INSNET, Spring 1997

INS (CNS) which was founded by Hannelore Kohl, the wife of the current chancellor.

As me might conclude neuropsychology is still a developing field in Germany. On the one hand there are a lot of jobs and research opportunities. On the other hand, there is the tight financial situation of the health system and the stagnation of funding through the national and private science foundations which will very likely impair the growth rate during the next years.

References

Gauggel, S. & Haettig, H. (1994). Eine Uebersicht ueber Ausbildungsstand, Arbeitssituation und berufliche Taetigkeit von deutschsprachigen Neuropsychologen: Ergebnisse einer Umfrage uiiter Tagungsteilnehinem. [An overview on education, working conditions and professional duties of German-speaking neuropsychologists: A survey among congress participants.] Zeitscitrift fuer Neuro,psychologie, 5, 172-179.

Markowitsch, H.-J. (1992). Intellectual functions and the brain A historical perspective. Toronto: Hogrefe & Huber.

Markowitsch, H.-J. (1993). Neuropsychology: A selective survey of the last decade of clinical neuropsychological research in the German language area. The German Jourtnal of Psychology, 17, 91-134.

Poser, U., Kohler, J. A. & Schoeiile, P. W. (1996). Historical review of neuropsychological rehabilitation in Geresuity. Neuropsychological Relsabi&ation, 6, 257-278.

The Status of Neuropsychology Beyond the Former Iron Curtain

By Andrei Dumbrav6, M.D.

A..I.Cuza University,

Iasi, Romwtia

B-dul Copou 11, RO-6600

Brain scientists in the Iron Curtain countries have realized the necessity of improving connections between East and West and developing the field. Because of this, actions were taken very early after the historical changes of 1989 (Rose, 1990).

I will try to present the development and current status of neuropsychology in Eastern European counties considering the behavioral side of brain-mind inquiry.

In my opinion, there is a separation line regarding neuropsychology that can be traced inside the former communist block, that includes the countries starting from Poland and Czech and Slovak Republics up to Hungary and East Germany that are far ahead of the other block countries. I will briefly describe the status of neuropsychology in the lagging countries of the block.

Neuropsychology in Bulgaria has developed as a result of collaboration between a few behaviorally oriented neurologists and some clinical psychologists. This is probably the most egalitarian relationship between the two disciplines in all of the countries. This has occurred in medical institutions where both professions have significant inputs. The physicians are focused upon clinical aspects and the psychologists upon research. This allows for broader study and more elaborate investigations.

Neuropsychology in Moldavia (the former Soviet Union Republic) is almost entirely confined to people with medical training who take a more behavioral approach. Many of these clinicians have received specialized training from the famous Institutes of Neurology in Moscow and Saint Petersburg and have solid backgrounds in the Luria's approach to investigate neurological patients. Research tends to be primarily with language disturbances and their management.

Neuropsychology in Romania has strong roots in neurology and has evolved as an additional interest of open-minded neuroscientists. Because of the vicissitudes of history , some are now well recognized professors in Norffi American universities (e.g. M.I.Botez and M.Steriade). The Romanian research is very clinical oriented with the main areas of interest involving aphasia, epilepsy, and the psychological outcomes of vascular, trauma, and tumor disorders.

In addition to these national differences, there are different conditions for training and practice.

Training: Neuropsychological knowledge for psychologists is provided to unddergraduate students in psychology in the early semesters. This is academic and theoretical in orientation. There is no practical or applied orientation. There are no postgraduate programs available. Correspondingly, the emphasis for medical students is more on "more vital" biological information and less upon behavioral information. There are no boards or commissions to examine or select the very few persons from psychology or medicine who chose to work in this field.

Clinical practice: Neuropsychodiagnosis is the most relevant area of activity. The hospitals have very limited access to neuroimaging techniques. This calls for more reliance upon clinical evaluation. The techniques used vary depending upon "clinical tastes." The common diagnostic tools are either obsolete versions of Russian inspiration or copies of tests from abroad. There are no local population norms. The DSM-III-R is available in official and unofficial translations but is used sporadically.

Rehabilitation: Neuropsychological rehabilitation is generally focused upon language disturbances.

Private practice: Private practice and the forensic use of neuropsychology is nonexistent.

Research: Science is largely funded by the old Soviet model of centralized planning but a western competition-based system is now being introduced. As financial resources become even more scarce, the competition- base system will probably replace the old central system. Access to up-to-date literature is very limited. It takes extreme individual effort to obtain publications from abroad and be informed. There are no local neuropsychology publications. It is very difficult to publish abroad. There are no official nation-wide professional societies dedicated to neuropsychology.

Despite all of these limitations, there is reason to be optimistic about the future and the potential in these growing countries. There is a good pool of human resources. There are many persons that have solid clinical skills. They are curious, enthusiastic, and dedicated. They are accustomed to working hard even though they are not motivated by financial gain. There are many patients to see. The still centralized system of delivering specialized medical services allows the few neuropsychologists available to have access to a large diverse group of patients. This provides a fertile opportunity for learning, treatment, and potential research.

Efforts to build and rebuild bridges with the western world are underway. There are several immediate things that need attention:

1. A large normative study is needed to develop the main psychometric assessment techniques. This is needed for both good clinical practice and research.

2. There is a need for a thorough analysis and review of existing research to learn from the work of others and to avoid costly errors of "reinventing the wheel."

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