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PSYCHOLOGICAL EVALUATION IN REHABILITATION SETTINGS

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Psychological disorders are highly prevalent among patients admitted to acute rehabilitation units. Soon after their medical event, patients are forced to quickly wrestle with myriad emotions, such as powerlessness, shock, demoralization, and loss, while often concomitantly experiencing a variety of physical discomforts. Many patients must also suddenly grapple with the reality of alterations in lifestyle and relationships, cope with stigma that may accompany their limitations or injury, and bear significant financial burdens. Particularly during the acute phase, physical and cognitive deficits, as well as the inability to perform basic activities of daily living, serve as a significant source of distress and irritation. Unanswered questions related to prognosis and quality-of-life issues fuel feelings of worry and unrest about the future, for both patients and caregivers.

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Although many patients adjust well to their disability, others develop significant psychological distress, in a manner that goes beyond expected reactions to loss. Estimates of the prevalence of mood disorders among rehabilitation patients vary, ranging from 20% to a striking 64%. However, these disorders are common among a host of diagnostic categories, including spinal cord injury (SCI), burns, stroke, amputation, brain neoplasms, and traumatic brain injury (TBI). Identification and treatment of psychological disorders in patients with injuries such as SCI is particularly important, as psychological and biopsychosocial factors are often better predictors of adjustment or quality of life than biomedical variables, such as severity of injury. Emotional disturbances following acquired brain injury may be the result of a structural brain lesion or psychological reaction to the trauma, or some combination thereof. A psychologist skilled in assessment can be invaluable in determining the relative contributions of neurocognitive and emotional factors to a patient’s presentation. Discrimination of these factors can advance treatment strategies and facilitate successful postacute transition and care.

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COMMON PSYCHOLOGICAL REACTIONS & DISORDERS AMONG REHABILITATION PATIENTS

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Psychological reactions or disorders commonly occurring in rehabilitation patients are summarized below.

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Adjustment Disorders
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Many patients admitted to rehabilitation units are confronted with medical events that may result in physical disfigurement, pain, psychological distress, cognitive dysfunction, and reduced functional independence; these events can be abrupt, unexpected, and have implications for change in life roles or plans (eg, inability to fulfill domestic responsibilities or return to work). Successful adjustment to a new disability requires the patient to acknowledge the functional consequences of the injury and incorporate these changes into his or her personal identity. Significant emotional reactions can occur that can lead to poor adjustment or more severe psychological disorders, such as depression or anxiety. According to the Diagnostic and Statistical Manual, Fourth Edition Text Revision (DSM-IV-TR)*, an adjustment disorder is present if the patient’s reaction to an identified stressor results in marked and excessive distress, or the reaction to this stressor causes significant impairment in functioning. An inability to adapt to injury can have an impact on ...

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