LAST MINUTE - clin psyc Flashcards
______ is the accumulation of fluid (.e.g, in the brain) that can lead to there being not enough space for the braint o swell into.
Oedema
Describe how the Glasgow Coma Scale is used to assess the depth of a patients coma. (describe how and what it measures)
The glasgow coma scale is a brief test of simple visual, verbal and motor abilities.
Visual - does the patient open their eyes? ranked from 1 (not at all) ->2 (to pain) ->3 (to speech)-> 4 (spontaneous)
Verbal - do they respond verbally? ranked from 1-5: none, incomprehensible, inappropriate, confused, orientated.
Motor - Do they respond to a motor command (e.g., can you move X) ranked from 1-6: none, extension, abnormal flexion, withdrawal, localises pain, obeys command
What GCS rating combined with Coma durations suggest Mild, Moderate and Severe traumatic brain injuries, respectively?
What level of disability are each of these categories predictive of?
MILD
- GCS: greater than 13
- Duration: less than 30 minutes
- Predicts: good recovary
MODERATE
- GCS: 9-12
- Duration: less than 6 hours
- Predicts: moderate disability
SEVERE
- GCS: less than 8
- Duration: greater than 6 hours after admission
- Predicts: severe disability
What rating on the Glasgow Coma Scale is predictive of greater mortality?
A GCS score of less than 7.
At what score on the Glasgow Coma Scale is the unconsciousness considered to be a “Coma”?
less than or equal to 8.
however it is important to recognise that “coma” is a continuum from no coma -> shallow coma -> deep coma …and that people come out of coma gradual in stages.
Post-traumatic amnesia severity can be categorised based on it’s duration.
at what duration would PTA be considered:
- very mild
- mild
- moderate
- severe
- very severe
- extremely severe
- very mild < 5 mins
- mild 5-60 mins
- moderate 1-24 hours
- severe 1-7 days
- very severe 1-4 weeks
- extremely severe > 4 weeks
Another word for severe bleeding is_____
Haemorrhage
What are the four main complications of a closed head injury?
- Oedema (accumulation of fluid, not enough space for brain to swell into)
- Haemorrhage (bleeding) and resulting hematoma (accumulation of blood)
- Skull fractures (protrude into the brain and can result in infection)
- Post-traumatic epilepsy (due to scar tissue)
What are (or can be) the cognitive symptoms of traumatic head injury? (its neuropsychological profile)
- Orientation
- attention
- memory
- behavioural slowing
- sensory function
- verbal retrieval
- executive functioning
What personality changes can result from traumatic brain injury?
- Lack of initiative & loss of spontaneity
- Temper outbursts & mood alterations
- egocentricity
- poor self-awarenss (of deficits)
- deppression (usually after 6 months post-injury)
Describe the duration of loss of consciousness(LOC) post-traumatic amnesia (PTA) and ‘complaints’ consistent with a mild traumatic head injury (i.e., concussion)
- LOC: less than or equal to 30 mins
- PTA: less than or equal to 24 hours
- Complaints: less than or equal to 3 months (changes in the brain are microscopic)
What are the common complaints of a mild traumatic head injury (i.e., a concussion)?
How long does it usually take complaints to emerge?
How long does recovary usually take?
PHYSICAL
- Dizziness, headaches, noise sensitivity, vision (e.g., blurred)
COGNITIVE
- Orientation (initial person/time/place), Attention (concentrating) and Memory
PERSONALITY
- Patience/temper, anxiety and deppression.
Symptoms/complaints emerge a few days after injury (When people attempt to resume regular activity)
Recovary can take 3 months and symptoms tend to disappear gradually.
What is the timeline of recovery for traumatic brain injuries?
During what time period are the most recovery gains made?
Max level of recovery reached around 2 years post-THI
Most gains made during the first 6 months.
a _______ is when a temporary obstruction occurs in an artery resulting in temporary hypoxia.
is short lasting resulting in transient deficits.
Transient Ischemic Attack (TIA)
______ is when there is an permanent obstruction in a blood vessel resulting in prolonged hypoxia resulting in necrosis (i.e., an infarction)
Obstructive Ischemic Stroke
What are the symtoms of a Transient Ischemic Attack (TIA)?
Physical - dizziness
Cognitive - orientation, sensation & perception, language, motor skills (weakness)
_____is a Type of Obstructive Ischemic Stroke whereby plague forms elsewhere in the body and travels to the brain where it blocks a blood vessle
Embolic
_____is a Type of Obstructive Ischemic Stroke whereby fatty deposits built up in vessle walls block/narrow blood vessles in the brain (accident occurs over 30minutes)
Thrombotic
The space between the surgace of the brain and the skull is called the _______
subarachnoid space
_____ referes to inside the brain itself
Intracerebral
What are the common cognitive symptoms of a CVA?
- Orientation - self, place, time
- Attention -
- Motor function - slowing, paralysis, unsteady, coordination
- Executive function - trouble planning, organising, responding to novel situations
- Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important
What are the common cognitive symptoms of a CVA?
- Orientation - self, place, time
- Attention -
- Motor function - slowing, paralysis, unsteady, coordination
- Executive function - trouble planning, organising, responding to novel situations
- Memory - mostly STM (LTM usually alright) misplace things, getting lost, struggle to live independently - structure is important
How do the symptoms of a left hemisphere stroke differ from those of a right hemisphere stroke?
(i.e., lateralisation)
for the 98% of people with left language lateralisation:
- damage to the left hemisphere affects receptive and expressive language.
- damage to the right hemisphere affects visual-spatial ability (perceptual, estimating distances between points)
What personality changes can result from a CVA?
(and the hemisphere where possible)
- Depression (left hemisphere stroke)
- Apathy/indifference (right hemisphere)[tone expression]
- Euphoria (right hemisphere stroke)
- Impulsiveness
- Emotional lability - exagerrated or incongruent responses
- Lack of initiation - not being able to start a behaviour
- Perseveration - Not being able to stop a behaviour
- Poor judgement - leading to inappropriate or dangerous behaviour
What are Lack of initiation and
Perseveration, respectively?
- Not being able to start a behaviour
- Not being able to stop a behaviour
What is the recovary timeline for CVAs?
When does most of the recovery occur?
Plateau at 6 months
Improve most rapidly for the first few weeks
(i.e., quicker initial recovery and quicker plateau than brain injury patients.)
what is “epilepsy”?
A cluster of symptoms
- Recurring seizures (reversable alterations of consciousness) [ arousal alertness, awareness
- Hyperventilation
- Migraine
the ______ posits a negative linear relationship between age of brain lesion and outcome expectancy
Kennard Principle
_______ is not being able to start a behaviour
lack of initiation
_____ is not being able to stop a behaviour
perseveration
The first stage of a seizure where Auras occur is known as the _____
Prodromal phase
The second stage of a seizure where a person experiences a temporary change in consciousness is known as the ______
Ictal phase
The last stage of a seizure where a person regarins consciousness (minutes or hours later) is known as the ______
post-ictal phase
strange pre-seizure symptoms that occur in the prodromol phase such as dizzy, nauseous, metallic taste, smells, mood changes, deja-vu, stomach butterflies are know as______
AURAs
Seizures were the whole brain is involved/affected are _______ seizures
Generalised
Seizures were only part of the brain is involved/affected are _______ seizures
partial (focal)
What type of genealised seizure involves a person letting out a cry, crumpling, face goes blue, stop breathing, tense/rigid —-> follow by approx 30 secs on rythmic jerking?
Grand mal seizure
in the _____ phase of a grand mal seizure a person might let out a cry, crumple, their face goes blue, they stop breating and they go tense/rigid for about 30seconds
Tonic
in the _____ phase of a grand mal seizure a person has rythmic jerking of the limbs for approx 30 seconds.
Clonic
partial seizures with one mode of expression are called ______
simple seizures.
partial seizures involving an entire lobe or a number of brain areas are known as_______
Complex partial seizures
partial seizures involving the motor cortex are know are_____
Jacksonian/marchign seizures.
_____ involve repeatedly doing the same behaviour (i.e., ‘stuck’) and feature in complex partial seizures.
Automatisms
Seizures of the motor cortex. That start with muscle contractions in just one area (e.g., moving one finger) then the seizure progresses across the motor cortex, are known as_______
Jacksonian/marching seizures
The ________ is a test done prior to surgery for epepilepsy whereby a barbituate is injected at the base of the brain which causes 6-8 minutes of half-brain paralysis.
This enables the neuropsychologist to ensure that the other side of the brain can compensate, thus it is highly useful for partial sezures, specifically temporal lobe seizures.
WADA
What is the neuropsychological profile of epilepsy? (cognitive and personality symptoms)
Cogntive symptoms
- attention
- memory and learning
Personality symptoms
Epilepsy ->
Reduced quality of life -> : limitations in driving, swimming, jobs, reduced social interaction (no late nights or alcohol.
**Personality changes: **anxiety, deppression, tension, stress, psychotic. (high than in the general population)
Personality are most common in what kind of epilepsy?
- Most common in temporal lobe epilepsy (mood, detail obsessed)
What are the treatments for epilepsy?
- Anticonvulsant medication
- Surgical procedures
- Behavioural management
- Seizure control
Split-brain surgery, whereby the corpus-collosom is cut is called a _______
Commissurotomy
Recognising the signs of an impending seizure and counteracting them
e.g., a patient with a specific smell aura, may purposefully smell something different.
A patient with a specific taste aura, may purposefully eat somehing pleasant
this is an example of ______
Seizure control
An abnormal groth of brain tissue is called a?
Neoplasm (i.e., brain tumour)
What role does the Neuropsychologist have in Evaluation in the case of epilepsy?
- Functional asessment during WADA test (brief assessment of language and memory function)
- Determine prescense and extent of cognitive & personality disturbances
- Rudimentry assessment of cerebral organisation for speech.
a tumour that is spread out, invades and destroys other areas of the brain, consumes healthy tissue has an ______nature
Infiltating
a tumour oninvading that is an encapsulated growth, growing within itself, does NOT ‘take-over’ has a ______ nature
non-infiltrating
a tumours rate of growth and the degree of symptoms it is casuing is reffered to as its _____
Malignancy
A Secondary brain tumour” whereby tumour ceels brak of from a primary cancer elsewhere in the body (e.g., lungs) and travel through the blood to the brain is reffered to as having a ______ origin
Metastatic
What is the ‘malignancy’ of a tumour? and how is it graded?
The tumours rate of growth and the degree of symptoms it is causing
it is graded from 1-4
- Slow growth, minimal symptoms
- low-Intermediate growth, low-moderate symptoms
- Intermediate growth, moderate symptoms
- Fast growth, severe symptoms
How does the damages caused by an infiltrating tumour differ from that caused by a non-infiltrating tumour?
- Infiltrating tumours - invade and destroy healthy brain tissue, directly damaging the brain tissues.
- Non-infiltrating tumours - are encapsulated, but as they grow they cause intracranial pressure (ICP) which displacees and compresses the healthy brain tissue causing damage.
What are the (behavioural/sickness) symptoms of a brain tumour?
- Headaches (pressure as tumour grows)
- Nausea and vomiting
- Seizures
How is a brain tumour diagnosed?
Brain imaging techniques (both are similar, but MRI is more detailed) - locates tumour
- CT - visualise structure of cells
- MRI - differentiate between brain cells and tumour cells
Brain biopsy - determines the type of tumour
______ is a procedure by which a neuropsychologist works out what areas around a tumour ‘do’ and thus what will be affected by the removal of a tumour and nearby tissues. i.e., mapping out brain functions.
It helps the surgeon determine the “balancing act” between removing tumour cells and protecting brain cells. If the area contains important function, the surgeon may choose to be more conservative (at the risk of tumour reoccurance). Surgery is often followed by radiation.
the process:
Local anestetic and the skull is opened, exposing the brain
Low voltage electrode directly stimulates the brain area
patient responds e.g., touch motor cotex and they move their hand, or they are asked to count etc.
Because, for example, a motor cortex tumour could cause motor trouble and a tumour in the basal ganglia could cause tremours.
Cortical stimulation
What role does the neuropsychologist have in evaluation in the case of brain tumour (and surgery/treatment)?
- Evaluate baseline (which areas are most affected by the tumour)
- Patient has surgery or treatment
- Follow-up (hopefully documents improvement)
Risk factors for cerebrovascular disorders include:
A. gender
B. High cholesterol
C. History of traumatic head injury
D. Both A and B
D: both A and B (Gender and High cholesterol)
The cognitive symptoms associated with temporal love epilepsy include…
A. Visual-spatial deficits
B. Memory impairments
C. Executive dysfunction
D. All of the above
B. Memory impairments
The rey figure test is an assessment instrument used to measure the cogntive functioning of ______
Visual-spatial organisation
What is the purpose of neuropsychological evaluation?
- Profile patient strengths and weaknesses
- Differentiate between functional and organic disorder
- Document impact of brain dysfunction on a patients life
- Monitor progress in rehabilitation
- Disability determination for froensic/legal purposes.
What is reliability?
What are the 4 types of reliability?
Reliability: the stability/dependability/consistency of a test on repeated measures of the same person. Includes:
- Test-retest reliability - consistency between scores of an individual measured more than once.
- Inter-rater reliability - reliability between different people’s use of the measure to score the same individual
- Split-half reliability - the correlation between two halfs of a test
- Internal reliability/consistency - the degree to which items of a scale measure the same thing, also known as ‘cronbach’s alpha)
What is validity?
What are the 3 types of validity?
A test is valid when it measures what it purports to measure. The validity of a test is the meanifulness of specific inference made from the test scores.
An unreliable test cannot be valid, but a non-valid test can be reliable.
- Construct validity - does the test score measure the abstract psychological charactersitic or construct of interest (e.g memory or intelligence etc.)
- Content validity - do the items or tasks that make up your test make conceptual sense. Various items of teh test should correspond to the behavior te test is designed to measure or predict.
- Criterion validity - demonstrates that scores relate systematicaly to one or more outcome criteria. has two components:
- Concurrent validity - relates to outcomes now (important for testing capacities now)
- Predictive validity - relates to outcomes in the future (e.g predicting improvements or decline in recovary)
Neuropsychological testing focuses on what functional areas? (from the most basic to the most complex)
- Orientation
- Sensation/perception
- Attention
- Motor skills
- Language
- Visuospatial
- Memory
- Executive functioning (abstract reasoning/conceptualisation, emotional/psychological distress, activities of daily living)
What part of the brain is (predominately) responsible for orientation?
Where is it in the brain?
Reticular formation.
The reticular formation is a group of nerve fibers located inside the brainstem.
The Galveston Orientation and Amnesia Test (GOAT) is used to assess____?
Orientation and amensia (inc awareness)
______is the processing and intepretation of sensory input
Perception
______is the stimulation of sensory organs (touch, vision, hearing, taste, smell)
Sensation
Halstead-Reiten Neuropsychological Battery (visual, auditory & tactile modalities) is used to assess?
Perception/intepretation
Where are the two parts of the brain that deal with TOUCH sensation, what are they called and what do they do?
- Primary somatosensory cortex - basic awareness of touch - in the parietal lobee
- Secondary system - Intepretation - parietal lobe
The primary somatosensory cortex (SI) is across the central sulcus and behind the primary motor cortex configured to generally correspond with the arrangement of nearby motor cells related to specific body parts. The area includes gray matter along the central gyrus and its extension into the postcentral gyrus.
Goes across both brain hemispheres.
Where are the two parts of the brain that deal with VISION sensation, what are they called and what do they do?
- Primary visual cortex - the occipital lobe
- Secondary area of the visual cortex - two systems: ‘what’ system (faces, objects), ‘where’ system (where in space) - the occupital lobe
“The visual area known as V1, striate cortex, or (primary visual cortex, Brodmann area 17) is located on the calcarine sulcus deep within the inside folds of the occipital lobe.”
Where are the three ares of the brain that deal with HEARING sensation, what are they called and what do they do?
- Primary auditory cortex - frequency volume length
- Secondary area 1 - Wernickes area (Temporal lobe) - Understanding speech
- Secondary area 2 - Brocha’s area (Frontal lobe) - produce speech
_______ attention is paying attention ot something over a prolonger period
sustained
_____attention is paying attention to more than one thing at a time.
Selective
What areas of the brain are involved in attention/concentration?
Frontal lobe and Parietal Lobe
What does the Symbol Digit Modalities Test i.e., SDMT (see picture) assess?
Attention/concentration
specifically assesses: complex scanning, visual tracking and sustained attention
What is the D2 test used to assess?
test of selection attention
measures processing speed, rule compliance and quality of performance; allowing estimation of individual attention and concetration performance.
Getting a person to attend to various verbal stimuli and then repeat them, becoming progressively more complex. e.g repeating numbers (589, 9275, 71632) and then also do it backwards. is an assessment of ________
Attention span
_____ is the inability to perform purposeful sequences of motor behaviours.
Apraxia
the _______involves commands regarding shapes in a picture e.g show me a pink shape, show me a blue square, show me a small blue shape,show me the green sqaure etc.) and is a test of ________
Token test; receptive language
What do the following subtests of the Halstead-Reitan Neuropsychological Battery assess?
Finger-tapping test - tap index finger as fast as possible.
Grip strength test - measure with a hand-dynamometer - 3 goes with each hand averaged.
Motor skills
What aspects of motor function is dealt with by the frontal lobe and basal ganglia/cerebellum respectively?
Frontal lobe = Planning/sequencing
Basal ganglia/cerebellum = coordination and balance
What part of the brain handles understanding language? (i.e., receptive language) and where is it on the brain?
Wernikes area
Traditionally thought to be located posterior section of the superior temporal gyrus (STG) in the dominant cerebral hemisphere (which is the left hemisphere in about 97% of people).
Which hemisphere is broca’s area and Wernickes area situatied in?
The left hemisphere in about 97% of people, but it is in the right hemisphere for some people.
What part of the brain handles producing language? (i.e., expressive language) and where is it on the brain?
Broca’s area
Broca’s area is a region in the frontal lobe of the left hemisphere
the _____ involves come up with words beginning with # (a letter) letter in 1-minutes, must be more than four letters long and not names or partial repitions. and is a test of _____.
Controlled Oral Word Association test (COWA); Expressive language
the __________ involves simple line drawing of common objects, if they can’t name what the object is they are given a stimulus (e.g for ‘seahore’ might say ‘it’s an ocean creature’). if they still have trouble they are given a phonetic cue (e.g it starts with a ‘c’ sound) and is used to assess_______
Boston Naming Test; Language
Why are the letters F, A and S often used in the Controlled Oral Word Association (COWA) test
F = lowest digital frequency
A = vowel
S = Highest digital frequency
_____ language describes the patients ability to comprehend simple spoken commands (e.g., ‘say hello’)
Receptive
____ language is vocabulary knowledge and recognition of concepts and objects (e.g., please tell me wheat ‘happiness’ means or ‘make up a sentance using the word ‘vacation’)
Expressive
____ is Deficits in the motor component of writing
Dysgraphia
The clock drawing test, Rey figure test and directional skills/mazes/motor-free construction tasks; and facial recognition are used to assess _____
Visuo-spatial organisation
What is ‘visual-spatial organisation’ and what factors does it include?
Involes a range of cognitive processes e.g., map reading, route finding, visual perception, constructional ability & facial expressions)
- Construction
- Route Finding
- Spatial orientation
- Facial recognition
_______ is The intentional production of false or grossly exaggerated physical or psychological symptoms, motivated by external incentives such as avoiding military duty, avoiding work, obtaining financial compensation, evading criminal procecution, or obtaining drugs.
Malingering
the ________ apprach to neuropsychological intepretation relis on perfroming a broad set series of standardised tests
standard battery approach
the ________ is the idea that the neuropsychologist should adapt each examination to the individual patient rather than use a standard battery of tests. The neuropsychologist selects the tests and procedures for each examination, using hypotheses he or she has made from impressions of the patient and from information available about the patient.
Process approach
memory for factual information is also known as _____
Explicit/declarative memory
What are the advantages of the standard Battery approach to neuropsychological intepretation?
- Comprehensive evaluation of abilities
- Objective interpretation based on normative data
- Facilitates teaching because of standard rules/norms
- Useful for empirical studies
What are the disadvantages of the standard Battery approach to neuropsychological intepretation?
- Time demanding and labor intensive
- Tests only as good as standardisation
- Relatively infelxible approach to testing
- Scores may not reflect a single cogitive process
What are the advantages of the ‘Process Approach’ to neuropsychological intepretation?
- Acknowledges the individuality of the patient
- Examination focuses on most important deficits
- Emphasizes how a task is failed or solved
- Useful for clinical case studies
What are the disadvantages of the ‘Process Approach’ to neuropsychological intepretation?
- Test procedures may be biased by clinician
- Opinion of the clinician is subjective
- Difficult to teach, because it requires experience
- Does not lend itself to large-scale research
What type of memory deals with action or “doing” memory?
Implicit/procedural
What 3 main areas of the brain are involved in memory? and what aspects of memory are they associated with?
Where in the brain is the the basal ganglia and the cerebellum?
- Hippocampus (middle of the temporal lobe) - encoding and cognitive maos
- Basal Gaglia (mid-brain) - motor memory
- Cerebellum - learning of procedural memory and motor learning
The Wechsler memory scale and
Rey Auditory Verbal Learning test are used to test what?
MEMORY
WMS: verbal, visual, STM, LTM, serial recall, free recall, recognition
RAVL: Immediate memory, verbal memory, suceptability to interference, recognition memory)
What is the trail making test used to asses?
Executive functioning
Specifically: mental flexibility
What is the winconsin card sorting test used to assess?
Executive Functioning - shift between sorting categories and ignore irrelevant information
What is the tower of london task used to assess?
Executive functioning - specifically plannin and problem solving.
a _________ involves comparing an individual’s test scores to test norms
normative comparson standard
What is the WAIS and what is it used to test?
Wechsler Adult Intelligence Scale
Used to assess Intelligence
6 verbal scales and 5 performance scales
Is factual information or learning experience factors (culture incl.) fluid or crystallised intelligence?
Crystallised
What is the purpose of ADLs (Adaptiving Living or Behaviour-Adaptive tests)?
gives an assessment of activities of daily living (e.g., bathing, grooming, feeding), that enables recommendations about care facilities or helps determine compensation litigation.
What does the “Category” subtest of the Halstead-Reiten Neuropsychological battery assess?
Abstract reasoning
What does the “seashore rhyming test” subtest of the Halstead-Reiten Neuropsychological battery assess?
Auditory perception
What does the “speech-sounds perception test” subtest of the Halstead-Reiten Neuropsychological battery assess?
Verbal Ability
What do the “grip-strength” and “finger tapping” subtest of the Halstead-Reiten Neuropsychological battery assess?
Motor Skills
What does the “Tactile Perfromance” subtest of the Halstead-Reiten Neuropsychological battery assess?
Tactile Memory
What does the “sensory-perceptual examination” subtest of the Halstead-Reiten Neuropsychological battery assess?
Sensory and perceptual functions
What does the “aphasia examination” subtest of the Halstead-Reiten Neuropsychological battery assess?
Language ability
_________involes testing a patient at multiple time-points (e.g every few weeks) and comparing the results.
When assessing decline (e.g., dementia) or improvement
Individual compariosn (standard)
_____ is a type of maligering were one pretends to be worse off
simulation
_____ is a type of maligering were one pretends to be better off
dissimulation
what is the Rey 15 item memory test used to detect?
Malingering
The biological repair of neurons is called ____
Neuronal restitution
When function is impaired but not lost and the usual ‘way of doing things’ is restored it is reffered to as ____
Psychological restitution.
Compensation with other brain areas is reffered to as _____
Neuronal substitution.
Use of adaptive stratergies/compensatory stratergies is reffered to as _______
Psychological substitution
_______ is the processes of restitution and substitution applied to neuropsychological treatment
Cognitive remediation
What does the neuropsychologist do DURING the rehabilitation process?
Conducts regular follow-up assessments
- Monitor patient progress
- Evaluate effectiveness of treatment program
Counsels caregivers and family members
- Effects of brain damage on behaviour
- stratergies to cope with cognitive and behavioural deficits
Becks Depression Inventory (BDI)
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
Measures deppression (both cognitive-affective and somatic symptoms)
Assesses personality changes i.e., an indirect relationship to brain injury/disability
any population
Deppression, Anxiety and Stress Scales (DASS)
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
Measures deppression, Anxiety & stress (long form DASS [42 items], short for DASS-21)
Assesses personality changes i.e., an indirect reaction to brain injury/diability
Any population
Hooper Visual Organisation Test
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Measures ability to mentaly manipulate and reintegrate visual imformation
Parietal lobe
Dementia (often used for elderly driving assessment), stroke, brain injury
Patient identifies 30 objects represented in line drawings as puzzle pieces - what would the picture be if the pieces were back together
