Pushing the frames of reference in traumatic brain injury rehabilitation

Cognitive rehabilitation is an empirically based field driven by multiple sources of activities and knowledge bases. Drawing on frames of reference provided by rehabilitation, neuropsychology, and rehabilitation psychology, cognitive rehabilitation has evolved to a point where studies have been generated to qualify for consideration in tables of evidence. At the center of cognitive rehabilitation is the effort to teach people to overcome or adapt to limitations. While rehabilitation has traditionally been focused on activity, a recent trend in the literature is to incorporate the individuals experience into a frame of reference for rehabilitation. Emphasizing the experience of the person in the situation fits into cognitive rehabilitation and raises the bar for rehabilitation not only in viewing rehabilitation as an activity to relieve burdens but also in terms of how rehabilitants come to grips with limitations. Dealing with limitations is an important indicator of mental health.

Current trends in the reimbursement of professional neuropsychological services

Professional members of the National Academy of Neuropsychology (NAN) completed a survey focusing on clinicians' time requirements for activities, number of yearly claims to funding sources, average reimbursement rates, reimbursement rates associated with specific current procedural terminology (CPT) codes, managed care tolerance, hourly reimbursement rates, and other relevant practice issues such as incident-to. Clinicians continue to offer neuropsychological services through traditional assessment and evaluation activities, receive referrals from other healthcare professionals (i.e., neurologists, other medical specialists), and answer traditional referral questions related to patient diagnoses and determination of neuropsychological deficits. Two-thirds of respondents disapprove of managed care, and clinicians engage in activities which appear to minimize the ongoing changes in, and detrimental effects of, managed-care-based funding, in the form of dropping managed care panels, opting for fee-for-service, requiring self-pay patients, or spending more time in clinical activities for which there is a higher percentage of time approved such as forensic evaluations and evaluations for private practice. Clinicians continue to rely on managed care for their referrals even though they are only being reimbursed at about 50%. Overall, across service providers, clinicians are only receiving 60% of their hourly rate, and only 22% report receiving full compensation for their hourly rate. These results suggest that the effects of managed care have, for better or worse, altered the practice of clinical neuropsychology.

[Can psychiatry become neuropsychiatry?]

Today more and more often there are prognoses that in the future psychiatry will have been absorbed by neurology. It would be thanks to the stormy progress of research on the neurophysiological, genetic and molecular foundations of mental disorders. The aim of the article is to assess the possibility as well as the supposed consequences of such an evolution of psychiatry. The considerations concern the peculiarity of the object of interest and the methods used in psychiatry in relation to the neurological object and methodology. This way the appraisal of raison d'etre of one common science: neuropsychiatry becomes possible. The question of fundamental importance for the evaluation of similarities and differences between the psychiatric and neurological perspectives is the way the psychophysical issue and especially the problem of the mind-brain relation are approached. The article presents the manners of solving these problems proposed by the contemporary philosophy of the mind. Together with parting with the full of errors and simplifications heritage of Descartes it appears the necessity to regard the presence of subjective mental states both conscious and unconscious in model of mind-brain relation. The example of such a solution is the biological naturalism of John Searle. The psychical life of the man in its subjective dimension remains the peculiar area of interests for psychiatry irrespective of the progress in research on the biological base of mental disorders. The especially valuable cognitive and therapeutic tool in this aspect is psychotherapy constituting the integral part of psychiatry. The present state of knowledge does not indicate that the psychotherapeutic wing of psychiatry can lose its importance and rather somewhat the contrary. The progress of neurobiology does not have to threaten the autonomy of psychiatry by any means and the maintenance of this autonomy depends decisively on the psychiatrists themselves.

Unity within psychology, and unity between science and practice

The unity of psychology as a science is to be found in its definition as the science of mental life, and its explanation of individual behavior in terms of mental states. This disciplinary focus will help negotiate psychology's relations with other disciplines, such as neuroscience and cognitive science. The unity within psychology between science and practice is to be found in a focus on scientific evidence as the source of the status, autonomy, and privileges of professional practitioners. Psychology should avoid the temptations of reductionism, and assert (and enjoy) its twin status as both a biological science and a social science.

The concept of 'developing the brain': a new natural science for learning and education

From the viewpoint of biology, learning and education can be defined as the processes of forming neuronal connections in response to external environmental stimuli, and of controlling or adding appropriate stimuli, respectively. Learning and education can thus be studied as a new field of natural sciences with the entire human life span as its subject, thus including various problems such as fetal environment, childcare, language acquisition, general/special education, and rehabilitation. Non-invasive imaging of higher-order brain functions in humans will clarify the brain's developmental processes, and will provide various evidence for learning sciences. This new approach is called 'developing the brain' or 'brain science and education'. The origin of the concept and its present state are described and its future prospects are briefly analyzed.

Neuropsychologische Entsprechungen und therapeutische Konsequenzen des strukturdynamischen Modells

Firstly the core concepts of the dynamic structural model and the methods from which the model was developed will be discussed. These core concepts include concepts of personality structure and affect dynamic, of dynamic affective derailment with dissociation of individual element structures, the capacity of disactualisation of unwanted mental content, and autopraxis as the basis of memory renewals, which are formed and channelled through selection. Furthermore we will consider the dependence of memory function on texturing, development of coherence, affective freighting and repetition of usage in Janzarik's system. Neuropsychological counterparts are to be found in experimental studies on filter, gating and control functions, in studies on automatic vs. controlled processes, the central executive and executive control function. Autopraxis and priming operations will be related to each other. Furthermore, the connection of neuronal plasticity to a raised signal-to-noise ratio and the relationship to extinction of delusional content through broadening of new fields of experience will be discussed. In a summary of the frappant parallels of experimental and clinical viewpoints of Janzarik's model we will show the therapeutic perspective and the psychotherapeutically important integration of the lifeworld of the patient with experimentally investigated neuropsychological functions through Janzarik's conceptualisation.

Developing the brain -- a proposal to pediatricians

What we should do as pediatric neurologists to solve educational problems may be not only to find symptomatic solutions but also to drastically re-evaluate 'the view of children'. Brain science, rapidly advancing at present, gives us some new scientific achievements, such as neuronal cell death, synaptic overproduction/elimination, sensitive period, higher cortical function of neonates, and neural correlates, useful for this re-evaluation. From this aspect, I have made a proposal for the establishment of new developmental neurology.

SIREN CALL OF METAPHOR: SUBVERTING THE PROPER TASK OF NEUROSCIENCE

Under the assumption that nervous systems form a distinct category among the objects in Nature, applying metaphors of psychological and behavioral science disciplines is flawed and invites confusion. Moreover, such practices obscure and detract from the primary task of Neurophysiology: to investigate the intrinsic properties of nervous systems, uncontaminated with concepts borrowed from other disciplines.

Development of orbitofrontal function: current themes and future directions

In recent years, an exciting thrust in the developmental research literature has been the focus on "executive" functions (EF). However, the emphasis has been on the more purely cognitive aspects of EF operative in abstract reasoning and problem solving-aspects associated mainly with dorsolateral frontal regions. Although the literature on adult neuropsychology has seen an emerging and growing interest in the study of processes more related to orbitofrontal cortex (OFC), including emotion and personality, research on the development of EF has lagged behind. This special issue of Brain and Cognition is intended to redress this imbalance by bringing together researchers who are studying the nature and development of orbitofrontal function from a wide variety of perspectives.

Current directions in social cognitive neuroscience

Social cognitive neuroscience is an emerging discipline that seeks to explain the psychological and neural bases of socioemotional experience and behavior. Although research in some areas is already well developed (e.g. perception of nonverbal social cues) investigation in other areas has only just begun (e.g. social interaction). Current studies are elucidating; the role of the amygdala in a variety of evaluative and social judgment processes, the role of medial prefrontal cortex in mental state attribution, how frontally mediated controlled processes can regulate perception and experience, and the way in which these and other systems are recruited during social interaction. Future progress will depend upon the development of programmatic lines of research that integrate contemporary social cognitive research with cognitive neuroscience theory and methodology.

A friendly critique of neuropsychology: facing the challenges of our future

Neuropsychology emerged as a discipline in the 1940s when prior to performing a craniotomy, neurosurgeons based their localization on EEGs, X-rays and neuropsychological test results. This practice ended in the mid 1970s when computerized tomography became available. As the neuropsychologists' role in localizing has become miniscule, the referral questions have shifted to obtaining quantitative descriptions of the patient's cognitive status. The current paper explores future directions for neuropsychology on the basis of asking the following question: are we meeting the needs of the patients? The answer is clear: patients' needs are not met by merely diagnosing cognitive deficits. There is a growing need to advance services that maintain cognitive health, since modern societies place increasing value on highly educated and skilled work forces. Thus, the time has come for neuropsychologists to identify as caretakers for cognitive health. Just as we expect from the disciplines responsible for physical and emotional health, we must provide a combination of diagnostic and treatment services for cognitive health.

Reporting of Demographic Variables in Neuropsychological Research: Trends in the Current Literature

Demographic variables have long been known to exert effects on psychological testing. Variables such as age, education, and gender have been thoroughly researched, and their effects are well documented. Other demographic variables such as race, ethnicity, socioeconomic status, native language, and acculturation are less well researched within the field of neuropsychology. Research that has been produced to date has demonstrated that each of these variables does indeed wield some effect on neuropsychological test performance. Therefore, it is important that these variables be reported in the literature so that neuropsychologists are able to generalize research findings to their everyday practice with patients from diverse backgrounds. With this in mind, the current study was undertaken in order to determine the frequency with which a range of demographic variables are being reported in current neuropsychological research journals. Publications from 1995 to 2000 in five of the most frequently utilized neuropsychology journals were reviewed. Results showed that while age, education, and gender are frequently reported, information on race, ethnicity, native language, and acculturation are rarely, if ever, reported. These results show that even though great strides have been taken in the burgeoning field of cross-cultural neuropsychology, current trends need to be changed in order for progress to continue.

Challenging dogma in neuropsychology and related disciplines

Challenging "dogmas" in neuropsychology and related fields is important for the advancement of our professional development. Five dogmas that I have found worth challenging are reviewed in this article.

Forensic Neuropsychology: are we there yet?

Forensic Neuropsychology is a new and rapidly evolving subspecialty of clinical neuropsychology that applies neuropsychological principles and practices to matters that pertain to legal decision-making. Forensic neuropsychologists provide the trier of fact with specialized information regarding brain-behavior relationships. The primary responsibility of the forensic neuropsychologist is to provide information based on scientifically-validated neuropsychological principles and clinical methodology that is pertinent to the Forensic Question at hand-which is not just whether the patient has dysfunction, but whether the dysfunction results from the event under consideration. To best answer the Forensic Question, the neuropsychologist must use a methodology that has been scientifically-validated on brain-impaired individuals, and can distinguish various brain conditions from each other as well as from normal variation. The methodology must be able to determine whether any dysfunction found is, in fact, the result of a neurological condition as opposed to non-neurological, psychological, or even factitious disorders. This paper discusses neuropsychological methodology in the context of forensic application and the requirements of the legal process and illustrates these issues with case examples.