Jason A D Smith, Ph.D., Epilepsy Research
The clinical roles of neuropsychology and rehabilitation psychology have long been well integrated into the assessment and intervention or care of people with neurological and chronic health conditions. As integrated health models continue to develop and integrate clinical psychology and its respective subspecialties into broader healthcare, a great many opportunities exist for refining how clinical psychologists operate in medical centers and specialized medical specialties. The role of clinical psychology in healthcare is necessary to holistically address the emotional, cognitive and behavioral concerns of patients. Similarly, the sociodemographic makeup of people in the U.S. demands increased awareness of these dynamic psychosocial factors and attention to the development of culturally and linguistically appropriate assessment and interventions for people living with chronic health conditions and disabilities. An example of this is the continued work that has been done, and remains to be done, in regards to the neuropsychological assessment of, and interventions for, Spanish-speaking people in the U.S. with psychiatric and other medical conditions.
Past and Future Research
My research experience began in a behavioral neuroscience laboratory studying neuroplasticity, particularly looking at the role of exercise and enriched environments and synaptogenesis. Interested in about translational research, I pursued clinical psychology, emphasizing clinical training in neuropsychology. My dissertation research focused on performance validity in neuropsychology and included a cohort of people with moderate and severe traumatic brain injury (TBI).
Starting in my postdoctoral fellowship in rehabilitation psychology I combined my interest in the neuropsychological assessment of patients with neurological conditions with my interest in underserved populations. Clinically, I worked with Spanish-speaking patients with TBI, spinal cord injury, and other neurological conditions, including epilepsy. I created a large database documenting clinical and demographic characteristics of Spanish-speaking people with epilepsy (PWE), with focus on clinical outcomes after surgery for intractable epilepsy, in particular the effects of quality of life (QOL). My interest in neuropsychometrics is also reflected and applied to the assessment of people with TBI, and how common test scores relate to a measure holding ecological validity of real world functioning, i.e., the Frontal Systems Behavior Scale (FrSBe), which I used as an opportunity to mentor a clinical trainee and Ph.D. student to be the first author.
The above experiences have led to funded research to develop a culturally and linguistically appropriate intervention for Spanish-speaking PWE. To address the myriad psychosocial issues relevant to the Spanish-speaking people living in the U.S., my most recent research project to translate into Spanish and culturally adapt the Program of Active Consumer Engagement in Epilepsy Self-Management (PACES). PACES is a program that, in English-speaking PWE, improves the QOL, mood, self-efficacy, self-management and medication side effect related aspects of QOL.
Epilepsy surgery in underserved Hispanics
This patient population has a history of underutilizing epilepsy surgery, despite the higher incidence of intractable epilepsy in minority population and the demonstrated efficacy that epilepsy surgery has had on improving seizure control, mood, anxiety and QOL in other populations. This population has also been documented to have a number of beliefs, or stigma, about epilepsy and surgery, sometimes associated with lower levels of health literacy. Similarly, access to care and concerns about legal status prevent many patients from pursuing epilepsy surgery as an option. This article specifically outlines these issues and presents the benefits of epilepsy surgery and outcomes specific to this population, which are useful for patient education and counseling and for overcoming stigma that inhibits otherwise good surgical candidates.
Seizure lateralization in Spanish-speaking patients with epilepsy
Neuropsychological assessment of Spanish-speakers living in the U.S. has long been a challenge. In part, this is due to the heterogeneity of nation of origin, linguistic and cultural differences within the broader group. Similarly, Spanish neuropsychological tools are limited, much less validated for use in particular neurological groups. In epilepsy, the Neuropsychological Screening Battery for Hispanics (NeSBHIS) was validated to document general impairment across cognitive domains; however, lateralization was poor with the NeSBHIS in following studies. These results were hypothesized to be due to limitations in previous studies that did not adequately address the importance of educational levels, which greatly vary amongst Latin American countries and are an anchor for clinical neuropsychological use. This bolstered the clinical utility of the NeSBHIS in Spanish-speaking PWE by using more refined educational groupings and by highlighting the importance of how nation of origin varies significantly across US regions.
Cognitive process scores and chronic traumatic brain injury
The Boston process approach is a longstanding method of examining patients with formal neuropsychological tests that gives special attention to incorporating behavioral or clinical observations (e.g., test taking approach) with actuarial test data to inform clinical conclusions. This particular study reflected this philosophy and investigated the relationship between underutilized cognitive process scores of common tests and self-ratings on a formal measure of executive functioning behaviors. These results highlighted that cognitive process scores, compared to the usual neuropsychological test scores, were the strongest factors with behavioral or executive dysfunction, in patients with moderate and severe TBI.
Future Research Goals
In line with existing interests in neuropsychometrics, I am a co-investigator in a multi-institutional effort to establish new normative neuropsychological data using a battery of tests with Spanish-speaking people living in the regions across the U.S.
In the more nascent stages, is the work that is emerging from the Interdisciplinary Committee on Epilepsy Research and Functional Outcomes, which I established with my colleague in neuroradiology. Now, our effort includes faculty from neurology, neurosurgery, neuropsychology (Department of Psychiatry) and rehabilitation psychology (Department of Physical Medicine and Rehabilitation). We ultimately aim to utilize our neuroimaging capabilities to better investigate our presurgical and postsurgical outcomes, anchored in neuropsychological and functional outcomes. Finally, with colleagues at the University of Southern California and the Neurorestoration Center, I am collaborating in the development of translational research of physical activity, exploring neurophysiological changes related to physical activity, as well as neuropsychological and functional outcomes after epilepsy surgery.