Uploaded byShweta Kotwani
Psychological Assessment
This document outlines the role of rehabilitation psychologists in assessing and addressing cognitive, emotional, and behavioral issues in patients undergoing rehabilitation. It covers various assessment strategies, including neuropsychological evaluations for both inpatient and outpatient settings, aiming to identify strengths and weaknesses that inform intervention strategies. Key focuses include the significance of psychological factors on rehabilitation progress, methods of pain assessment, and the effectiveness of evidence-based psychotherapy practices.
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Psychological Assessment
- 1. PSYCHOLOGICAL ASSESSMENT Dr. ShwetaKotwani; Pediatric Physical Therapist BPTh (MUHS); MPT (Neuro,MUHS); LASHS-U.K. Fellowship Dip.(Peds.Rehab.; Clinical Neuro.Sc.)
- 2. Objectives • Goals ofrehab psychologists assessments • Assessment strategies • Neuropsychological Assessment Inpatient neuropsychological assessment Outpatient neuropsychological assessment Measurement of psychological status • Psychological issues in rehabilitation settings • Intervention • Pain and its treatment
- 3. • Rehabilitation psychologiststake a multifactorial, multidimensional approach to assessment of cognitive functions, emotional state, behaviour, personality, family dynamics and the environment to which the patient will ultimately return.
- 4. List of goalsof rehabilitation psychologists assessments 1. Providing information 2. Identifying patient’s cognitive and behavioural strengths and weaknesses 3. Offering indications of potential future functioning
- 5. • Assessment strategiesinclude interviews, behavioral observations and consultation with other members of the treating team 1. A comprehensive clinical interview- Developmental history Medical history Prior psychiatric and psychological treatment Behavioral health issues (eg. Substance abuse) Educational and vocational achievements Psychosocial factors (eg. Information about family of origin, current family system and other potential social supports) Historical style of coping with stress The main focus will be on the effects of these psychological factors and cognitive abilities on daily functional abilities
- 6. 2. Behavioral observations-of the patient during the interview and in other settings eg. Rehabilitation unit, community settings • These behavioral observations can enrich the understanding of a patient’s current functional cognitive abilities, including communication, comprehension, attention/ concentration and self-regulation 3. Observation of the patient’s behavior by other team members across various rehabilitation situations are integrated with other data to reach an understanding of how best to work with the patient and family to promote participation and progress in rehabilitation
- 7. Neuropsychological Assessment • InpatientNeuropsychological Assessment In inpatient settings, rehabilitation psychologists identify neurobehavioral problems eg depression , irritability, fatigue, restlessness; that are frequently reported after brain injury These difficulties can impede participation and gains in rehabilitation, and they also have long term functional implications Rehab psychologists can highlight the interplay between psychological issues and functional performance and assist the team in developing behavioral strategies to minimize this impediment to progress.
- 8. • Inpatient NeuropsychologicalAssessment Neuropsychological assessments involve the evaluation of fundamental skills eg. Attention, which underlie more complex behaviours that are the goals of other therapies The rehab psychologists can work with the team to develop intervention strategies for maximizing the patient’s success in acquiring the skills that are the goals of therapy Depression can significantly limit a patient’s ability to learn new skills in rehabilitation Dementia in elderly population
- 9. • Outpatient NeuropsychologicalAssessment Assessment findings form the basis for specific recommendations regarding adaptation tactics that can be used in patient’s daily lives eg. memory notebooks and for guidance regarding how to achieve or adjust necessary long term goals such as returning to work, school or independent living.
- 10. Domains Assessed • Primarydomains assessed in neuropsychological evaluations include- intelligence, academic ability, memory, attention, processing speed, language, visual- spatial skills, executive abilities, sensory- motor functions, behavioral functions and emotional status
- 11. Primary Cognitive Domain •Intellectual Functioning/ Academic Abilities • Learning / Memory • Attention • Language Skills • Visual - Spatial Skills • Executive Functions • Sensory Motor and Sensory Perceptual Functions • Neuropsychological Assessment Batteries
- 12. Measurement of psychologicalstatus • Emotional status 1. Beck Depression Inventory-II (BDI-II) this is a 21-item questionnaire, in which the person rates severity of symptoms on a 4-point scale 2. Geriatric Depression Scale (GDS) Developed for use with older adults, responses are given in a yes-no format. 3. Beck Anxiety Inventory (BAI) Twenty-one items assess symptoms of anxiety each on a 4-point scale 4. Brief Symptom Inventory (BSI) The BSI is an abbreviated (53 items) version of the SCL-90-R 5. Symptom Checklist 90-Revised (SCL-90-R)- Ninety items are rated on a 5-point scale reflecting how much individual has been troubled by the symptom; results provide information on nine clinical scales and three summary indices.
- 13. Chemical use history- •Alcoholism Screening Questionnaires • CAGE (four items) • SMAST (Short Michigan Alcohol Screening Test) • AUDIT-C (Alcohol Use Disorders Identification Test)
- 14. Psychological issues inrehab settings • Depression and Anxiety • Personality Disorders and Personality Styles • Substance Abuse • Denial of illness
- 15. Intervention • Facilitate patient’sawareness of and acceptance of changes in their capacities • Work with the patient, family, and rehab team to support components of hope • Identify and address emotional, behavioral, and cognitive factors that impede progress in the medical rehab plan • Assess the patients psychosocial envt (including family, work setting, friendship network) and identify what must be accomplished to reintegrate the patient back into those settings when possible
- 16. Intervention • Psychotherapy • Psychotherapyis a method for assisting clients to understand their emotional and behavioral reactions and create the potential to act from a position of choice rather than from reflexive responding • Rehab psychology faces several challenges 1. Measuring the relationship 2. Measuring the intervention 3. Translating research to clinical practice
- 17. Interventions targeting behaviourand thoughts • Psychoeducation • Skills training • Motivational interviewing • Behavior modification • Cognitive behavior therapy • Interpersonal psychotherapy
- 18. Interventions targeting meaning •Psychodynamic • Existential • Therapies targeting the context Dialectical behavior therapy Mindfulness-based cognitive therapy Acceptance and commitment therapy
- 19. Evidence based psychotherapy practice •Effectiveness of psychological interventions- have been shown to be helpful in improving mood and preventing depression after stroke • In reducing depression and promoting coping among persons having MS • In reducing anxiety and reducing the likelihood of developing PTSD among individuals with mild-mod TBI’s
- 20. Pain • Among rehabpopulations, prevalence of chronic pain ranges from 42%-85% • Gate control theory of pain recognizes that the experience and expression of pain have medical, sensory as well as psychological (cognitive and affective) determinants.
- 21. Assessment of Pain •Pain assessment includes evaluation of both physiologic and emotional factors including sensory experiences, mood,coping and behavioral disturbances • Comprehensive clinical interview Nature of pain Severity Characteristics Duration Location Emotional response Experience of life disruption caused by pain
- 22. Common self reportpain scales • Visual analogue scales- valid and useful for documenting incremental improvements from treatment • McGill Pain Questionnaire-includes sensory, affective and cognitive domains of pain • Assessing pain behaviors
- 23. Treatment of Pain •Perceptions of control over pain- more strongly associated with patient satisfaction than with the ratings of pain themselves • Increased attention is being given to the influence of individual’s beliefs about their pain, including their ability to manage it, their perceptions of its influence on their lives
- 24. Treatment of Pain •Rehab psychology interventions for patients with chronic pain are multidimensional including instruction in behavioral techniques for pain management such as relaxation techniques as well as cognitive-behavioral- psychotherapy to address negative thoughts about the experience of pain and its implications on daily functioning
- 25. Treatment of Pain •A recent meta-analysis showed CBT-effective for reducing subjective experience of pain, increasing positive coping with pain and decreasing negative impact of pain on social role functioning.
- 26.