[1] 16w Neuropsychology and Rehabilitation Services in the United States: Brief Report from a Survey of Clinical Neuropsychologists

[1] 197w Objective: To provide a brief presentation of preliminary data on rehabilitation services provided by clinical neuropsychologists within the United States. Method: This survey utilized data extracted from a larger international research study conducted in 39 countries including N = 173 professionals who reported to engage in neuropsychological rehabilitative services within the past year (63.6% female, 44.36 ± 11.83 years of age) took part in the study. Results: Neuropsychologists providing rehabilitation services in the United States in the past year were more likely to provide individual versus group therapy, likely to employ technology (e.g., personal computers, mobile phones/smartphones) as part of treatment services, see a range of diagnostic groups most prominently traumatic brain injury and stroke/vascular conditions, and work to address a range of both cognitive (e.g., memory, attention/concentration, and executive functioning) and psychological (e.g., emotional/behavioral adjustment and well-being, awareness of disability/disease) issues. Conclusions: Prior published surveys suggest that clinical neuropsychologists have a growing involvement in rehabilitation services within the United States but with little clarity as to the actual characteristics of actual professional activities and practices. The present study aimed to provide such information and hopefully will be helpful in promoting additional systematic studies in this area.

[1] 164w A transdisciplinary collaborative approach to the conceptualization and treatment of disease and injury is integral to successful medical rehabilitation and, in many cases, eligibility for accreditation by national bodies, such as the Joint Commission and Commission on Accreditation of Rehabilitation Facilities (CARF). One of many important roles on these transdisciplinary teams is the clinical neuropsychologist (Caplan, 1982;Wilson, 2008). Neuropsychological expertise in the area of cognition is especially helpful in conceptualizing the patient's abilities, facilitating goal-planning efforts through clinical input and comprehensive assessment findings, translating impairments into useful functional recommendations, modification of interventions, and provision of education to the patient/family and staff (Caplan, 1982;Tsaousides & Gordon, 2009;Wilson, 2008). Cognitive rehabilitation has long been a part of the array of services that clinical neuropsychologists offer (e.g., Hartlage, 1985;Seretny, Dean, Gray, & Hartlage, 1986), and nowadays rehabilitative efforts by neuropsychologists may also be conducted outside of the typical inpatient setting, as smartphone and touchscreen technologies are increasingly utilized for treatment and compensation for cognitive impairments (Wilson, 2008).

[2] 211w To the best knowledge of the authors, there are no published findings with a purpose limited to solely outlining rehabilitative practices specific to clinical neuropsychology in the United States. However, there are some American data available for comparison. A recent salary survey of N = 1,777 United States neuropsychologists (Sweet, Benson, Nelson, & Moberg, 2015) did include data from n = 151 respondents who identified as working within a rehabilitation setting, roughly 10% of the total sample. These individuals reported that they were more likely to work with adults only (13.6% reported working with adult-only vs. 6.4% pediatric-only), and make on average less than their doctoral-level professionals in neuroscience (in thousands, 140.3 vs. 122.8), or doctoral-level medical (i.e., neurosurgery = 161.1 and neurology = 127.9) settings. Another survey of N = 1,406 neuropsychologists in the United States (Sweet, Peck, Abramowitz, & Etzweiler, 2010) included some daily practice data on neuropsychological rehabilitation. In this survey, the fewest number of hours per week on a clinical activity were spent on cognitive rehabilitation (i.e., 0.82 hr/week) and 81.3% of the sample denied providing this service at all. Individuals more likely to engage in cognitive rehabilitation were twice as likely to be employed in a private practice versus institutional setting (i.e., 1.13 vs. 0.51 hr/week).

[3] 154w As rehabilitation psychology and neuropsychology continue to develop in the United States, it would be useful to characterize the ways and settings in which these two psychological specialities intersect. This present brief report sought to complete two primary objectives: (a) to provide preliminary data on demographics of neuropsychologists in the United States who conduct rehabilitation services; (b) to characterize the rehabilitative services provided by neuropsychologists in the United States, in particular what types of treatment (i.e., individual, group, or mixed), technology tools utilized as part of treatment, treatment foci, and clinical populations encountered in treatment. Such data could ultimately prove helpful to spur more targeted professional surveys of neuropsychologists conducting rehabilitation, and provide a basis for educating others about this unique knowledge and skill set-to our patients and their families/caregivers, as well as to other professionals with whom neuropsychologists interface. Such data could also be useful for the purposes of reimbursement and professional advocacy.

[1] 107w Out of the 418 professional neuropsychologists in the United States captured as part of this larger international survey, 173 individuals endorsed conducting neuropsychological rehabilitation services within the past year. Compared to the larger international sample, respondents endorsing engagement in neuropsychological rehabilitation services within the past year were more likely to be female (63.6% vs. 59.8% in the general sample). Clinically, respondents reported a mean of 12.7 ± 16.6 patients receiving these services each month, with the median number of patients served being 6. The authors have presented other characteristics of treatment provided and technological tools in Table 2, and diagnostic groups and treatment domains in Table 3.

[1] 116w The present survey attempted to extrapolate data on rehabilitation practices of clinical neuropsychologists in the United States. Professional surveys with an eye towards detailing the daily practices of neuropsychologists have become an increasingly frequent area of interest, and help to clarify the developmental direction of the field as well as new areas of growth. Many such surveys have been conducted of the larger field of neuropsychology, some of which suggest increasing growth and presence of neuropsychologists in rehabilitation settings (e.g., Seretny et al., 1986;Sweet, Nelson, & Moberg, 2006;Guilmette, Faust, Hart, & Arkes, 2009;Sweet et al., 2010;Sweet, Meyer, Nelson, & Moberg, 2011;Fonseca-Aguilar et al., 2015;Sweet et al., 2015;Arango-Lasprilla et al., 2016;Fernandez et al., 2016;Olabarrieta-Landa, et al., 2016).

[2] 117w In this brief manuscript, the authors have provided some preliminary data characterizing basic sociodemographics and practices of neuropsychologists who have conducted rehabilitation services in the United States within the past year. Both rehabilitation psychology and neuropsychology are developing as unique specialities within psychology, but with some overlap in knowledge base, competencies, and employment settings. Data regarding rehabilitation services as provided by clinical neuropsychologists may be of some use in educating patients and their families/caregivers about this aspect of our profession. It would also be of benefit in provision of education to other healthcare providers-some of whom may represent potential new referral sources, reimbursement bodies, and in advocacy efforts in the ever-changing healthcare system in the United States.

[1] 86w Participants in the present study are self-identified psychologists who worked in the field of neuropsychology from United States. This survey forms part of an international research study conducted in 39 countries from Latin America (Arango-Lasprilla, Olabarrieta Landa, Rivera, Olivera Plaza, De los Reyes Aragón, & Quijano et al., 2015;Fonseca-Aguilar et al., 2015;Arango-Lasprilla, Stevens, Morlett-Paredes, Ardila, & Rivera, 2016;Fernandez, Ferreres, Morlett-Paredes, Rivera, & Arango-Lasprilla, 2016), Spain (Olabarrieta-Landa et al., 2016), Nordic countries (Egeland et al., 2016), and South Africa (Truter, Mazabow, Morlett-Paredes, Rivera, & Arango-Lasprilla, Under Review).

[2] 233w In this study participants' data were included for analyses if they: reported living within the United States, reported having completed at least a bachelor's degree, identified as a neuropsychologist, and reported being engaged in professional activities related to neuropsychology (i.e., assessment, diagnosis, treatment, teaching, or research) over the past year. All participants were required to complete the relevant sociodemographic questions included in this participant section below. A total of 456 individuals began the survey. Of these, two reported not considering themselves to be a neuropsychologist or not performing at least some of the activities related to the area, and 36 of the individuals did not complete all demographic questions. Thus, the final sample for analysis was 418 individuals who met all inclusion criteria, 173 of whom identified as engaged in neuropsychological rehabilitative services (see Table 1). Recruitment was conducted by sending an email inviting participation from neuropsychology professionals in various local/regional, national, and international psychological and neuropsychological organizations. In the United States specifically, the member directory of the National Academy of Neuropsychology was utilized to cull emails to which the study advertisement was sent. Additionally, a study advertisement was sent over the electronic listserv operated by the Society for Clinical Neuropsychology (Division 40 of the American Psychological Association). The advertisement email included the study details, survey hyperlink, and a request for assistance in recruiting neuropsychology professionals as participants. No participation incentive was provided.

[3] 189w A comprehensive literature review was first conducted by researchers at the University of Deusto in Spain on the topic of professional issues in neuropsychology to establish the large international study. Through this exhaustive review, seven pertinent themes were identified: (a) professional training, (b) employment, (c) evaluation and diagnosis, (d) rehabilitation, (e) teaching and research, and (f) ethics in the workplace. A series of questions were generated to address each of these thematic areas and to ask about demographic information. All questions were initially developed in Spanish. Subsequently, the survey was sent to a group of experts in neuropsychology from each country that was to be surveyed to ensure the questions were adapted to the cultural and linguistic context of each country involved in the larger international study. When necessary, questions were translated and back-translated by experts to ensure their accuracy. Once all final comments and edits by the experts were incorporated, the resultant survey was composed of 67 questions that were then entered into an online survey platform (www.surveymonkey.com). Five neuropsychologists completed the entire survey to ensure accuracy, validity, and proper operation of the online survey prior to distribution.

[4] 78w The larger parent survey project was approved by the Ethics Committee of the University of Deusto in Bilbao, Spain. The active study phase, consisting of recruitment and data collection, took place from July 1, 2013 to January 1, 2014. Upon the conclusion of the data collection period, respondents' data were downloaded from the secure server directly into an SPSS file to minimize subsequent data entry errors. Statistical analyses were then conducted using SPSS 22.0 (IBM Corp., Armonk, NY).

[1] 105w Current results must be viewed in light of a number of limitations, most prominently the limited number of neuropsychologists who endorsed providing rehabilitation services that were culled from the larger international sample. First, the intended nature of the parent data set was not necessarily to characterize the population of neuropsychologists which this manuscript describes. Rather, it was to capture neuropsychology across a range of settings in order to compare cross-cultural practices. With a more targeted data set and recruitment methods, future studies should be able to more reliably compare neuropsychologists providing rehabilitation services on additional variables (e.g., speciality credentials, number of years practiced, employment setting).

[2] 124w These limitations aside, we believe that this study is an important first step in characterizing rehabilitative services provided by clinical neuropsychologists in the USA. Overall, results showed that respondents were more likely to provide individual therapy; employ computers and mobile devices when delivering services; see patients with acquired brain injury (e.g., TBI and stroke/vascular conditions); and address memory, attention, and executive functions as well as emotional/behavioral adjustment, well-being, and awareness of disability/disease issues. Contrarily, respondents generally do not provide group therapy; use virtual reality, neurofeedback, or neuromodulatory techniques; or work with patients with schizophrenia, mental retardation, pervasive developmental disorders, or AIDS. These findings thus highlight the types of treatments, technologies, treatment foci, and clinical populations involved in rehabilitative services provided by the neuropsychologists sampled.

[3] 116w In this brief manuscript, the authors have provided some preliminary data characterizing basic sociodemographics and practices of neuropsychologists who have conducted rehabilitation services in the USA within the past year. Both rehabilitation psychology and neuropsychology are developing as unique specialities within psychology, but with some overlap in knowledge base, competencies, and employment settings. Data regarding rehabilitation services as provided by clinical neuropsychologists may be of some use in educating patients and their families/caregivers about this aspect of our profession. It would also be of benefit in provision of education to other healthcare providers -some of whom may represent potential new referral sources, reimbursement bodies, and in advocacy efforts in the ever-changing healthcare system in the USA.