Neuropsychology is the study of brain-behavior relationships and the impact of brain injury or disease on the cognitive, sensorimotor, emotional and general capabilities of an individual. Clinically, its application is carried out in the form of diagnostic evaluations which attempt to indentify the nature, or extent of injury to the brain. In some cases, the injury may be uncertain, and neuropsychological assessment is helpful in clarifying the neurological injury (e.g. mild head trauma or early dementia). In other cases, the injury may be more obvious and neuropsychological assessment may be helpful in tracking the course of a disease or delineating the behavioral sequelae of a brain injury (e.g., stroke, tumor, or severe head trauma).
Central to a neuropsychological evaluation is testing. Dr. Schwalbe may administer a brief battery (1 to 2 hours) of tests or in other cases, a longer battery (4 to 7 hours) to better understand the nature of the neurological injury. At the completion of testing, Dr. Schwalbe interprets findings and integrates them with historical data, unique aspects of individual performance, and the life situation of each client.
The results of a neuropsychological evaluation can help to guide treatment. Depending on the nature of the problem, the results might indicate that an individual’s current plan of treatment ought to be modified, changed, or that a new plan altogether should be initiated. Treatment for neuropsychological dysfunction can occur in the form of cognitive remediation or medication. As a psychologist, Dr. Schwalbe does not prescribe medication, however, recommendations for referrals to neurologists and psychiatrists can be made.
Dr. Schwalbe was trained in cognitive remediation during his fellowship at the College of Physicians and Surgeons at Columbia University. Cognitive remediation refers to behavioral based training techniques given to improve cognitive functioning in people with normal range intelligence, who have suffered a decline in neuropsychological functioning stemming from neurological injury or a psychiatric illness.
Clients are given mental exercises with the expectation that there will be improvements in attention, memory, and problem solving, and that these improvements will translate into greater competency at negotiating real world challenges. A variety of behavioral techniques are used including specific drills and exercises using computerized software and paper and pencil tasks. Cognitive remediation specifically targets the processes of thought rather than the content of thought. In contrast to standard education which focuses on domain specific knowledge such as learning about history or law, cognitive remediation focuses on targeting underlying cognitive skills such as attention, memory, problem solving and reasoning, planning, processing speed, multitasking, organization and time management; all skills that are required if one is to learn domain specific knowledge. By improving these cognitive processes, one is more equipped with the necessary underlying skills to find greater success in daily activities which most often require adequate cognitive functioning.
In his private practice, Dr. Schwalbe first assesses clients to accurately determine the nature of their cognitive complaint. Following an evaluation, clients will be provided with an individually tailored program designed to target the different cognitive functions which require remediation. In most cases, compensatory approaches will also be utilized which directly target functional deficits.