Clinical Neuropsychology at Neurosciences Centre, All India Institute of Medical Sciences, New Delhi: A story of metamorphosis
Correspondence Address: Source of Support: None, Conflict of Interest: None DOI: 10.4103/0028-3886.193822
Source of Support: None, Conflict of Interest: None
The services of clinical psychology (neuro) were established in 1969 under the tutelage of Dr. Surya Gupta. The unit has now established itself as a core group in the Neurosciences Centre, providing services to various other departments. The research and clinical services in Clinical Neuropsychology have substantially expanded since 2005. Research initiatives are underway toward better and more sophisticated systems of assessment and neuropsychological rehabilitation, aimed at facilitating patient care and in providing value-added services for the patients and their families.
Keywords: All India Institute of Medical Sciences; clinical psychology; clinical neuropsychology; history; metamorphosis; neuropsychology
The services of Clinical Neuropsychology have been continuing for 46 years at the All India Institute of Medical Sciences (AIIMS), New Delhi. Clinical Psychology (neuro) was started on 13th August, 1969 at AIIMS, with the appointment of Dr. Surya Gupta [Figure 1] as the first clinical psychologist posted at the Neurosciences Centre.
In the year 1973, Prof. J. S. Neki, the erstwhile Professor and Head of the Department of Psychiatry at AIIMS, mooted the idea of forming a behavioral sciences unit under the executive umbrella of the Department of Psychiatry. At that time, the services of clinical psychologists working in other departments, namely the Department of Pediatrics and Pediatric Surgery, were also recruited for the Neurosciences Centre. These faculty members, at the same time, also continued to function in their respective departments. This arrangement lasted until 1978, after which Professor J.S. Neki left the department to join as the Director of Post Graduate Institute (PGI), Chandigarh. In 1978, the behavioural sciences unit got disbanded and clinical psychologists automatically got shifted to their respective departments/centres, except for Dr. Surya Gupta, who remained exclusively in the Department of Psychiatry. However, in his day-to-day functioning, he was expected to contribute his services towards the newly formed Neurosciences Centre. During the years of his stay, Dr. Surya Gupta carried out clinical neuropsychological workups of patients referred from the Neurosciences Centre. After his appointment as the Assistant Professor of Clinical Psychology at the Neurosciences Centre, in the year 1985, he began to conduct teaching assignments in Neuropsychology for DM and MCh students of the Neurosciences Centre and also began to generate items for assessing organicity, lateralization of organicity, and lobar functions. After this exercise, he wrote the first research project on standardizing and developing a comprehensive neuropsychological battery in Hindi for use amongst adults and forwarded this project to the Indian Council of Medical Research (ICMR) for funding. The project was sanctioned by the ICMR for a period of 3 years from 1989 to 1992. This project was aimed at detecting organic brain damage and its lateralization. In 1993, another project was sanctioned by the ICMR which aimed at generating scales to be used for assessing lobar functions. Soon after, a need was felt to standardize and develop a comprehensive neuropsychological battery to detect and lateralize organic brain dysfunction in neurologically impaired children; the project was again approved by the ICMR. After these scientific endeavours, another project was submitted to the ICMR in the area of Geriatric Neuropsychology. This project could finalize a scale for the comprehensive assessment of dementia. Further validation of these scales and an assessment of their effectiveness in the clinical setting was continued at the Neurosciences Centre until 2004, when Dr. Surya Gupta got superannuated. Prior to his superannuation, he also strengthened the practice of Clinical Neuropsychology at the Neurosciences Centre. This involved clinical neuropsychological assessments, teaching of neuropsychology to DM (Neurology), MCh (Neurosurgery), and MD (Psychiatry) students, along with guiding research assignments allotted to postgraduate students of the above mentioned three departments (in areas involving the neuropsychological workup).
Dr. Ashima Nehra [Figure 2], [Figure 3], [Figure 4], [Figure 5] joined as an Assistant Professor, Clinical Psychology (Neuro) at the Neurosciences Centre, taking over the position which was left vacant after Dr. Surya Gupta's superannuation. She joined the Neurosciences Centre on the 14th of October, 2005, after being relieved from the position of Assistant Professor, Clinical Psychology, Department of Neurosurgery, PGI, Chandigarh. Under the thoughtful vision of Professor V. S. Mehta, the erstwhile chief of Neurosciences Centre, exclusive clinical psychology (Neuro) services were started at the Neurosciences Centre for patients referred to the Neuropsychiatry outpatient department (OPD). However, at this point, there were no separate neuropsychology services being run for the neurosciences centre; in fact, neuropsychology services were being conducted along with the Neuropsychiatry/Neuropsychology registry, twice a week.
In 2009, an exclusive clinical neuropsychology registry/OPD service was started by Dr. Ashima Nehra, being run 4 times a week, and catering to the neuropsychological assessment, rehabilitation, and assessment for disability certification of patients visiting the Neuroscience centre. Two more specialized clinics were started under the registry of Cognitive Disorder and Memory (CDM) clinic in the year 2011, and the Neurorehabilitation (NR) clinic in the year 2013. In addition, teaching assignments for MBBS, postgraduate nursing, and B. Sc. (Hons.) nursing were continued. This service profile included guidance for various theses, (both as a co-guide or as a doctoral committee member). The demand for the neuropsychology services have considerably expanded so that at present, the Clinical Neuropsychology unit gets referrals from over 20 departments within AIIMS.
Numerous neuropsychological tests and assessment tools have been developed by the Clinical Neuropsychology unit for facilitating an early assessment and diagnosis of neurological conditions involving cognitive decline; and, also for screening for neuropsychological impairments, in order to chart out an early preventive treatment by the clinicians. Dr. Ashima Nehra, in conjunction with Dr. Dwarka Pershad (who has also been recruited from PGI Chandigarh), developed the Indian Aphasia Battery, which is an indigenized battery for the assessment of aphasia in the Indian population. This test has been copyrighted and is undergoing the process of publication and marketing. Another paradigm developed to evaluate the multitasking ability of a person has been developed, funded by the Department of Science and Technology, Government of India, called the Computerized Opus in Neuropsychological Testing using E-application of Multitask Paradigm (CONTEMP). This is presently being used as an functional magnetic resonance imaging paradigm to assess the ability of the human brain in the areas of visuo-auditory stimuli and memory retention.
Several screening tests have been developed including the Dementia Assessment by Rapid Test (DART), which assesses the degree of cognitive decline amongst the elderly population; Neuropsychological Evaluation Screening Tool (NEST), which screens for cognitive decline in various neurological conditions; and, the Preliminary Aphasia Screening Tool (PAST), which screens for persons with language difficulty.
Cognitive retraining and rehabilitation have been provided to patients referred to the Clinical Neuropsychology OPD. Initially, an eclectic approach was being followed for providing neuropsychological rehabilitative services to patients who had suffered from stroke, head injury, and other conditions involving cognitive decline. More specific cognitive retraining, basic skills training, functional skills training, rehabilitation packages that target specific domains, family therapy, and vocational rehabilitation and guidance services are being provided by the Clinical Neuropsychology Unit since 2005. During this period, several Masters level students from different government recognized universities have been trained as short-term trainees in the areas of neuropsychological assessment and rehabilitation.
PhD in Clinical Neuropsychology was started under the supervision of Dr. Ashima Nehra, with the first batch of students joining in the 2013, and the second batch joining in 2014. The total number of PhD research scholars in the department now numbers 4. A course curriculum specific for the PhD program in Clinical Neuropsychology, which focuses on three broad domains: Clinical core, teaching core, and research core has been established. All these three domains enable provision of a holistic experience and learning to the PhD scholars enrolled in the program. The course curriculum is an amalgamation of the three core principles of clinical practice, training, and research, and are based on the International Houston Conference Guidelines for Specialty Education and Training in Clinical Neuropsychology (1998).
In the PhD program, the topics for the PhD thesis are chosen based on the specific needs of the Neurosciences Centre. The thesis topics focus on developing and standardizing rehabilitative packages for specific neurological conditions that are assessed through randomized clinical trials.
During this time, a response inhibition retraining module, called the Cognitive Rehabilitation of Response Inhibition Ability (CRRIA) has been developed and is successfully being used in the outpatient clinic for the neuropsychological rehabilitation of patients.
Some of the home-based neuropsychological rehabilitative packages that have emerged from the PhD research projects are as follows:
Keeping with the times, Clinical Neuropsychology is now amalgamating computerized rehabilitative measures in the services being provided in the Neuroscience Centre. Newer PhD research in Clinical Neuropsychology is expanding into broader areas of Psychiatry, as well as in the area of computerized cognitive retraining of patients suffering from schizophrenia.
In addition to the clinical work, clinical Neuropsychology also focuses on social and policy reforms for disability involving neuropsychological impairments. The current policies have been found to be inadequate to measure the degree of disability caused by neuropsychological decline in functioning; and therefore, work has been undertaken for proposing a different format of the assessment of disability in neurological conditions involving neuropsychological decline that results in functional impairment. A format called the “Indian Standard Track for Assessing Neurological Disability (I-STAND)”is in the process of development.
Several interdisciplinary projects are being run by the Clinical Neuropsychology group in conjunction with other departments. Dr. Ashima Nehra is also a part of several central and state government boards for the protection of women's and children's rights and rehabilitation, and, is on several review committees for research and development in the field of Psychology.
The clinical services at the Clinical Neuropsychology unit are ever-expanding since 2005 [Figure 6] and research initiatives are underway toward better and more sophisticated systems of assessment and neuropsychological rehabilitation, which can facilitate patient care and provide value-added services for the patients and their families.
I would like to thank all the Directors of our prestigious institute and Chiefs of the Neurosciences Centre for their valuable support. I would also like to acknowledge my PhD students who have worked as team players and helped to accomplish the objectives.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]