Neuropsychology in Rehabilitation: Supporting Cognitive and Behavioral Recovery in Pediatric and Transitional Patient Populations

Melissa Sutcliffe, PhD, assistant professor in the Department of Physical Medicine and Rehabilitation is a neuropsychologist and vice chair of the Division of Neuropsychology and Rehabilitation Psychology. Her clinical work encompasses inpatient and outpatient care for pediatric and young adult patients with acquired brain injuries, epilepsy, and neurodevelopmental disorders. As a clinician and educator, Dr. Sutcliffe works with patients and families to navigate the cognitive, emotional, and behavioral challenges that often accompany a neurologic injury or disease.

“Our goal is to understand how a brain injury or neurologic illness impacts function and how we can support a person’s ability to live independently and do what matters most to them,” says Dr. Sutcliffe.

Clinical Focus and Multidisciplinary Integration

Dr. Sutcliffe's primary clinical work deals with children and adolescents, and their families recovering from traumatic brain injuries, pediatric stroke, and intractable or drug-resistant epilepsy, and other conditions. She performs neuropsychological evaluations in both acute and outpatient settings.

Dr. Sutcliffe serves as part of the multidisciplinary Epilepsy Surgery Program at UPMC Children’s Hospital of Pittsburgh, where she conducts preoperative neuropsychological evaluations to help determine surgical candidacy and risk, as well as follow-up evaluation to determine any changes in function after surgery.

“We assess cognitive baselines, language lateralization, memory function, and other cognitive abilities that could be affected depending on the surgical target,” says Dr. Sutcliffe.

Her work plays an important role in helping neurosurgeons, epileptologists, and other team members weigh potential benefits and cognitive trade-offs associated with epilepsy surgery. In the postoperative environment, Dr. Sutcliffe assists with long-term monitoring and helps families understand the neurodevelopmental implications of surgical intervention for epilepsy.

"Rehabilitation is where my heart is. I love being on the inpatient units and working in these kinds of multidisciplinary care dynamics," says Dr. Sutcliffe.

Pediatric Brain Injury: Challenges Related to Prognosis and Plasticity

One of the most difficult challenges in pediatric neuropsychology is the unpredictability of recovery after a brain injury. Even when injuries appear clinically similar, outcomes can vary widely.

"Not having a crystal ball is the most challenging part. Two children can have near-identical injuries and completely different outcomes," says Dr. Sutcliffe.

The developing brain's plasticity allows for remarkable functional adaptation after an injury, but this same plasticity also can mask the early signs of impairment. As a result, children may "grow into" their deficits as academic and social demands increase with age, though this is a controversial topic within the literature. Ongoing, dynamic assessment is essential to monitor emerging challenges in attention, executive function, and memory.

Behavioral and Emotional Injuries: Supporting Patients and Families

Dr. Sutcliffe also serves as a neurobehavioral specialist, helping families distinguish between neurologically driven behaviors and trauma responses. She describes her work as identifying "what's brain-related, what's trauma, and what's not," particularly in cases of severe injury or non-accidental trauma.

"Children who experience a brain injury often have little or no memory of the event, but their parents carry the full emotional weight of the trauma. We spend a lot of time helping families work through those differing realities, supporting the child’s recovery while also helping parents process what happened and how it changed their lives," says Dr. Sutcliffe

She collaborates closely with behavioral health colleagues, including trauma-informed therapists, to support families through the psychological aftermath of a child’s injury. For adolescents and young adults, the focus often shifts to reestablishing autonomy, goal-setting, and redefining their path forward when previous life plans are disrupted. Behavioral challenges often linger after physical recovery is complete.

"The attention, memory, and executive functioning issues are usually the last to recover, and they’re the ones that affect independence," says Dr. Sutcliffe.

Long-Term Recovery and Return to Function

Patients recovering from a brain injury or illness often experience a mismatch between their physical recovery and their cognitive readiness to resume what were their regular everyday activities. This discrepancy can be particularly difficult for adolescents who are eager to return to sports or school routines.

“One of the hardest things for families is that there is nothing visible to track recovery after a brain injury — no cast, no bandage, no scar. So, when a child or adolescent struggles with memory or attention weeks or months later, it feels invisible but very real. Helping families accept that this is part of the healing process is a big part of our work,” says Dr. Sutcliffe

Her clinical work often involves counseling families on the risks of premature return to high-impact activities, especially when injuries involved skull fractures or prolonged loss of consciousness. Decisions about returning to sports or other physically demanding activities are made collaboratively with physiatrists, and Dr. Sutcliffe helps families understand the long-term implications of reinjury.

Transition to Adult Care: Building Continuity

Transition planning is an important area of development in pediatric rehabilitation (much as it is in many other pediatric subspecialties in which chronic illnesses are common), and Dr. Sutcliffe is helping to shape UPMC’s approach. Working with colleagues including Ted Barrios, PhD, and Renée Lajiness-O’Neill, PhD, she is supporting new protocols to facilitate the shift from pediatric to adult services for patients with complex medical needs, including those with spina bifida and epilepsy.

"We want to maximize independence and happiness while ensuring safety. That requires individualized and often long-term planning," says Dr. Sutcliffe.

Dr. Sutcliffe supports a more systematic approach to evaluating a young person’s ability to make decisions about their own care and life circumstances as they transition to adulthood. Rather than defaulting to full legal guardianship, she encourages the use of structured readiness assessments that examine executive function, communication skills, and practical judgment. These tools can help the clinical team determine whether supported decision-making or other less restrictive alternatives might allow a patient to retain greater autonomy.

“In some cases, guardianship may be necessary, but it should be a last resort,” says Dr. Sutcliffe. “We want to be thoughtful about what decisions a young adult can and cannot make, and how we can scaffold that process in a way that preserves their dignity and rights”

Educational Advocacy and Reintegration

Returning to school after a brain injury can be one of the most challenging tasks for pediatric patients. Dr. Sutcliffe works closely with the rehab team, including a school liaison, at UPMC Children’s to prepare students, teachers, and families for the reintegration process.

“Traumatic brain injury is often invisible. A child may be walking and talking again, but that does not mean they are functioning as they were before. Families and schools may not recognize the lingering effects like difficulties with memory, attention, or regulation until academic or social challenges arise. Part of our role is helping caregivers and educators understand that these are brain-based changes, not behavioral problems, and to guide them in supporting the child’s recovery,” says Dr. Sutcliffe.

She and her colleagues participate in discharge planning meetings with schools and intermediate units to ensure that accommodations or adaptations ranging from physical access to academic modifications are available and in place. Dr. Sutcliffe also refers families to Pennsylvania’s BrainSTEPS program, which helps bridge the gap between medical recommendations and educational implementation.

Commitment to Education and Workforce Development

In addition to her clinical responsibilities, Dr. Sutcliffe plays an active role in training the next generation of neuropsychologists. She is an associate director of the Lifespan Neuropsychology Fellowship, alongside program director Amy Letteri, PhD, and fellow associate director Dr. Barrios. The team is also planning to launch a formal internship program in 2026, led by Sarah Laughlin, PhD, and Dr. Lajiness-O’Neill.

"Rehabilitation and education are the two halves of my professional identity," says Dr. Sutcliffe. “When I joined UPMC in 2013, I was the sole pediatric neuropsychologist in pediatric rehabilitation medicine at UPMC Children’s. Since then, the program has grown significantly, and I look forward to many more years of sustaining excellence in neuropsychological care.”