Neuropsychological Rehabilitation in Russia
Jill Winegardner, PhD
This two-day training entitled Neuropsychological Rehabilitation: Master Classes took place on 12 and 13 November 2018 at the Three Sisters Rehabilitation Centre in Moscow, Russia, with support from the Flying Faculty of the World Federation for NeuroRehabilitation. The invitation came about as a result of the decades-long work of British neurologist Dr Pauline Monro, who has brought western methods in neurology-related care to Russia. As part of this broad effort, she invited world-renowned expert in neuropsychological rehabilitation, Professor Barbara Wilson, and others to introduce the concept of holistic neuropsychological rehabilitation to Russia. Although these ideas were met with some resistance in early days due to Russian strict adherence to the teachings of Alexander Luria, more recently there has been gradual acceptance that these new ideas are consistent with the fundamental beliefs of Luria regarding the importance of careful study of individual patients and reliance on evidence in our practice.
In March 2018, Dr Jessica Fish and Dr Jill Winegardner from the Oliver Zangwill Centre delivered a two-day practical workshop entitled A Formulation-based Approach to Neuropsychological Rehabilitation at First Pavlov State Medical University St Petersburg and Sputnik Rehabilitation Center in Kamarova. The workshop was very well received, and Jill and Jess received a special invitation from the leading rehabilitation specialist in Russia to participate in the Tenth International Congress on Neuro-Rehabilitation, 31 May – 1 June 2018, in Moscow, along with three other British colleagues, in a day devoted to British-influenced neuropsychological rehabilitation. To their delight, two Russians (one psychologist and one neurologist) presented on their incorporation of the British formulation model in their own work.
At this Congress, Jill and Jess were invited back to Moscow to the Three Sisters Centre for further practical training in the formulation-based approach. Unfortunately, Jess was unable to go, but Jill traveled to Moscow in November 2018 to spend two days with a group of psychologists from Three Sisters, from Moscow State University, and from the International Institute of Psychosomatic Health. These three groups work closely together and at the end of the two days, we formed plans for further collaboration and promotion of this model in Russia, working together with British colleagues.
The two days consisted of a combination of lectures, clinical case presentations, and family meetings, along with opportunities for discussion and networking. The lectures covered Holistic Neuropsychological Rehabilitation: Principles and Practice; Selecting and Interpreting Neuropsychological Tests; and Evaluation and Outcome Measurement. The clinical case presentations led to practical sessions on goal setting and on formulation.
The first of the clinical case conference patients was a 32-year-old man who was four months post right hemisphere stroke with left hemiparesis and cognitive impairments including poor memory, lack of awareness of his deficits and poor insight into his limitations. Our intervention focused on helping the team respect his goals (drive and walk again) while supporting the short-term more realistic goals (transfers, safe wheelchair use). The second patient was a 29-year-old woman who was five years' post-traumatic brain injury whose chief goal was the improvement of mild right-sided physical weakness and sensory changes. However, on reflection, she also agreed with goals that would improve her engagement in social and leisure activities and improve her confidence and emotional well-being. In this case, our intervention was to identify that the team presentation was disjointed and piecemeal, making it very difficult to share a coherent understanding or set appropriate plans. Our action was that the psychologists and the occupational therapist withdrew to another room and spent an hour developing a formulation for her. There was a constant buzz in the room as participants eagerly discussed and debated the formulation and goals.
At the end of the two days, the participants felt they were able to see for themselves how to implement what they learned in the lectures into their own practices. Everyone agreed the process of formulation leant a sense of “personhood” to the patients and resulted in a shared and coherent understanding of their features and goals. The session on neuropsychological testing led to an agreement to collaborate on bringing useful tests to Russia, where psychologists from Moscow State University will oversee their translation and adaptation to Russian language and culture. In addition, we agreed to have an ongoing collaboration to design studies through Moscow State University to demonstrate and promote the use of formulation-based assessment and rehabilitation in Russia.