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Psychologists who specialize in acquired brain injury (ABI) often work directly with patients-conducting assessment and rehabilitation-while also putting their research skills to use, says Kathleen Kortte, PhD, an early-career psychologist and assistant professor at Johns Hopkins School of Medicine. The satisfaction of helping people overcome brain injury, paired with the intellectual challenge of researching the link between brain and behavior, makes ABI an attractive specialty, she says.

"It's a great area to be in," Kortte says. "You get to draw on so many different parts of your training."


WHY IT'S HOT:

The number of Americans who have strokes will more than double by 2050-primarily due to the nation's aging population-according to the American Heart Association. About two-thirds of stroke victims survive, and medical advances may cause that percentage to increase.

As the ranks of stroke survivors grows, so will the demand for psychologists who assess what cognitive abilities were lost and work to ameliorate those deficits, says Stephen Wegener, PhD, an associate psychology professor at Johns Hopkins University School of Medicine and the president of APA's Div. 22. Many such psychologists also assist patients with other sources of ABI-such as car accidents or military service-he notes.


WHAT YOU CAN DO:

The most common task performed by an ABI specialist is assessing the cognitive strengths and weaknesses of people soon after their stroke or accident, says Rodney Vanderploeg, PhD, a supervising psychologist at the James A. Haley Veteran's Hospital in Tampa, Fla. A case in point: Vanderploeg administers a series of attention, memory, language and reasoning tests to people who acquired brain injury while on military duty. Speech pathologists and occupational therapists then use his reports to tailor rehabilitation programs to each individual's strengths and deficits.

The satisfaction of helping people overcome brain injury, paired with the intellectual challenge of researching the link between the brain and behavior, makes ABI an attractive specialty.

For example, a person with ABI may be able to follow instructions that are written but not spoken. A physical therapist might use that knowledge by writing down instructions for exercises rather than speaking them.

Other psychologists work directly with patients, helping them compensate for their cognitive impairments and adjust to changes in themselves, says Kortte. As memory problems are among the most common for people with ABI, Kortte generally helps her clients learn to use calendars or personal digital assistants to keep track of appointments, medication schedules and physical therapy regimens.

Psychologists who work with ABI patients also help them to come to terms with any permanent disability and help family members deal with feelings of grief and loss, she notes.

"They have a sense of self that has been there their whole life, and after a brain injury-all of the sudden their abilities have changed," says Kortte. "It is challenging to try to understand and reflect on that."

Kortte provides traditional psychotherapy to some ABI clients to help them accept their new selves, and she also researches post-trauma denial of impairments, which can keep individuals with ABI from making changes in their lives. Other ABI specialists investigate links between the brain and behavior through brain imaging studies, develop new rehabilitation techniques and explore how the brain can compensate for damaged areas, she notes.


EARNINGS OUTLOOK:

Many ABI psychologists serve as faculty at medical schools, and according to the 2003 Psychologists Employment Survey, the median base salary for psychologists employed full time in medical school settings is $88,550.

"As a rule of thumb, people with specialties are paid better than generalists," notes Wegener.

However, some psychologists who specialize in ABI assessment and rehabilitation are employed in less-funded settings, such as nursing homes, notes Marge Welsh, a former director of a nursing home rehabilitation unit and a second-year clinical psychology student at the Massachusetts School of Professional Psychology.

"It can be difficult to receive insurance reimbursement for long-term care, especially if a client is making slow progress," says Welsh.


HOW TO GET THERE:

Students who want to work in ABI rehabilitation and research should first get broad training in a clinical or counseling doctoral program, says Vanderploeg.

Neuropsychology programs also provide a good basis, says Kortte. Seek out coursework in neuroscience, psychopharmacology and cognitive testing, she suggests. Students may want to take classes on disability and counseling the disabled, she notes.

Advanced graduate students would benefit from internships with rotations in rehabilitation psychology, health psychology and neuropsychological testing, Vanderploeg says. However, he cautions against focusing on ABI rehabilitation too early.

"To be a specialist you need a good foundation in clinical and counseling skills," says Vanderploeg. "You build the specialized training at the postdoc level."

After graduate school, most ABI-focused psychologists spend two years in a postdoctoral program, learning how to assess, counsel and rehabilitate people with ABI, says Vanderploeg. Many such programs are located within university medical schools and veterans' medical centers, he notes.


PROS AND CONS:

Psychologists who work with people who have ABI face heartbreaking tragedy on a daily basis. Prior to their stroke or accident, many ABI patients were happy and healthy, says Kortte. Previously witty conversationalists suddenly find they can't string together a coherent sentence.

"It can be hard to deal with your own vulnerability-the potential that you, too, might get into a car accident or have a fluky medical accident," she says.

But, for many psychologists, knowing that you are helping people get through that trauma, regain some functioning and learn to accept what can't be changed more than makes up for the challenges.

"Some people go back to work or school who you never would have thought could do it," says Vanderploeg.

What are the growth areas in psychology?

gradPSYCH takes a look in this third article of an occasional series on areas where opportunities abound