Neuropsychologist

Abstract

32 Multiple sclerosis (MS) is a disease of the central nervous system with prominent physical symptoms such as muscle weakness and spasticity that lead to limitations in mobility. 1 Although MS care often focuses on the assessment and treatment of these physical symptoms, changes in cognition can be of greater concern to people with MS and their families. It is believed that at least half of people with MS eventually experience some degree of cognitive dysfunction, 2 which can occur early in the disease and progress over an interval as short as 2 years. 3 Cognitive impairment in MS is associated with loss of employment, 4 reduced driving skills, 5 diminished socialization, 6 and dependence on others for activities of daily living (ADLs). 4 Subtle changes in cognitive efficiency may be readily noticed by a person with MS but overlooked by health-care providers and misunderstood by family members and coworkers. For this reason, cognitive dysfunction is often referred to as an "invisible" symptom of MS. Because cognitive decline may not be readily apparent at bedside examination, 7 a neuropsychological evaluation can be invaluable in providing information about brain function to people with MS and their health-care teams. Additionally, test results can be used to support an application for disability benefits or school/work accommodation. Repeat testing can identify changes or stability over time, following relapses, or with treatment. Test results can also guide development of compensation strategies. In addition to conducting a cognitive evaluation, neuropsychologists can provide treatment in the form of individual psychotherapy, family counseling, behavior management, and cognitive rehabilitation. What Is Neuropsychology?A clinical neuropsychologist is a licensed psychologist with specialized training in the relationship between brain functioning and abilities such as memory, attention, language, and reasoning. Following completion of a doctoral program, neuropsychologists undergo further training and supervision in the practice of neuropsychology through a clinical internship and then a 2-year postdoctoral residency or fellowship. Clinical neuropsychology is a specialty recognized by the American and Canadian Psychological Associations. After completion of training and a period of independent practice, an individual can go through the examination process to be certified through the American Board of Professional Psychology.The primary clinical service provided by neuropsychologists to people with MS is assessment of cognitive functioning. While a magnetic resonance imaging or computed tomographic scan can provide information about the structural integrity of the brain, a neuropsychological evaluation documents functional capacity. Neuropsychologists typically administer a series of stan-

A systematic review of research undertaken in vocational rehabilitation for people with multiple sclerosis

“…Strategies should not focus on reducing the impairment but on performance of an activity [35,41], and may require referral to OT, PT, speech and language therapy, neuropsychology and specialist rehabilitation and neurological services, both medical and nursing [5,16]. These services can minimize the impact of symptoms on work such as cognitive difficulties [5,26,31,40,94,95], visual decline [94], fatigue [8,19,36,92,94], heat sensitivity [94] and poor mobility [94]. An essential component in work performance is increasing self-belief [34], developing good self-management skills [25] and self-efficacy [77].…”

A Protocol for Measuring the Direct Psychological Benefit of Neuropsychological Assessment with Feedback in Multiple Sclerosis

“…The broad content of the strategic management advice is based on the current neuropsychological rehabilitation literature in general (e.g., Wilson, 2002, 2008), and the MS neuropsychological literature specifically (Benedict & Zivadinov, 2011; Chiaravalloti & DeLuca, 2008; Fuchs, 2009; O'Brien et al, 2008) and is constantly updated. The specific content of this advice is adapted to take account of: the nature and severity of the patient's cognitive impairment; pre-morbid level of intelligence, personality, relevant beliefs; nature of their other impairments and disabilities; personal, vocational and educational history; age, sex and cultural background; nature of the environment in which they are functioning (including the people with whom they interact); the nature of their short-term and long-term life goals.…”

“…Neuropsychological assessment is often described as the first step in cognitive rehabilitation, providing detailed information about the nature and severity of the cognitive impairment, which can then guide the choice of rehabilitation intervention (Benedict & Zivadinov, 2007; Fuchs 2009; Langdon, 1998). Detailed objective assessment of cognitive impairment is particularly important in MS, because this area of complex symptomatology can be difficult to detect during clinical interview alone, is often overlooked by health professionals (Fischer et al, 1994), and is not possible to assess accurately for rehabilitation purposes via brief cognitive screening alone (Benedict et al, 2006; Pepping & Ehde, 2005).…”