GUEST EDITORIAL: NEUROREHABILITATION AND BRAIN PLASTICITY

Barbro B. Johansson
2003 Journal of Rehabilitation Medicine  
Clinical neuropsychology and psychology have evolved as diagnostic and treatment-oriented disciplines necessary for individuals with neurological, psychiatric, and medical conditions. Treatment effectiveness in neurorehabilitation is best predicated on an accurate assessment of residual and deficit functions, and an appreciation for the impact of the neurological injury on the individual and its interpersonal meaning. This thematic issue provides an opportunity to spotlight these disciplines
more » ... hese disciplines and their respective utility as useful reservoirs of skill, knowledge, technique, and theory. The contributions showcased in this issue illustrate the synergistic benefits of neuropsychology and psychology when applied to individuals with suspected or known neurologic and neuropsychiatric conditions. It is with a keen interest in promoting the practice and continuous availability of neuropsychological and psychological services in neurorehabilitation that this endeavor is promulgated. It is quite fitting that I begin this editorial with reference to an advisory article written almost twenty years ago by Ronald Ruff, Clinical Neuropsychologist, entitled "A friendly critique of neuropsychology: facing the challenges of our future" (volume 18, issue 8, December 2003 pp. 847-864). Dr. Ruff postulated that neuropsychological services and specifically, the neuropsychological evaluation, "must not remain an adjunct to the physician's diagnostic screening as it is better perceived as an essential component of optimal patient care." In the years since Ruff's presentiment, the meaning remains apropos. Nevertheless, our modern healthcare system has since continued to impose ever-increasing hurdles in the way of recommended services that impacts patient care in hospitals and medical specialty centers, residential, and private outpatient treatment programs. These obstacles have materialized in the forms of excessive documentation requirements imposed by third-party payors and external attempts to manage clinical decisions and service delivery by placing limits on the duration, type, and sometimes restrictions on specific treatment methodologies and diagnostic procedures. These limitations are, in no small part, compounded by stagnant reimbursement rates that make perseverance and affordability in inpatient and outpatient neurorehabilitation venues far from easy for the provider, and unnecessarily disruptive for the patient. Whether the intended consequence or not, these impediments remain a vexatious challenge to the provision of essential and comprehensive neuropsychological and psychological services to those with unique neurological profiles. Typically, individuals with neurological impairment require more than the traditional or onedimensional intervention. As Ruff also inferred years ago, and as it currently remains, the manner in which services are delivered and the degree to which neuropsychologists can control quality and guide service delivery in ways that are known to work (or likely to work) is not always upheld and certainly, not guaranteed. At a minimum, control over quality and method is best achieved through perseverance and with an eye for new, consumer-friendly, cost-effective, and empirically based, treatment options. Otherwise, creative and beneficial means and methods are at risk of capitation, curtailment or obsolescence due to disuse.
doi:10.1080/16501970306105 pmid:12610840 fatcat:i3ytzrxhvjdmnhwpbol66bhkem