PSYC3003 - Introduction to Clinical Psychology - Neuropsychology P1: Evaluations and general knowledge Flashcards
What does a neuropsychologist study?
The brain -behaviour relationship.
What does a neuropsychologist ‘do’? (i.e work)
- Evaluation & diagnsosis (neuropsychological evalution, brain imaging techniques)
- Rehabilitiation
- Teaching
- Research
- Mediolegal (compensation litigation, diminished criminal responsibility)
What types of patients does a neuropsychologist deal with/see?
- Traumatic head injury
- Strokes
- Brain tumours
- Dementing conditions
- Learning diabilities
- Pervasive develomental disorders
- Attention deficit disorder
- Seizure disorder
- Effects of toxic chemical or chronic substance abuse
What is a neuropsychological evaluation?
Assessment of behaviour using standardised tests that are sensitive to breain-behaviour relationships.
Recommended when brain-based impairment is suspected.
As in all psychometrics, tests should be standardised, reliable and valid.
What does a neuropsychological evaluation involve and how long does it take?
Usually involves a number of tasks (a ‘battery’ of tests) which are non-invasive, flexible to to the situation (e.g table or bedside) and taileored to the individual patient’s needs based on the nature of the presenting problem.
They can take 6-8 hours of face-to-face time, this can be in a single session or spread over a series of appointments.
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 others pieces of patient imformation compliment neuropsychological evaluation?
(i.e integral approach)
- Patient backgroun (persnal history, description of illness, medical history, family history of brain disorder)
- Neurological examination
- Data from neuroimaging techniques (e.g., EEg, MRI, CT & PET
Briefly, what is ‘standardisation’ and ‘test norms’?
Standardisation: administer test and intepret results in the same way
Test-norms: data with which to compare the test result to, making it possible to determine the relative standing of an individual who has taken a test, thus, giving the results meaning.
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 are the 4 lobes of the brain and where are they?
Where is the cerebellum, spinal cord and cerebrum?
See diagram!
Where is the hindbrain, midbrain and forebrain?
See diagram!
What is ‘orientation’ and why is it one of the first test administered?
what factors does it include?
Orientation is an awareness of oneself to the surrounding world.
It is a most basic level of functioning upon which other higher functions are built. It represents the capacity of the patient to actually undergo formal neuropsychological testing. (if they don’t know who they are, where they are or when they are…some further testing won’t yield much)
Three main types:
Orientation to person (who are you?)
Orientation to time (what date is it?)
Orientation to place (where are you?)
But also:
Arousal, degree of confusion, awareness of change
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.
What neuropsychologial items are used to test a persons ‘orientation’?
Assessment instrument: Galveston Orientation and Amnedai Test (GOAT) (or Glasgow Come Scale (GSC))
BOTH Assesses the extent and duration of confusion and amnesia after traumatic brain injury.
GOAT - Yields a score from 0-100 with a suggested cut-off of 75 or better indicating relatively intact orientation.
Also more generally:
- Orientation evaluation questions (what is your full name?, where do you live?, how old are you? where are you now? Who is the current president? who was the president before them?)
What is sensation?
What is perception?
What overal brain system does it use?
Perception = processing and intepretation of sensory input
Sensation = stimulation of sensory organs. (touch, vision, hearing, taste, smell)
Sensorymotor system (organised contralatterally) made up of many areas of the brain
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
What factors are assessed in sensation/perception?
- Recognition
- Familiarity of stimuli
- Relationship among features
- visual acuity
- Auditory
- Taste/smell
- Tactile/prioprioceptive
- Internal/environmental
- Awareness
What methods and instruments are used in the assessment of perception/intepretation?
Assessment instruments: Halstead-Reiten Neuropsychological Battery (visual, auditory & tactile modalities)
Also,
- Visual field examination: testing for interactions of the patients right and left hempispheres.
What is ‘Attention/Concentration’?
What areas of the brain are involved in attention/concentration?
Attending to the environment, maintaining attention.
- Sustained attention - paying attention to something over a prolonger period.
- Selective attention - Paying attention to more than one thing at a time.
Frontal lobe and Parietal Lobe
What methods and instruments are used to assess attention/concentration?
Instruments:
- Symbol Digit Modalities Test i.e., SDMT (see picture) - assesses complex scanning, visual tracking and sustained attention
- ‘d2 test’ - test of selection attention were one crosses out all the d’s with a “ above, below or both the letter. (BUT NOT any other combination) - also measures processing speed, rule compliance and quality of performance; allowing estimation of individual attention and concetration performance.
Methods:
- Maintaining attention - Easy tasks that require attention (count from 1-20 quickly, recite the alphabet, count in 3s till you reach 22)
- Attention span - 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.
- Sustained attention - tap on he table when you hear me say the number 4
What would the following methods be used to test?
- Count from 1-20 quickly, recite the alphabet, count in 3s till you reach 22
- neuropsychologist says some verbal stimuli, becoming progressively more complex, patient repeats each set e.g repeating numbers (589, 9275, 71632) and then also do it backwards.
- Patient has to tap on the table when they hear the psychologist says the number 4
Attention/Concetration
What is the Symbol Digit Modalities Test (SDMT) and ‘d2’ test, used to test?
Attention/Concentration
What is the Halstead-Reiten Neuropsychological Battery designed to assess?
Visual, Auditory & tactile modalities.
i.e., Sensory and Perception
What is the Galveston Orientation and Amnesia Test (GOAT) used to assess?
Orientation
What are motor skills?
Ability to demonstrate movement control in the upper and lower extremities.
What methods and instuments are used to assess motor skills?
Instruments:
Subtests of the Halstead-Reitan Neuropsychological Battery:
- Finger-tapping test - tap index finger as fast as possible.
- Grip strength test - measure with a hand-dynamometer - 3 goes with each hand averaged.
Methods:
- Gross motor movement - raise your right hand, left hand, move left leg
- Motor speed - touch your thumb to your forefinger as quickly as you can.
- Fine-motor ability - touch your thumb to each finger, one after the other
- Inhibit motor behaviour - “If i clap twice, you clap once”; “if you clap once, you clap twice”
- Visual pereption input and complex motor response output - copy a design (scored via correct shape, size, symmetry and integration).
- Motor apraxia - show me how to make a telephone call from beginning to end
What is ‘apraxia’?
The inability to perform purposeful sequences of motor behaviours.
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 systems deal with motor skills and what areas of the brain are they in?
Organised contrallatraly
Primary motor cortex - initiate movement and some finer movements posterior portion of the frontal lobe.
a number of secondary areas:
- Frontal lobe area - planning sequencing (i.e., higher order)
- Cerebellum and basal ganglia (midbrain)- co-ordination and balance
Primary motor cortex works in association with other motor areas including premotor cortex, the supplementary motor area, posterior parietal cortex, and several subcortical brain regions, to plan and execute movements.
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 two components make up ‘language’?
Receptive language
Expressive language
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
What methods and instruments are used to assess ‘Language’?
Instruments:
- Token test -receptive language
- COWA - Controlled Oral Word Association test - expressive language
- Boston Naming Test
What is the Token test used to test, how is it administered?
Token test - used to test receptive language - 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.)
What is the Controlled Oral Word Association (COWA) test used to assess? How is it administered?
COWA - Controlled Oral Word Association test - expressive language - 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.
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
Descrive the administration of the Boston Naming Test, what is it designed to asses?
Boston Naming Test - Language - 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)
what is receptive and expressive language?
Receptive: The patients ability to comprehend simple spoken commands (e.g., ‘say hello’)
Expressive: 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’)
What is dysgraphia?
Deficits in the motor component of writing
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
What methods and instruments are used to assess visual-spatial organisation?
Assessment instruments:
Clock drawing test = draw 12:00 etc
Rey Figure tes = complex figure, replicate while looking at it, then replication and original are removed and patient must draw again from memory.
Methods:
- directional skills, mazes, clock drawing, motor-free constructional tasks
- Facial recognition (e.g recognise familiar face or ‘show me the happy face, sad face and angry face’)
- Visual sequencing (higher order) - putting pictures of a story in the correct/logical order.
What is malingering (according to DSM-IV)?
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.
What are the two approaches to neurospychological intepretation?
Standard battery approach (Realiance on standardised tests)
Process Approach (aka hypothesis approach) 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.
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 is the difference between a focal and a diffuse neurological disorder of the brain?
Focal have a prticular focus or site. (E.g., tumour, stroke or brain bleed
Diffuse are more generalized, affecting the brain as a whole. (e.g., closed head injurys [CHI], toxic conditions, degenrative disorders)
What is type of memory deals with factual information?
Explicit/declarative memory
What component of memory does explicit/declarative memory deal with?
Factual information
What type of memory deals with action or “doing” memory?
Implicit/procedural
What is Implicit/procedural memory?
Memory for action or “doing”
What are the three processes of memory?
- Encoding
- Storage
- Retrieval
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
What neuropsychological assessment instruments are used to assess memory?
- Wechsler memory scale (subtests test: verbal, visual, STM, LTM, serial recall, free recall, recognition)
- Rey Auditory Verbal Learning test (Immediate memory, verbal memory, suceptability to interference, recognition memory)
Descrive how the Rey Auditory verbal Learning Test (RAVL) is administered (i.e., what is the procedure?)
(for memory)
Equiptment:
- Neuropsychologist has 2 lists (A and B) each containing 15 different words)
- one list containing all the words from A and B + 20 additional words that either sound like (e.g., mouse [house]) or relate to (e.g., home [house]) words on the A and B lists - this is the A+Bextra recognition list
Procedure = Ax5, B1, A6 -> 20 minutes->, A7, recognition ABextra
- List A presented, then taken away, P must recall as many words as they can (tests: immediate memory)
- This is then repeated 4 more times (tests: verbal memory, expect to see improvement)
- List B is presented, then taken away and P must recall list B (Tests: immediate memory)
- Patient must recall list A (without another presentation) (tests: Susceptability to inteference)
- 20 minutes of other non-related neuropsyc tests
- Patient must recall list A again (without further presentation) (tests: LTM)
- Patient presented with A+Bextra list, must determine which words were on the A and B lists only (Tests: recognition
What is Executive Functioning?
Higher-order cognitive processes
e.g: goal-directed planning, flexible problem-solving, self-monitoring & self-regulation of behaviour.
What instruments are used to assess executive functioning? and what components do they assess?
- Trail making tests - mental flexibility - 1>A>2>B>3>C [connect the letters and numbers in this way]
- Wisconsin card sorting test - shift between sorting categories and ignore irrelevant information - sort cards and learn rules based on whether they are declared true or false
- Tower of London task - *planning and problem solving *- match the configuration of balls on your model to a picture, only move one ball at a time, do it in the minimum no. of moves
What test is this from? what does it assess?
Wisconsin card sorting test
Assesses executive functioning - shfting between sorting categories and ignoring irrelevent information.
What is an intelligence assessment?
A composite measure of varbal and performance abilities
Provides an index of general intellectual functioning.
Why is an intelligence test useful in a neuropsychological assessment?
It gives an initial indication of spared and impaired abilities which can be used to guide further tests.
It may give an indication of pre-morbid functioning.
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 speed of processing fluid or crystal intelligence?
Fluid
Is factual information or learning experience factors (culture incl.) fluid or crystallised intelligence?
Crystallised
What are the two ways that brain dysfunction can result in personality change?
- Direct - personality alterations due to brain disorder
- Indirect - reaction to disability
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.
Why is the “referral question” so important to neurpsychological evaluations?
The referral questions convey’s the patients problems & complaints as well as the goals.
It also GUIDEs the assessment. Determines purpose and nature of the neuropsychological assessment.
What is the name given to the questions generated by the neuropsychologist in response to the referral question, the patient’s backgroun and their impressions of the patient?
Hypotheses
What 3 aspects go into the making of the neuropsychologsts hypotheses?
- Referral question
- Patient’s background
- Impression of patient
What types of questions (hypotheses) will the neuropsychologist try to answer?
(give some examples, that is fine!)
- How severe is the brain-damage and impairment
- What it the patients prognosis
- How is the patient reacting to their diagnoses
etc.
What are the two methods of test selection for a neuropsychological assessment/evaluation?
- Process/Hypotheses Approach - adapts examination to individual patient
- Standard battery approach - administer standard test battery
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 “trail-making” subtest of the Halstead-Reiten Neuropsychological battery assess?
Executive Function
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
What happens when a cutoff score for a neuropsychological assessment of brain damage is set to low?
Over-inclusion - fasle positive errors.
(people are classified as brain damaged when they are not)
What happens when a cutoff score for a neuropsychological assessment of brain damage is set to High?
Over-Exclusion - false negative errors
(People are not classified as brain damaged/impaired, when they are!)
Why is a bell-curve interpretation of brain impairment often better than having a cut-off?
In a cut-off you are classified as either brain damaged or not, whereas in reality their are degrees of brain impairment - this is more accurately captured in a Bell-curve intepretation which uses the number of Standard Devations a patient’s score is away from the mean to asses what category of brain damage they have - meaning there is less room for over- inclusion or over-exclusions (though it can still occur)
e.g.,
Below mean
1SD - Borderline brain imapired
2SD - Brain impaired
3SD - Severely brain impaired
What is a normative comparison standard?
Comparing an individual’s test scores to the test norms.
What is an individual comparison standard?
When might it be utilised?
Testing a patient at multiple time-points (e.g every few weeks) and comparing the results.
When assessing decline (e.g., dementia) or improvement
What is pattern analysis? (intepretation of neuropsychological assessment)
looking for a pattern of strengths and weaknesses to help identify specific brain disorders.
What are the 9 Important Subject variables (factors about the individual that affect their test performance)
- Age
- Gender
- Cultural Background
- Dominance
- Premorbid functioning
- Medication
- Substance abuse
- Psychiatric disorder
- Malingering
How does AGE affect test performance and how we intepret neuropsychological assessments?
- Test performance decreases with age
- There is a lack of age-stratified norms for 85+, a neuropsychologist can use the norms of a slightly younger age-group but they have to keep this in mind when intepreting the results.
What patient information AND assessment instrument can give you an indication of pre-morbid function?
- Education, occupation, socio-economic status
- National adult reasing test (NART) - 50 words of irregular pronounciation, Patient must pronounciate words - obviously does not work if there are speech/visual/hearing impairments
what is Dominance?
Hand-preferance (which is related to) Cerebral organisation for speech
What assessment instruments are used to identiy hand-preferance (dominance)?
(4 methods)
- Self-report: “are you right-handed or left-handed?” - if left-handed or ambidextrous, likely to have to do other assessment.
- Motor task performance - show me how you would X (e.g., hold a knife to cut bread)
- Behavioural techniques - Target test, dotting test (timed trial, attempted with each hand and compared)
- Hand-preference questionaire (e.g., handedness inventory)
What biological factors and psychosocial factors influencing recovery and rehabilitation (after e.g., traumatic brain injury)?
Biological factors
- Location and extent of damage
- Age of onset (Kennard principle)
Psychosocial
- Motivation
- Emotional state
- Support
Describe the rehabiitation process?
Acute care hospital - brief neuropsychological evaluation(orientation, attention, and sensorimotor skills)
->
Rehabilitation Hospital - Head injuries, Cerebrovascular disorders
->
Outpatient Treatment - Community re-integration
The rehabilitation team employs a multidisciplinary team, what professions are involved? (5)
- Neuropsychologist
- Physical therapist
- Occupational therapist
- Speech therapist
- Clinical psychologist
How does Gender affect test performance and how we intepret neuropsychological assessments?
Minor differences,
women better at verbal tasks than men
men better at visuo-spatial tasks than women
Just keep it in mind when intepreting results, sometimes gendered norms are availiable, but sometimes they are not.
How does cultural background affect test performance and how we intepret neuropsychological assessments?
- Minority groups are potentially more anxious (might be unusual to perform tests in this setting)
- Individuals from a non-english speaking background may have difficulty on verbal tasks or the verbal instuctions of other tasks, even if they are fluent they may have first language habits.
How does medication, psychiatrict disorders and substance abuse affect test performance and how we intepret neuropsychological assessments?
Many and varied effects. It is important to take a good history!
What is Malingering?
The intentional presentation or exaggeratio of neuropsychological symptoms for personal gain.
What are the 2-types of malingering?
- Simulation - pretending you are worse off (e.g., for liability)
- Dissimulation - pretending they are better off (e.g., to avoid rehab center)
How can malingering be detected?
- Pattern analysis
- Assessment instrument - Rey 15 item memory test
How can the Rey 15 item memory test be used to detect malingering?
Participants are ‘primed’ that they will be getting a memory task that is difficult.
“15 items will be displayed for only 10 seconds, then you need to recall as many as you can in order”
then the 15 items are presented:
ABC, 123, abc, [] o ^, I II III
They should be very easy to remember because they follow a easy pattern - but someone who is malingering will perform poorly.
in terms of the speed of occurance….Brain damage is ___, while recovery process is _____
- Sudden or gradual
- Gradual or not possible
What are the two recovery mechanisms? describe them.
RESTITUTION
- Neuronal = repair of neurons
- Psychological = Impaired but not lost function - restoration of usual way of doing things, mental abilities, via RETRAINING
SUBSTITUTION
- Neuronal = compensation with other brain areas
- Psychological = Adaptive Stratergies: alternative stratergies and compensatory stratergies.
What biological factors affect the success of recovery and rehabilitation?
- Location and extent of the damage
- Age of onset (kennard principle)
What Psychosocial factors affect the success of recovery and rehabilitation?
- Motivation
- Emotional state
- Support
Outline the rehabilitation process from occurance of brain damage to rehabilitation ‘completed’ (for THI and CVAs)
- Acute Care Hospital (Medical stabalisation, brain imaging, assessment of consciousness) - Brief neuropsychological evaluation (orientation, attention & sensormotor skills)
- Rehabilitation hospital (patients have a larger role here) - indepth neuropsychological evaluation and treatment process begins with multidisciplinary team.
- Outpatient Treatment - Community reintegration
Rehabilitation teams are multidisciplinary, what other proffessions do they employ?
- Neuropsychologist
- Physical Therapist
- Occupational therapist
- Speech therapist
- Clinical Psychologist
(depending on what is required)
What is the purpose of a neuropsychological evaluation?
- Profile of cognitive/behavioural deficits
- Provides a Basis for intervention
- Baseline measures
What is the purpose of assessment of everyday activities?
GIve an example of in vito and simulated assessments of this.
- Pinpoint problem areas in practical real-life tasks
- Task analysis - e.g., show me how to make a sammich
- Simulation - e.g., driving
What is the neurospychologists role in rehabilitation?
To neurospychologically evaluate patients and then make recommendations to treatment team about intervention strategies.
also, follow up testing
What is cognitive remediation?
The processes of restitution and substitution applied to neurospychological treatment.
What role do physical therapists have in rehabilitation?
- Motor control - strength, balance, coordination & endurance
- Functional activities - standing, sitting, walking & using a wheelchair.
What role do occupational therapists have in rehabilitation?
- Sensorimotor functioning - ADLs and work-related skills
What role do speech therapists have in rehabilitation?
- Communication - hearing & understanding; speech production, reading, writing & social use of language.
What role do psychotherapists have in rehabilitation?
- Personality changs - coping with limitations, adjustment to changed life style
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
What patient populations usually require rehabilitation?
- Traumatic head injury
- Stroke
- Tumour surgery
- Degenerative diseases (Alzheimers and parkinsons)
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
Boston Naming Test
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Expressive language - Measures word-finding ability
Broca’s Area
Dementia, stroke, brain inury (aphasia), tumour
60-item test, the patient is told to tell the examiner the name of each picture and is given about 20 seconds to respond for each trial. If patient can’t the examiner may give the patient a phonemic cue, which is the initial sound of the target word.
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
Judgement of Line Orientation
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Measures spatial perception, orientation and visuospatial judgement
Visual cortex, frontal lobe
Traumatic brain injury, dementia (alzheimers, turner syndrome, parkinsons, left visual neglect)
Judging the orientation of lines!
National Adult Reading Test (NART)
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Test of premorbid intelligence functioning (level of cognitive functioning before brain injury)
N/A - but damage to certain areas of the brain will mean a person is unable to pronounce words (e.g., expressive language - broca’s area)
Anyone for who cognitive decline is suspected (dementias or brain injuries)
A list of words that have an unusual pronounciation. the person needs to be familiar with the words to be able to pronounce them)
Rey Auditory Verbal Learning Test (RAVL)
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Test of verbal learning, immediate memory, recognition and susceptibility to inteference, recognition.
Hippocampus
Individuals suspected of memory dysfunction (Dementias or brain injury)
Immediate memory (A-list x1) -> verbal memory (A-list x4) -> Immediate memory (B-list x1) -> 20-minutes of non-related tests -> LTM/delayed memory (A-list x1) -> Recognition (A+B+20 similar words)
Rey Complex Figure
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Measure of visuospatial construction and visuospatial memory (also assesses planning, organisation and fine motor skills)
Parietal lobe
Brain injury, dementia, and to assess some developmental learning deficits
Examinees are asked to reproduce a complicated line drawing, first by copying it, and then from memory.
Token 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 receptive language
Wernickes area
Brain injury, aphasia, and certain language and learning disabilities.
series of commands regarding plastic shapes of different shape, size and colour - increasing complexity (e.g., touch a square, touch a yellow square, touch a yellow small square, touch a yellow small square and a small blue circle)
Wisconsin Card Sorting 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 shift categories and inhibit irrelevant responses. (executive functioning)
Frontal lobe
used in patients with acquired brain injury, dementias and mental illness
- 4 face up cards + participant response ards with similar shapes, colours and numbers (of shapes).
- Patients sort the cards either by colour, shape or number - but the examiner does NOT TELL THE P THE ‘RULE’ - they are told “right” or “wrong” for each sort attempt, when they do the right sort x10, the rule is changed.
Grip Strength Test
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Assesses lataralised cortical impairment
Motor cortex
Brain injury
Use of a hand-dynamometer
Trail Making Test
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Measure of executive function - mental flexibility
Frontal lobe
Dementia, stroke, injury, tumour
Trace 1->A->2->B->3->C etc
Tower of London Task
What function does it test?
What brain structures does it asses?
What clinical population is it used for?
What does the test involve?
Measures executive functioning - planning and problem solving
Frontal lobe
Dementia, stroke, injury, tumor
- 3 sticks: long, medium, short
- 3 balls: blue, green and red
- Can only move one ball at a time, do it in the minimum no. of moves.
What neurospychological tests would you use to assess depression, anxiety and stress? (personality changes)
Depression, Anxiety and Stress Scales (DASS)
Beck Deppression Inventory (BDI)
What test would you use to assess expressive language and Broca’s area?
Boston Naming Test
What test would you use to measure the ability to mentally manipulate and reintegrate visual information?
Hooper Visual Organisation test
What test would you use to measure spatial perspection, orientation and visuospatial judgement?
Judgement of Line Orientation
What test would you use to assess premorbid intellectual functioning?
National Adult Reading Test (NART)
What test would you use to assess verbal learning, immediate memory, recognition and susceptibility o inteference?
Rey Auditory Verbal Learning Test (RAVL)
What test would you use to assess visuospatial construction and visuospatial memory (also planning organisation and fine motor skills)?
Rey Complex Figure
What test would you use to assess ability to shift categories and inhibit irrelevant responses?
Wisconsin Card Sorting Test
What test would you use to assess receptive language?
Token Test
What test would you use to assess lataralised cortical impairment?
Grip strength test
What test would you use to assess excutive functioning/mental flexibility?
Trail-making test
What test would you use to assess planning and problem solving (executive functioning)?
Tower of London Task
