 |
 |
 |
 |
 |
 |
 |
| | | |||||||
|
|
||||||||
 |
|
Neuropsychology
Mission The Neuropsychology service is a division of the Department of Neurosurgery at Yale. The clinical, scientific, and academic missions converge in the dedication to enhancing neurosurgical care of patients with neurological disease and injury. The Neuropsychology service provides comprehensive clinical evaluations of cognitive functioning in patients to identify symptomatic conditions and facilitate focused treatment planning before and after surgery. Interdisciplinary scientific collaborations allow for innovative research investigating the neural substrates of complex cognitive abilities and mechanisms of plasticity and recovery in patients of all ages. Training of medical students, residents, and fellows in the techniques of clinical examination provides a foundation for the future. Central to the Neuropsychology mission is the philosophy that all patients, while similar in many respects, are nonetheless unique with respect to the organization of their cerebral functions and the range of their social and personal attributes. Clinical Care Neuropsychological services are integrated with the many clinical and experimental Neurosurgical programs, and include the entire developmental span from infancy to diseases associated with aging. Although the main focus of clinical care is neurosurgical, neuropsychological services are also provided to patients in general neurology, pediatrics, and trauma. Clinical care is provided by the Neuropsychology faculty and psychometrician staff. The core faculty in neuropsychology consists of Michael Westerveld, Ph.D. Dr. Westerveld supervises and directs the delivery of clinical neuropsychological services in the Department of Neurosurgery. Dr. Stoddard provides general neuropsychological consultations for inpatient and outpatient services, and directs the therapeutic and rehabilitation component of the clinical program. The Epilepsy Surgery Program (ESP) serves as a model for how neuropsychological services are integrated into the comprehensive care and treatment planning. During Phase I, a comprehensive multidisciplinary evaluation is obtained. Neuropsychological examination determines baseline levels of functioning, facilitates localization of seizure onset, and ascertains the risk of surgical morbidity with respect to cognitive functioning. This information is integrated with data obtained from other clinical evaluations at phase 1 (e.g., scalp recording of ictal onset, video monitoring of seizure semiology, structural imaging studies including volumetric analysis, and functional imaging studies) to identify surgical candidates, and enhance treatment for nonsurgical candidates. During Phase II, the Intracarotid Amytal Procedure (IAP, or Wada test) is performed to determine hemispheric speech dominance, determine memory capacity of each hemisphere, and provide additional convergent evidence of localization of seizure onset. Cortical stimulation for functional mapping during phase III (i.e., invasive electrophysiological recording) determines the precise location of sensory, motor and language cortex. Cortical stimulation and neuropsychological assessment during Phase IV (surgery) allows for more precise assessment of language function in the surgical field. Post-operative cognitive examinations facilitate the provision of rehabilitative and psychotherapeutic services and re-integration to the community. Pediatric neuropsychology provides a broad base of assessment services to children with neurological disease or injury. The recognition that the evolving nervous system responds to injury, illness, and treatment in different ways than the mature brain underlies the philosophy of the Pediatric Neuropsychology Service. Consultations are provided to all medical services treating children at Yale, with special programs including children with epilepsy, pediatric neuro-oncology, Spina Bifida, hydrocephalus, a broad spectrum of genetic and developmental disorders, infectious disorders (e.g., HIV, meningitis, encephalitis, CNS Lyme), and disorders of learning and attention. The neuropsychology faculty also collaborates with the faculty of other departments and sections to deliver services to patients who are not managed primarily by neurosurgery. Consultations are provided to all patients who may benefit from neuropsychological services, including Neurology, Trauma, Geriatrics, Psychiatry, Cardiology, Internal Medicine, and Pediatrics. Research Programs The philosophy of the Neuropsychology program is that ongoing clinical research is critical to the development and maintenance of the highest standards of care. There is a reciprocal relationship between clinical care and research, in that research programs should enhance clinical care, and clinical needs should drive research questions. Diverse research efforts that contribute to direct efforts to improve patient care as well as further our general understanding of cognitive functioning and the processes that govern development and recovery of cognition form the basis of our research programs. The research efforts of the clinical faculty have yielded direct and immediate benefits to the care of neurologically impaired patients. Improvement of the selection criteria for the surgical treatment of the epilepsies has been a major emphasis of the Neuropsychology service. Pioneering research in structure function relationships has enhanced not only surgical selection, but prediction of surgical outcome with respect to cognition. Other research efforts emphasize interdisciplinary and multicenter collaboration in epilepsy research. The Yale Neuropsychology program is one of the centers participating in the Bozeman Epilepsy Consortium. This collaboration has resulted in multiple publications on issues of importance such as early hemispheric vulnerability to seizures, preservation of language in temporal lobectomy, and utility of existing visual memory paradigms for human neuropsychology. This large database also serves as a foundation for many other areas of research, including personality and emotional functioning, developmental issues in epilepsy, and treatment and outcome research. This ongoing collaboration is also conducting prospective studies of neuropsychological functioning and assessment. Yale also serves as the coordinating center for a multicenter study of cognitive and psychosocial/quality of life outcome in epilepsy surgery. Research programs also include diverse areas of neurological injury and disease. The Neuropsychology service contributes to ongoing studies of treatments for Parkinson's disease. Clinical trials in Multiple Sclerosis and HIV, long term outcome of premature birth children, and plasticity of function are ongoing areas of study. Functional imaging is increasingly being made available as a clinical tool, but requires validation with existing standards. The development of functional imaging paradigms that are applicable to clinical practice is another area of ongoing research. Through consultation with physicists developing more powerful imaging techniques, behavioral tests are adapted for the functional imaging environment, allowing in-vivo study of higher cortical functions. Education The academic mission of the Neuropsychology service is met through a variety of teaching rounds and supervisory relationships. Didactic seminars on the role of neuropsychology in the medical setting are provided to medical students, residents and fellows. Introduction to neuropsychological techniques provides a better understanding of the contribution detailed cognitive examination can make to overall patient care and treatment planning. The Neuropsychology program also provides an introduction to neuropsychology for psychology students. Doctoral candidates from accredited institutions serve clinical practica under the supervision of the Neuropsychology Faculty. Pre-doctoral and post-doctoral fellows at the Child Study Center also receive supervision from the neuropsychology faculty. Phone: 203-764-9052
(contact person: Judy Volosin)
|
|||||||||||||||||||||||||||||
