Transcription:
Neuropsychological Assessments at Northwestern Medicine Marianjoy Rehabilitation Hospital

Melanie Cole, MS (Host): Welcome to Better Edge, a Northwestern Medicine Podcast for physicians. I'm Melanie Cole and joining me today is Dr. Lauren Crisanti. She's a neuropsychologist at Northwestern Medicine's Marianjoy Rehabilitation Hospital, and she's here to talk about neuropsychological assessments with us today. Dr. Crisanti, it's such a pleasure to have you with us.

I'd like you to start by telling us the ways that neuropsychology fits into rehabilitation. We don't typically think of them as going together. What role does the testing play in inpatient and outpatient rehabilitation at Marionjoy Rehabilitation Hospital?

Lauren Crisanti, PhD : Sure. Thank you so much for having me. I appreciate it. I think, in general, neuropsychology wears many hats in the rehab setting. Certainly on the inpatient side, I think the most important role we have is providing information to the treatment team about a patient's emotional and behavioral and cognitive needs, during their rehab admission. And really that can be important in maximizing the benefits and outcomes of their treatments.

I think another way that they can be helpful is we're providing direct support to the patients. We're helping them cope and adjust to what brought them into rehab and really supporting them through their recovery process. And in some cases, the treatment team asks for recommendations about what they can do to help interact with the patients to maximize their needs as well.

In an outpatient setting, it's a little different. Neuropsychologists are usually tasked with administering neuropsychological testing in order to assess a patient's cognitive strengths and weaknesses. And that's really important in one, measuring their healing after an injury; and two, providing really helpful treatment recommendations to help kind of assist them through the recovery process, which can take up to a year.

Melanie Cole, MS: What kind of patients are we talking about? Dr. Crisanti? Who would benefit from this type of evaluation and testing?

Lauren Crisanti, PhD : I think, in a traditional way, anybody can benefit from this type of testing, if the patient or their provider or their family has noticed seeing a change in their cognition. So just generally speaking, anybody who experiences a change in their cognition can benefit from this testing.

But when we're talking about rehab, I think that neuropsych testing can be really important in being able to tell the patient and the treatment team how their brain is healing from an injury that they've had. What kind of strengths and weaknesses that they have in the moment of testing, so that we can provide ongoing treatment recommendations for their recovery process. And that can be for both children and adults.

Melanie Cole, MS: This is such an interesting topic to me because I see that cognitive function is so important, certainly after an injury, but also that psychosocial and the neurological effects and defects from different kinds of accidents, but also from being in the hospital, as you say, there's all of those feelings.

So tell us about how you go about doing a neuropsychological test and what's the difference between testing and imaging?

Lauren Crisanti, PhD : Yeah, that's a very good question and I think that neuropsych testing and imaging are kind of interdependent. They have an interdependent relationship and they really compliment each other really well. And when it comes to testing, what makes neuropsych testing unique from other diagnostic methods of brain activity, is that it's specifically and objectively measures cognitive strengths and weaknesses. So how that patient is actually functioning cognitively in their day-to-day and emotionally as well. Whereas neuro imaging literally takes pictures of the patient's brain. So you are actually looking at pictures of a person's brain to see any abnormalities or anomalies in the brain that could potentially be causing their functional changes.

And so that's why they really compliment each other well, because a lot of times the neuropsych testing will help support what we're seeing in neuroimaging.

Melanie Cole, MS: That was an excellent explanation because they are completely different. One is purely physical and you can see what's going on, and the other one is psychological and neuropsych, so they do compliment each other so well. How do you measure the healing of a patient's brain when we're talking about cognitive function and because some of this is really what you do to me, Dr. Crisanti is a mystery, but I mean, it is to many people. So, what is your measurability for these things?

Lauren Crisanti, PhD : Yes. And as you kind of touched upon, it can be a little tricky trying to objectively measure a person's thinking, because we can't see their thinking. And so the neuropsychology field has done a wonderful job in being able to construct valid and reliable tests that we can actually administer to the patients.

And neuro recovery from an injury can be measured in many different ways, including neuro imaging and clinical neurological tests that neurologists do in their offices. But neuropsych testing uses, what sets us apart from those other methods, is that we use objective test scores to actually track cognition over time.

So, each test that a person takes during neuropsych testing, generates a score. And then those scores are compared to other people their age who have not sustained an injury. So it lets us know through this comparison, how that person is doing, how is that patient functioning, where we think they should function had they not had that injury.

So it kind of lets us know what kind of healing they have left and how far they've come since their injury.

Melanie Cole, MS: How do you account for variables, Dr. Crisanti, such as medication, such as emotional states, such as things that might affect the outcomes of what you're trying to determine?

Lauren Crisanti, PhD : That's a good question and thank goodness there are people out there who are doing a lot of research on this. So we have a lot of scientific studies to show how certain medications can affect cognitive function, so we know what to look for when we have test data, as well as emotional outcomes. So there's actually patterns of scores in neuropsych testing that are strongly associated with certain conditions, including neurological conditions, but also emotional conditions.

And in some cases, we may defer testing if we think those variables will confound the outcomes of the testing.

Melanie Cole, MS: That makes a lot of sense. So what would you like other providers to know about Marianjoy Rehabilitation Hospital program for neuropsychological evaluation and testing, and what makes you guys so unique for patients?

Lauren Crisanti, PhD : Well, I think there's so many great qualities in Marianjoy that make, Marianjoy a great place to come. And neuropsychology is just one of those aspects. But I do think that the Neuropsychology program at Marianjoy offers a unique advantage to patients compared to community neuropsych; in that we're actually housed within a well-established rehab program. Patients are part of a holistic approach when it comes to their care and treatment. And when a patient comes to us for neuropsychological testing and treatment recommendations involve follow-up rehab services, it's a nice, smooth, easy kind of in-house handoff to other services such as you know, additional speech therapy or a driver's evaluation, and we have access and knowledge to a variety of helpful community resources as well.

Melanie Cole, MS: What a great service you provide. And as we wrap up, I'd like you to just summarize and reiterate how neuropsychological testing and evaluation benefits patients, their recovery, ongoing treatment plans, and even the family, the whole family situation with patients that have suffered an injury.

Lauren Crisanti, PhD : Yeah, so, neuropsychological testing really benefits patients because the testing data provides really important information about how the patient's brain is healing from an injury, what treatment recommendations as a result of their results can help benefit and aid in their ongoing recovery, how family members can help in terms of maximizing their cognitive strengths and compensating for their cognitive weaknesses from the injury, and making important recommendations really to enhance the patient's independence overall because that's really what's most important.

Melanie Cole, MS: Well, it certainly is. That was well said. Thank you so much Dr. Crisanti, for joining us today. To refer your patient or for more information please visit our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers.

That concludes this episode of Better Edge, a Northwestern Medicine Podcast for physicians. Please always remember to subscribe, rate, and review this podcast and all the other Northwestern Medicine podcasts. I'm Melanie Cole.