traumatic brain injury, tumor, aneurysm repair, dementia, and other neurologic conditions. Outpatient testing and counseling cases can be former inpatients or referrals from other UAB departments. Neuropsychological evaluations are referred from Trauma and Burn ICU, Neurosurgery and Neurology. Behavioral health services are provided to outpatients in Cardiopulmonary Rehabilitation. 

Distribution of Clinical Activities:
The intern will spend approximately 50% of the time in inpatient or outpatient evaluation, 25% in consultation with members of the interdisciplinary treatment team and 25% in treatment interventions and report writing. The intern will also participate in supervision and inpatient rounds. Participation in outpatient neuropsychological evaluations for a neurological population is available on select days.  The emphasis for this rotation will vary depending on intern interest in either Neuropsychology and/or Rehabilitation Psychology.

Assessment Characteristics:
Interns will learn to employ both neurocognitive and emotional status screening to evaluate inpatients with various medical conditions. A thorough medical and psychosocial evaluation is also completed. Assessments using either cognitive screening measures or more comprehensive neuropsychological techniques are employed depending on the ability level of the patient.

Intervention Characteristics:
Brief interventions may involve supportive contact, education, psychotherapy (individual and/or family), behavioral interventions and/or crisis intervention. A wide range of treatment models are utilized ranging from psychodynamic and cognitive behavioral to family systems. Collaboration with treatment team members is integral to this service.

Return to Top