Neuropsychology involves the evaluation and treatment of problems associated with brain dysfunction. This may include testing or rehabilitation to improve attention, concentration, memory, problem solving, emotional functioning or behavior. Generally, your doctor requests the assistance of a neuropsychologist for diagnosis or treatment planning. A neuropsychologist works as a member of a team which may include your family doctor, neurologist, neurosurgeon, physiatrist or others involved with your treatment.
Typically, your doctor suspects something abnormal has happened to the brain and wants a detailed assessment or assistance in planning your treatment. People who have suffered strokes, head injuries, brain tumors or alcohol or drug problems are often referred to a neuropsychologist. Sometimes an individual has no identified brain disease, but may have a history of learning disability or be experiencing attention or memory difficulties. The neuropsychologist determines what factors are important, such as attention, memory, depression, anxiety, fatigue, medical effects, and such. Once the problem is fully understood, it is possible to plan treatment.
The neuropsychologist uses harmless procedures involving paper and pencil tasks. These measure attention, perception, motor skills, memory, language skills and intellect. Sometimes basic academic skills like reading, writing and arithmetic are examined. Other times, more complex skills such as problem solving or abstraction are measured. Furthermore, assessment of mood, emotion, personality, and interpersonal functioning may occur. Some procedures are simple, and some are difficult. Some may even seem silly to you, but the procedures all have a serious purpose. All that is asked is that you try your best.
Often an individual’s moods and emotions are measured in order to get an overall picture of the total person - not just the problem areas. It is similar to taking a snapshot of both your strengths and weaknesses, some of which affect your thinking and some of which affect your feelings. These tests do not imply an emotional disorder, but they are designed to examine your emotional status.
The testing may require several hours (2-10) but breaks are given as needed. The process will not interfere with your meals or other important treatments. When longer testing is necessary, it is divided into sections so that it will not make you overly tired.
The findings are sent to your doctor within two weeks, who will briefly discuss them with you at your next appointment. It usually takes several days to score and interpret the results. We will also schedule an appointment with you to review the results in more detail. The results are confidential and will only be shared among the doctors, therapists or case managers who are working directly with your treatment. If you have any questions about the procedures, please feel free to discuss these with the neuropsychologist.
Like other medical procedures, neuropsychological tests are usually covered to one degree or another by your insurance. If you are an inpatient, these tests will be handled in the same manner as other “physician charges”. Likewise, if you are an outpatient, there is usually some coverage which may pay for at least a portion of these costs. For more information about your charges, insurance coverage and your payment obligations, please contact us.
A person with a MTBI is one who has had a traumatically induced physiological disruption of brain function as manifested by at least one of the following:
The disruption of functioning during head injury occurs when the soft, moveable brain collides with the skull because of a violent motion or blow to the head. The brain may be bruised, or nerve fibers may be damaged.
Often, someone who has sustained a MTBI may have no apparent problems, or the symptoms may go away very quickly. However, in some cases, MTBI may lead to physical, cognitive, and emotional problems.
One or more of the symptoms listed below may be experienced immediately following the injury:
Quite often, these symptoms resolve in a day or two, or more commonly, within a few weeks.
In a few instances, ongoing symptoms may persist. These may include:
It may be difficult to describe or define the symptoms. A person with a MTBI may simply feel that “something is different”. While many of their skills are still intact, they may feel that they are just not the same person they were before the injury occurred.
Some people find it difficult to work, function at home, and also to relax. The suggested way to handle this is to rest and gradually resume daily activities. To ignore the symptoms and try to get back to a normal routine can make the symptoms worse and extend the length of time for recovery. Most people will recover completely in three to six months. However, if the symptoms worsen or do not disappear, help should be sought. Early evaluation and treatment are vital to attaining the best possible recovery.
It is common to be treated in an emergency room for a mild blow to the head, and then immediately discharged. Damage from a MTBI may not show up on an x-ray, CT scan, or Magnetic Resonance Imaging (MRI), so one should consult their physician if they have suffered any head injury.
If symptoms persist or there are concerns about a possible MTBI, one may want to consult a specialist. Often, a physiatrist (rehabilitation physician) will conduct a physical exam to further define any problems the person may be experiencing. The physiatrist would then determine what other specialists need to be involved in the patient‘s care.
Is defined as pain which occurs on most days and lasts from three months to many years.
Nociceptive pain occurs when there is clear damage to tissue. Nociceptive simply means ‘causing pain’.
Neuropathic pain is the other type of chronic pain and results from damage to the nerves, spinal cord or the brain.
In reality, many pain conditions can involve a combination of nociceptive and neuropathic pain.
Is an unpleasant sense of discomfort.
Chronic pain may cause other symptoms or conditions, including depression and anxiety. It may also contribute to decreased physical activity given the apprehension of exacerbating pain.
Are defined as things people do when they suffer or are in pain. Pain behaviors may include:
Chronic Pain is usually best managed with the combination of medication and nonmedication techniques such as: group and individual psychotherapy, biofeedback, progressive muscle relaxation and visualization.
The focus of Pain Management includes the following goals:
Cognitive therapists work with the person to challenge thinking errors. By pointing out alternative ways of viewing a situation, the person’s view of life, and ultimately their mood will improve.
Is based on the understanding that much of how we feel is determined by what we think. Common cognitive errors for chronic pain sufferers include:
CBT is undertaken when people decide they are ready for it and with their permission and cooperation.
The therapy is directed at the person's specific anxieties and will be tailored to his or her needs
There are no side effects other than the discomfort of temporarily increased anxiety.
It may be conducted individually or with a group of people who have similar problems.
Post Traumatic Stress Disorder (PTSD) results from exposure to an overwhelming stressful event or series of events, such as an automobile accident, work place injury, natural disaster, war, physical or sexual assault. It is a normal reaction to an abnormal situation. Most survivors of trauma experience some degree of stress reactions (such as nightmares, flashbacks, difficulty sleeping, feeling detached) yet return to normal given a little time. However, for some these reactions do not go away on their own, or may even get worse over time. These individuals may develop PTSD.
Post Traumatic Stress Disorder is an anxiety disorder that can occur after experiencing or witnessing a traumatic event.
People with PTSD develop three different kinds of symptoms:
In addition, we now know that there are biological changes that are associated with PTSD. People with PTSD often may develop depression, substance abuse, problems with memory and cognition, and physical and mental health problems. These problems may lead to impairment in the person’s ability to function in social or family life. PTSD can contribute to occupational instability, marital and family problems.
People with PTSD describe themselves with words such as shattered, broken, wounded, ripped or torn apart and report they will never get their life back together. The event has divided their life into a two distinct times: before and after the trauma. Loss of happiness, diminished positive life outlook and resentment are common features of this disorder. In addition they have the following four symptoms:
People with PTSD relive the traumatic event. They may have upsetting memories that can come back when they are not expecting them. They may be triggered by a reminder such as when a combat veteran hears a car backfire, a motor vehicle accident victim drives by a car accident or a rape victim sees a news report of a recent sexual assault. These memories can cause both emotional and physical reactions, sometimes feeling so real it is as if the event is actually happening again. This is called a "flashback." Reliving the event may cause intense feelings of fear, helplessness and horror similar to the feelings they had when the event first took place.
People make an extra effort to prevent the recurrence of the traumatic event by avoiding situations that trigger memories, such as places where the trauma occurred or seeing TV programs or news reports about similar events. They may avoid other sights, sounds, smells or people that are reminders. Some people try to distract themselves with busy activities to avoid thinking about the traumatic event.
People with PTSD may find it difficult to be in touch with or express their feelings. They may feel emotionally "numb" and may isolate from others. They may be less interested in activities they once enjoyed. Some people forget, or are unable to talk about, important parts of the event. Some people think that they will have less opportunity or a shortened life span and can no longer reach personal goals. They may neglect their work or family responsibilities, while others self medicate with alcohol and drugs and become addicted to the substance in the process.
People with PTSD may feel constantly alert after the traumatic event. This is known as increased emotional arousal and it can cause difficulty sleeping, outbursts of anger or irritability and difficulty concentrating. They may find that they are constantly ‘on guard’ for signs of danger and they may also startle easily.
Although symptoms can begin right after a traumatic event, PTSD is not diagnosed unless the symptoms last for at least one month, and either cause significant distress or interfere with work or home life. In order to be diagnosed with PTSD, a person must have the three different types of symptoms: re-experiencing symptoms, avoidance and numbing symptoms and arousal symptoms.
About 60% of men and 50% of women experience a traumatic event in their lifetime and most who are exposed to a traumatic event will have some of the symptoms of PTSD in the days and weeks to follow. For some, these symptoms are more severe and long lasting. The reasons why some people develop PTSD are still being studied. There are biological, psychological and social factors that affect its development.
It is very common for other conditions to occur along with PTSD. More than half of men with PTSD also have problems with alcohol. The next most common is depression followed by behavioral problems and then drug abuse. In women, depression is the most common followed by anxiety and then alcohol or prescription medication abuse.
People with PTSD often have problems functioning. In general, they experience more unemployment, divorce or separation, spouse abuse and job loss. They may experience a wide variety of physical and emotional symptoms.
PTSD can be managed through self directed techniques that can be learned in psychotherapy. The symptoms can be improved with medicines such as antidepressants. People in treatment often reveal concealed wounds, resolve guilt and reduce the effect of the traumatic incident. Treatment enables the person to transition back into a meaningful life.
Alzheimer’s Disease is a neurological illness involving deterioration in mental functions resulting from changes in brain tissue which includes shrinking of brain tissues.
Alzheimer’s Disease is progressive, irreversible, and at this time, there is no known cause or cure.
Senile dementia/Alzheimer’s type is the most common cause of intellectual decline with aging. Though Alzheimer’s Disease can be found in people in their forties and fifties, it is generally diagnosed in individuals sixty years of age and older. In fact, there is an increasing incidence of Alzheimer’s with each decade past sixty. Alzheimer’s Disease is found in both sexes and in people of all races and social, economic, and environmental backgrounds.
Common symptoms may include:
May forget things more often, and not remember them later.
May prepare a meal and not only forget to serve it, but also forget they made it. May burn more meals, because person is easily distracted.
May forget simple words or substitute inappropriate words.
Become lost on their own street, not knowing where they are, how they got there, or how to get back home.
Could entirely forget the child under their care and may dress inappropriately.
May completely forget what numbers are and what needs to be done with them.
May put things in inappropriate places; for example, iron in the stove.
Could exhibit rapid mood swings; for example, from calm to tears to anger, for no apparent reason.
Personalities could change drastically, becoming confused, suspicious, or fearful.
May become passive and require cues and prompting to become involved.
It is important to see a physician when any symptoms are recognized. Alzheimer’s Disease is diagnosed by the health care provider based in part on the history and progression of symptoms. Each person suspected of having Alzheimer’s Disease should undergo a thorough physical and neuropsychological evaluation.
The physical evaluation will discover reversible physical conditions that mimic Alzheimer’s Disease by undergoing comprehensive medical assessment and laboratory tests.
The neuropsychological examination will isolate perceptual and cognitive domains and evaluate each one in relation to standardized norms. This includes basic perceptual-motor abilities, memory, attention and concentration, language, problem solving, mental flexibility, and orientation. In addition, an assessment of mood and personality is usually included. This aids in the formulation of a diagnosis.
There is no known cure for Alzheimer’s Disease, and treatment is limited at relief of symptoms and protection from the effects of the deteriorating condition. There are some new medications that may slow the progress of the disorder. Anxiety and agitation can be minimized through proper handling by the caretaker, but may require the use of drugs and tranquilizers. General nutrition, guided exercise, and activities that are mentally stimulating can be done to help an Alzheimer’s patient function at the best of his or her capabilities. Family counseling may help in coping with the changes required for home care. Eventually, 24-hour monitoring and assistance may be required to provide a safe environment, control aggressive or agitated behavior, and meet physiologic needs. This may include in-home care, boarding homes, adult day care, or convalescent homes.
Caring for an Alzheimer’s patient can be an extremely difficult task and can produce an enormous strain on a family’s physical, emotional, and financial resources. Several local area support groups are part of the Mid-Michigan chapter. These support groups are free educational and supportive meetings to provide a forum for family and friends to discuss mutual problems, experiences, and ideas.