Unit 10 (CH.13 TEXT) Flashcards
. Neuropsychological assessment
may be defined as the evaluation of brain and nervous system functioning as it relates to behavior. Subspecialty areas within neuropsychology include pediatric neuropsychology, geriatric neuropsychology, forensic neuropsychology, and school neuropsychology
neurotology vs behavioural neurology
A subspecialty within the medical specialty of neurology that also focuses on brain–behavior relationships (with more biochemical and less behavioral emphasis) is behavioral neurology (Feinberg & Farah, 2003; Rizzo & Eslinger, 2004). There are even subspecialty areas within behavioral neurology. For example, neurotology is a branch of medicine that focuses on problems related to hearing, balance, and facial nerves.
contralateral control
Each of the two cerebral hemispheres receives sensory information from the opposite side of the body and also controls motor responses on the opposite side of the body—a phenomenon termed contralateral control.
why is the left hemisphere usually more dominant?
The meeting ground of the two hemispheres is the corpus callosum, although one hemisphere—most frequently the left one—is dominant. It is because the left hemisphere is most frequently dominant that most people are right-handed. The dominant hemisphere leads in such activities as reading, writing, arithmetic, and speech. The nondominant hemisphere leads in tasks involving spatial and textural recognition as well as art and music appreciation. In the normal, neurologically intact individual, one hemisphere complements the other.
lesion/focal/diffuse
lesion is a pathological alteration of tissue, such as that which could result from injury or infection. Neurological lesions may be physical or chemical in nature, and they are characterized as focal (relatively circumscribed at one site) or diffuse (scattered at various sites). Because different sites of the brain control various functions, focal and diffuse lesions at different sites will manifest themselves in varying behavioral deficit
Anomia vs amusia vs Acopia vs Anosmia
Amusia Deficit in ability to produce or appreciate music
Anomia Deficit associated with finding words to name things
acopia: Inability to copy geometric designs
anosmia: Deficit in sense of smell
brain damage and organicity
brain damage is a general reference to any physical or functional impairment in the central nervous system that results in sensory, motor, cognitive, emotional, or related deficit/ factors differentiating organically impaired from normal individuals included the loss of abstraction ability, deficits in reasoning ability, and inflexibility in problem-solving tasks.
view that organicity and brain damage are nonunitary is supported by a number of observations.(two different things)
Persons who have identical lesions in the brain may exhibit markedly different symptoms.
Many interacting factors—such as the patient’s premorbid functioning, the site and diffuseness of the lesion, the cause of the lesion, and its rate of spread—may make one organically impaired individual appear clinically quite dissimilar from another.
Considerable similarity may exist in the symptoms exhibited by persons who have entirely different types of lesions. Further, these different types of lesions may arise from a variety of causes, such as trauma with or without loss of consciousness, infection, nutritional deficiencies, tumor, stroke, neuronal degeneration, toxins, insufficient cardiac output, and a variety of metabolic disturbances.
Many conditions that are not due to brain damage produce symptoms that mimic those produced by brain damage. For example, an individual who is psychotic, depressed, or simply fatigued may produce data on an examination for organic brain damage that are characteristically diagnostic of neuropsychological impairment.
Factors other than brain damage (such as psychosis, depression, and fatigue) influence the responses of brain-damaged persons. Some types of responses are consequences (rather than correlates) of the brain damage. For example, if brain-injured children as a group tend to be described as more aggressive than normals, this may reflect more on the way such children have been treated by parents, teachers, and peers than on the effect of any lesions.
Persons who are in fact brain-damaged are sometimes able to compensate for their deficits to such an extent that some functions are actually taken over by other, more intact parts of the brain.
hard sign vs soft sign
A hard sign may be defined as an indicator of definite neurological deficit. Abnormal reflex performance is an example of a hard sign. Cranial nerve damage as indicated by neuroimaging is another example of a hard sign. A soft sign is an indicator that is merely suggestive of neurological deficit. Soft signs include test scores that are more likely to be obtained by people with brain injuries than by people without brain injuries.
progressive (likely to spread or worsen) or nonprogressive
why are . Case history files valuable in neuropsychological assessment?
particularly valuable in neuropsychological assessment. In many instances, the referral question concerns the degree of damage that has been sustained relative to a patient’s pre-existing condition. The assessor must determine the level of the patient’s functioning and neuropsychological intactness prior to any trauma, disease, or other disabling factors. In making such a determination of premorbid functioning, the assessor may rely on a wide variety of case history data, from archival records to videotapes made with the family video camera.
mastication reflex and age
One such reflex is the mastication (chewing) reflex. Stroking the tongue or lips will elicit chewing behavior in the normal infant; however, chewing elicited in the older child or adult indicates neurological deficit.
cranial nerve assessment pg 5 60
Parkinson’s disease/ dyskineasiuas and PD meds
- (such as tremors, rigidity, slowness, and problems with balance and coordination), Parkinson’s disease (PD) is a progressive, neurological illness that may also have several nonmotor symptoms associated with it (ranging from depression to dementia).
-PD results from cell loss in a specific area of the brain called the substantia nigra - The neurons in the substantia nigra are responsible for producing dopamine, a neurotransmitter (or, a chemical facilitator of communication between neurons) essential for normal movement. PD is a consequence of the compromised function of the substantia nigra to produce adequate levels of dopamine.
-no one has come up with a satisfactory answer to the question of why one or another person contracts PD.
idiopathic= of unknown origin
-dyskinesias (involuntary, jerking-type movements) may result from the long-term use of some of these medications.
rapid eye movement sleep behavior disorder / PD
Another of the many varied potential consequences of PD is rapid eye movement sleep behavior disorder which is a condition characterized by an “acting out” of dreams with vocalizations or gestures. A wide variety of symptoms that are not properly neuromuscular in nature may also be evident in patients with PD.
dbs
DBS is a neurosurgical treatment for use with patients who have advanced PD. The procedure entails the surgical implantation of electrodes at specific sites in the brain. The electrodes are attached to battery-powered pulse generators implanted in the chest (much like cardiac pacemakers) which operate continuously to suppress the motor symptoms of PD. The gain in quality of life as a result of DBS may be substantial. However, like all surgery, the procedure itself carries with it risk. Potentially serious or even fatal events, such as bleeding, infection, stroke, or any of the complications that could arise from the administration of general anesthesia, are possibilities with DBS. While the risks associated with a DBS procedure remain relatively small, they must be weighed against any potential benefits of DBS in terms of the patient’s quality of life.
Lewy body dementia (LBD).
s Lewy bodies are clusters of stuck-together proteins that have the effect of depleting available dopamine and other brain substances (such as acetylcholine) critical for normal functioning. Lewy body dementia results from the formation of a number of Lewy bodies in the brain stem and cerebral cortex that cause Parkinsonian-like symptoms, Alzheimer-like symptoms, and other symptoms of dementia.
DaTscan
(pronounced in a way that rhymes with “cat scan”). A DaTscan entails the use of high-tech imaging equipment to visualize the substantia nigra and gauge the amount of dopamine present. Perhaps because of the relatively limited availability of the highly specialized equipment that is required, DaTscans are currently more a tool of assessment in neurological research as opposed to being an aid to everyday diagnosis.
pattern analysis
Because certain patterns of test response indicate particular deficits, the examiner looks beyond performance on individual tests to a study of the pattern of test scores, a process termed pattern analysis.
deterioration quotient or DQ
number of researchers intent on developing a definitive sign of brain damage have devised various ratios and quotients based on patterns of subtest scores. David Wechsler himself referred to one such pattern, called a deterioration quotient or DQ
measures of ef
Porteus Maze Test (Figure 14–3) are used primarily as measures of executive function
tower of hanoi
clock-drawing test (CDT)
As its name implies, the task in this test is for the patient to draw the face of a clock, usually with the hands of the clock indicating a particular time (such as “ten minutes after eleven”). As used clinically, there are many variations of this test—not only in the time that the clock should indicate but also in the setup of the task (some clinicians begin the test with a pre-drawn circle) and in the scoring of the patient’s production (there are more than a dozen scoring systems). Observed abnormalities in the patient’s drawing may be reflective of cognitive dysfunction resulting from dementia or other neurological or psychiatric conditions. Poor performance on the CDT has also been associated with visual memory deficits
field-of-search item. and ef
Shown a sample or target stimulus (usually some sort of shape or design), the testtaker must scan a field of various stimuli to match the sample. This kind of item is usually timed. People with right hemisphere lesions may exhibit deficits in visual scanning ability, and a test of field-of-search ability can be of value in discovering such deficits. Field-of-search ability has strong adaptive value and can have life-or-death consequences for predator and prey.
confrontation naming;
confrontation naming; that is, naming each stimulus presented. This seemingly simple task entails three component operations: a perceptual component (perceiving the visual features of the stimulus), a semantic component (accessing the underlying conceptual representation or core meaning of whatever is pictured), and a lexical component (accessing and expressing the appropriate name). Difficulty with the naming task could therefore be due to deficits in any or all of these components. Persons who are neurologically compromised as a result of Alzheimer’s disease or other dementia typically experience difficulty with naming tasks.
