Rehabilitation Psychologists Maximize Outcomes for Individuals with Cognitive and Physical Disabilities

Rehabilitation is a widely-understood concept that refers to the restoration (return to a state of functional health or work, and the like) of people, places or things. However, the concept of rehabilitation psychology is sometimes misunderstood in much the same way as disabilities – both cognitive and physical – are misunderstood. By definition, rehabilitation psychology is a specialty area within the field of psychology that assists individuals with injuries or illness, most of which are chronic, traumatic and/or congenital, in achieving optimal physical, psychological and interpersonal functioning. This can include treatment of traumatic brain injury, dementia, stroke, substance abuse disorders, chronic pain, and more.

Quick Facts

• The Center for Disease Control and Prevention estimates that there are currently more than 16-million people with cognitive impairment living in the US – a total equal to twice the population of New York City.

• According to DoSomething.org, people with a physical disability make up the largest minority group in the US – a figure equal to an astounding 74.6 million people.

• According to the latest reports released by the US Census (2010), nearly 56.7 million, or 19-percent of the population have a disability, and the trend of people needing assistance is increasing.

And although the core mission of public health is to improve the health of all populations, many health professionals continue to be ill-prepared to meet the complex psychosocial needs of people with cognitive and/or physical disabilities. That’s why rehabilitation psychologists will provide services within a network of psychological, biological, social, environmental, and even political environments. People in this field assist individuals, their families and caregivers, and others within the individual’s social and community network, to achieve rehabilitation goals through intervention, therapeutic support, education, consultation, and advocacy.

In addition to assistance to individuals and their families, rehabilitation psychologists also provide advice about disabilities and the impact of disabilities to government agencies, schools, attorneys and courts, insurance companies and private employers, as well as advocate for improvement in quality of life for people with disabilities and their families. They also work with other interdisciplinary and/or multidisciplinary professionals to expand opportunities and help facilitate individual functioning and participation in employment, relationships education, and in the community.

As people with disabilities, from all cultures and walks of life, continue to fight against social discrimination, rehabilitation psychologists continue to break down these barriers in relation to psychological treatment, by finding more and more opportunities to reframe the way society defines problems related to disability.

“People with disabilities or mental health issues often feel ashamed, or they feel abnormal,” states Dr. Kelley Kitley, Psychotherapist and licensed clinical social worker. “Educating people through the use of media and through social networking can help eliminate many of these feelings and concerns, and alter how society views disabilities in general.”

A Brief History of Rehabilitation Psychology

The rehabilitation movement is thought to have evolved from private charitable organizations, veteran's programs, and through partnerships with state and federal agencies. From there, the National Council on the Psychological Aspects of Disability, a forerunner of APA’s Division 22, was formed. The Great Society – a set of domestic programs launched by Democratic President Lyndon B. Johnson in 1964–65, and the passage of the Rehabilitation Act of 1973 also greatly affected the growth of the field.

As far back as WWII, rehabilitation psychologists met both the educational and vocational needs of our veterans of war, especially those with a disability. In order to best serve this area, a rehabilitation psychologist would blend medical – which explains the disability and what is necessary to restore health, vocational – guidance to make job and personal decisions, and mental health – assisting and supporting the person when adjusting to his or her surroundings, friends, and family.

Although the APA established the division of rehabilitation psychology in 1958, as an organization for psychologists concerned with the psychological and social consequences of disability, it wasn’t until August of 2015 that the APA Council of Representatives approved recognition of Rehabilitation Psychology as a specialty in professional psychology. (The APA defines a specialty as an area of professional psychology practice, which can be characterized by a distinctive configuration of competencies for specified problems and populations).

In 1994, Division 22 Psychological Services and Professional Issues Committee assumed a leadership role in the APA Practice Directorate's Federal Advocacy Network, and Division 22 also organized the APA Conference on Health Care Reform.

In 1995, the American Board of Rehabilitation Psychology (ABPP) was established.

In 1996, Division 22 played a role in developing the APA Interdivisional Health Care Committee.

In 2010, the Foundation for Rehabilitation Psychology was established.

While it’s true that over the years, prevailing attitudes (and laws) have changed regarding social expectations and treatment of people with physical and/or cognitive disabilities, many stigmas remain and people remain misinformed. Too many people with disabilities continue to find limited opportunities in the areas of employment, public services, and public accommodations (among others) because of social attitudes, lack of knowledge, and discrimination. The Americans with Disabilities Act (ADA), a comprehensive civil rights law that prohibits discrimination on the basis of disability and provides protection in the areas of employment and public services, as well as the Affordable Care Act serve to shift these attitudes.

The Unique Role of Rehabilitation Psychologists

Increasingly, rehabilitation psychologists conduct relevant and often significant research regarding the lifelong implications of a disability on individuals, as well as on society as a whole. Their range of research often includes:

• Chronic illness
• Identification of co-morbidities
• Use and effectiveness of assessment tools
• Effectiveness of intervention strategies
• Risk factors for disability
• Coping needs and resources
• Community re-entry
• Aging resources and costs

Today, rehabilitation psychologists serve a wider scope of diverse populations then ever before, including:

• People with brain injuries
• People with spinal cord injuries
• The aged
• Individuals with neuromuscular disorders
• Those with chronic pain
• People with medical conditions, such as:
  • Cancer
  • Multiple sclerosis
  • Developmental disorders
  • Psychiatric disability
  • Substance abuse
  • Deafness or hearing loss
  • Intellectual disability
  • Blindness and vision loss
  • Impairments compounded by educational or other disadvantages

Rehabilitation psychologist are also looking back to what worked in the past, and modifying their use to fit new regimens for treatment.

Dr. Bart Rossi, PhD and board-certified clinical psychology states that two (among others) treatment options that are taking (or re-taking) a firm hold in the field of rehabilitation psychology are cognitive behavior therapy, and guided imagery. Although cognitive behavior therapy was designed originally to treat depression and anxiety, psychologists are seeing these methods evolve for use in rehabilitation and mental health facilities.

“A lot can be done today with cognitive behavior therapy. If you get people to think differently about their situation or their problems, change their expectations and help them become realistic regarding immediate or long-term outcomes, they will respond more favorably to therapy.”

Guided imagery, a mind-body intervention where trained psychologists help patients imagine the future – weeks, months or years ahead – by focusing their attention on positive events or memories, and actually picturing themselves in pleasant and self-affirming experiences or places, is also a standard treatment option in rehabilitation facilities.

Rehabilitation Psychology and Head Injuries

Today, all a person has to do is turn on a sports channel or pick up a newspaper to hear or read a story about another sports injury. In fact, never before has so much attention been given to the development and implementation of psychological interventions during the sport injury rehabilitation process. Many sport injury rehabilitation programs are now integrating psychological interventions into the treatment regimens in order to expedite both physical and psychological recovery, as rehabilitation psychologist’s work alongside sports psychologists, surgeons, physiotherapists, exercise scientists, athletic coaches, and dieticians to determine treatment, and facilitate healing.

In the past ten-years, researchers have devoted a great deal of time exploring the psychological impact of injury to athletes, which in turn has generated studies into the psychological adjustment most athletes endure when dealing with an injury; how they perform after an injury, what, if any, mental adjustments they go through, and the emotional impact of their injury.

Lately, more and more emphasis has been placed on the specific field of rehabilitation psychology facing the growing onset, and public outcry of head injuries of pro-athletes. In 2014, PBS’s Frontline Magazine reported that 76 of 79 deceased NFL players were found to have brain disease that occurred because of brain concussion. In September 2015, Frontline updated their earlier findings and reported that 87 deceased NFL players tested positive for brain disease following concussion. Both the New York Times and the Huffington Post also report such findings, as teams, both pro and amateur, as well as college, high school and elementary coaches now look to rehabilitation psychologists for treatment following injury.

But head injuries are not exclusive to the NFL, or football in general, as recent findings show soccer athletes are (and have for years) experienced repetitive head injuries. Wrestling and boxing athletes are also gaining attention as doctors continue to seek the help of psychologists to treat low, moderate and high neurocognitive injuries.

With serious injury, most athletes will experience one or more of the following emotional episodes:

• Anger
• Denial
• Depression
• Bargaining
• Acceptance

A rehabilitation psychologist can help an athlete deal with these emotions by helping him or her accept the injury, set goals for recovery, focus on objectives, and help set a timeline to meet their goals. And although the psychological impact of an injury can sometimes affect an athlete long after the injury is healed, a rehabilitation psychologist can help an athlete from the onset of the injury, through rehabilitation, and back to full competition.

Dr. Ildiko Tabori, PhD, a licensed clinical psychologist, with a specialty in Neuropsychology and Geriatrics, relates a story about a young patient who had been in a number of automobile accidents within a very short period of time. Her medical doctor had not found any underlying physical issues that answered why she was feeling confused and overwhelmed. Dr. Tabori diagnosed her patient with post-concussion syndrome, and told her to go on-line and read about this syndrome.

Through education and giving her patient the resources to understand her syndrome, Dr. Tabori was able to significantly influence her patient’s understanding and outcome.

“We don’t always understand the relationship between brain functioning and psychological functioning, but by educating people and giving them the resources needed to understand this relationship, we can greatly influence outcomes and contribute to their wellness and recovery.”

Pediatric Rehabilitation

Section 1 of the APA’s Division 22 is a network of pediatric rehabilitation psychologists. Their main goals are to promote healthy development in children with disabilities through psychological services, advocacy education and research, as a voice for the rights of children with disabilities, and to identify factors that weaken the capabilities of children with disabilities. Thankfully, in recent years parents, teachers, school officials (including school psychologists), and the community as a whole have strived to gain more insight and understanding of children with disabilities, and there has been an increase in the involvement of society as a whole in developing advocacy for these children.

There are a number of hospitals like C.S. Mott Children’s Hospital in Michigan that embrace rehabilitation psychology in the treatment of all young patients admitted for physical illness and rehabilitation services. Some of the issues addressed are how children feel about their bodies or themselves, and how to maintain healthy behaviors. Patients, as well as their families are also provided with information about community resources that may be helpful, which include counseling, psychological testing and evaluations, and family education.

Seattle Children’s Hospital and Research Center is also known for having one of the leading children’s rehabilitation psychology programs in the US, and one of the nation’s top five research centers. Their team of psychology professionals treats conditions, such as traumatic brain injury, chronic neuromuscular illnesses, neurological infections, peripheral neuropathy and stroke, among other developmental and behavioral disorders. Their rehabilitation psychologists are specially trained to evaluate a child’s needs, related to thinking, emotions, social skills, and behavior, and to provide recommendations. According to the website, a large part of their work is doing neuropsychological evaluations, both for inpatient children and for those who visit their outpatient clinic.

Rehabilitation Psychology in Flux

The field of rehabilitation psychology has seen tremendous change, as well as exceptional growth over the past several decades, and there doesn’t seem to be a slowdown anytime soon. This is due in part because of the development of training and education guidelines, as well as the establishment as a recognized specialty by the American Board of Rehabilitation Psychology. An increased understanding and the on-going research of current healthcare problems that confront our nation are also some that behavioral management specialists, including rehabilitation psychologists, are now thought to substantially influence.

Not long ago, rehabilitation of people with traumatic brain injury was one of the fastest growing areas in all of healthcare, and rehabilitation psychologists led the way to treatment. Treatments included assessment of psychological needs and intervention, and ranged from referrals for services and therapy, to implementation of behavior-management plans for individuals hospitalized for long periods of time.

However, a new focus for rehabilitation psychology, according to the Internet Journal of Allied Health Sciences and Practice, now includes the need for rehabilitation psychologists to expand their clinical practices, modify their training model, involve themselves in improving disability policies, and broaden the scope of their research efforts. Corporations, too, that are largely unaware of what rehabilitation psychologists can offer in terms of disability and chronic illness advice/help and employee benefit services can benefit greatly from the knowledge and expertise of rehabilitation psychologists.

Rehabilitation and Technology

More and more rehabilitation psychologists are modifying the way they treat people with chronic, traumatic, and/or congenital injuries or illness, as many believe that in order to successfully treat patients in this ever-changing environment, the field must be permitted the opportunity to grow and develop through the use of technology. The response of rehabilitation psychologists to these new methods and opportunities will ultimately have an impact on the welfare of persons with disabilities and the future of the profession.

Dr. Tabori says that computer games and software are increasingly becoming useful treatment options in the field of neuropsychology – a field of psychology that strives to understand how behavior and cognition are influenced by brain functioning and is concerned with the diagnosis and treatment of behavioral and cognitive effects of neurological disorders. One such program Dr. Tabori suggests is Lumosity, an online fit test/game that challenges memory, attention and more, and is increasingly popular for people with dementia and other brain-related illnesses or injuries.

“For older adults, in particular, keeping their minds as active as possible with crossword puzzles and word searches, reading, and socializing with others is not new to rehabilitative psychology, but is proven to work well. Newer methods, like simply showing older people how to use a computer are also gaining favor. The brain is a muscle. If we don’t keep it going it will dissipate.”

Dr. Rossi agrees.

“Current breakthroughs in rehabilitation psychology include the use of technology with digital platforms and computers where patients, who are undergoing both physical and mental rehabilitation, such as from traumatic brain injuries, can benefit and relearn basic skills from games and other software programs.”

Neofect, a Korean health tech company, is making waves in the field of rehabilitation psychology with the creation of a new system to help stroke victims return to a life of normalcy, using robotics and virtual reality. The World Health Organization reports that every year nearly five-million people globally are affected by stroke. To meet the growing need for advanced and alternative treatment options, Neofect has created a smart rehabilitation solution, called the Rapael Smart Glove, which is designed to teach stroke victims how to reuse their hands.

According to Ho Young Ban of Neofect,

“The main difference from traditional techniques is that we use innovations in technology to motivate the clients. The vast majority of stroke victims don’t complete their rehabilitation process because of the costs associated, and the frustration over a slow process. We use games to motivate them while their doctors, in turn, receive valuable data regarding the rehabilitation progress, and can adjust the program based on the results.”

Neofect’s smart glove has been used in several hospitals in Korea since December of 2014, and is now approved for use in the US and EU.

“We just opened an office in the US and the next step is to offer the product for at-home use (great tool for mobile medicine)! We are planning to do it this spring.”

As methods in the field of rehabilitation psychology change, professionals will no doubt find it essential to modify or find alternative forms of treatment as no one model is sufficient to address all of the many problems confronting individuals living with disabling conditions or chronic health concerns, whether a condition is congenital or newly acquired. As such, a rehabilitation psychologist must learn, and thus command a broad skill-set and flexibility in their approach and treatment of people with cognitive and physical disabilities and limitations.