Supporting patients with a new neuropsychology service
Clinical neuropsychologists Dr Emily Handyside and Dr Graham Jensch have worked together for nearly 10 years at Imperial College Healthcare NHS Trust. We talk to Emily and Graham about their roles, their careers and the new private neuropsychology service they’re leading together at Imperial College Healthcare Private Care.
Tell us a little about your roles at the Trust.
Emily: We’ve worked together within the clinical health and neuropsychology department at Charing Cross Hospital for the past nine years and between us we are involved in all aspects of the neuropsychology service. My clinical role is particularly focused on the outpatient side of the service and I see patients primarily for diagnostic neuropsychological assessments.
I’ve also developed an intervention service for patients with Parkinson's disease who are experiencing mental health difficulties associated with the condition.
Another part of my role is to supervise and manage the clinical psychologists who work on the neurological rehabilitation unit.
Graham: In addition to outpatient neuropsychological assessments, I work on the neurology and neurosurgery wards, supporting people who have come in with various neurological problems and need rehabilitation and an assessment of their needs.
I also supervise the stroke neuropsychologists who work on stroke wards here at Charing Cross Hospital and I work with Emily in the intervention service for people with movement disorders.
Can you tell us about the new private neuropsychology service?
Graham: We’ll be providing neuropsychological assessments for adult patients presenting with neurological or suspected neurological conditions, and we’ll also provide pre and post-surgical neuropsychological assessments. For example, we would provide assessments for people who are coming in for deep brain stimulation surgery and people who are receiving focused ultrasound thalamotomy, which is a treatment for essential tremor.
Neurologists and sometimes psychiatrists or neurosurgeons, will refer their patients to our service. They may have a question around a patient’s thinking and memory skills and whether they have a particular diagnosis, such as Alzheimer's or vascular dementia. They may also question whether their patient’s cognition is impacting on their thinking skills and their day-to-day functioning.
We also provide neuropsychological assessments for sports people who may have concerns about their cognitive functioning following involvement in contact sports such as rugby, football, or boxing; or who may be required by their regulatory body to have a neuropsychological assessment (e.g. the British Boxing Board of Control).
The assessments we do look at the various areas or what we call domains of cognition. We try to assess where a person is scoring, how they should be scoring and if there are certain areas they may be struggling in that we can identify. We can then discuss what might be helpful and either provide onward referrals or strategies and recommendations that we think might be helpful based on the results of the assessment.
What inspired you both to go into this field?
Emily: For me it was always a fascination with the brain. I’ve always been really interested in how the brain works and what happens when things go wrong within the brain.
I began my career as an assistant psychologist within a neurorehabilitation unit and my interest in neuropsychology really began there. After completing my clinical doctorate training, I’ve specialized in neuropsychology. Working first at the National Hospital for Neurology and Neurosurgery and now here within Imperial College Healthcare has enabled me to witness and develop my knowledge on a wide range of neurological conditions.
The great thing about this field is that there is always more to learn – it never gets boring!
Graham: The mix of biology and psychology has always been fascinating to me. I did a degree in psychology and it was when I did my clinical doctorate training that I decided to pursue neuropsychology.
It’s a privilege to work with people, often during very uncertain times in their lives and to help them to understand how neurological conditions may have affected their functioning as well as helping them to emotionally make sense of what has happened to them.
What are some of your career highlights?
Graham: I’m proud that as a team we have set up the Parkinson’s intervention service at the Trust. Emily has led the set-up of the service from scratch, so we can now provide input from psychology for people with movement disorders, which is something our patients have not had before.
Also, because we’re a specialist service, we can support patients and their families who are possibly unsure of the diagnosis in addition to GPs when they want a specialist opinion, alongside neurology. For example, they may ask if a person has Alzheimer’s or if they have another neurodegenerative condition.
Emily: During the COVID-19 pandemic when many outpatient neuropsychology services stopped seeing neurological patients, we worked hard to develop a tele-neuropsychology service – attending webinars and learning from colleagues in other parts of the world who use tele-neuropsychology more routinely.
We were then able to continue to offer a service to patients remotely during the pandemic which helped reduce delays in diagnosis and treatment. Of course, the tele-neuropsychology service was not appropriate for some patients and not all could access it; however, it meant that when we could resume face to face work there was a much smaller waiting list.
Tele-neuropsychology in the form of remote neuropsychological assessments as well as intervention/therapy remains part of our service and is something that is offered to patients for whom it is deemed appropriate. It works particularly well for those who live further afield and for those who might struggle for various reasons to get into the hospital to be seen face to face.
Generally, one of the parts of my job I enjoy the most is working with people, helping them to make sense out of the difficulties that they are experiencing and thinking about the best ways of moving forward.
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