Medical Evaluation and Psychological Evaluation

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					Medical Evaluation and Psychological Evaluation

Several important aspects of obtaining medical information include
 choosing a physician for the medical evaluation;
 making an effective medical referral;
 knowing what to expect from the evaluating physicians; and
 using the medical consultant.

Factors in choosing a physician
 knowledge of the client’s medical history;
 medical expertise with specific disabilities; and
 level of established rapport with the client.
We added
 Familiar with goals of rehab (agency)
 Positive about role of work for individuals with disabilities

When referring a client the rehabilitation counselor should specify the information needed.
      the client’s general health;
      the progressive nature, stability, or controllability of the disabilities;
      recommended medical treatment and appropriate source and location of treatment;
      the type of life situations or stresses that could exacerbate the conditions;
      disability-imposed limitations on daily activities;
      potential effects of prescribed medication on work performance;
      potential future complications stemming from the disabilities; and
      additional medical evaluation needed.

Basic issue of the medical report is the extent to which the disability-related limitation affect the person’s
capability to satisfy certain job demands. Consider limitations in the following areas: hand and finger
dexterity; reaching; climbing; kneeling; standing; lifting; and sitting. Person’s medical ability to tolerate
environmental conditions such as heat, cold, dampness, dryness, fumes, dust, noise, and vibration.
Working on or around machinery, high places, and special work-setting factors such as length of workday,
work pace, working alone or with others.

The medical information from the medical evaluation should assist the counselor in determining:
1. the presence of a physical or mental disability;
2. the degree the condition limits the activities that the individual can perform; and
3. the extent and means by which the disabling condition can be corrected or ameliorated through
   physical restorations services.

Medical determination of type of disability: single incident, recurrent acute incident, long-term dysfunction,
or long-term dysfunction with recurrent acute incidents.

Course of the medical condition: acute stage, convalescent, acute stage controlled, acute stage controlled
but requires continuous supervision to remain stable, acute stage controlled but liable to reactivate,
metastasize or involve other functions, uncontrollable--slowly progressive, uncontrollable--rapidly

Extent of residual effects of the disability: none, partial residuals, residuals of undetermined nature,
determined stable residuals, progressive residuals.

Prognosis of the disability: fully controlled with no future recurrence, controllable by continuous supervision,
currently controllable but liable to later complications, compensable through provision of prosthesis and
training use, compensable through other function training required, partially compensable , improvable
only, undetermined, or no improvement is possible with best known methods.

Work tolerance and potential: heavy manual; manual; work subject to regulated regimen; sedentary work;
work at home; not able to work - full time or part time.
Medical consultants are generally used with
 cases representing multiple disabilities
 needing specialized medical treatment;surgery;
 prosthetic devices;
 those cases with conflicting file information;
 cases with differing opinions about the client’s limitations and prognosis.

Medical consultants
 assist with clarifying technical data;
 recommendations of further diagnostic or treatment services;
 teaching counselors about disabilities;
 coordinating medical services;
 selecting rehabilitation facilities with competent medical programs.
Psychological evaluations provide information regarding

1. existence of a disability such as cognitive developmental disabilities, learning disabilities, and
   emotional disturbance;
2. an understanding of the relationship of the person’s intellectual, psychoneurological,
   personality/behavioral functioning to the demands of vocational roles, interpersonal coping and social
   skills, psychological functioning issues of self-esteem and image problem, work-related adjustment
   problems, family adjustment and social support systems.

The objective of the psychological evaluation is to determine the person’s ability to cope with life demands.
Secondarily the rehabilitation counselor will want to know the person’s interpersonal skills, ability to learn
new jobs, emotional stability, and commitment to vocational goals.

Neuropsychological evaluations are called for with people with traumatic brain injury. Common test
batteries include the Halstead-Reitan Neurological Test Battery and the Luria-Nebraska Neurological

Psychologists can assist in differentiating between temporary adjustment reactions that are disability
specific and those that are a function of social learning.

Determining the need for a psychological evaluation:
       diagnosis of cognitive developmental, learning, or emotional disability;
       long-term expensive training is involved for areas which the individual has no work history;
       no feasible vocational alternatives are clearly apparent for the individual;
       individual has several vocational objectives;
       counselor is not sure the vocational objective is feasible and needs more information to confirm or
        disconfirm it;
       conflicting information or significant information gaps exist in the educational or vocational history;
       counselor and client suspect unidentified limitations or talents;
       client’s disabilities may affect capacities, abilities, skills, interests, or personality such as, blindness,
        traumatic brain injury, and deafness.

Clients should be prepared for the psychological evaluation including discussion of
        increasing their self-awareness;
        identification of strengths and needs;
        development of vocational goals and plans; and
        determining future testing and treatment programs.

In addition, we discussed perhaps including the client in the preparation of the referral questions, using a
standard form that the client could take with them, and making sure we review the results of the evaluation
with the client.

Information you should provide the psychologist doing the evaluation:
 history of the person’s disability;
 educational and vocational history;
 psychosocial history;
 economic situation;
 vocational choice.

Most importantly the counselor should supply the psychologist with SPECIFIC QUESTIONS to be
answered by the evaluation in regards to
      physical functioning,
      psychosocial functioning,
      intellectual functioning,
      and how these relate to vocational interest and goals.

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