Assessment of Neuropsychological Functions
A neuropsychological assessment allows the Neuropsychologist to consider the following after an individual has suffered an acquired brain injury:
Ability to function and cope with day-to-day cognitive challenges
Ability to deal with demands from the job that the individual held before the accident or neurological event
The nature of an individual’s cognitive impairment will depend to some extent on the severity and location of the brain injury. These injuries can have a significant impact on the individual’s ability to function and cope with daily life
Cognitive impairment following brain injury may include difficulties with memory, concentration, initiation, planning, problem solving and self-monitoring. It is possible that an individual will lack insight and awareness of their difficulties, which will impact on their day-to-day life as well as their ability to engage effectively with their rehabilitation programme
The neuropsychological assessment serves to inform the neurorehabilitation programme in the following ways:
To provide a detailed picture of an individual’s cognitive impairments
To assess the likely impact of the individual's cognitive impairments on the rehabilitation programme
To assess the areas of strength that the individual may be able to draw on during rehabilitation
To assess the individual's prognosis in terms of their ability to function independently in the community, or to return to work or study
To identify the appropriate areas for effective rehabilitation input in relation to independent living and/or return to work or study
Cognitive rehabilitation provided by a Neuropsychologist can include:
Strategies the individual can learn to assist with cognitive functions, for example memory aids
Learning of new strategies to compensate for cognitive functions that cannot be restored to pre-injury levels
Strategies to improve attention and information processing skills
Learning of compensatory techniques to overcome everyday difficulties associated with the brain injury
Management of the individual’s environment to ensure an optimal environment for highest levels of functioning
Psychological Treatment to Assess Emotional Difficulties
Individuals who have suffered a neurological event are often left with emotional difficulties (for example, a large proportion of individuals who have suffered a stroke are left with symptoms of depression and will benefit from neuropsychological intervention). Psychological treatment includes various types of talking therapies, including Cognitive Behavioural Therapy, Compassion Focused Therapy, and Mindfullness, and the patient is always considered within ‘the system’ they function in. Systemic intervention helps the Neuropsychologist to support the patient within relationships and families, as well as in groups and organisations.
After a neurological event, individuals may present with changes in behaviour as a result of the brain injury. The Neuropsychologist can support patients and their families to address unwanted behaviours (for example, obsessive compulsive type behaviours, impulsivity and low frustration tolerance).
The Neuropsychologist can contribute to various aspects of rehabilitation in the community. This includes not only supporting the individual who has suffered the neurological event, but also families, carers, case managers, solicitors and employers to ensure a good understanding of the totality of the patient’s difficulties, their rehabilitation, strengths and weaknesses, and prognosis to return to specific functions.
Psychological disorders such as depression, anxiety, self-esteem issues and adjustment issues are common after brain injury. If they remain unidentified and untreated they will increase in severity, which can in turn have a negative effect on the individual’s rehabilitation progress.
The role of a Clinical Psychologist is to provide assessment, formulation and management of these psychological disorders after brain injury. Their work can include the following:
To provide appropriately adapted psychological interventions, taking into account the individual’s neuropsychological deficits, for the effective management of psychological disorders
To assess and assist the individual in the management of unwanted or antisocial behaviours, such as verbal or physical aggression that may develop after brain injury
To work indirectly with carers on managing carer strain as well as helping carers to develop the capacity to act as a co-therapist
To provide carers and families with specific information and support to help them understand the nature of the individual's cognitive and/or behavioural difficulties alongside guidance on how best to interact with the individual
To consult and advise the multidisciplinary team and external care providers on how best to work within the parameters of an individual’s cognitive, emotional and behavioural needs
A Psychiatrist can offer a valuable contribution to rehabilitation by considering the individual’s mental state functioning, aspects of behaviour, and the patient’s ability to manage pain, and by reviewing his or her medication regime to ensure optimal pharmaceutical support. We believe the contribution of a Psychiatrist allows us to offer even higher quality services, as psychiatric expert advice ensures the right medication is prescribed and taken to support the rehabilitation programme.
Neurological Physiotherapists provide specialist physiotherapy treatment to individuals with a neurological disorder.
As a consequence of damage to the nervous system following a neurological disorder, muscles can feel weak, lax or even tight with spasms or tremor. Individuals can experience uncoordinated movement and altered sensation. There may also be difficulties with speech and swallowing.
The work between the Neurophysiotherapist and the patient tends to be carried out in the individual's home to make it as meaningful to the individual and those involved in their life. Depending on the individual’s needs, a range of methods can be used, such as stretching and strengthening of muscles, management of muscle tone, balancing and walking practice. The frequency of sessions will vary depending on the individual's needs, and the work will involve a home exercise programme to complete between sessions.
The role of the Neurophysiotherapist includes:
Providing a full, initial physical assessment that incorporates a detailed account of past medical history and previous mobility
Developing bespoke interventions that assist individuals in regaining and sustaining maximum movement and functional independence
Developing and setting physiotherapy goals with the individual, family and carers where appropriate
Making any recommendations for home adaptions or any suitable equipment to assist with functional independence
Our personal trainers work closely with our Neurophysiotherapists as part of the interdisciplinary team service we provide at Psicon.
Work with a specialist personal trainer can be especially helpful following a period where an optimal level of functioning has been reached through rehabilitation input from therapists. The personal trainer will assist the individual with an improvement of fitness, strength and stamina. This can further support individuals in reaching higher levels of functioning and assist with the rehabilitation of a wide range of physical, psychological, cognitive and behavioural challenges that result from the brain injury.
Work with our specialist personal trainer at Psicon includes the following:
Development of a home- or gym-based plan in accordance with the individual’s specific needs or challenges
Development of reports at the end of each training session so that an individual’s approach can be carefully monitored
Acquired brain injury can affect communication in different ways.
Areas of impairment can include:
Motor speech production and reduced intelligibility
Receptive or expressive language skills (including reading and writing)
High-level abstract language skills
Social interaction skills
Impairment in swallowing functions
The role of the Speech and Language therapist includes:
Assessment of speech and language skills and recommendations for the areas and intensity of input required
Development of appropriate treatment programmes to improve the individual’s communication, both in spoken and written form; the programme allows for clear monitoring of progress and achievable goals
Working with other healthcare professionals and family to improve all-round communication
Assessing swallowing function and providing treatment for swallowing disorders as well as advice on safe eating and drinking
Occupational Therapy input aims to develop independence in tasks of everyday living.
The role of the Occupational Therapist (OT) forms an important part of the interdisciplinary team, contributing to the assessment and rehabilitation of various difficulties, including cognitive rehabilitation.
Specific work with an Occupational Therapist includes:
Developing independence in everyday tasks such as dressing, cooking and housework
Development of practical skills for everyday living, such as budgeting, planning, thinking and problem solving
Developing strategies and frameworks to deal with specific executive difficulties as mentioned above
Implementing specialist equipment and adaptations around the home where appropriate
Support Workers and Rehabilitation Assistants allow the team to expand services when patients need support in daily life, for example in the implementation of certain programmes. The support worker will contribute to the Neuropsychologist’s and Occupational Therapist’s work in ensuring optimal use of external memory aids in the community. The Support Worker will also work with the Speech and Language Therapist, Physiotherapist and Personal Trainer in implementation of rehabilitation programmes in the community.
Psicon’s senior clinicians and therapists offer support worker training and supervision on an ongoing basis. The training programmes include:
Knowledge about neurological conditions
Effective communication when working with brain injury
Basic psychological counselling skills
Effective team work and interdisciplinary ways of working
For more information on our support worker training please contact us
Psicon’s Consultant Clinical Psychologist, Neuropsychologist and Psychiatrists offer the following medico-legal support in relation to brain injury cases:
Specialist assessments and high quality expert witness reports for the court on those individuals who have suffered a traumatic brain injury (TBI) and are involved in a personal injury case
Multidisciplinary reports for the court on the difficulties and needs as identified by a group of professionals including Neuropsychologist, Neurophysiotherapist and Occupational Therapists
Assessment of mental capacity
Assessment of Mental Capacity
A neurological assessment may be required to determine whether an individual has capacity in relation to aspects of their functioning, including their ability to make a decision regarding their finances and affairs, as well as aspects of their rehabilitation programme and continued care.
In some cases it may be necessary for decisions to be made on an individual’s behalf. A neurological assessment may be needed in accordance with the legal framework provided by The Mental Capacity Act 2005 (MCA) and will ensure the following:
When an individual is found to lack capacity to consent to a certain intervention, there should be a set of procedures in place to ensure an individual’s ‘best interests’ are established and the process of evaluating this should be fully documented.
When an individual is assessed, mental capacity is considered based on various factors, including the individual’s ability to understand the nature of the relevant issues, the individual’s ability to remember information about relevant issues, the individual’s ability to consider important issues long enough to then be able to formulate an opinion, and the individual’s ability to communicate their decision or thoughts (by talking, sign or any other means).
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