“What is a neuropsychologist?”, and “When would I need to see one?” are two questions Aimee Custer, PsyD, LP, is often asked. Dr. Custer is a neuropsychologist with the TRIA Sport Concussion Program. We talked with Dr. Custer about her role at TRIA, and how she helps care for patients who have suffered a concussion.
Q: What is neuropsychology?
A: Neuropsychology is a specialty of psychology that is concerned with how the brain and the rest of the nervous system influence a person's cognition, emotions and behaviors. Specifically, neuropsychologists examine the functions of the brain, such as attention, executive functioning, and memory - all of which can be affected with a concussion. Over the past 10-15 years, neuropsychologists have made a substantial contribution to the extensive literature, research, and clinical management of traumatic brain injury, including sports related concussion. Neuropsychologists have a very unique background training in functional neuroanatomy, neuropathology, neuropsychological assessment, research design and analysis, psychological treatment, and behavioral neurosciences that apply well to the management of brain injury and concussion.
Q: What is a clinical sports neuropsychologist?
A: Clinical sports neuropsychology is a sub-specialty of neuropsychology that requires additional training in concussion assessment, diagnosis, management/intervention, and counseling of athletes and families all in the unique context of the sports domain. Clinical sports neuropsychologists are often leaders of or part of an interdisciplinary sports concussion program, working alongside other important members of the athlete’s care team, including athletic trainers, team physicians, physical and occupational therapist, sports psychologists, etc. They often play a large role in the assessment and management of neuropsychological functioning and rehabilitation, understanding interplay of premorbid comorbidities (i.e., ADHD/LD), psychological reactions to injury, and determination of clearance from a neuropsychological or cognitive standpoint.
Q: What is your role at TRIA?
A: I am the clinical sports neuropsychologist with TRIA’s Sports Concussion Program. This is a multidisciplinary program specializing in the assessment, diagnosis, management and treatment of sports related concussions through a collaboration of physicians, neuropsychologists, physical therapists and athletic trainers.
Q: What type of patients do you see?
A: I treat a wide range of athletes, ages 5-65 years who have suffered a concussion or are dealing with post-concussive syndrome. I work with youth, high school, collegiate, recreational, professional and retired athletes. As the clinical sports neuropsychologist I typically see the more complex cases or athletes that are experiencing an atypical or protracted recovery from their concussion. This may include athletes who are not responding well to prescribed treatments, are experiencing significant psychological, mood or personality changes, or those who have premorbid comorbidities complicating the clinical picture (i.e., multiple concussions, learning disability, ADHD).
Q: When do you see patients in their recovery?
A: This really depends on the case and the athlete’s specific need. I see some athletes in the first week of their injury and others perhaps weeks, to months or even years out.
Q: How is an appointment with a neuropsychologist/TRIA Sport Concussion team different than an appointment with a primary care provider?
A: Appointments in the TRIA Sports Concussion clinic are generally longer and more in-depth than an appointment in a primary care setting. We spend a considerable amount of time with athletes to understand their specific concussion needs and to create an individualized treatment plan. Most athletes in our program experience the multidisciplinary approach and are evaluated and treated by multiple specialists to ensure complete recovery and safe return to sport. The TRIA Sports Concussion Program offers onsite brief and extended neuropsychological evaluations, medication management, cervical spine management, ocular motor and vestibular rehabilitation, exertion therapy, and sport specific return to play guidance. Appointments with myself will vary dependent on the athlete’s need. Some appointments will seem similar to appointments with any other physician in our program, but athletes that need extended testing may spend several hours with me undergoing neuropsychological evaluation to further examine cognitive (i.e., memory, concentration) deficits and/or changes in mood and personality.
Q: What is involved in a neuropsychological assessment?
A: Again, this is all dependent on the individual athlete’s need. Some athletes that see me only undergo computerized neuropsychological testing (i.e., ImPACT), while others need additional paper and pencil assessments to further investigate symptoms or concerns. For example, additional testing allows me to understand causes of prolonged recovery, including cognitive concerns such as difficulties with concentration, divided attention, processing speed, or memory.
Q: Why did you become a clinical sports neuropsychologist?
A: Clinical sports neuropsychology was the perfect fit for me. I have always been fascinated with the functions and plasticity of the brain, including the brain’s ability to heal itself after injury, and sports have always played an important role in my life; I was a three sport athlete growing up and began competing in triathlons in college. The majority of my educational background and clinical experience prior to specializing in sports concussion involved health and rehabilitation psychology working primarily with moderate to severe traumatic injury, polytrauma and spinal cord injury. Being a clinical sports neuropsychologist has allowed me to combine my educational background with my strong passions for sports and helping others.