Assessment Services

Arizona Neurorehabilitation (AzN) offers a comprehensive interdisciplinary evaluation of individuals who have experienced a brain injury or other neurological medical condition.  Over a two-week period, a client will spend from two to eight hours (depending upon the discipline) being assessed in a variety of cognitive and functional abilities.  The interdisciplinary report features separate sections for each discipline, with an integrated Recommendations section that offers both separate and joint treatment goals.  The evaluation includes a full neuropsychological assessment unless the client has already undergone such an evaluation within the past year, in which case only a clinical interview and brief neuropsychological testing is conducted.  There is a feedback session with the client and their family, the referring Vocational Rehabilitation Counselor or case manager, and all of the AzN treatment Team, with each discipline summarizing their findings and recommendations.

Once a client has completed the two-week interdisciplinary evaluation and has been determined to possess the potential to benefit from further treatment services, they may choose to participate in the AzN intensive neurorehabilitative treatment program.  Clients must have the means to come into the office five days a week between 9 a.m. and 3 p.m., although direct assistance in learning to use public transportation options is available as part of the AzN treatment program.  The typical treatment week over the first two months will involve between 10 and 15 hours of direct therapy contact each week, as indicated by each client’s specific needs.  Depending upon the level of progress in all participating AzN participants, clients must be asked to interact with therapists and other participants in a group therapy format.  Finally, family members are expected to meet or otherwise communicate at least every two weeks with either the AzN Neuropsychologist or Clinical Social Worker.

General Treatment

Depending upon the preference of the referral source, monthly staff meetings are available to review ongoing assessment and/or treatment efforts with the client, family, and referral source.  In addition, referral sources may be contacted via the phone or email as the need arises to discuss problems or determine the course of treatment.

It should be noted that although the following treatment services are organized by discipline, multiple disciplines may be involved in delivering a particular service.  Additional disciplines providing a particular service will be noted in brackets at the end of the paragraph. 

Neuropsychology

Adjustment to Disability Counseling: Reviewing available cognitive test scores and associate them with acknowledged functional difficulties, provide understandable information about the client’s brain injury, educate the client and their family about expected recovery rates, and help develop strategies and techniques to assist the client and their family to improve functional abilities. 

Psychotherapy: Assisting the client and their family to effectively deal with the emotional distress associated with the changes caused by the brain injury, to overcome the depression that comes with letting go of prior abilities and life goals, to counteract the anxiety of facing a future of unknown ability to function independently, and to learn to adjust to significant changes in role expectations within important relationships.  [Social Work]

Social Work

Education in Community Resources:  Educating the client with regard to supportive community resources and provide referrals and assistance in completing applications to such resources, including: cash assistance, health/behavioral health insurance benefits, subsidized housing and daycare resources through the Department of Economic Security, and the Social Security Administration (SSDI/SSI benefits). 

Case Management Services:  Generating customized treatment plans that focus on stimulating client’s abilities to function at their highest level, coordinate services with external case managers and other payee sources, and provide ongoing communication with physicians and the treatment team to deliver projected outcome.  [Neuropsychology]

Speech and Language Therapy

Datebook/SmartPhone Training:  Analyzing the client’s needs regarding memory and organizational deficits.  This will involve the discussion of the pros & cons of using a datebook vs. a smartphone, research and review various product options before deciding upon a specific item, obtaining the specific datebook or smart phone, helping the client transfer data to the datebook/smartphone, instruct client in the use of the datebook/smartphone, and repeatedly practice techniques to help the client acclimate to carrying and using the compensation.  Such training is likely to involve multiple Team members so as to reinforce the idea that this compensation is a valuable tool, enhance the relevancy of the memory assignments, and increase the amount of practice available within the available time frame.  [Neuropsychology, Occupational Therapy]

Pragmatics Training: Assisting the client with social aspects of communication, including but not limited to: disinhibition, hyperverbality, impulsivity, eye contact, confabulation, interviewing skills, body language, and non-verbal communication.  Strong pragmatic skills are important to acquiring and maintaining employment (supervisor and co-worker interactions), as well as improving participation in other important social activities.  Strategies are employed through role-playing, modeling, recording, and practice with the Speech Pathologist. 

Cognitive Remediation:  Improving cognitive skills in the areas of multi-tasking, attention and concentration, problem solving, word-finding, basic academic skills, auditory comprehension, written expression, and memory.  Improving these skills is advantageous for returning to work as well as improving capabilities in the home environment.  Skills will be improved through re-teaching of concepts, paper and pencil tasks, and homework assignments.  [Neuropsychology, Occupational Therapy]

Expressive/Receptive Language Therapy:  Analyzing the client’s need for improvement in expressive and/or receptive language skills, especially with regard to aphasia.  A strong emphasis is placed on improving these skills through language formulation and remediation exercises so that the client is able to maintain employment and participate in other social activities to avoid isolation. 

Occupational Therapy

Home Office Organization (with Filing System and Bill Center):  Analyzing the client’s current system and, if necessary, assist in purchasing new and more functional components for the filing system.  Provide hands-on instruction for setting up individualized filing systems and bill centers.  Implement strategies for sorting through paperwork and instruct in rules on purging/shredding vs. saving important documentation. 

Financial Management: Assessing the client’s current knowledge of money management and instruct on basic budgeting strategies.  Develop an individualized working budget with income/expenditures, provide a written system to track spending, and provide instruction for incorporating daily spending strategies into a working budget.  Educate the client on the concepts of estimated budget vs. actual amount spent and develop strategies to modify the budget based on changes in cash flow, and help the client to begin saving on any income. 

Home Management:  Assessing the current home environment and instruct in organizational strategies/tools to effectively organize all areas of the home.  Provide written, individualized checklists to assist with completion of various household tasks and instruct in scheduling strategies for work responsibilities, household tasks, and children’s activities utilizing a datebook and home office tools.  Other services include: instructing in parenting strategies for working parents; demonstrating and instructing in meal planning (with a focus on saving money and time as well as utilizing various community resources); implementing grocery shopping strategies to save money and time, as well as increase healthier choices; and provide strategies to schedule time effectively, minimizing time wasters, and prioritizing important tasks within home and work environment.  [Neuropsychology]

Visual Perceptual Training:  Assessing seven key areas of perception, including visual discrimination, visual memory, visual spatial relationships, visual form constancy, visual sequential memory, visual figure ground, and visual closure.  Improve visual skills through a retraining regime that includes paper-pencil tasks, homework, and functional tasks within the home and community environment.  Recommendations are made regarding deficit areas to fine tune job searches or to assist in a current work position as well as overall functioning within home and community environment. 

Transportation Training:  Assisting client with learning independent means of transportation through participation in an adaptive driving assessment or providing alternate public transportation training. 

Upper Extremity Functioning:  Assessing and treat upper extremity deficits relative to range of motion, strength, gross-motor coordination, fine motor coordination, and sensation, with the focus on how the client functions on the job as well as in home and community.  Develop home exercise programs specific to the client’s needs and provide activity analysis to increase functional use of upper extremities.  Instruct in compensation techniques for loss of function for greater ease with work performance, and make recommendations to employers intended to improve work performance.  [Physical Therapy]

Physical Therapy

Posture and Body Mechanics: Assessing the client's muscle flexibility, joint range of motion, strength of postural muscles, and alignment of spine.  Assess ability to maintain proper position at rest, during movement, while lifting and carrying on the job, and then the home and community.  Instruct in proper posture, lifting, and carrying techniques.  Develop a home exercise program to improve flexibility, strengthen postural muscles, and increase overall cardiovascular and muscular endurance.  [Occupational Therapy]

Ergonomics: Assessing the home and work environment, and if necessary, modify work-station, tasks, or job duties to encourage proper body mechanics. 

Therapeutic Exercise: Assessing the client's posture, range of motion, strength, balance, coordination, and functional mobility.  Develop a therapeutic home or community exercise program with the goal of preventing dysfunction, as well as for improving, restoring, or maintaining normal strength, endurance, mobility, coordination, and motor skills. 

Pain Management:  Reviewing the client’s complaints of chronic pain and providing education regarding long-term management that seeks to minimize use of medications.  They will also learn how to develop a daily routine of stretching and exercise to increase functional mobility.

Vocational Services

Prior Level of Job Performance: Interviewing prior, current, or potential employers in order to obtain a detailed review of the client’s prior work history and the critical demands of the job task.  When the goal is to return to a previous employer, an interview focuses on the return to work process, job task analysis, and potential accommodations (e.g.: job modification). 

Vocational Exploration: When the client is unable to identify a specific vocational goal, local labor market research will help to determine whether or not employment in a particular job is available in a desired area.  In addition, informational interviews can be facilitated to assist in gathering detailed job duty information so that a client can make an informed decision regarding the demands of a particular position.

Trial Work Experience Supervision:  For clients whose ability to benefit from vocational neurorehabilitation services is in question, a Work Trial Experience is often recommended in an effort to determine their ability to sustain gainful employment.  This typically takes place in either a volunteer situation or a special supported work environment.  [various disciplines]

Preparation for Employment: Assisting the client with resume development and interview skills, particularly related to difficult questions [e.g., gap(s) in employment, disclosure of disability status] as part of the process. 

Job Development and Placement:  Working with the client in the process of seeking and obtaining gainful employment.  This process may involve providing the client with potential job leads, which are acquired by examining posted help wanted ads, employing Internet job placement services, or attending job fairs.  Depending on the client's needs, the vocational consultant may advocate to potential employers on behalf of the client and accompanying clients on job interviews. 

Job Coaching: Assisting clients with their transition to employment by the development of compensatory strategies specific to their job duties (e.g., a checklist), and encouraging the development of natural supports through educating supervisors and coworkers about brain injury in general, as well as the client’s specific brain injury related deficits and techniques for compensating for these difficulties.  [various disciplines]