5 Questions With: Christina Kunec
By: Christina Kunec, PsyD
What exactly is a Neuropsychologist?
A clinical neuropsychologist is a professional in the field of psychology with special expertise in the applied science of brain-behavior relationships. I like to think we bridge the gap between neurology and psychology. Unlike neurologists and other physicians who go to medical school, we go to graduate school and obtain a doctorate in psychology. Throughout our studies we take classes that focus on brain function, neuropsychological testing, and rehabilitation/educational planning strategies. Our clinical training consists of working with individuals with neurological, neurodevelopmental, psychiatric and cognitive disorders in the areas of assessment, diagnosis, treatment and rehabilitation. We evaluate individuals’ neurocognitive, behavioral, and emotional strengths and weaknesses and their relationship to central nervous system functioning. We work with other health care professionals in terms of identifying and diagnosing neurobehavioral disorders and planning and implementing intervention strategies.
With regard to assessment of concussion, neuropsychologists evaluate not only an individual’s symptoms, but also use neurocognitive testing to help assess deficits in certain areas of functioning that can be affected with a concussion. Neurocognitive testing is recommended as a “cornerstone of management” according to the new management guidelines from the consensus statement on concussion in sport. Neurocognitive tests are designed to examine a variety of cognitive abilities including memory and learning, language, attention, information processing, and executive functions. By examining a range of cognitive abilities and examining patterns of performance in different cognitive areas, we can make inferences about underlying brain function. Our background provides us with the unique training to interpret these test results and make specific recommendations regarding interventions and treatment.
What other medical professionals do you work with?
When it comes to concussion management, “it takes a village.” No two individuals are the same so why do we think all concussions are the same? Each concussion is unique with regard to mechanism of injury and presentation. My job is to evaluate individuals and figure out where their problems are coming from and then refer them to the appropriate clinician for treatment. As a result, I work very closely with physical therapy, as many individuals may have vestibular or cervicogenic problems that warrant rehabilitation. In cases where there are ocular issues, I may refer to neurobehavioral optometry. I work closely with neurology and other physicians with regard to pain management and migraine management. Pediatricians and PCPs often want to be involved in their patient’s care. In certain cases, individuals have more severe injuries involving skull fractures or brain bleeds and are coming from neurosurgery. Some athletes also sustain orthopedic injuries and so I have to coordinate care with orthopedic surgery. For patients with an emotional component to their presentation I may work with psychotherapists or psychiatrists. There has to be constant communication and collaboration between all parties involved to provide a consistent message to the patient. This will get them back to play more quickly.
What is one recent advancement in your field that is innovative or integral to your work?
Identification of different trajectories or subtypes of concussion. No two individuals are the same and so no two injuries are the same. Some individuals present with more migraine symptoms, others present with vestibular or neck problems. Identifying the different types of problems people may experience is crucial in determining how to treat and individual.
What is the most common problem you see in your patients?
In my experience, I find that most patients don’t even know what a concussion is or what is the normal expected course of recovery. Some individuals have been told by their primary physicians to avoid doing anything that causes symptoms. Because so many individuals experience environmental sensitivity, this can lead an individual to avoid life, and become deconditioned. I make it a point to educate all patients that feeling symptoms is part of the recovery process and that at certain points they will have to push themselves. It’s all about educating and empowering the patient.
Why do you do what you do? What is the most rewarding part of your job?
I’ve always been interested in the physiological side of psychology, particularly working with individuals with neurological impairments. Concussion is the perfect marriage of my interest in sports and traumatic brain injury. I get to work with athletes at all levels. The most rewarding part of my job is being able to follow them throughout the course of recovery. Usually I start seeing the patient when they are at their worst. Often, I feel like I’m meeting the real them for the first time at the end when they are discharged.