Spain Rehabilitation Center

 
Neuropsychology – Sarah E. Wright, Psy.D.

Patient Characteristics:
The primary population on this service is stroke patients, although patients undergoing rehabilitation for other medical conditions are seen also. Patients range in age from young adults to the elderly, the majority being older adults. Most are experiencing cognitive 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.

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SPINAL CORD INJURY / PAIN / REHABILITATION PSYCHOLOGY – Elizabeth Richardson, Ph.D.

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.
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NEUROPSYCHOLOGY – Thomas Novack, PhD

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 adolescent and young adult range. All activities take place at SRC, a multi-disciplinary rehabilitation facility.

Distribution of Clinical Activities: 
Approximately 60% of the intern’s time is spent in assessment. This usually begins with observation of assessment procedures, administration under supervision and finally independent administration of the test protocols. Writing of reports is expected, once basic familiarity with the tests has been established. The intern is also able to participate in rounds on hospitalized patients. The type of those rounds varies depending upon the day the intern is at SRC.

Assessment Characteristics: 
Interns will learn to employ measures of neurocognitive ability at a screening level and in a more comprehensive battery. The latter usually involves a full day of assessment focusing on major neuropsychological instruments. This includes assessment of intellectual and academic skills, as well as memory functioning, reasoning skills and language abilities. Personality assessment, particularly use of projective instruments, is not common. Interns are expected to participate in initial interviews for testing cases and also in feedback sessions, which usually occur at the end of the day. A psychometrician is available, but in many cases the intern does the testing, which is considered an important part of the learning 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.
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Medical Neuropsychology / Rehabilitation Psychology – Sarah E. Wright, Psy.D.

Patient Characteristics:
Patients on this service encompass a wide range of medical conditions, many of which are not neurological in nature. However, cognitive and emotional difficulties are frequently present. Common medical conditions seen on this service include orthopedic injuries (motor vehicle accidents, falls, etc.), cardiovascular disease, amputations, peripheral vascular disease, end stage renal disease, dementia, anxiety, cancer, transplants, depression and pressure ulcer flap surgeries. This is primarily a geriatric population but younger adults are also seen. A range of race/ethnicities are also represented.

Distribution of Clinical Activities:
The intern will spend approximately 50% of the time in inpatient 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 is also available. 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. Personality assessment is needed at times.

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.

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