Conference “Complex neurorehabilitation as the basis for reintegration
into society and the labor market”
„NEUROPSYCHOLOGY and SENSORS“
Praha, 27. - 28.9.2013
Clinical Neuropsychology An Overview of the Field in
Germany
Tobias Gräßer
Clinical Neuropsychologist (GNP)
Systemic Therapist (IGST)
Bonn, Germany
Clinical Neuropsychology in
Germany
Contents:

Definition of Neuropsychology

Domains of intervention according to ICF

Working fields of Neuropsychologists in
Germany

Topics adressed in clinical settings

Benefits (and side effects) of NP for patients

Benefits (and side effects) of NP for teams in
rehabilitation
What is Neuropsychology?
Definition Wikipedia:
„Neuropsychology adresses the structure and
function of the brain as they relate to
psychological processes and behavior.“
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Functional changes / deficits in cognition
Emotional and psychological symptoms or
consequences
Consequences on behavior, activities and
participation
C:\Users\Tobias\Job\Workshop
Int. Classification of Functioning,
Disability and Health (WHO, 2001)
Definition of Health in ICF
(WHO, 2001)
A person in considered healthy if
a) his/her bodily and mental structures and
functions are intact according to statistical norms
b) he/she is able to perform all kinds of activities
as a person without a health problem would
c) he/she is able to fulfill social roles and partake
in society as a person without a health problem
would (participation)
Working fields of
Neuropsychologists in Germany
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Assessment and therapy in clinical (diagnostics
and treatment) settings
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Acute clinics and early rehabilitation
Stationary rehabilitation
Ambulatory rehabilitation
Neuropsychological Practice
Diagnostics and assessment to verify claims
against insurances, pensions, forensic
questions
Working fields of
Neuropsychologists in Germany
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Rehabilitation in the workplace
Case management
University and research settings
Topics adressed in clinical settings
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Functional status
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Attention
Memory
Visuo-spatial functions
Visual field and Neglect
Executive functions
Awareness of symptoms
Psychological status (e.g. Depression, Anxiety)
Topics adressed in clinical settings
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Consequences of functional deficits in everyday
life
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Basic activities of daily living
Mobility (including Driving)
Work
Social Roles
Relationship and Family
Topics adressed in clinical settings
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Therapy
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Functional Training (e.g. attention, visual defects)
Adaption and Compensation (e.g. memory,
executive Functions)
Coping with consequences of illness (individually,
family coping)
Topics adressed in clinical settings
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Therapy II
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Support of rehabilitation in the workplace
Support in finding alternative work settings if return
to former one is not possible
Support in finding activities and life content if work
is not possible at all
Essential views on NP-Therapy
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In Neuropsychological Therapy a clear
distinction between cognitive therapy and
psychotherapy is impossible.
Changes in one field always lead to changes in
the other.
Coping with neuropsychological deficits always
challenges former ideas of how life is.
Diagnostics are part of the therapy process.
What can Neuropsychologists do
for patients?
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Assessment of function and explanation about
the meaning of the result for the life of the
person can help clarify unknown / strange /
irritating sensations and experiences
Development of a therapeutic strategy that
comprises functional improvements as well as
aspects of dealing with the symptoms and
coping can help patients to regain a sense of
control
What can Neuropsychologists do
for patients?
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Actual improvements in functional status can
lead to improvements in activities of everyday
life and, ideally, lead to „healing“, reinstatement
of former ways of living
Neuropsychologists can take a useful role as
„translator“ or counselor for patients in relation
to partners/families, and if return to work is an
option, towards employers and collegues
What can Neuropsychologists do
for patients?
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Neuropsychological Diagnostics can give clear
recommendations for otherwise unclear
questions, i.e. can I drive, go back to work, take
care of my finances etc.
Psychotherapeutic interventions can enhance
coping and dealing with the illness
Side Effects and Limitations of
Neuropsychological Therapy
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Not every assessable symptom is treatable
Improvements might not go far enough to fullfil
the goals a patient has
Relatively extensive diagnostic options are not
matched with clear-cut strategies for treatment
Diagnostic results can lead to restrictions and
negative consequences
Side Effects and Limitations of
Neuropsychological Therapy
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Frequently, neuropsychological diagnostic and
therapy is „prescribed“ by doctors and not
something a patient voluntary seeks after
This can lead to the fact that the
neuropsychologist has the role of control agent
more than the role of a therapist
Confrontation with deficits can lead to
frustration, anxiety or depression
Interview with Patient FL
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Horse-Riding Accident in 2007
Traumatic brain injury
Beginning: hemiparesis, wheelchair, speech
disorder, intense aggressiveness, severe
neuropsychological disorders
Ressources: excellent family support, probably
high intelligence before accident, good verbal
skills
Today: bodily functions and speech about
normal, remaining neuropsychological deficits in
attention, memory and executive functions
Interview with Patient FL
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Living in her own apartment in mother´s house
Not successful in trying to find a job perspective
in office / administration
At the moment “supported work” as volunteer in
daily care for elderly people
Videos
2, 4, 5, 6 about Neuropsychology
8 about Rehabilitation Clinic
9, 10 about Aggression
14, 13 about NP Therapy
15, 17, 18 about Situation today
20, 21 about Outcome of Therapy
Use of NP for other occupations
in the rehabilitation team?
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Provide information that is relevant for the
planning of rehabilitation
Help explain problems experienced in other
therapies
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Attention deficits might be interpreted as insufficient
motivation
Visuospatial deficits might lead to the impression of
inappropriate contact behavior
A lack of awareness or drive might seem as
motivational problems
Use of NP for other occupations
in the rehabilitation team?
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Neuropsychologists can take the role of contact
person for partners or relatives of the patient
Neuropsychologists can make contact with
employers in order to plan and advance return
to work
Case management
“Side effects” and problems in
interdisciplinary team settings
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Different occupational backgrounds lead to
different views and interpretations about
symptoms and ways to treat them
Different languages and „codes“
In neurorehabilitation there are wide overlaps of
possible responsibilities (neuropsychologist –
occupational therapist; neuropsychologist –
doctors). This can lead to a lack of clarity about
who is responsible for what
“Side effects” and problems in
interdisciplinary team settings
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Hierarchical differences between occupations
(in Germany Doctor – Npsych – other
therapeutic occupations)
Ways to deal with problems in
interdisciplinary team settings
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Clarity about the hierarchical structure
Clarity about individual fields of responsibility
Defined ways to deal with conflicts
Well defined processes of team meetings
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Clear definition of goals of rehabilitation and the
therapist or occupation that is mainly responsible
Therapy goals should be described as concrete and
practical as possible
Evaluation of goal attainment on a regular basis
Ways to deal with problems in
interdisciplinary team settings
Differing views of patient problems and
needs and resulting ideas for
treatment are the most important
strength of interdisciplinary teams.
Thank you for your attention!