Neuropsychological assessment in rehabilitation: Current limitations and applications

Neuropsychological assessment is a standard procedure for rehabilitation patients with cognitive dysfunction. However, the use of neuropsychological evaluations in rehabilitation settings is limited as the most commonly used measures were originally developed for diagnostic purposes with an emphasis on localization/lateralization of lesions and description of brain-behavior relationships. As a result, the functional (versus diagnostic) utility of neuropsychological evaluations is questionable at best. Furthermore, neuropsychological evaluation in rehabilitation settings will continue to be of limited utility as long as INS-APA Division 40 guidelines continue to emphasize training in neurologic and neuroanatomic factors, with minimal attention to rehabilitation issues and resources. Several factors necessitate the use of neuropsychological evaluations for functional rather than diagnostic purposes, including advances in neuroradiological evaluation, the growth of rehabilitation facilities given increased survival rates for brain injured patients, and an associated greater need for psychological services for these patients. Suggestions are offered for improving the functional utility of neuropsychological evaluations, as well as more effective ways to train neuropsychologists in rehabilitation issues and interventions.