At what point after a spinal cord injury is a psychological evaluation made?

Often times people are seen by a psychologist while they’re still in the intensive care unit within days of the injury. I think in a more formal way by a rehab psychologist, it tends to be after somebody has transferred, stabilized in intensive care setting and comes to rehab, which can about two weeks, three weeks after an injury.

There should be an evaluation really in the emergency room as soon as the person is stable. There should be another evaluation as soon as the person is admitted into rehabilitation. And, the psychologist should keep in contact with that person throughout the rehabilitation process because they’re learning what their limitations are going to be, what their abilities are, what’s going to be hard, what’s going to be easier. And, then we check in with people—we do a three month post-rehab evaluation after they go home. We tell people what’s it likely to be like when they get home and they seldom believe us. Things are a lot easier in a hospital where everything is designed for people in wheelchairs.  So, then we reassess how well they’re able to adapt in their own home and we see them again nine months after that. And, then at least once year for the rest of their life, as they continue to adapt and their bodies begin to change.

The psychological evaluation started the minute someone said, “Are you ok?” They ask if they know what date it is, your name and basically how you’re doing. And from that point on, there will be a series of these little psychological evaluations, and that feeds into a history of where you were at injury, that event, and then throughout the process. Then you’ll be with someone like me in psychology, or psychiatry or social work and they’ll take a little more time to get to know “Are you ok?” because “Are you ok?” can vary from day-to-day and from year-to-year. The evaluation is ongoing and it’s something that we always want to keep open. So if you need therapy, if you need someone to talk to, we’re there.

For many inpatient units, the psychologist is involved from the very beginning, and they begin the psychological assessment. And that’s going to begin through a series of questions—asking the individual about their life, about the injury, how they have experienced the injury. Asking them key background information questions, but also getting a sense of how the individual is interpreting and thinking about the injury now. So we really start at the very beginning collecting information, all that information is actually pertinent to helping to decide what are their current strengths, what kind of coping experiences have they had so far? What are their current coping skills to helping an individual refine and improve those skills in dealing with this life change?

We want to make it as soon as they come into a physical rehabilitation facility, but ideally if we’re able to get them even while they’re in an acute-care hospital, sometimes we’ll go in and do that as well. We just let them know that we’re there for them, and that we’ve worked with a lot individuals who have had similar injuries, and that we want give them, if you will, the hope that somehow there are positive things to look forward to. They won’t be left alone and they’ll get the emotional support needed to go through the ordeal.

Psychologist can be involved immediately after the injury to years after. A couple of my patients are 30 years post injury, and the issues that they deal with now are those with aging with injury. They were able to snap back after the initial spinal cord injury, they powered through it, they went back to work, they figured out how to live and suddenly their body is slowing down. And so they then get in ruts, and hopefully someone notices and says “Let me send you someone who may help and try and figure out what’s going on.” Initially though, as I said, it can happen right away, and it shouldn’t be this big “Oh this is a psychological evaluation!” For me, being a psychologist on a rehab unit is about figuring out who the person is, and where the currently are and helping to nudge the process. If there are problems that come up, yeah, there might be a more in-depth assessment, and let me look at that. But, I think all the team members have to focus on learning about the individual—their strengths and promoting both the right environment that’s tailored to those strengths and that individual, and helping to do the attitude adjustment that’s important for both the individual and the familly.

Ideally it's right away, but a lot of times when individuals first come into the picture, there's this huge adjustment to the trauma and what that was, so that psychological evaluation is very different than the next stage, which would be adjusting to "Where am I now? What does this mean?" So right away I encourage psychological evaluations to be involved and continued to be included in the rehab process.