Physicians and Other Consultants: Part IV

Speech pathologist (CCC-SLP)

The speech pathologist assesses and treats deficits in attention/concentration, memory, and cognition involving speed of information processing, thought organization, initiation, and decision-making. A complete evaluation includes both speech/language and oral-motor functions. Academic skills are assessed to rule out potential deficits that may have an impact upon the person's return to a more independent lifestyle, community interaction, and work.

Assessment tools include:

• Muma Assessment Program (MAP)
• Woodcock-Johnson Psychoeducational Battery
• Oral Peripheral Examination
• Boston Diagnostic Aphasia Examination (BDAE)
• Minnesota Test of Differential Diagnoses of Aphasia (MTDDA)
• Ross Information Processing Assessment (RIPA)

Physical therapist (PT, RPT)

A complete evaluation by a physical therapist should include:

A review of the person's complete history; testing his/her range of motion, flexibility, and strengths in all extremities (including neck and trunk); evaluating his/her pre-ambulatory activities and balance; and a vestibular system evaluation. This evaluation includes assessment of cerebellar functions. The Dix-Hallpike maneuver, Unterberger test, Babinski-Weil test, and Vestibular Sensitivity test should be performed.

If vestibular dysfunction is detected, vestibular rehabilitation should be provided by a physical therapist or occupational therapist trained in this specialty.

A cardiovascular conditioning program should be initiated and gradually transferred to a community gym as the person becomes more independent. Fitness can have a positive impact upon the person's mental and physical stamina, reduce pain, and elevate his/her feeling of well-being.

Occupational therapist (OTR)

A complete occupational therapy evaluation should include:

• Range-of-motion, manual muscle, and sensation testing of the upper extremities
• Grip prehension strengths
• Chemosensory evaluation (taste and smell)
• Boston Box Test (bilateral coordination)
• Fine motor coordination
• Vision screening
• Motor Free Perceptual Test (MFPT)
• Test of Visual Perception Skills (TVPS)
• Hooper Visual Organization Test (HVOT)
• Santa Clara Perceptual-Motor Evaluation
• Physical Capacity Evaluation
• Assessment of higher-level ADL's and home/community safety judgment
• Pre-vocational skills assessment

Findings from the vision screening may result in a referral to a neuro-ophthalmologist and/or a developmental optometrist. An occupational therapist in a neurorehabilitation setting should have training in vision-therapy to provide treatment and education to the client and family.

Counselor/psychotherapist (marriage/family therapist or clinical psychologist)

Assessments of personality (MMPI), depression (Beck), and family/psychosocial history should be included in the initial evaluation.

Treatment includes education for client and family, as well as help with adjustment to disability, anxiety, and post-traumatic headaches.

Vocational Rehabilitation Counselor (CRC)

Vocational rehabilitation testing should not be initiated until clinical goals are met involving vision, vestibular and cerebellar function, attention, memory, auditory and visual information processing, reaction times, adjustment to disability, and other psychological issues.

Testing and initiation of training and placement into the community should be gradual and supported by the entire neurorehabilitation team.

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