Level 1 Trauma
Clinical Psychology

Webster defines neuropsychology as "a science concerned with the integration of psychological observations on behavior and the mind with neurological observations on the brain and nervous system". Dr. Greg Malo, of the Level I Trauma Department at Advocate Good Samaritan Hospital, has added a different twist with the practice of trauma neuropsychology. The types of patients most often referred to Dr. Malo are mild to moderate head injuries. Specific mechanisms include sudden deceleration during a motor vehicle crash resulting from the impact of the frontal lobes against a windshield. This type of injury may cause a shearing of brain tissue that is not always detected via traditional neuroimaging. As Dr. Malo points out, patients can have negative CT scan results, but still exhibit significant brain behavior abnormalities.

The standard testing previously used for establishing deficits, such as the Halstead-Reitan or Luria-Nebraska neuropsychological tests, often required between 4 and 12 hours to complete. Dr. Malo believes this time-consuming process is stressful in itself for the patient, besides not being cost effective. The diminished utility of these tests has led to his development of a "mini-test battery" for evaluating a trauma patient's neuropsychological status. This screen requires approximately 15 to 20 minutes to administer, with obvious time and resource advantages. Not only is the procedure less strenuous for the patient, but it can be easily repeated through the course of the person's treatment to measure progress over time. Dr. Malo feels this is especially beneficial for quantifying progress in the recovery phase and establishing goals for post-acute rehabilitation. The test battery of questions includes brief tests of memory and frontal lobe function, and an assessment of cognitive operations. It also examines visual and spatial function along with motor coordination. The evaluation assesses most parts of the cortex with an accuracy in neuropsychological testing that is considerably enhanced over the customary diagnostic interview or mini-mental status. An added feature is that the test administrator, which may be a non-psychologist, needs only a brief training session and requires no additional equipment. The Level I Trauma Center at Good Samaritan Hospital is actively developing normative standards for this test to ensure its reliability and validity in comparison to other well-respected but more strenuous tests. This research process will be completed in the near future, and the test will then be available for other facilities to utilize, ideally in Emergency Departments.

Neuropsychological services have another important function in meeting the needs of trauma patients at Good Samaritan Hospital. As Dr. Malo explains, the emotional sequelae of experiencing a traumatic incident can be very difficult for both the patient and family. Those individuals who have survived but lost family or friends are particularly devastated. During this post-traumatic phase extensive counseling may be required.

The Trauma Department neuropsychologists receive referral requests from a variety of sources. The most frequent contacts are from trauma surgeons, psychiatrists, neurologists, neurosurgeons and family practitioners. Often they will see the patient during the rehabilitation phase of their injury. At times, the deficits are not truly noted until the patient is back in his/her typical routine and is unable to function at their previous level. Once the deficits have been identified, a course of treatment can be instituted. Often cognitive rehabilitation is required, a therapy Dr. Malo compares to teaching children with learning disabilities. The goal is to stimulate compensation skills, such as using a daily log or calendar for persons with memory difficulties.

Optimal care of trauma patients demands more than physical treatment of injuries. Achieving the best possible outcome requires a coordination of services designed to meet our patients' needs. Recognition of these additional service requirements is a hallmark of the Good Samaritan Hospital's Level I Trauma Department.