Intro to Neuropsych and Rehabilitation

Question 1

What is neuropsychology?

Answer 1

Understanding of the relationship between physiological processes and cognition, behaviour and emotion

Question 2

What is neurorehabilitation?

Answer 2

Services that aim to aid recovery from a nervous system (including peripheral nervous system), injury, and to minimise/compensate for any functional alterations resulting from it

Question 3

How prevalent are neurological impairments?

Answer 3

The average health district consists of 250,000 people. 5000 have a disabling neurological disorder (2%) and 1500 are so disabled that they require a carer

Question 4

What are the most prevalent neurological conditions?

Answer 4

Stroke (25%), Trauma (14%), Parkinson’s (8%), MS (6%), Tumour (2%). The remaining 45% are other conditions

Question 5

How much does the neurological service cost?

Answer 5

2.5% NHS budget on neurological services. 14% social care budget on neurological conditions

Question 6

What are some problems with the economic sides of neurological services?

Answer 6

NHS money is not infinite, so not everyone can receive all the treatments that could help them. Treatment needs to be cost effective

Question 7

What are the social costs of disability?

Answer 7

85% patients are cared for at home by relatives which can be stressful, and can cause PTSD. Other losses include the carers original job, and their time

Question 8

What are the personal costs of disability?

Answer 8

47% of neurology patients meet the DSM criteria for anxiety/depression. Major depression is the most common (27%) and those with neurological conditions have the lowest health-related quality of life of any long term condition

Question 9

Where does the word ‘rehabilitation’ come from?

Answer 9

Rehabilitare (Latin): ‘to make fit again’

Question 10

What is the WHO definition of rehabilitation?

Answer 10

An educaational, reiterative, problem solving process which focuses on disability and aims to maximise the patient’s social role functioning and to minimise the somatic and emotional distress experienced by both patient and family

Question 11

Why are clear and agreed definitions in clinical neuropsychology important?

Answer 11

To facilitate discussion between different individuals involved in the diagnostic/rehabilitation process (work in a team, and not all members may be up-to-date with changes to terms/definitions etc), for health planning and management, and for systematic analysis of intervention

Question 12

What is systematic analysis of intervention?

Answer 12

Diagnosis of a condition does not determine the individuals need, and so a disability definition is needed. Need to test for disability vs impairments so the correct measures of improvement can be used

Question 13

What is the role of a clinical neuropsychologist?

Answer 13

Diagnose neurological conditions, work alongside other health professionals, help user and family with the rehabilitation/acceptance of change/education about the condition

Question 14

What was the original WHO model for disability?

Answer 14

1980: International Classification of Impairments, Disabilities and Handicaps (ICIDH), which was very medical, and centred around that side of things

Question 15

What was the revised WHO model?

Answer 15

1999: ICIDH-2 which emphasised the personal, social and physical context of rehabilitation, making it more inclusive, and less ‘medically-biased terminology’ making it more accessible

Question 16

How did the ICIDH-2 demonstrate disability to be non-linerar and multifactorial?

Answer 16

There can be: physical changes in body without impairment in functioning (seen in autopsies etc), impaired functioning without obvious physical change (seen in sleep disorders/migraines etc), and health conditions that can restrict participation in social activities without limiting what the person is capable of (eg HIV)

Question 17

What is the latest WHO framework for disability?

Answer 17

2001: International Classification of Functioning, Disability and Health (ICF), which takes a biopsychosocial approach

Question 18

How does the ICF see health?

Answer 18

Health conditions can affect the body structure and function, activity and participation, which can then all affect environmental and personal factors. Health conditions are the disease/disorder/diagnosis/pathology

Question 19

What is the ‘body structure and functions’ part of the ICF?

Answer 19

Structures are the anatomical parts of the body, and the functions are the physiological and psychological functions of body systems

Question 20

What is the negative term for the ‘body structure and functions’ part of the ICF?

Answer 20

Impairment. Body structure and functions can be impaired

Question 21

What is the ‘activity’ part of the ICF?

Answer 21

Executions of a task by an individual, measured by the Barthel Activities of Daily Living (ADL) index

Question 22

What is the ADL?

Answer 22

It is a test scored between 0 (dependent), to 5 (need help but can do about half unaided), to 10 (independent including small things like buttons/zips/laces). There are 10 activities in total: feeding, bathing, grooming, dressing, bowels, bladder, toilet use, transfers from bed, mobility, stairs. Index should record what a patient does, not what they could do (eg if could so something but doesn’t due to depression, that is still impairment)

Question 23

What is the negative term for the ‘activity’ part of the ICF?

Answer 23

Activity limitation

Question 24

What is the ‘participation’ part of the ICF?

Answer 24

Involvement in a life situation (social level functioning)

Question 25

What is the negative term for the ‘participation’ part of the ICF?

Answer 25

Restriction

Question 26

What are environmental factors?

Answer 26

Physical, social and attitudinal environment in which people live (the way the person lives)

Question 27

What are personal factors?

Answer 27

Not an official part if the classification but can have an affect

Question 28

What are the environmental and personal factors collectivley known as?

Answer 28

Contextual factors, which can be helpful (facilitators), or unhelpful (barriers)

Question 29

What are the advantages of the ICF?

Answer 29

Rehabilitation can occur at different levels, without necessarily influencing others, and this model allows for selection and evaluation of interventions aimed at particular levels. Also the model provides standardised terms which improves communication, planning and evaluation

Question 30

What are the limitations of the ICF?

Answer 30

Interpretation of the activity and participation domains (overlap, and different views on how to interpret this by different professionals), cross cultural differences in these domains, and a lack of detail regarding qualifiers (eg how much assistance? Should best/worst/intermediate level of performance be recorded?)