INTRODUCTION: Neurorehabilitation requires a team effort. Over time the nature of teams has evolved from single discipline work through multi-disciplinary and inter-disciplinary teams to trans-disciplinary teams. However, there are inconsistencies in the literature and clinical practice as to the structure and function of these team models. Each model engenders advantages over its predecessor and unless the models are well understood clinicians may labor in a model that is less efficacious than the most transcendent model. OBJECTIVES: To define and examine the models of single discipline care, multi-disciplinary teams, inter-disciplinary teams, and trans-disciplinary teams and to review in depth trans-disciplinary teams as the most advanced team model. This paper will also consider professional roles and integration across disciplines as well as the crucial topics of staff selection, attendance in rounds and the nature of rounds, staff physical plant assignments, and leadership responsibilities. Leadership responsibilities that will be addressed include scope of practice and role release, peer pressure, and culture change issues. CONCLUSIONS:The trans-disciplinary model is the gold standard for teams in neurorehabilitation because they entail more integrated service delivery than do other teams. Trans-disciplinary teams also represent a more persons-centered approach. To initiate a trans-disciplinary model, team members must have excellent communication and shared decision making including persons with brain injury. Leadership must address staff selection, scope of practice and role-release. Otherwise, the model will fail due to peer pressure and institutional or program cultural variables.
The application and transfer of free recall study strategies were examined for young, middle-aged, and elderly adults. Subjects were either instructed to use clustering and imagery, instructed to use their own study strategies, or given standard free recall instructions. Subjects at all age levels showed high initial use of categorization and low initial use of imagery. Subject-reported imagery increased after training, but categorization was the only strategy associated with higher recall levels. Training produced increases in recall clustering that were apparent only on a transfer list. The results provided evidence that adult age differences in memory occur even when middle-aged and elderly adults show evidence of categorization in recall.
This study surveyed 200 back pain patients and 64 health care providers/staff on their physical, emotional, and sexual abuse histories as victims or perpetrators. Depending on the type of abuse, 27%-36% of female patients, 6%-23% of male patients, and 33%-55% of female providers/staff were abuse victims. From 1%-12% of female patients, 3%-10% of male patients, and 3%-15% of providers/staff were abuse perpetrators, depending on the type of abuse. A startling 94% of abuse perpetrators were also abuse victims. Among those who were both victim and perpetrator, 81% of physical-abuse perpetrators, 60% of sexual-abuse perpetrators, and 41 % of emotional-abuse perpetrators were previously or concurrently some type of abuse victim. The study discusses the implications for health care diagnoses and treatment decisions, caregiving by providers/staff, and the psychologist's role on multidisciplinary treatment teams.Physical, emotional, and sexual abuse are powerful life events. Yet health care providers rarely inquire about abuse in their standard history and physical examinations. The lack of attention to this subject by health care providers is particularly ROBERT L. KAROL received his PhD from the University of Missouri-Columbia in 1981. He is the director of Psychological Services at the Institute for Low Back Care and program director for the Backs at Work Reactivation Program. He also sees brain-injury survivors through Karol Neuropsychological Services & Consulting. His clinical and research interests focus on the application of medical psychology to back pain and neuropsychological assessment and intervention after brain injury. REBECCA GORMAN MICKA received her physician assistant B.A. from the University of Nebraska in 1985. She works clinically with neurological patients, and her research interests concern the interaction of psychological variables and medical treatment. She is also studying at the Gestalt Institute of the Twin Cities. MICHAEL KUSKOWSKI received his PhD from the Institute of Child Development at the University of Minnesota in 1983. He is currently employed at the Geriatric Research, Education and Clinical Center (GRECC) at the Minneapolis Veterans Administration Medical Center. His research interests include the psychophysiology of the aging nervous system, particularly as it relates to Alzheimer's disease.
Psychologists are becoming increasingly involved in the treatment oj'chronic pain. This involvement has lead to the emergence of psychologists as directors of multidisciplinary pain treatment programs. Although the rote of pain unit director offers many opportunities to psychologists, several potential problems exist. Relationships with physicians must be carefully addressed; adequate administrative support must be secured;and the requisite clinical privileges must be sanctioned. Without such interprofessional and administrative groundwork, psychologists will have difficulty functioning within a medically dominated health care system.
Purpose/Objective: Teams are a critical part of modern health care, particularly in rehabilitation settings where multiple providers with different backgrounds and training work toward common goals. Rehabilitation psychologists have a legacy of providing leadership and influence for complex teams. Knowledge of interdisciplinary/transdisciplinary systems, leadership within those systems, and consultation across disciplines are foundational competencies for rehabilitation psychologists. Research Method/Design: This paper summarizes the different roles rehabilitation psychologists serve on health care teams and identifies opportunities for improved effectiveness. An overview of leadership theory over time is provided. Results: Even when psychologists are not formal team leaders, opportunities exist to leverage team member strengths and encourage the development of leader behaviors across the team in support of good patient care. Conclusions/Implications: Drawing from the management and organizational development literature, evidence-based suggestions are provided for rehabilitation psychologists seeking to foster healthy team dynamics within and among health care teams. The authors encourage rehabilitation psychologists to use their unique training to facilitate shared leadership on teams that foster and encourage a climate of trust, psychological safety, healthy and productive conflict, along with strong communication practices. These issues became even more salient as teams transitioned to virtual platforms during the pandemic and continue to adapt to hybrid work environments. Impact and ImplicationsThis paper integrates management and organizational behavior theory with rehabilitation psychology competencies to offer evidence-based suggestions for enhancing leadership behaviors on health care teams. This is one of the first papers to highlight the potential leadership strategies rehabilitation psychologists can employ on transdisciplinary teams, which consist of highly educated and skilled individuals who likely have different reporting structures. By leveraging their education, training, and integration of evidence-based practices, rehabilitation psychologists can aid in teams' incorporation of recommendations that will allow for healthy and productive processes and dissent in pursuit of excellence both within individual teams and across multiteam systems.
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