Psychological Assessment in Rehabilitation
Assessment in rehabilitation serves diagnosis, treatment planning, capacity determination, and outcome monitoring. Know the major instrument families and their limits. Cognitive screening (e.g., MMSE, MoCA) is brief and sensitive to orientation and attention but weak for executive function and insensitive to premorbid ability; full neuropsychological batteries are indicated when cognitive complaints affect safety or decision-making. Mood and adjustment measures (PHQ-9, GAD-7, Beck scales) require attention to somatic-item confounding-fatigue, sleep, and appetite items inflate scores in medically ill populations, a frequent trap. Functional and participation measures (FIM, Barthel) quantify independence in ADLs but say little about mood or cognition. Pain and coping measures (e.g., pain catastrophizing, coping inventories) inform treatment targets. Premorbid functioning estimation matters: education, occupation, and word-reading tasks help interpret current scores. Understand ecological validity-lab tests may not predict real-world functioning-and performance validity concerns.
Worked example: A patient with MS scores high on a depression screen driven by fatigue and sleep items. The best next step is a clinical interview and a measure less confounded by somatic symptoms, not automatic diagnosis of major depression. Rule of thumb: match the instrument to the referral question, check whether the population was validated on your patient, and never interpret a single score in isolation from medical context.